Counter-Errorism in Diving: Applying Human Factors to Diving24 Tammi

SH247: At a system level, we don't learn from diving fatalities, and here's why

This episode explains why the diving industry struggles to learn from fatalities and argues that the problem is not one bad decision or one person, but the whole system. Using the death of 18-year-old diver Linnea Mills as an example, it shows how normal people, doing what made sense at the time, can be caught by gaps in training, supervision, equipment, communication, and emergency planning. The focus is on moving beyond neat, blame-based “first stories” and instead telling messier “second stories” that explore context, pressure, trade-offs, and gradual drift away from safety margins. The episode looks at ideas like normalisation of deviance, weak feedback loops, authority gradients, and the gap between what rules say should happen and what really happens on dives. The key message is that safety improves when we change conditions, not just criticise people: by building psychological safety, matching supervision to the real task, checking equipment properly, planning for emergencies that fit the location, learning from near misses, and raising standards above the bare minimum. Learning from tragedy requires courage, honest stories, and system-level change, but it is possible—and it starts before the next dive.

Original blog: https://www.thehumandiver.com/blog/we-don-t-learn-from-diving-fatalities-and-here-s-why

Links: Webinar about Linnea Mills: https://www.youtube.com/watch?v=lu4tc8gtNio&t=3s

No learning focused investigation process in diving: https://www.thehumandiver.com/blog/learning-reviews-in-diving

Compliance can give an illusion of safety: https://www.youtube.com/watch?v=VNhmxz2_adc

What conditions made it harder to do the ‘right’ thing and easier to do the ‘wrong’ thing?

Creating the conditions and space for speaking up: https://www.thehumandiver.com/blog/top-tips-for-diving-instructors-leadership-creating-the-space-for-others-to-be-heard

Having difficult conversations as an instructor: https://www.thehumandiver.com/blog/top-tips-for-diving-instructors-communication-the-difficult-kind

TEDS open question acronym: https://www.thehumandiver.com/blog/communications-ask-better-questions

Psychological safety blogs: Blog 1. Blog 2. Blog 3. Blog 4. Blog 5.

Debrief model: https://www.thehumandiver.com/debrief

Diving Talks video: https://www.youtube.com/watch?v=VNhmxz2_adc

Child welfare changes: https://www.collaborative-safety.com/collaborative-safety-reading-packet

Tags: - english gareth lock safety safety culture system safety

Tämä jakso on lisätty Podme-palveluun avoimen RSS-syötteen kautta eikä se ole Podmen omaa tuotantoa. Siksi jakso saattaa sisältää mainontaa.

Jaksot(293)

SH293: Why does nothing change? Why do the same failures keep happening?

Over the past decade, diving fatalities have remained stubbornly consistent despite better equipment, more training, and growing participation, suggesting the problem isn’t just technical or individua...

4 Heinä 22min

SH292: Learning or Blaming: The Choice the Diving Industry Needs to Make. Part 3 of 3.

This final blog explores what the research means and how the diving community can realistically improve learning and safety. It argues that the problem is not broken individuals but a system that quie...

1 Heinä 14min

SH291: What the Data Told Us: Fear, Trust, and the Stories That Never Get Told. Part 2 of 3.

This blog explains how a mixed-methods study explored why divers struggle to share honest, learning-focused stories about incidents. Using a large international survey, focus groups, and expert interv...

27 Kesä 13min

SH290: What Happens Underwater, Stays Underwater — And That's a Problem. Part 1 of 3

This episode introduces the problem behind learning in diving safety, using the 2020 death of Linnea Mills to highlight how incidents are often caused by deeper system issues, not just individual mist...

24 Kesä 12min

SH289: Chac Mool - Diving Deeper into a Triple Fatality with Human Factors

This episode examines a 2012 triple fatality at Cenote Chac Mool in Mexico using a Human Factors approach, showing how accidents are rarely caused by a single mistake but by a combination of small, in...

20 Kesä 24min

SH288: The 'Obvious Thing' Nobody Noticed

This episode explores the fatal case of 18-year-old Linnea Mills to show how visible hazards can go unnoticed when an instructor lacks the mental capacity to recognise them. Linnea was overweighted, u...

17 Kesä 15min

SH287: When the Picture Goes Dark

This episode explores why divers don’t truly “lose” situation awareness, but instead run out of the mental capacity needed to maintain it. Through the story of James on a challenging wreck dive, it sh...

13 Kesä 16min

SH286: The Shortcut That Gets You Home — and the One That Doesn't

Divers make many decisions quickly, often without realising it, by using heuristics—mental shortcuts that help us act fast when time and information are limited. These shortcuts are essential and ofte...

10 Kesä 10min