Mishaps and unsafe conditions in recreational scuba diving and pre-dive checklist use: a prospective cohort study

BACKGROUND Recreational scuba diving involves the use of complex instruments and specialized skills in an unforgiving environment. Errors in dive preparation in such an environment may lead to unsafe conditions, mishaps, injuries and fatalities. Diving mishaps can be major and minor based on their potential to cause injury and the severity of the resulting injury. The objective of this study is to assess the incidence of diving mishaps and unsafe conditions, and their associations with the participants' routine use of their own checklists. METHODS Between June and August 2012, 426 divers participated in the control group of a randomized trial to evaluate the effectiveness of an intervention pre-dive checklist. The current nested analysis prospectively follows the control participants, who did not receive the intervention checklist. Poisson regression models with generalized estimating equations were used to estimate rate ratios comparing written checklist use with memorized and no checklist use. RESULTS The overall incidence of major mishaps and minor mishaps was 11.2 and 18.2 per 100 dives, respectively. Only 8% participants reported written checklist use, 71% reported using memorized checklists, and 21% did not use any checklist. The rate ratio for written checklist use as compared to using a memorized or no checklist was 0.47 (95%CI: 0.27, 0.83) for all mishaps (major and minor combined), and 0.31 (95% CI: 0.10, 0.93) for major mishaps. The rate of mishaps among memorized checklist users was similar to no checklist users. CONCLUSION This study reinforces the utility of written checklists to prevent mishaps and, potentially, injuries and fatalities.