August 19, 2015By Lance Baily

Lessons from Last Week's Scuba Diving Tragedy That Can Be Incorporated into Simulation

lessons from dr garman

As a PADI DiveMaster I have spent hundreds of hours training above and below water to further develop my skills and experience the thrills of deep water diving. Yet my 200+ dives are nothing compared to those professionals out there some with 10,000+ dives in their log book! You may remember a previous article entitled “What Can Medical Simulation Learn From Scuba Diving?” where I compared the classroom, pool lessons, shallow dive, and deep dive experiences of the scuba training to the higher and higher levels of medical simulation fidelity. As a trained fire fighter and a rescue diver I can attest that there are a lot of similarities between the utilization of simulation, yet I would say the standardization of PADI regulations did provide a more structured education. But sometimes even that structured education and community support can fail. Last week on August 15th Dr. Guy “Deep Doc” Garman died during a record breaking attempt as the World’s Deepest Diver.

Excerpt from About the Incident:

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Early reports from the St. Croix Source indicate that Dr. Guy Garman, known as “Doc Deep” to the technical diving community, died on Saturday while attempting to break the world record for deepest scuba dive. Garman’s plan was to descend to a depth of 1,200 feet off the coast of St. Croix on Saturday, August 15th, exceeding the current record of 1,090-feet set by Ahmed Gabr in 2014. A social media post reported that everything was going to plan as he and his support team (along with his son) reached the 200-foot mark, where he continued descending solo. Thirty eight minutes later, he was expected to have reached the bottom of his dive and ascend to the 360-foot mark, where a separate support team was waiting for him, but he never arrived. Read the full article here.

At first glance we might expect tragedy with a world record breaking attempt at becoming the deepest scuba diver ever. With a team of 24 behind Dr. Garman and two years of preparation for this dive, it seems as if the due diligence and training was adequate. But as I learned more I was seriously convinced otherwise.

On his website Consultant Technical Diving Instructor Andy Davis provides 9 key psychological areas that lead to this tragedy which I think as healthcare professionals and medical simulationists we can all learn from. I am going to only focus on two for this article but you can read Andy’s full article here.

Andy starts by reminding us “Now, I would like to consider some psychological factors that seem pertinent to the failed, and fatal, world depth record attempt. I am not seeking to attribute blame, nor to define a cause for the tragedy. I am writing purely for educational purposes in the hopes that the information shared may help prevent future accidents.” 

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1) Dr. Garman, known amongst his friends as ‘Doc Deep’, had only been diving for 4 years and accumulated less than 600 dives. Only 200 of those dives being below 200 ft, and a mere 35 dives below 450 ft. (Note: Recreational dive limits are 130 feet.) To many, in the technical diving community (or professional recreational diving industry, for that matter) this experience total would be considered woefully small; his profession extremely fast and without pause for consolidation. Speaking only for myself; my humble diving experience is more than 10x that of Dr. Garman. I’ve been diving more than 25 years; 10 years in technical diving as full-time, professional instructor and diver. Yet, I wouldn’t currently consider myself ready to attempt breaking a world depth record. Far from it.

2) Competency needs to be proven at one level, before progression to subsequent levels and challenges. Proving that competency can only occur through accumulated experience. A technical diver must have had the chance to encounter and overcome a full breadth of real (NOT SIMULATED) foreseeable and unforeseeable problems… and must prove to themselves their ability to deal with these issues.

3) Normalization of Deviance describes a dangerous facet of human nature. It goes something like this: We do something that does not follow the accepted (and acceptable) rules or guidelines – for example we skip certain steps in a “standard” procedure because it saves time. The trouble stems from the unfortunate fact that we get away with taking the shortcut. Then, believing it’s safe to make the same safety shortcut next time around, we do the same thing.. we ignore safe and established practice.

Other key areas that Andy covers in his article:

  • The issue of giving unrealistic positive feedback
  • The issue of groupthink
  • The issue of destructive goal pursuit
  • The issue of support team mindset
  • The issue of normalization of deviance
  • The issue of ego and over-confidence
  • The issue of glorifying deep diving
  • The issue of experience

I think these points can speak well to our community. At SimGHOSTS 2015 Australia Dr. Kenneth Gilpin Shared Why Sometimes We Can Do More Harm Than Good Through Medical Simulation. Direct experience is the best teacher, and that even with simulation as a tool on our belt for education, training, and certification — we still need to find ways to tip our hats to the experience of hands-on time.

When it comes to healthcare education and medical simulation, Andy’s key points about the Dr. Garman Tragedy should have us asking:

  • Are healthcare team-members of my institution professionally challenging one another when there are possible mistakes being made?
  • What prevents our healthcare culture from evolving past 440,000 patient deaths a year?
  • How are we glorifying individuals or processes in our institution that are risky?
  • What kind of simulation experience can prepare learners and professionals to better speak up when errors are being made?
  • Has my simulation scenario been reviewed by other educators?
  • Should there be a role assigned to quality assurance in the simulation space?
  • How can we use simulation to demonstrate competency accurately enough to progress the learner to advanced skillsets?

Do you have a simulation scenario that doesn’t require many skills demonstrations by the primary learner, but rather to simply call out when an error is being made? Share on the HealthySimulation Linkedin group about some of the ways your simulation and educational programs deal with such psychological factors.  This is a very powerful read and I suggest you make time for it!

Read Andy’s full article on

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