Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, The Netherlands.
Corresponding author: Mr Benjamin L Turner, Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, The Netherlands,
Diving Hyperb Med. 2024 Mar 31;54(1):39-46. doi: 10.28920/dhm54.1.39-46.
Diving injuries are influenced by a multitude of factors. Literature analysing the full chain of events in diving accidents influencing the occurrence of diving injuries is limited. A previously published 'chain of events analysis' (CEA) framework consists of five steps that may sequentially lead to a diving fatality. This study applied four of these steps to predominately non-lethal diving injuries and aims to determine the causes of diving injuries sustained by divers treated by the Diving Medical Centre of the Royal Netherlands Navy.
This retrospective cohort study was performed on diving injuries treated by the Diving Medical Centre between 1966 and 2023. Baseline characteristics and information pertinent to all four steps of the reduced CEA model were extracted and recorded in a database.
A total of 288 cases met the inclusion criteria. In 111 cases, all four steps of the CEA model could be applied. Predisposing factors were identified in 261 (90%) cases, triggers in 142 (49%), disabling agents in 195 (68%), and 228 (79%) contained a (possible-) disabling condition. The sustained diving injury led to a fatality in seven cases (2%). The most frequent predisposing factor was health conditions (58%). Exertion (19%), primary diver errors (18%), and faulty equipment (17%) were the most frequently identified triggers. The ascent was the most frequent disabling agent (52%).
The CEA framework was found to be a valuable tool in this analysis. Health factors present before diving were identified as the most frequent predisposing factors. Arterial gas emboli were the most lethal injury mechanism.
潜水损伤受多种因素影响。分析影响潜水损伤发生的潜水事故全过程的文献有限。先前发表的“事件链分析”（CEA）框架由五个步骤组成，这些步骤可能会依次导致潜水死亡。本研究将其中的四个步骤应用于主要是非致命性潜水损伤，并旨在确定荷兰皇家海军潜水医疗中心治疗的潜水员所受潜水损伤的原因。
这是一项回顾性队列研究，对 1966 年至 2023 年期间由潜水医疗中心治疗的潜水损伤进行研究。从数据库中提取并记录了基本特征和与简化 CEA 模型的所有四个步骤相关的信息。
共有 288 例符合纳入标准。在 111 例中，可以应用 CEA 模型的所有四个步骤。在 261 例（90%）中确定了诱发因素，在 142 例（49%）中确定了触发因素，在 195 例（68%）中确定了致伤因素，在 228 例（79%）中存在（可能）致伤情况。持续的潜水损伤导致 7 例（2%）死亡。最常见的诱发因素是健康状况（58%）。用力（19%）、潜水员的主要失误（18%）和设备故障（17%）是最常见的触发因素。上升是最常见的致伤因素（52%）。
CEA 框架在本分析中被证明是一种有价值的工具。潜水前存在的健康因素被确定为最常见的诱发因素。气栓是最致命的损伤机制。
