Could This Diver’s Death Have Been Prevented?

Melanie Stoddart from Manchester, England, was on an April dive trip in the Maldives and collapsed while diving off Vaavu Atoll, but because there was no immediate transport to the hospital, she died less than 12 hours later without being treated for decompression sickness.

Stoddard, 38, had booked the trip on the MV Sea Spirit through the British agency Scuba Tours Worldwide, and she had Divers Alert Network Europe as her insurer for dive medical emergencies. On April 3, on a dive at Vaavu Atoll, she "collapsed," according to the Daily Express newspaper. She was given oxygen and taken to the Alimatha Aquatic Resort, where a doctor said she needed to be transferred to a decompression chamber. But there was no transport available until, after a call to DAN Europe, Scuba Tours Worldwide sent for a speedboat from Bandos Island, more than 40 miles away. Stoddard reached the island at 8:20 p.m., and a doctor sedated her but she was not stable enough to be placed in a chamber. She was transferred again by boat six miles to the hospital in the Maldives capital of Male, where her head and chest were scanned. She died at 2:45 a.m. Tests found brain damage caused by nitrogen bubbles in her bloodstream, and during the inquest into her death in England, a pathologist testified that everything pointed to her having DCS. In his verdict, coroner Paul McCandless wrote, "It is possible if her condition had been diagnosed sooner that she would not have died when she did."

Would Stoddard have lived if the Sea Spirit and the other Maldives travel operators had acted faster to get her to a chamber? Or can this be chalked up to the death of a diver who just happened to get into trouble at a very remote dive site? It was the latter, according to Sandro Marroni, president of DAN Europe. He told Undercurrent the case was handled properly and quickly. "The dive tour operator immediately organized speedboat evacuation with no delay, but clearly the time to reach the patient needed to be taken into account. Stoddard was at the chamber four hours after surfacing. We were involved when we were informed about the above (we did not have to do anything, as everything had been done properly, and we were limited to providing insurance guarantee of payment and followup).

"It was a tragic case, but I can hardly see that anyone could be blamed. It was one of those catastrophic cases where DCS can be a cause, but cardiac or pulmonary causes are also very likely. Symptom onset was immediate -- 10 minutes after surfacing -- and very, very serious (no clear focal cerebral sign, but shock-like cardio-pulmonary involvement)."

Petar DeNoble, vice president of mission for DAN North America, says Stoddard's nine-hour delay for treatment is actually less than the average delay in recreational diving injuries. "Given the remoteness of the accident site and the late-afternoon time when it happened, one cannot expect anything much better. We have this issue with dive injuries in many other remote sites."

Divers traveling overseas should keep in mind that if it takes several hours to get to your destination from a sizeable city with good medical facilities, it will usually take more time to get you out. "To organize an emergency evacuation takes hours, and depends on the time of day and local weather," DeNoble says. "Nobody should bet their safety on local emergency services. The Maldives cover a huge area, and it is impossible to have stand-by coverage for every part of it. We suggest that dive boats be self-sustained for the first 24 hours of an injury. Unfortunately, for most severe injuries, only top trauma centers can provide proper treatment and possibly save the diver's life. Divers should mitigate their risk of DCS with additional precautions. Older divers and divers with health issues should avoid travelling into remote areas that lack medical facilities they may need. That all said, people still have the right to accept risks and enjoy the diving life."