1

Visitor Safety:How Are We Doing?

Dan GalanisInjury Prevention and Control Section,

EMS & Injury Prevention Systems Branch,Hawaii Department of Health

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Overview of presentation

• Part I: Visitor Safety: How are we doing?– Statewide data, 2003-2012

• Injury rates: residents compared to visitors– Fatal and non-fatal injuries

• Part 2: County descriptions– Rate comparisons– County specific trends, data, and maps

• Locations, victim residence, and seasonality (October-March vs. April-September)

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Annual rates of injury-related hospitalizations and deaths, by residence status, 2008-2012

0

10

20

30

40

50

60

2.5

12.6

4.10.6

30.4

18.1

3.1 4.71.7

37.4

0.2

20.5

6.8

1.6

43.9

2.5

8.1 8.5 7.5

50.3

neardrowning

falls mvc-total

poisoning total drowning falls mvc-total

poisoning total

Hospitalizations (/10,000) Deaths (/100,000)

non‐residents Hawaii residents

Non-residents:46%

Non-residents:49%

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Leading causes of fatal injuries in Hawaii, 2008-2012

poisoning

falls

suicide

mvc-occupant

DROWNING

DROWNING

mvc-occupant

poisoning

falls

suicide

15 (5%)

17 (5%)

28 (9%)

36 (11%)

162 (51%)

505 (16%)

541 (17%)

852 (27%)

276 (9%)

170 (5%)

0 250 500 750 1000

Hawaii residents

non-residents

Most (80%) of drownings occur in the ocean (86% for non-residents)

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“Injury Pyramid” for injuries among non-residents in Hawaii

Deaths 68/year

Hospitalizations~550/year

Emergency department visits~7,730/year

Nonfatal injuries

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Leading causes of hospitalizations for non-fatal injuries among non-residents in Hawaii, 2008-2012

assault

suicide

overexertion

water transport

mvc-bicyclist

mvc-motorcyclist

mvc-occupant

near-drowning

struck by/against

falls

12 (2%)

12 (3%)

14 (3%)

15 (3%)

19 (4%)

21 (4%)

25 (5%)

46 (9%)

51 (10%)

227 (46%)

0 50 100 150 200 250

Average annual number (% of total)

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Leading causes of spinal cord injuries in Hawaii, 2009-2012

other injuries sky dive

bicycle crashes (no mvc) water dives, non-ocean

assault other sports (non-aquatic)

striking falls

motor vehicle crashes ocean activities

27 (6%)5 (1%)6 (1%)9 (2%)10 (2%)

15 (3%)25 (6%)

102 (22%)104 (23%)

151 (33%)

0 50 100 150

number (% of total)

Most (77%) are non-residents

body surfing: 42body boarding: 37

“tossed by wave”: 42

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Location (beach) of spinal cord injuries from ocean activities in Hawaii, 2009-2012

un k no w n2 1 b eaches1 3 b eaches

B ellow s H am oa

P o lo B each W aim analo

W aik ik iK aanap ali

W aim eaK ua B a y

L aaloaS and y

H apunaB renn eke

M akena

141

23333

455

78

1113

1416

0 5 10 15

M au i K auai H aw aii O ahu

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Ocean drownings, 2003-2012

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Number and ten-year rate of ocean drownings in Hawaii, by residence of victim, 2003-2012

0

100

200

300

73

209

282 256

179.3 150.1 156.7

19.7

foreign country (14%)

U.S. mainland

(39%)

visitors-total

(52%)

Hawaii residents

(48%)

foreign country

U.S. mainland

visitors-total

Hawaii residents

Number of drownings Rate (/100,000) of drownings

Japan: 39 Canada: 8South Korea: 4 China: 3

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Ocean drownings in Hawaii, by residence and activity of victim, 2003-2012

Unknown activity

Other activity

Surfing/body boarding

Swimming

Snorkeling

Scuba

Free diving

Picking opihi

Fishing shorecasting

Fell in/swept in

Boat accident

23

15

10

92

102

15

3

0

0

21

1

32

22

26

53

13

8

48

9 (2%)

18 (3%)

21

6

55 (10%)

37 (7%)36 (7%)

145 (27%)

115 (21%)

23 (4%)

51 (9%)

42 (8%)

7 (1%)

0 50 100 150

76 (14%) from 

unintentional immersions

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County-specific data

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Ten-year rate (/100,000) of ocean drownings in Hawaii, by residence status and county, 2003-2012

0

50

100

150

200

250

300

32.216.9 25.0 20.0

171.0

125.2

269.0

158.7

50.126.2

83.3

54.3

Hawaii Oahu Kauai Maui Hawaii Oahu Kauai Maui Hawaii Oahu Kauai Maui

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Ocean drownings on Kauai, 2003-2012

