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Perspectives on Boating Safety and Life Jacket Use - Dr. Daniel Maxim

  1. Perspectives on Boating safety and Life Jacket Use Dr. L. Daniel Maxim 2017 Life Jacket Association Annual Conference
  2. The findings and conclusions are those of the author and do not necessarily represent those of the United States Coast Guard, the United States Coast Guard Auxiliary, or the National Boating Safety Advisory Council (NBSAC) 2
  3. •The focus of this presentation is on use of life jackets when boating •Alcohol involvement is also a major cause or contributing factor to boating fatalities, but the focus of this presentation is on life jackets, so alcohol involvement is addressed only briefly 3
  4. Background facts •Fatalities are the key measure for assessing boating safety efforts •We have made substantial progress over the years—but progress is becoming more difficult •Most boating fatalities (67%) are caused by human error •Most boating fatalities occur on small boats 4
  5. Fatality rates have decreased over the years 5 Substantial progress to date, but progress is becoming more difficult 1960 1970 1980 1990 2000 2010 2020 Year 0 10 20 30 40 Fatalitiesper100,000registeredboats
  6. Casualties by cause 2014 6 Human factors Environment Machinery Misc./other 0 20 40 60 80 Percentage Accidents Fatalities Injuries These percentages have remained roughly constant over the years
  7. More data •Drowning is the major cause of recreational boating fatalities •Most drowning victims are not wearing life jackets •Falls overboard, capsizing, collisions, and flooding/swamping are major accident types •The percentage of accidents with fatalities are greatest in fall, spring, and winter seasons and during nighttime hours 7
  8. 8 Drowning accounts for ~ 70% of boating fatalities in a typical year ~85% of victims are not wearing life jackets
  9. Drownings as % of total fatalities by boat type 9 Canoe/Kayak Rowboat Inflatable Open motorboat Cabin motorboat PWC 0 20 40 60 80 100 Drownings as % fatalities 2016 Data Reasons why drowning % is lower for PWC?
  10. Drownings and other fatalities by boat length 10 < 16 ft. 16 - < 26 ft. 26 - < 40 ft. 40 - 65 ft. > 65 ft. Unknown 0 50 100 150 200 250 300 350 Fatalities Drownings Other 8 out of 10 fatalities on boats < 16 ft. were drownings
  11. Fatalities by accident type 11 How many of these can be predicted in advance? 2016 Data
  12. % of accidents that are fatal by month 12 2012-2016 Basis for seasonal wear regulations in some states JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 0 5 10 15 20 25 %Accidentswithfatalities
  13. % Accidents that are fatal (ex. Unknown) 13 12:00 to 02:30AM 02:31 to 04:30AM 04:31 to 06:30AM 06:31 to 08:30AM 08:31 to 10:30AM 10:31AM to 12:30PM 12:31 to 02:30PM 02:31 to 04:30PM 04:31 to 06:30PM 06:31 to 08:30PM 08:31 to 10:30PM 10:31 to 11:59PM 0 5 10 15 20 25 30 % Acidents with fatalities (2012-2016)
  14. 14 Dangerous conditions: the mental model What is the reality?
  15. Drownings and environment the reality •Nearly 50 percent of drownings occurred on lakes, ponds, reservoirs, dams, and gravel pits—only 8 percent occur on the gulf, Great Lakes, or oceans •When water conditions were known: 75 percent of drownings occurred on waters with wave heights less than 2 feet—50 percent with wave heights less than 6 inches •When wind conditions were known: 58 percent of drownings occurred with wind conditions described as none or light (< 6 mph) 15 2008-2013
  16. Drownings and environment the reality •When visibilities were known: 82 percent of drownings occurred under conditions described as “good visibility,” and •When water temperatures were known: 61 percent of drownings occurred at water temperatures > 60 degrees Fahrenheit and 45 percent when the temperature was 70 degrees or more; only 2.7 percent when water temperatures were less than 39 degrees 16
  17. Drownings and swimming ability • Being a strong swimmer is obviously desirable, but does not guarantee survival in a boating accident • Canadian studies show that only a minority of drowning victims in boating accidents were non- swimmers or weak swimmers • Research shows that unexpected immersion in cold water is a serious risk to life if a boater is not wearing a flotation device. This is true despite the boater's experience, closeness to shore, and even swimming ability. 17
