Finding into death of Dale Graham Russ
Deceased
Dale Graham Russ
Demographics
26y, male
Coroner
Deputy State Coroner Paresa Spanos
Date of death
2008-01-09
Finding date
2010-06-10
Cause of death
Upper cervical spinal cord injury
AI-generated summary
A 26-year-old man suffered an upper cervical spinal cord injury (C2 fracture with vertebral artery dissection) after diving head-first from Brooks Jetty into shallow water on New Year's Day 2008. He was transferred to ICU where he required mechanical ventilation. After being informed of his dire prognosis (permanent ventilator dependence and institutional care), and after psychiatric assessment confirmed his decision-making capacity, he consistently requested cessation of ventilatory support. Medical staff withdrew mechanical ventilation, and he died on 9 January 2008. The coroner found the signage at the jetty inadequate, noting that as of 1 January 2008 there were only two signs, both poorly positioned and one defaced by vandalism. The case highlights the importance of clear, visible safety signage at public aquatic structures to convey specific hazards.
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Specialties
Drugs involved
Clinical conditions
Procedures
Contributing factors
- shallow water at diving location (1.8 metres height from water, 2 metres depth)
- inadequate and poorly positioned safety signage
- vandalism-defaced signage reducing visibility of warnings
- head-first diving into water of unknown depth
Coroner's recommendations
- Parks Victoria should consider further upgrades to signage by installing additional signs at eye level at the furthest end of Brooks Jetty
- Parks Victoria should consider a public education campaign highlighting dangers of shallow water and submerged objects, particularly when jumping and diving from jetties, targeted to children and young adults
Full text
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