77

318

10 25

0 10 20 30

unint. immersion

swimming

snorkeling

diving

other activity

unknown

9

4

7

2

5

9

6

4

6

9

3

5

11 1 1

34

2

01

21

98 8

10

6

76

0

4

8

12

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

total (70) non-residents (54, 77%) HI residents (16, 23%)

Number of drownings, by activity

Annual trends,

by residence of victims

• Summary

• 70 total, 2 to 10 per year• Somewhat decreasing trend • Mostly (77%) non-residents • Activity: Swimming (36%) and

snorkeling (26%)

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Napali Coast: 4 drownings:-3 non-residents

-all during Oct-March-3 swimmers

Kee-Princeville: 19 drownings:-17 non-residents (all US)

-no seasonality-5 at Queen's Bath, none since 2008

Poipu area: 15 drownings:-13 non-residents (all US)

-no seasonality-8 snorkelers, 5 swimmers

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North Shore (Polihale-Lighthouse): 29-20 (69%) from Oct-March

East Shore (Larsens - Lihue): 21-13 (62%) from April-Sept.

South Shore (Kekaha-Poipu): 22-13 (59%) from April-Sept.

Seasonality

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Ocean drownings on Oahu, 2003-2013

2846

4150

3167

0 20 40 60 80

unint. immersion

swimming

snorkeling

diving

other activity

unknown

19

2630

22

812 10 8 10 9 10

1712

9

1621

12

29

22 19

31

22

43

10

14 1714

26

17

11

0

10

20

30

40

50

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

total (263) non-residents (108, 41%) HI residents (155, 59%)

Number of drownings, by activity

Annual trends,

by residence of victims

• Summary• 263 total, 19 to 43 per year• No consistent trend

• Slightly more residents (59%)•• Activity: wide distribution

18Leeward coast: 42 drownings:52% residents; not much seasonality

North Shore: 26 drownings:

eastern Oahu (Honolulu-Kailua): 154 drownings (59%)

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Point Panic-Ala Wai marina: 25:-21 residents

Hilton Hawaiian-Kapahulu: 35:-26 non-residents (10 US, 16 foreigners)

Kahala-Portlock: 23:-17 residents

Hanauma: 20:-19 non-residents

-7 US, 12 foreigners

Residence

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South Shore: 104 drownings:-71 (68%) from April-September

Seasonality

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Ocean drownings on Maui County, 2003-2013

87

1030

1436

-15 5 25 45

unint. immersion

swimming

snorkeling

diving

other activity

unknown

11

14 13

75

11

16

7

13 3 3

6

19

6 7

12

86

9

5

8755 54

11 20

4

8

12

16

20

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

total (105) non-residents (76, 72%) HI residents (29, 28%)

Number of drownings, by activity

Annual trends,

by residence of victims

• Summary• 105 total, 6 to 19 per year

– (95 on Maui, 8 Molokai, 2 on Lanai)• Increasing trend

• Mostly (72%) non-residents •• Activity: Swimming (34%),

snorkeling (29%), and unintentional immersions (13%)

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Kaanapali: 21 drownings:-13 in Black Rock area

-20 non-residents (18 US)-17 from 2008-2012

-14 from October-March

Kamaole-Oneloa (Big Beach) 26:-10 at Big (5) or Little (5) Beach

-24 non-residents (21 US)-16 from 2008-2012

-little seasonalityMolokini: 6

-5 from 2011-2012

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Ocean drownings on Hawaii County, 2003-2012

1213

2017

2117

-5 5 15 25

unint. immersion

swimming

snorkeling

diving

other activity

unknown

13

4

9

16

3 4 4

0

4

75 4 5

9

4 5

9

15

99

97

9

2

11

4

65

4

0

4

8

12

16

20

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

total (100) non-residents (44, 44%) HI residents (56, 56%)

Number of drownings, by activity

Annual trends,

by residence of victims

• Summary• 100 total, 4 to 16 per year• No consistent trend

• Slightly more residents (56%)

• Activity: wide distribution

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Waikoloa Beach-Mauna Kea: 13:-11 non-residents (8 US)

-8 snorkelers

Kailua Bay-Keauhou: 17-12 from April-September

Kumukahi Lighthouse-Pohoiki: 11:-10 residents

-10 from 2006-2012

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west coast (Mauna Kea-Milolii):

-33 of 51 (65%) victims non-residents

south and windward coasts:-35 of 41 (85%) victims non-residents

Residence

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Summary

• Visitors have low risks (rates) of injury, with the exception of drowning, near-drowning and spinal cord injury– Comprise nearly half the drowning victims/patients

• Mortality rates ~7 times higher, morbidity ~10 times higher– Comprise 77% of ocean-related SCI

• Specific beaches on each island

• County data– Hawaii County highest drowning rate among residents– Kauai highest rate among non-residents and total– Descriptions (victim residence, activity, seasonality,

trends) available for each county