  18. Life Jackets 18 “If we were on a sinking ship and there was only one life jacket…I would miss you so much!”
  19. Key perspectives •Life jackets do not guarantee survival of boating accidents, but substantially increase the chances of survival •Studies prove the effectiveness of life jackets •Wear rate studies show that most boaters fail to wear life jackets, except when required by law •Boaters have a variety of reasons for failing to wear life jackets 19
  20. Reasons why life jackets don’t always guarantee survival •Life jacket may be wrong size, wrong type, worn out, malfunction, or worn improperly •Victim was trapped inside boat •Mouth immersions from wave splash •May die from hypothermia (in cold water situations) before being rescued •Other cause of death, injury, or impairment 20
  21. 21 Studies prove that increased wear rates could reduce boating fatalities dramatically
  22. Studies prove benefits of life jacket wear •Cummings et al. (2011) matched cohort design U.S.: authors estimated that wearing a life jacket reduced the risk of drowning by 49% (95% CI 26% to 65%) •Maxim (2010) U. S.: For open motorboats, canoes, kayaks, and rowboats the incremental lives saved if wear rates could be increased to 70% estimated to be approximately 125 annually, a 34% reduction 22
  23. Studies prove benefits of life jacket wear •Gungor and Viauroux (2014) U. S.: the expected number of drownings per vessel would decrease by about 80% if the operator wears a life jacket •O’Connor and O’Connor (2005) Australia: probability of surviving was 34/50 = 0.68 (95% CI 0.5317 - 0.8007) if the person was wearing a life jacket compared to 128/257 = 0.50 (95% CI 0.4355 - 0.5607) if not •Bugeja et al., (2014) Victoria Australia: 67% decrease in drownings after regulation requiring life jacket wear went into effect 23
  24. Given these data, wearing a life jacket ought to be a no brainer, right? Let’s look at wear rates! 24
  25. National data (JSI): all boats except PWCs 25 Youth Adults What will it take to move the needle for adults?
  26. Adults in powerboats by length (PWC excluded) 26 Beginnings of a trend for Small boats?
  27. Wear rates by age; JSI (excluding PWCs) 27 • Children subject to mandatory wear requirements • Do teen-agers view freedom from legal wear requirements a “rite of passage?” • Adults: the primary behavioral target group 2015 Data
  28. Adult wear rates by boat type (JSI) 28 PWC Kayak SUP Sail Canoe Power(ex PWC) 0 20 40 60 80 100 Wear rate (%) Regulation and risk perception?
  29. Attitudes on life jacket wear 29
  30. Quistberg et al., 2014 •US Survey: Low/no life jacket use associated with • Longer boat length (per foot, risk ratio [RR] 1.03, 95% CI 1.02 to 1.05), • Alcohol use (RR 1.11, 95% CI 1.01 to 1.20), • Perception of life jackets as ‘uncomfortable’ (RR 1.29, 95% CI 1.09 to 1.52), • Perceived greater level of swimming ability (RR 1.25, 95% CI 1.03 to 1.53 for ‘expert swimmer’), • Lack of confidence that a life jacket may save one from drowning (RR 1.13, 95% CI 0.96 to 1.32) 30
  31. Canadian study: Groff and Ghadiali (2003) 31 Reason More detail Low risk of drowning I’m a good swimmer; Experienced boaters don’t drown; I don’t go far from shore; I can easily reach my life jacket Life jackets restrict movement PFDs are bulky and uncomfortable; you can’t go swimming or get a sun tan with a PFD Life Jackets are uncomfortable PFDs are bulky and hot to wear Life jackets are unattractive or unfashionable Unfashionable, unattractive, unflattering are words used by boaters to describe PFDs Wearing a life jacket is a sign of fear Perception that wearing a PFD is a sign of weakness or fear as revealed in focus groups particularly among young males.
