Multifactorial determinants of diving-associated deaths in Turkey: autopsy-based insights and the imperative of integrated forensic assessment

ABSTRACT Doğan M, Atan Y, Dağ MA, Üzün İ. Multifactorial Determinants of Diving-Associated Deaths in Turkey: Autopsy-Based Insights and the Imperative of Integrated Forensic Assessment. Undersea Hyperb Med. 2026 First Quarter; 53(1):1-14. Introduction: This autopsy-based study aims to investigate the underlying causes and forensic characteristics of fatal diving incidents in Turkey, emphasizing the autopsy-based strategies employed to distinguish drowning from other diving-related pathologies such as decompression illness and arterial gas embolism. Methods: A retrospective analysis was conducted on 11 fatal diving cases evaluated by the First Forensic Medicine Specialization Board between 2002 and 2023. Data were retrieved from judicial records, including detailed autopsy reports, histopathological findings, toxicological analyses, and scene investigations. Results: The decedents consisted of ten males and one female (median age: 45), reflecting the male- dominant profile of diving activity. Diving modalities included SCUBA (n=7), breath-hold (n=2), and surface-supplied compressor diving (n=2). The leading cause of death was drowning (n=5), followed by arterial gas embolism (AGE; n=2), sudden cardiac death (n=2), subarachnoid hemorrhage (n=1), and asphyxia due to mechanical entrapment (n=1). AGE cases demonstrated intravascular gas via specialized autopsy techniques. Cardiovascular comorbidities were identified in four cases, while medications— primarily prescribed—were detected in five. Alcohol and illicit drugs were absent in all cases. Discussion: Diving fatalities pose complex medicolegal challenges that require a multidisciplinary approach. Drowning and AGE were the most frequent causes, often accompanied by cardiovascular pathology. Proper autopsy techniques, scene correlation, and pre-dive medical screening remain critical for accurate diagnosis and prevention. The findings underscore the need for standardized forensic protocols, especially in regions with limited access to postmortem imaging. Keywords: arterial gas embolism; autopsy; cardiovascular disease; compressor diving; decompression illness; diving fatalities; drowning; forensic pathology; postmortem diagnosis; SCUBA