HUMAN FACTORS & STIGMA
Introduction
DCS, or “decompression sickness,” is something you can get after diving—even if you did everything right. Sometimes inert gases cause damage in the body, and the exact threshold where this happens cannot be reliably predicted for individuals.
When DCS is discussed, however, the question often arises: What did the person do wrong? What profile, what physical condition—there MUST be a reason. And this is often not just about a rational explanation, but also about assigning blame.
This is exactly what makes it so hard to be honest, and why symptoms are so often denied. And that is precisely why we, as a community, often learn less than we could.
But what is the reality: Is diving a dangerous extreme sport, or rather a normal leisure activity? How does the risk compare to other sports?
How high is the risk?
Article from Alert Diver about the risks of recreational diving
What makes DCS so “different”?
If you sprain your ankle playing football, trip on a mountain hike, or get injured while cycling, you treat the wound properly, let it heal, and move on. These things happen and usually don’t end with accusations; you don’t have to explain exactly what you did to make it happen.
With DCS, it’s often different. For one thing, symptoms can be delayed, ambiguous, or fluctuating—and sometimes you’re not even sure if it’s really DCS. At the same time, DCS is emotionally tied to an invisible accusation: “You must have done something wrong.”
Accident analysis is, of course, useful, and even when someone gets DCS, you can look at whether the profile was simply very risky or if everything was within what is generally considered safe. In the vast majority of cases, that’s exactly it: a profile that is actually safe still leads to DCS. And that is something you simply have to accept—you will never know for sure what caused it.
Searching for reasons is human nature. DCS is so mysterious, and we would naturally like to understand what is happening—that is one side of it. The other side, however, lies in a defensive attitude: if the person affected did something wrong, but I do everything right, then it can’t happen to me.
This isn’t important because DCS is such a severe illness that you truly need to be afraid of it. Most symptoms are so mild that they disappear with a little oxygen or simply on their own. Sometimes hyperbaric chamber treatment is needed, very rarely several. And extremely rarely, permanent damage remains.
So it is not the severity of the illness that causes fear, but something else: the stigma associated with it. You’re the one who did something wrong, you’re marked—no one wants to dive with you anymore…
Better to just say nothing… right?
Talk about DCS
Page on the question of why it is so hard to talk about DCS
Talking about incidents
Even though DCS is an important topic and, for us within the context of decompression theory, naturally the most important, it plays a rather minor role among diving accidents. Much more common are ear problems, falls during exits, rapid ascents and resulting issues, as well as medical emergencies that occur while diving.
Diving accidents are also talked about a lot—always with the justification of wanting to learn from them. But often, one thing happens above all: the search for who is to blame. And that doesn’t help.
When talking about incidents and accidents in diving, we should keep two things in mind that shape the way we talk about them.
Hindsight Bias
Hindsight bias occurs when you know the outcome of an event. After an accident—no matter the field—everyone suddenly knows why it happened and is certain that it should have been known beforehand.
You wouldn’t have. Knowledge of what happened changes perception. Because we know something went wrong, we see warning signs that we would otherwise tend to ignore.
Just Culture
Just Culture means: we don’t look for someone to blame first, but rather understand the system. We talk about incidents in a way that all those involved can feel safe and are willing to share their perspective in full detail.
What were the circumstances? What information was available? What routines, what group dynamics, what stress? Why did decisions make sense at the moment they were made?
This doesn’t exclude responsibility—but it prevents learning from being stifled by shame and fear.
This topic is, of course, far too large for our course here. But as usual, we have a few pointers on how to get more information.
On the subject of Human Factors in Diving, Gareth Lock, the author of “Under Pressure,” has developed a wealth of resources and courses.
Anyone interested in this topic will find a really good overview and a wealth of ideas in the introductory “Essentials” course on how to look at diving incidents in a way that you actually learn from them.
the human diver
Gareth Lock’s site, specializing in Human Factors in Diving
The Human Diver Essentials - online course
Introductory course on accident analysis, with many real-life examples
Note: This is an affiliate link
Talk. Give O₂. Share data.
If we want to change how divers handle DCS and incidents in general, it’s up to us to demonstrate different behavior.
When you’re not feeling well yourself: If you feel something “not normal” after a dive—talk about it. Immediately. Not tomorrow. Not “let’s see.” Not “I don’t want to annoy anyone.” And certainly no “that’s impossible”—even if the profile was unremarkable, something could have happened.
And if you notice someone else isn’t doing well: support them, give oxygen, offer something to drink, be there, and get help if necessary. What you should definitely not do is start theorizing about the dive profile or anything else.
What applies to all incidents: silence protects no one. At most, it protects an image—and potentially costs time, information, and options. A community becomes safer when it can talk about incidents without tearing people apart. So just talk about all the little things that go wrong for everyone at some point—you can learn something from those stories. From accidents, rather less so.
Anyone who would like to contribute to making diving even safer overall can help on various levels. One way is to share your own data. Here you can report incidents you were involved in and be sure that the data will be handled properly by DAN.
Reporting incidents
Help DAN evaluate even minor diving incidents by reporting them.
Don't hold back on the O₂!
When you give O₂, you are always doing the right thing. Even if symptoms don’t turn out to be from diving, you can’t go wrong with it.
Oxygen is the one truly relevant measure after a diving accident that directly affects the outcome: the faster O₂ is breathed, the more likely it is that the symptoms will disappear completely.