  32. UK Study: Turner et al. (2009) 32 Rank Reason 1st Do not perceive a substantial threat 2nd Would only go out in good conditions and would not wear a lifejacket unless conditions got rough 3rd Lack of confidence in lifejackets to save their lives (may use harnesses instead and careful movement around the boat) 4th Habit or laziness 5th Because lifejackets are restrictive 6th They would rather die quickly and have little hope of getting rescued 7th They do not sail offshore 8th Because lifejackets are uncomfortable, especially chafing the neck 9th The ‘on holiday’ mentality 10th tied Because they trust the skipper to keep them safe Do not do anything on the boat that would risk falling overboard Because lifejackets are a hassle to maintain Because lifejackets prevent an even suntan Because lifejackets are a hassle when changing other clothing
  33. Remarks on user perceptions •Can’t be dismissed out of hand—to the consumer, perception is reality; understanding barriers is key to success •Some obviously flawed (e.g., good swimmer, don’t go far offshore, won’t save lives, will wear in potentially “dangerous” conditions) •Need to reinforce correct perceptions and counter incorrect perceptions (well researched FAQs) 33
  34. Strategies to increase life jacket wear 34 Options Outreach Design Regulation
  35. Outreach materials 35
  36. More outreach materials 36
  37. Additional comments on outreach efforts •Clearly well intentioned and successful to various degrees (e.g., awareness), but have had only a limited impact on behavior •Need to determine messages that resonate, identify target audience(s), and choose the right media mix to optimize likelihood of success 37
  38. Media not entirely helpful! 38
  39. Life jacket design •Designs have evolved over time, but is there still room for further improvement? • Style • Function • Reliability • Comfort •Design competitions potentially valuable 39
  40. Why have they been successful? 40
  41. Regulation • Mandatory life jacket wear regulation – In certain countries (e.g., Australia and Ireland) – In certain seasons in seven US states (CT, MA, MD, ME, NY, PA, and WV) – In certain bodies of water (e.g., USACE) – For certain types of craft (PWC) – For persons engaged in certain activities (e.g., water skiing) – For persons of certain ages (youth) – Efforts to date typically successful 41
  42. Concluding comments 42
  43. Conclusions •Drownings account for the majority of recreational boating deaths •Most drownings result from capsizing, falls overboard, and flooding/swamping— events not always easy to forecast •Most drownings occur in relatively benign weather conditions •There are valid (and underappreciated) reasons to wear, rather than merely carry life jackets 43
  44. Conclusions •There is now strong statistical evidence that increased life jacket wear would reduce fatalities substantially •Boaters have a variety of reasons for failure to wear life jackets—perceptions of low risk, lack of efficacy, restrictions to movement, lack of comfort, impact on appearance, sign of fear •Wear rate studies indicate that present initiatives have had only limited success 44
  45. Conclusions •We need to develop more effective outreach efforts (media choices, target audience(s), and use of focus groups to develop messages that resonate) •Regulation has generally been effective (where used), but not easy to implement and seen as a “last resort” by many •There are lessons to be learned from other successful safety campaigns 45
  46. A reminder about alcohol 46 All Fatalities 701 Alcohol Related 133 Drownings 509 2016 Data Drowning and alcohol-involved fatalities account for about 80% of total boating fatalities on average in all years
  47. 47 Questions?
  48. Most fatalities occur on small boats 48 46.3 % < 16 ft. 90.3 % < 26 ft. if length known 2016 Data < 16 ft. 16 - < 26 ft. 26 - < 40 ft. 40 - 65 ft. Unknown Total: 701
  49. Fatalities by cause of death (when known) 49 Some year-to- year variation, but chart is representative CO Cardiac Arrest Hypothermia Trauma Drowning Other Total: 634 2016 Data
  50. Fatalities by cause and age range 50 0-12 12-19 20-29 30-39 40-49 50-59 60-69 70-79 80+ Age range 0 20 40 60 80 100 120 Numberfatalities Other Drowning