An inquest into the death of a British scuba diver in Komodo in September 2023 has found he likely died from Immersion Pulmonary Oedema.
Robert Bolton, a 65-year-old retired Royal Navy officer, was diving at Crystal Rock in Komodo National Park when he ascended with his guide approximately 10 minutes into the dive. He was removed from the water but fell unconscious while receiving treatment.
He was taken to hospital and subsequently flown to a Mount Elizabeth Private Hospital in Singapore, but he never regained consciousness and died on 23 September 2023.
The inquest, held at Winchester Coroner’s Court, was told that Mr Bolton was an experienced diver, who ‘had been diving for many years, since his service in the Royal Navy’. His wife, also an experienced diver, was with him at the time of the incident and described Mr Bolton as a ‘fit and strong’ man who ‘played a number of sports’.
Mrs Bolton also described how she saw ‘panic’ in her husband’s eyes as he realised something was wrong.
Dr Peter Wilmshurst, an expert in IPO who first identified the condition in 1989, and himself a keen diver, told the inquest that he was certain that Mr Bolton suffered immersion pulmonary oedema leading to a hypoxic brain injury.
Recording a verdict of accidental death, Coroner Jason Pegg said that Mr Bolton was an experienced diver and had quickly realised something was wrong.
In a statement issued by the court, he said: ‘On 17 September 2023 Mr Bolton descended into the waters of the Flores Sea.
‘In a relatively short period of time, around 10 minutes, it became evident that Mr Bolton was panicking and indicating to the surface.
‘Mr Bolton was indicating things were not as they should be, he achieved a controlled ascent before surfacing to the waiting boat.
‘Soon after Mr Bolton became unconscious and sadly remained unconscious until he passed away having been medevacked to Singapore.
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Relatively unheard of until recent years – and still overlooked by many members of the scuba diving community – Immersion pulmonary oedema is now thought to be one of the leading causes of scuba diving fatalities.
It is primarily caused by immersion in cool water, which affects the pressure and distribution of blood within the cardiopulmonary system, forcing fluid into the lungs and starving the body of oxygen.
Typical symptoms include difficulty breathing – divers suffering IPO may mistakenly believe their regulator is malfunctioning – panic, and eventually unconsciousness.
IPO is often mistaken for drowning, and is often missed during a post-mortem examination unless the autopsy is carried out by a physician with knowledge of the condition.
Known triggers for IPO include hypertension (high blood pressure) and age. For reasons still unknown, women are eight times more likely to suffer IPO than men.
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