Benjamin McQueen

1. 1. stand-by diver ran out of breathable gas

   “A stand-by diver was present at the dive exercise and he was deployed to try to find and rescue [name redacted]. However, the stand-by diver had to surface having run out of breathable gas before [name redacted] was found. A spare breathing apparatus cylinder was not carried in the safety boat for the stand-by diver (or other divers) to use in the event that the stand-by diver's main cylinder ran out.”

2. 2. accelerated safety-critical training

   “The progression of the dive training in which [name redacted] was engaged was safety-critical. The progression of training was accelerated for several reasons, one of which was a visit by a high-ranking naval officer. The concern of the instructing staff was to polish the drills ahead of that visit and to take the pressure off the dive students by allowing them to practise the dive with relevant equipment ahead of the visit. This acceleration of safety-critical training in part because of such a visit was not appropriate.”

3. 3. lack of on-site defibrillator

   “[name redacted] was lifted unconscious from the sea bed and Cardio Pulmonary Resuscitation was immediately started. A defibrillator was also applied, but this was only available because it was carried by a Harbour Patrol vessel which came to assist. 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. This did not cause or contribute to [name redacted]'s death but could lead to future fatalities.”

4. 4. inconsistent breathing apparatus pressure standards

   “There is an inconsistency regarding the minimum safety pressure level for the relevant diver's breathing apparatus as between the maintenance manual for which DE&S is responsible and all other policy and safety guidance.”

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