title: The effect of using a pre-dive checklist on the incidence of diving mishaps in recreational scuba diving: a cluster-randomized trial.
abstract: BACKGROUND
  Scuba diving mishaps, caused by equipment problems or human errors, increase the occurrence of injuries and fatalities while diving. Pre-dive checklists may mitigate mishaps. This study evaluated the effect of using a pre-dive checklist on the incidence of diving mishaps in recreational divers.
  
  
  METHODS
  A multi-location cluster-randomized trial with parallel groups and allocation concealment was conducted between 1 June and 17 August 2012. The participants had to be at least 18 years of age, permitted to dive by the dive operator and planning to dive on the day of participation. They were recruited at the pier and dive boats at four locations. The intervention group received a pre-dive checklist and post-dive log. The control group received a post-dive log only. The outcomes, self-reported major and minor mishaps, were prompted by a post-dive questionnaire. Mishap rates per 100 dives were compared using Poisson regression with generalized estimating equations. Intent-to-treat, per-protocol and marginal structural model analyses were conducted.
  
  
  RESULTS
  A total of 1043 divers (intervention = 617; control = 426) made 2041 dives, on 70 location-days (intervention = 40; control = 30) at four locations. Compared with the control group, the incidence of major mishaps decreased in the intervention group by 36%, minor mishaps by 26% and all mishaps by 32%. On average, there was one fewer mishap in every 25 intervention dives.
  
  
  CONCLUSIONS
  In this trial, pre-dive checklist use prevented mishaps which could lead to injuries and fatalities. Pre-dive checklists can increase diving safety and their use should be promoted. Trial Registration: ClinicalTrials.gov ID NCT01960738.
authors.forename: Shabbar I
authors.initials: SI
authors.lastname: Ranapurwala
authors.forename: Petar J
authors.initials: PJ
authors.lastname: Denoble
authors.forename: Charles
authors.initials: C
authors.lastname: Poole
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Kucera
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
authors.forename: Steve
authors.initials: S
authors.lastname: Wing
mesh_terms: D000056:Accident Prevention / Q000379:methods*; D000328:Adult; D057189:Checklist; D004242:Diving / Q000293:injuries*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011998:Recreation; D012044:Regression Analysis; D057566:Self Report