Years of drownings highlight critical gaps in ocean safety education

A spike in drownings on Maui has many wondering what’s going on, though it’s not a new phenomenon. Always Investigating took a look and found there are big gaps in resources for response and prevention.

Drowning — mostly while snorkeling at beaches with no lifeguards — is the biggest killer of tourists and has been for over a decade. More effort is going on to track who, how, and why in order to curb the problem, but lack of resources and sensitivities about scaring tourists are holding back a full-throttle response.

For most visitors, snorkeling at the beach is their idea of paradise, and most have a safe time doing it. Yet when there’s trouble, it comes on fast, unexpected in what many thought would be an easy, scenic float.

“It’s pretty classic how they try to get out of trouble without yelling for help,” said Kawika Eckart, an Oahu lifeguard and Ocean Safety lieutenant. “The anxiety kicks in. They get nervous, and when they can’t make it, or they can’t stand up, or they can’t make it to where they want to get to, fear or panic sets in.”

Nearly 160 visitors died by drowning while snorkeling over the past decade, almost as many as were killed in car crashes, falls, and air crashes combined.

“A very small minority of the people who visit here end up dying or being injured,” said Dan Galanis, injury epidemiologist at the state Department of Health, “but still, the leading cause of mortality for visitors is drowning. Ocean drowning.”

A statewide task force has been drilling down on the problem. Meanwhile, Maui copes with a spate of water tragedies.

But it’s an all-island, all-year problem. Drownings of all kinds have claimed hundreds of visitors over a decade.

“Even though it does seem to come in batches, it’s really a problem that’s with us every day, going back years, at least for the problem of people drowning while snorkeling,” Galanis said. “Twice as many victims drown while snorkeling compared to swimming.”

Always Investigating asked, what is it about snorkeling that is making it so much more dangerous than swimming?

“It does make you think, it seems like a benign activity,” Galanis said. “It’s cheap to engage in. It’s believed that you don’t need any training, but it would be good to sort of practice in a very safe, shallow environment before going out where you might get into more trouble.”

When that trouble turns deadly, it’s usually in the least-watched settings, at beaches without a lifeguard present.

“Our job is to make sure that person who walks down the beach walks off the beach safe,” Eckart said. “We explain to them the hazards, and if you find yourself in trouble, here’s what you’re going to need to do to get out of the water. Ninety-five percent of our job is educating the people before.”

Backing them up are a slew of messages, posters, a website, and in-flight videos, all about how to snorkel safely. Yet the numbers stay high for unguarded beach drownings.

KHON2 asked, why haven’t the preventions worked all these years so far, and what are experts seeing that’s just not getting through?

“I think it goes back to the ability to disseminate the prevention message and in this particular target group, visitors, it’s very difficult to get prevention out there to a very transient audience that’s coming in every day, leaving every day,” Galanis said.

But we found experts know much more about the people who are most at risk than the warning messages are saying outright.

Take these common threads among victims for instance:

“They’re generally older, definitely higher risk for say 50 years and above,” Galanis said. “It’s generally male, I’d say 75 to 80 percent of the victims. Circulatory diseases (i.e. respiratory, pulmonary, heart disease) possibly or probably contribute to 58 percent of these snorkel-related drownings.”

Always Investigating asked, will these medical and autopsy findings find their way into more specific warning language?

“Yes, I think they will, and in some ways, they already have,” Galanis said, “but again, it’s sort of somewhat softened into a ‘be aware of your own limitations’ sort of message. I think in general, you don’t want to alarm tourists coming here. You don’t want to scare them while they’re here.”

There are messages on all sorts of health-and-safety topics reaching customer pre-trip, in-flight, and upon landing at Hawaii’s airports. But a recent change in advertising vendors at the biggest airport removed HawaiiBeachSafety.com posters from baggage claim.

The Department of Transportation says it will “continue the open dialogue regarding the most effective means of messaging” and should have some safety messages on additional monitors in the near future.

“The Hawaii Department of Transportation Airports Division and the Hawaii Department of Health continue to work together on messaging and outreach regarding various topics. There are messages currently displayed on television monitors in multiple areas at the Daniel K. Inouye International Airport (HNL) regarding ocean safety, fighting infection, hiking awareness, rat lungworm disease and Fight the Bite, which includes dengue fever and Zika prevention information. There are also many standalone banners near the baggage claim exits displaying additional “Fight the Bite” information.

Ocean safety videos specifically produced for Maui and Kauai continue to play in monitors at Kahului Airport and Lihue Airport, respectively. Ocean safety posters had been displayed in HNL baggage claims since April 2016 and designed to inform travelers of the HawaiiBeachSafety.com website. The posters at HNL were removed during renovation and the transition to an advertising contract. HDOT, DOH and City & County of Honolulu Ocean Safety Division will continue the open dialogue regarding the most effective means of messaging. Initial data indicated the posters may not have driven a significant amount of people to the Hawaii Beach Safety website, however, DOH is planning to place ocean safety messages including information about the HawaiiBeachSafety.com website on additional video monitors in the near future.”

