PREVENTION OF SCUBA DIVING MISHAPS USING A PREDIVE CHECKLIST: A CLUSTER RANDOMIZED TRIAL

Ranapurwala, Shabbar I.

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March 20, 2019

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Ranapurwala, Shabbar I.
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology

Abstract

Scuba diving mishaps, caused by equipment problems or human errors, increase the risk of morbidity and mortality while diving. Pre-dive checklists may mitigate mishaps. This study evaluated the effect of using a pre-dive checklist on the incidence of diving mishaps in recreational divers. A multi-location cluster randomized trial with parallel groups and allocation concealment was conducted between June 1 and August 17, 2012. The participants had to be at least 18 years of age, permitted to dive by the dive operator, and planning to dive on the day of participation. They were recruited at the pier and dive boats at four locations. The intervention group received pre-dive checklist and post-dive log. The control group received a post-dive log only. The outcomes, self-reported major and minor mishaps, were prompted by a post-dive questionnaire. Mishap rates/ 100 dives were compared using Poisson regression with generalized estimating equations. Intent-to-treat, per-protocol, and marginal structural model analyses were conducted. Two nested studies were also conducted - first, among the control group participants, to evaluate the relationship of routine use of written self-checklist on the incidence of mishaps. And second, among the intervention group participants, to assess the factors affecting the adherence to the intervention pre-dive checklist. Total 1043 divers (intervention=617; control=426) made 2041 dives, on 70 location-days (intervention=40; control=30) at four locations. Compared to the control group, the incidence of major mishaps decreased in the intervention group by 36%, minor mishaps by 26%, and all mishaps by 32%. On average, there was one fewer mishap in every 26 intervention dives. Routine use of a self-checklist was associated with 69% fewer major mishaps and 50% fewer all mishaps in the control group. 30% participants were non-adherent to the intervention checklist. Factors associated with greater adherence were routine use of self-checklist and older age. Factors that were associated with lower adherence were non-white race and diving in North Carolina. In this trial, pre-dive checklist use prevented the incidence of mishaps which could prevent injuries and fatalities. Use of pre-dive checklists should not entail any risk and their use should be promoted. Trial Registration: ClinicalTrials.gov ID NCT01960738

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