Keynote Speaker - Dr. Daniel maxim, President, Everest Consulting

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