The format of Edition 2019 is similar to that of previous editions. In Section One, we present 2017 fatality data. At the beginning of this section are summary statistics for fatalities in the U.S. and Canada followed by a series of case studies that offer further insight into causes. This year’s report features enhanced spatial/geographic data. Section Two includes a series of maps of fatal and nonfatal dive-related injuries around the U.S. and the world. For the first time, we have county-level data in Florida and California, the states with the most diving. These popular dive destinations accommodate various scuba diving activities, including wreck diving and underwater harvesting. We are pleased to have reached this level of geospatial analysis and will continue to work with public health officials in these counties for the next 10 years. In Section Three we present the summary statistics of nonfatal injuries, based on data from the DAN Medical Services Call Center, as well as an in-depth review of select cases. Section Four focuses on incident reports, most of which did not involve any injury, provided voluntarily by divers. The breath-hold diving portion of the report follows in Section Five. DAN employs various injury and fatality prevention strategies, so we added a section, Section Six, about training programs, which target individual divers, and hazard identification and risk assessment (HIRA) programs, which promote operational safety. The addition of enhanced geographic data is a step forward for the report, but there is always more to do. Among the improvements we are considering for the coming years are interactive digital maps of injuries and fatalities, a revamping of the dive incident reporting system, an enhanced coding system for increased granularity, inclusion of diving-adjacent activities (such as topside accidents involving scuba cylinders) and greater coordination with training agencies and other organizations to standardize reporting and capture even more incidents. Our data revealed some interesting themes. For one, cardiovascular disease was present in many of the available autopsy reports. We also noted that fatalities occurred in people of various certification levels and participation frequency and that a significant number of deaths occur at shallow depths. Analysis by DAN experts revealed that a better understanding of cardiovascular disease and the buddy system’s role in dive fatalities is crucial. Dive fatalities are complex and poorly understood. If similar medical conditions and circumstances were to appear in a person outside of the water, death might be attributed to a chronic disease. Because symptoms presented in the water, however, the fatality is often attributed to diving. It is this complexity that makes it so challenging for scientists to decipher the risk factors and spurious associations in fatal and nonfatal dive accidents. It is not surprising that nonfatal scuba injuries occur with greater frequency than fatalities. The challenge in analyzing the trends and distribution of scuba injuries is identifying who is diving and how frequently. The analysis of the data on fatal and nonfatal breath-hold diving injuries yielded several insights. Notably, men were more often involved in breath-hold incidents than women, and people in their twenties and thirties were more often involved than people in other age groups. Divers over forty years of age, however, were more often involved in breath-hold fatalities. Breath-hold diving activities range from what could be described as child’s play to competitive freediving involving highly trained divers that push the limits of the human body. No matter the dive depth, it is vital that breath-hold divers understand the body’s reaction to diving. While chronic disease may have played a role in some of the analyzed cases, there is also reason to believe that some deaths were due to miscalculations of the individuals’ ability to hold their breath long enough to return to the surface. To prevent injury and loss of life, change must happen at various levels. We continue to expand our outreach to divers and dive professionals through training and risk management programs. DAN’s first aid and HIRA programs are the most relevant, detailed, and comprehensive such programs in the industry. This report has pages of detailed case analysis. Some of you will read through each in detail, while others will give them a passing glance. Perhaps the most important message to take away is that divers must continue to help divers stay safe.