DAN has been monitoring underwater diving injuries for over 30 years and producing the Annual Report for the last 28 of those. Past reports presented four distinctive sets of data: compressed gas diving fatalities, compressed gas diving injuries, breath-hold diving incidents regardless of outcome, and data from a prospective study of dive exposure and dive outcomes (Project Dive Exploration). The sources of data, the process of data collection, and the format of published reports have changed over time. Many factors affected the change.

Injury data (compressed gas diving) was provided for decades by hyperbaric facilities treating recreational divers for decompression illness. In the past decade, many reporting chambers dropped out due to changes in regulations in health information privacy under the Health Insurance Portability and Accountability Act (HIPAA). Fear of litigation, decreasing number of hyperbaric facilities treating divers and changes in the business environment left less time for staff to spend on unpaid reporting. DAN has since come to rely more on data acquired directly through the DAN Medical Services Call Center (MSCC) when divers call for assistance or advice. The primary role of the MSCC is to fulfill the DAN Mission: to assist divers in need, to help them find and get into healthcare facilities that are best suited to diagnose and treat their conditions, and to provide consultation to healthcare providers when they lack experience and expertise with specific diving injuries. In this process, data collection is of secondary significance and may be is forfeited to concentrate on better care for the injured diver. We strive to streamline the functions of the MSCC and enhance interaction with callers and care providers. Over time, we have trialled several systems of data collection to make it more efficient and less cumbersome for the MSCC on-call staff without affecting the quality of services. Frequent compliments from people who have used MSCC services testify to their satisfaction with the high quality and standards of our services. Nonetheless, the quality of collected data varied over time and this report reflects those changes.

In 2014, we declared data collection to be an equally important function of MSCC. We added staff dedicated to follow up on data collection, quality assurance and customer satisfaction control. Injury data has much improved and this will be reflected in the next edition of this report.

In addition, DAN established a new position, Director of Injury Monitoring and Prevention, to emphasize the commitment to injury prevention and safety of diving. The Director of Injury Monitoring and Prevention coordinates diving incidents, injuries and fatality data collection, data analysis and development of preventive interventions.

This edition is a four year report covering 2010 - 2013 data. It has several new chapters, one about incidents reported by divers through the DAN online incident reporting system (DIRS), additional injury data from public health sources and more data from our worldwide partners. The PDE study was completed and data will be published in a scientific journal. Chapters on fatality and breath-hold incidents have strong quantitative components while the injury chapter provides more qualitative analysis. Each segment abounds with a summaries and vignettes of memorable cases that we hope may help divers adopt safer behaviors than just raw statistics would do.

For the pleasure of bringing this edition to you we thank the DAN Mission staff and the new editor, Dr. Peter Buzzacott.

Let this read help you to be a safer diver and enjoy diving for years to come.