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From: "SCOTT, Lisa" <Lisa.SCOTT@rp*.co*.uk*>
To: "'Rebreather mail-list'" <rebreather@nw*.co*>,
     "'tech-rebreather-diver@eg*.co*'" ,
     "'techdiver@aquanaut.com'" ,
     "'scuba-uk@dr*.ne*'"
Cc: "'Rachel Gotto'" <rachelgotto@ti*.ie*>,
     "'Janegotto@ao*.co*'"
     ,
     "'DaveCWork'" ,
     "'richard@cl*.co*'" ,
     "'Martin.watson@bl*.co*'"
Subject: Harry Railing, Inspiration User, inquest
Date: Thu, 21 Oct 1999 10:24:28 +0100
Harry died on the 26th May this year. Here is a brief outline of the
inquiry:

Inquest, Harry Railing, Bournemouth coroner's office, 19th October 1999

Harry was using a standard argon bottle for suit inflation, and for reasons
not yet established, his suit overinflated, and he made a rapid uncontrolled
ascent to the surface.

On testing, DERA found no evidence of the suit inflator  sticking, however,
the argon bottle supplying the suit had only approximately 14 bar of
pressure remaining. It was thought that he had filled this bottle from a
larger bottle he had had filled a few days earlier, and may have been used
on a previous dive. DERA changed the batteries and sensors, and found the
unit was 'functioning within acceptable allowances'.

Initially the unit, when removed from Harry, was attached to a buoy, and
left in the water. It was retrieved when the other divers surfaced,
approximately an hour later. It was not stated whether the mouthpiece had
been closed, but there was an amount of flooding of the loop.
The (his) left handset gave readouts of: cell error, master 0.7, low O2
0.12	0.61	0.14
0.12	0.62	0.16
The second handset had no display at all.
An alarm was sounding. This continued until the boat reached shore, some two
hours later, when it was switched off.

There was a demand regulator that had been bungied around his neck. This was
coming from the diluent bottle, and was noticed to have a slight free-flow.

His diluent hose had become detached, possibly during de-kiting prior to
airlift
his exhail hose ad been pulled away from the counterlung
O2cylinder was 170bar
diluent cylinder 70 bar
bailout: 7l 70% nitrox, 250 bar
7l trimix (reportedly 23/27) was lost during de-kiting

No questions were asked as to the handset readout, and the absence of a
readout on the second handset.

The PM showed Harry was a normal and healthy, with no indication of any
health problems. He had died from a pulmonary haemoragic baratrauma. 

The helicopter winchman pointed out that his unfamiliarity with the
equipment and how to release the diver lead to delay. This was also stated
by the skipper of the boat

Harry's dive computer showed a descent time of 3 minutes, maximum depth of
54m ( normal descent rate as compared to previous profiles) followed by a
return to the surface in 54 seconds.

Harry had had the unit for only a short time, and it looked like new. He had
not reported any previous problems with it.

An open verdict was recorded.

My condolences once again, to Vanessa and his two children.

--
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