Contributing Factors• Unsecured pressurized SCUBA cylinder • Unknown hazards associated with old, out-of-date cylinders with stuck valves • Limited training and experience on the task • Non-routine maintenance on pressurized SCUBA cylinders • Selection, care and maintenance of SCUBA equipment • Inadequate risk versus gain analysis.
Key Recommendations• Fire departments should ensure that pressurized cylinders of all types are properly stored, handled and maintained in a safe manner following the manufacturer's recommendations and industry best practices by qualified and properly trained individuals.• Fire departments should follow guidance provided by NFPA 1852 Standard on Selection, Care, and Maintenance of Open-Circuit Self-Contained Breathing Apparatus (SCBA) and apply it to self-contained underwater breathing apparatus (SCUBA).Additionally, federal, state, local, and municipal governments, standards-setting organizations and authorities having jurisdiction should:• Consider developing and adopting a national standard on public safety dive teams and public safety dive operations including guidelines for the selection, care and maintenance of SCUBA equipment.The National Institute for Occupational Safety and Health (NIOSH), an institute within the Centers for Disease Control and Prevention (CDC), is the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. In 1998, Congress appropriated funds to NIOSH to conduct a fire fighter initiative that resulted in the NIOSH Fire Fighter Fatality Investigation and Prevention Program, which examines line-of-duty deaths or on-duty deaths of fire fighters to assist fire departments, fire fighters, the fire service, and others to prevent similar fire fighter deaths in the future. The agency does not enforce compliance with state or federal occupational safety and health standards and does not determine fault or assign blame. Participation of fire departments and individuals in NIOSH investigations is voluntary. Under its program, NIOSH investigators interview persons with knowledge of the incident who agree to be interviewed and review available records to develop a description of the conditions and circumstances leading to the death(s). Interviewees are not asked to sign sworn statements and interviews are not recorded. The agency's reports do not name the victim, the fire department, or those interviewed. The NIOSH report's summary of the conditions and circumstances surrounding the fatality is intended to provide context to the agency's recommendations and is not intended to be definitive for purposes of determining any claim or benefit.For further information, visit the program website at www.cdc.gov/niosh/fire or call toll free 1-800-CDC-INFO (1-800-232-4636).