Officials are saying, in no uncertain terms, “don’t turn your back to the ocean” and to go snorkeling where people in the know can help you.

Experts are also making headway on connecting the dots between other factors that may compound risk, like snorkeling soon after flying.

“Maybe the long in-flight experience of visitors is contributing to their vulnerability,” Galanis said. “Apparently there’s a type of edema that can present itself transiently with that sort of long flight.”

It’s something the task force is reviewing, though not ready to link cause-and-effect nor to include it in the messages warning tourists.

“I think it’s premature to determine something like that, but it’s something we’re working on and trying to get that kind of information. Also, when did they arrive to Hawaii?” Eckart said.

We found out the state is years behind on reviewing what medical examiners have noted about victims. State drowning prevention data relies on reports from Emergency Medical Services, hospital billing summaries, death certificates, and autopsy records.

But as for autopsies, they’ve got a pile of years’ worth to get through — backed up to 2012.

“We essentially have to contract with someone who will sit there and basically abstract from their narrative, from their toxicology report,” Galanis said. He says they have funding for that already and will aim to get it done within this calendar year.

We will follow up to see when that autopsy backlog gets caught up, and what trends and risk factors are seen in the latest data.

As part of the increased focus on the common links between drownings, ocean safety departments are starting to try to track the type of equipment being used, such as whether a snorkel was the traditional two-piece mask and breathing tube, or a full-face mask.

Full-face masks have been used in a couple of the recent drowning cases, but not all of them. Some experts say they worry whether the full-face mask might be harder to get off when trouble arises, make it harder to breathe or easier to swallow water.

“This is important because we’re finally stopping and looking at what were they doing, what kind of equipment they were using, and maybe we can come up with a reason why,” Eckart said.

Always Investigating reached out to one of the larger manufacturers of the full-face masks. Company officials insist the product is backed by years of research. The company, Ocean Reef, also says it will work with the state to help with its research into the causes of drownings.

Ocean Reef says its mask eliminates air containing high carbon dioxide when it’s being used, and says other full-face mask makers may not do that:

“Since 2014, there have been more than 1 million full face snorkeling masks, which have been designed and manufactured by Ocean Reef/Italy, sold into the world marketplace,” said Jon Wilkins, Ocean Reef USA’s sport division manager. “The design comes from more than 25 years of experience in the military, professional and recreational full face mask gas and scuba markets. These masks were designed to increase the enjoyment of snorkelers. Ocean Reef’s masks are designed so that users breathe in fresh air, and eliminate spent air containing high CO2 content, safely and comfortably. With reference to ‘knock-off’ versions, we believe that those which have been produced without understanding of, or non-adherence to, the same safety designs as Ocean Reef’s, may be a cause of reported discomfort to users. In addition, some of those products could be dangerous because of those design flaws, primarily related to inadequately eliminating carbon dioxide build up.”

The Hawaii Tourism Authority says it supports several water safety initiatives.

“The safety of our residents and visitors is always HTA’s top priority. HTA supports numerous water safety initiatives advising the public, especially visitors, on where to obtain essential information and how to stay safe while enjoying our beautiful ocean waters,” said George D. Szigeti, HTA president and CEO.

HTA shared the following initiatives with Always Investigating:

  • GoHawaii.com, which includes safety information under “Trip Planning”
  • HTA’s safety video (available in GoHawaii app, GoHawaii.com, and HTA’s YouTube channel).
  • HTA promotes http://hawaiibeachsafety.com on new GoHawaii.com, GoHawaii app, Travel Safety Guide
  • HTA’s Travel Safety Guide in English, Japanese, Korean, and Chinese (available in new GoHawaii.com and VASH website).
  • HTA provided water safety video footage to Hawaiian Airlines for its in-flight water safety video
  • HTA sponsored the 2017 State of Hawaii Drowning Prevention and Ocean Safety Conference
  • HTA supports the State Drowning and Aquatic Injury Prevention Advisory Committee’s efforts to increase visitors and residents’ water safety awareness
  • HTA has an internal “Do Not Promote” list for certain beaches (e.g. Lumahai Beach on Kauai, Puu Kekaa on Maui) due to safety issues.
  • Jr. Lifeguard Program: In 2016 and 2017, approximately 2,000 youths statewide were trained to enhance their ocean safety awareness and water rescue skills
  • The GoHawaii App HTA introduced in 2016 with safety information to inform and educate visitors
  • VASH, an HTA-funded program available on all islands, produces safety flyers, brochures, and cards to educate visitors

For more information:

Hawaii Department of Health drowning prevention resources

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