Absence of on-site defibrillator during training
Ministry of Defence received 2 coroners' reports about this hazard between 8 Sept 2015 and 28 Jul 2023.
They came from 2 different coroners in 2 coroner areas. A similar concern was raised again 1 time after the first warning.
No published response from Ministry of Defence was found for the earlier reports.
The story, report by report
Spacing grows with the time between reports.
“The lack of an AED and AED trained first aider at this type of cadet activity, poses a risk to future cadets.”
Original on judiciary.uk ↗ No published response from Ministry of Defence was found for this report.
- 7 years 11 months laterClosely relatedConfidence 0.90 · higha different coroner
“I am concerned that in such safety-critical military diving training, the dive support staff did not have available to them a defibrillator of their own either on the supporting safety boats or on land.”
Original on judiciary.uk ↗ Ministry of Defence responded, stating 4 specific actions.Response (PDF) ↗
“Carrying spare breathing apparatus cylinders in safety boats in addition to those carried by the stand-by diver where this is practicable”
“When SCADE is employed by the standby diver within un-marked swimming operations, consideration within the Dive Project Plan / Risk Assessment must be given as to the availability of a second Diving Life Support Equipment (DLSE) at immediate notice”
2 more stated actions in the Promises tab.
- All reports to Ministry of Defence
Each row is one judged link between an earlier and a later report. Open a row to read both quotes, found word for word in the originals.
2015 → 2023Benjamin McQueen7 years 11 months after David Efemena · different coronerClosely relatedConfidence 0.90 · high
Closely relatedConfidence 0.90 · highBoth reports highlight the absence of a defibrillator/AED during military training activities where prompt cardiac resuscitation could be life‑saving. The settings differ (cadet fieldcraft versus military diving), but the specific hazard is the same.
David Efemena · 8 Sept 2015
“The lack of an AED and AED trained first aider at this type of cadet activity, poses a risk to future cadets.”
Original on judiciary.uk ↗ Benjamin McQueen · 28 Jul 2023
“I am concerned that in such safety-critical military diving training, the dive support staff did not have available to them a defibrillator of their own either on the supporting safety boats or on land.”
Original on judiciary.uk ↗
No published response from Ministry of Defence was found for this report.
Stated action
“Carrying spare breathing apparatus cylinders in safety boats in addition to those carried by the stand-by diver where this is practicable”
Stated action
“When SCADE is employed by the standby diver within un-marked swimming operations, consideration within the Dive Project Plan / Risk Assessment must be given as to the availability of a second Diving Life Support Equipment (DLSE) at immediate notice”
Stated action
“Training establishments understand that safety critical training must not be accelerated or truncated solely to accommodate visits by VIPs or senior ranking Officers”
Stated action
“The use of defibrillators in drowning casualties must balance any potential benefit against the risk of harm”
- Each report's concerns were extracted by Nemotron 3 Nano on Nebius Token Factory, each with a quote copied from the report.
- Concerns from reports to Ministry of Defence at least six months apart were compared by meaning (Qwen3 embeddings) and wording (TF-IDF).
- The closest pairs were judged by Nemotron 3 Super with reasoning on. Only identical or closely related, with confidence of at least 0.70, are shown.
- Every quote was checked by code as an exact substring of the original text. Names of staff and family are redacted, and the deceased are named by report title only.
| Link | Meaning | Wording | Judge | Coroner |
|---|---|---|---|---|
| 2015 → 2023 | 0.68 | 0.00 | Closely related · 0.90 | different |
Judge model: nvidia/nemotron-3-super-120b-a12b. How Nemotron did the work · Full methodology.
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This shows that a similar concern was raised again after an earlier report. It does not say why, and it is not a finding about any organisation or person. To report an error, see the corrections route.