The counties have been unable to collect enough data on the type of mask worn in drowning incidents to draw any conclusions yet.
By Nathan Eagle
In 2017, Hawaii lifeguards started trying to track what type of snorkeling equipment was worn in drowning incidents throughout the islands after stories emerged about the potential hazards of the increasingly popular full-face masks.
They remain committed to the effort, but collecting information has proven challenging, county officials said.
Ocean safety experts have been unable to draw any conclusions from the data that lifeguards and paramedics have provided over the past two-plus years, but they are optimistic that ongoing studies and future surveys will net clearer answers.
“Everyone is really quick to indict these full face masks,” said Ralph Goto, who is on a snorkeling safety steering committee and co-chairs a multi-agency drowning prevention committee.
“Part of me wants to agree with them,” he said. “But the rational part says we don’t have any evidence.”
Of 112 snorkeling-related drownings in Hawaii from 2014 to 2018, there was information on the type of mask worn in just 16% of the incidents. A full-face mask was worn in five drownings and a traditional two-piece mask and snorkel was worn in 11 drownings, according to state health department data.
Drownings have continued to increase in Hawaii as tourism has surged. The rate of visitor deaths far outpaces that of local residents, especially when it comes to snorkeling. More than 90% of snorkeling-related drownings are tourists.
Guy Cooper, whose wife drowned snorkeling in 2016 while visiting the Big Island, turned his focus immediately to the type of mask she was wearing. It was a blue Azorro full-face mask she purchased on Amazon before the trip.
He has raised his concerns with county and state officials, consumer protection sites, media outlets and others over the past few years as full-face masks have proliferated. Beginner snorkelers in particular have gravitated to this new style for its highly touted ease of use.
“I have been heartened by the increasing number of tours and retail outlets banning full-face masks and the social media cautions after every incident,” Cooper said. “And, to be fair, I’m encouraged by the industry nudging towards independent testing.”
But he said he remains frustrated by the lack of consistency in county reporting.
Cooper, who moved from California to Hawaii after his wife died, and others concerned about this issue say the design of full-face masks may cause carbon dioxide to build up and lead to someone passing out. They add that it’s inherently harder to remove the mask in case of emergency because of how the strap harness fits around the head.
Some snorkeling stores, tour companies and resorts — from Hawaii to Puerto Rico and beyond — have either refused to carry or stopped carrying full-face masks due to safety concerns. Those decisions have been based on their own experience with snorkeling equipment, their observations over time and individual stories.
Robert Wintner, who owns Snorkel Bob’s rental stores on four of the Main Hawaiian Islands, said his employees tested the full-face masks and decided “no way.”
Pride of Maui recently banned full-face masks from its snorkel tours, citing the potential dangers of carbon dioxide build-up leading to dizziness, headaches or unconsciousness. The company says on its website that this can also happen with poorly designed standard snorkel tubes.
Company manufacturers of the original full-face masks, like Ninja and Head/Mares, have underscored that not all masks are created equal. They argue that there is nothing to worry about with their versions because they were designed to expel CO2, but the knock-offs from China and elsewhere don’t.
Ocean safety advocates in Hawaii have designed special instruments to start testing the equipment, but the results are not yet available.
“They’re all dangerous if you don’t know what you’re doing,” Goto said.
‘It’s Going To Take Awhile’
Dan Galanis, the state epidemiologist, said record collection improved over time as more people became aware of possible issues with full-face masks. But he said the narrative text on death certificates specifies nothing about the type of equipment.
He has relied on EMS records instead, but those have been spotty at best.
Galanis plans to review autopsy records next, but that requires filing an application with the Institutional Review Board, which ensures the rights of research subjects, and establishing a memorandum of agreement with the counties.
“So it’s going to take a while,” he said, adding that he doesn’t see a practical way of gathering sufficient data on the near drownings.
Galanis has suggested adding a question to the exit surveys that the Hawaii Tourism Authority administers.
The agency already asks what type of ocean activities visitors engaged in during their trip. Galanis wants to add a multiple choice follow-up that asks, if you went snorkeling, what type of equipment did you use?
He said these surveys are conducted several times a year and the results are pretty quick. It wouldn’t include local residents, but that wouldn’t matter much since nearly all of the snorkeling-related drowning victims are visitors.
The head of HTA’s research team said it would be possible to add a conditional question for people who went snorkeling but doubted whether it would get to the root of seeing if one type of mask is safer than another, HTA spokeswoman Marisa Yamane said.
Yamane said the researcher questioned if it would just ascertain if one type of mask is more popular than another, and noted that if someone drowned they wouldn’t be taking the survey anyway.
In the meantime, HTA is working with the Department of Health on a snorkel safety survey.
Dr. Philip Foti, principal investigator, and Carol Wilcox, project manager, are looking for at least 100 participants to share first-hand accounts of difficulties they experienced while snorkeling. They hope to identify risk factors associated with snorkeling-related drownings and then develop appropriate messages.
Kauai Leads In Data Collection
Kauai has led the effort so far in collecting data on the type of snorkel mask worn in drowning incidents, thanks in large part to the county having switched to electronic reporting on Jan. 1.
The Kauai Fire Department Ocean Safety Bureau reported four snorkeling-related deaths so far this year. One of the deceased was wearing a full-face mask.
Of 56 snorkeling-related rescues this year on Kauai, lifeguards reported 13 people were wearing full-face masks and 43 had two-piece mask and snorkel.
Lifeguards rescued an unconscious Princeville woman who was snorkeling in a full-face mask at Kee Beach in May. They resuscitated her on shore.
Shayne Enright, spokeswoman for the Honolulu Emergency Services Department, said the county does not systematically log what type of snorkel equipment was used in a drowning or maintain such information in a database. But she said officials do let the state epidemiologist and ocean safety committee know when possible if someone drowned while using a full-face mask.
Hawaii County officials did not respond to Civil Beat’s data request.
On Maui, Battalion Chief Jeff Giesea said the county, which has the highest rate of visitor drownings, does not have any useful numbers at this time but is working on developing systems to change that.
“We don’t currently have reliable or comprehensive data correlating drownings/snorkeling incidents with mask type,” he said in an email.
One reason is that many of Maui’s beaches don’t have lifeguards, he said, and many incidents happen outside of when lifeguards work. This means the county relies on data from responding fire crews or others, and there is currently not a reliable mechanism in place to ensure that data is collected, he said.
A Texas man wearing a full-face mask drowned there in May. The 64-year-old was snorkeling in calm waters off Black Rock at Kaanapali Beach when he was found floating face down.
“Efforts had been made in the past to collect this data but they need to be renewed and ‘fortified’ to be reliable,” Giesea said. “So any numbers we can gather at this point will likely tell a misleading story.”
He said a couple of weeks ago he started a conversation with the Department of Health to renew Maui’s efforts to acquire such data in a way that allows the county to draw meaningful conclusions. The county is also looking into adopting an electronic incident reporting system that will greatly enhance its data collection and processing.