Kaua‘i had the honor this last week of hosting the bi-annual meeting of the United States Lifeguard Association.
All the top officials of this association attended — people such as President Chris Brewster, the regional presidents, as well as medical officers and consultants. These are the men and women who have literally written the textbook on lifeguarding — and a near-perfect textbook it is.
There were also quite a few working lifeguards from around the country who took the opportunity to attend the meeting and visit Kaua‘i, as well as equipment vendors who provided key sponsorships.
I do have a day job, and there was much of the meeting that I wasn’t able to attend, but I’ll briefly mention a few of my highlights.
First, simply being around these individuals from all over the U.S. was an inspiration and learning experience. In the Northeast, for example, lifeguards only cover the beaches from Memorial Day to Labor Day. The rest of the year they have other means of employment, some within their county’s government, some in private businesses. But they love and live for the time of year when they’re on the beach lifeguarding.
It was fun to feel that enthusiasm, as Memorial Day isn’t that far away and you could see they were chomping on the bit to get to their beloved work.
The California lifeguards are full-time and have been pioneers in many unusual techniques, including using lifeguard patrol boats, fighting boat and ship fires, and rappelling down shoreside cliffs for beach and cliff rescues at some of the very remote Big Sur beaches.
We heard a definitive and very interesting lecture on the latest CPR recommendations by Dr. Paul Pepe, one of the main researchers in this field. He’s a college professor and one of his side jobs is being the CPR consultant for the White House staff. Bottom line: Good chest compressions with good release at 100 repetitions per minute, thus minimizing interruptions for heart rhythm analysis or breaths, are absolutely critical for the victim’s chance of survival. And all the fancy defibrillators in the world are ineffective unless the “pump is primed” with the blood perfusion that accompanies these good compressions.
Peter Davis gave a remarkable talk about drowning worldwide. He noted that in the U.S. there are 1.25 drownings per 100,000 population, a total of 3,000 drownings per year. Worldwide there are more than 250,000 drownings per year at a rate of five per 100,000 (this does not include natural or marine disasters such as ferries overturning).
In developing countries the rate is around 10 drownings per 100,000. I was shocked to be told that in many developing countries drowning is the No. 1 cause of death in children between 1 and 5 years of age. Worldwide, only 2 percent of drownings occur in recreational environments; the other 98 percent happen simply in the environment of daily living conditions.
Here on Kaua‘i our average of nine drownings a year in a population of 65,000 makes our rate per 100,000 people almost 14 — nearly one and a half times as high as other developing countries. O‘ahu has a rate of around four per 100,000, Maui about three, and statewide our rate is around five per 100,000.
I had to think about all these numbers for a while. Let’s assume, for example, that New York City has 10 million people. If they drowned at the rate of 1.25 per 100,000 (our national average), there would be 125 drownings there per year. If they drowned at Kaua‘i’s rate, there would be 1,400 drownings there per year — and that number would definitely cause a stir in public health circles.
To put these numbers in another perspective, the U.S. death rate from heart attack in people over 35 is around 150 per 100,000.
A big part of what makes our drowning rate so high is Hawai‘i’s geology.
We live on a 900-square-mile tip of a volcano that rises straight up out of an 18,000-foot-deep seabed with no continental shelf to blunt the storm effects from a massive surrounding ocean. Not to mention we have 52 miles of white, sandy beach of Kaua‘i’s 110-mile perimeter. A significant difference between us and O‘ahu, of course, is that O‘ahu has a much bigger tax base and, correspondingly, a much larger number of guarded beaches. Maui, too, has more guarded beaches as well as significantly calmer beach conditions than Kaua‘i.
All these worldwide numbers are only recently starting to be understood. Our U.S. solutions don’t really apply to developing countries. These countries don’t need more lifeguards, since virtually all of the drownings occur within 100 yards of the homes, many in low-lying areas such as in Bengladesh or near rivers, canals or ditches. The main solution in these circumstances would appear to be learn-to-swim child proofing. The United States Lifeguard Association is only now in the rudimentary phase of partnering with agencies such as the World Health Organization in coming to grips with these numbers.
As for our Kaua‘i numbers, maybe our tough natural conditions won’t ever permit the lower rate we’re striving for, but I won’t believe it until we feel satisfied that we’ve done all we can.
At the meeting, Kaua‘i speakers were given the opportunity to present a picture of how things are here — the challenges we face and the solutions we’ve been working on (more lifeguards, more and better education/prevention measures). Our panel of six was headed by Kalani Vierra, Kaua‘i’s ocean safety supervisor.
Then came Kaua‘i Vistors Bureau Executive Director Sue Kanoho, who described how her pioneering bureau includes a “please be careful” message into its welcome agenda. Geologist and statistician Chuck Blay provided some stunning maps and graphs, and aquatics expert and long-time community advocate Pat Durkin gave an outline of our leader-of-the-pack WAVE project. Kauaiexplorer.com’s Winston Welborn presented his outstanding informational and safety-oriented Web site, and I briefly tied this all together. I was told we all did a good job.
Our biggest challenge remains our large number of unguarded beaches, both remote and resort-fronting. This was brought home to us as we finished our Friday morning presentation only to hear the wail of sirens pulling up to the resort. A 30-year-old guest was critically injured playing in the surf during that day’s mild south swell, right as we were discussing our Kaua‘i ocean safety challenge.
I believe the meeting’s location here on Kaua‘i brought recognition of the hard work we have done to address and improve our ocean safety program, and it was a call to arms to dig deeper and get better.
We still have the highest drowning rate in the state, in the U.S., and — it turns out — in the world. Unguarded beaches, both quiet, remote ones and busy, resort-fronting ones: Look out! We’re zeroing in on you, with education, rescue tubes, kiosks showing beach information and lobbying efforts to get you guarded. We have to.
• Monty Downs is an emergency room doctor at Wilcox Memorial Hospital.