Hawaii Health and Safety Guide

Hawaii is one of the safest tropical destinations in the world. In contrast to travelers to Mexico or the Caribbean, the Hawaiian tourist can safely ignore factors such as climate, disease, and crime while planning a trip. This guide discusses some common safety concerns and highlights the most important considerations to ensure a safe holiday.

Hawaii's Ocean

The behavior of the ocean in Hawaii is unique, complex, and unpredictable. On Oahu lifeguards perform about 1100 "rescues" a year. On average 50 people drown in the ocean annually (all islands), approximately half being visitors.

Takng into account that over 7.5 million people visit the state each year, the overall risk associated with swimming in the ocean is low. Of concern is the distribution and circumstances surrounding many drownings - many happen at unguarded locations and often result from a lack of knowledge or poor judgment. Beaches and tide pools in Hawaii are deceptively dangerous. So, the rate of drowning in Waikiki may be 1 per 1,000,000 people entering the water, whereas a secluded location such as Larsen’s Beach on Kauai may be 1 per 5,000 (these numbers are fictitious and for illustration). The same set of standard caution signs are found at nearly every beach, so the signs lose credibility.

Of greatest importance is acknowledging that the ocean represents a dangerous environment and that those dangers are very difficult to judge. It's a mistake to assume that one can fully understand and analyze ocean conditions – they change rapidly and are greatly influenced by season, location, tides, weather etc. It takes years of local ocean experience to gain an insight.

To properly gauge safety one has to get advice from local experts, read the current surf report, and keep in mind that each swimming location has a completely unique character. Life guards understand the ocean better than anyone and are the preferred source of information. Residents are always eager to offer advice, but always err on the side of caution if you feel weary of a risk. Remember, locals drown as well. A group of teenagers swimming in a tide pool is not an endorsement of its safety. Because it takes so much experience to understand the ins and out of each swimming location, guide books and web sites can't be counted on for thorough safety advice.

Neck, back, shoulder and ankle injuries from boogie boarding and body surfing are very common. These injuries happen most frequently when the wave, however small, breaks abruptly on the sand. Several beaches have a reputation for having a consistent beach break, but all can exhibit the behavior depending on the ocean and tides.

Ocean Safety Checklist:

• Admit that you are not an expert, and do not attempt to be one. Ask lifeguards for advice.
• Be honest about your swimming ability. The ocean is not a swimming pool.
• Never turn your back on the ocean. Being hit by a wave while you're not watching can cause serious injury. Waves can sneak up on one.
• If you get caught in a current do not struggle against it. Rip currents are usually narrow, so calmly swim perpendicular to the current direction to get out of it, and then you will be able to swim back to shore.
• If you need help, shout “Help” (and not a family member’s name) or wave an arm to get attention.
• Always remain calm and relaxed in the ocean, whether you get caught in a current, hit by an unexpected wave, or bump into a turtle. Panic leads to drowning because of uncoordinated movement, sporadic breathing, and increased oxygen usage.
• Never take your eye off children in the water, no matter how calm the ocean.
• After watching the ocean for 30 minutes, only enter the water if you can handle waves 2x the size of what you've already seen. The only way to get a good idea of what the ocean is capable of throwing at you that day is to check the local surf report or ask a life guard.
• Remember, people also drown after being swept off rocks. Watching big waves from rocks next to the ocean is a very dangerous activity. Know the surf report before you approach any exposed location.
• A current can pull you away even in waist high water.
• Boogie board in conditions that suit your skill level. However tempting, don’t follow local kids when the waves aren’t breaking nicely.
• Don’t over estimate your swimming ability with snorkel gear. Snorkeling is a strenuous activity.
• There have been an alarming number of snorkeling deaths in Hawaii and investigators believe it may be dangerous to go snorkeling within a few days after a long flight. A condition called ROPE (rapid onset pulmonary edema) may be to blame. Please research this topic for the latest information before you go snorkeling.
• The ocean can be extremely inviting even in dangerous conditions. When in doubt don't go out.

Too many rules to recall? Then remember just one - swim in front of life guards. Many don't realize how exceptionally dangerous wave watching is (Queen's Bath, Kauai)

Shark Attacks in Hawaii

The risk of a shark attack is negligible considering the number of people entering the water every day. From 1828 to 2005 there were 119 shark attacks in Hawaii, 21 of which were fatal. The modern day average is about 3 attacks per year. Common precautions include not swimming at dawn or dusk and avoiding murky waters.

Portuguese Man of War

The man-of-war is jellyfish-like animal with a small air bladder that looks like a piece of inflated chewing gum, and a stinging tentacle that’s usually a couple of feet long. They float on the surface of the water. The sting that results from touching the tentacle can be very painful but medical attention is rarely required, although some people are allergic to the sting. For a bad sting expect to be out of action for an afternoon.

If stung, carefully remove the tentacle from the skin using something like a stick, and then thoroughly rinse the area with water. Do not rub the skin as this only helps to further lodge and disperse the poison. Lifeguards usually apply ice packs to relieve the pain. Rinsing with very hot water is said to help neutralize the poison. The folk remedy, peeing on the sting, does not help but can make a bystander feel useful. (This remedy make work for other types of stings)

Bluebottles are more common on East facing beaches as they are brought ashore by trade winds. Avoid entering the water when many are present on the beach (a sign that they are also in the water).

Box Jellyfish

The Box Jellyfish is a beautiful and delicate creature, but also one of the most venomous animals in the world. There are many species of Box Jellyfish. In Hawaii the species Carybdea alata is most common. These are smaller and less venomous than some of their deadly cousins like the Sea Wasp of Australia, but the sting is still excruciatingly painful and can bring even the most reputation-savvy surfer to tears. Although the stings are more dangerous than Portuguese-man-of-war stings, no one has died from a sting in Hawaii.

Coral

Coral has a high concentration of bacteria. It’s best to clean and disinfect a cut immediately using clean water. Do not clean in a stream or pond.

Ocean Water Quality

During periods of heavy rain streams and drains carry all sorts of pollution into the ocean including the pathogens leached by cesspools into ground water. The ocean’s salinity and sun’s radiation eventually kill the foreign bacteria (like Enterococcus). Leptosporosis (discussed below), is killed within a few hours of entering the salty ocean.

The Department of Health monitors water quality. Unfortunately they can not be relied upon for comprehensive and timely information as many beaches are measured infrequently (or not at all) and signs only posted when contamination is severe, such as from a sewage spill. The results of measurements are published on their web site but not displayed at beaches.

Once you realize that the water in Hawaii isn’t always pristine, you can rely on your common sense to judge its quality. The water shouldn’t smell bad, have oily patches, or brown frothy foam floating on it. After heavy rain the water will be dirt colored where streams run into the ocean (this water is polluted). A popular misconception is that ocean water, because it is salty, is good for healing wounds. This is not true - the ocean contains a high concentration of native bacteria species. These bacteria can also cause infection.

Leptospirosis

Leptospirosis is a tropical bacterial disease that causes fever and other flu like symptoms. In 10% of cases the illness causes severe complications like meningitis or liver failure. Roughly 1% of cases result in death. Hawaii averages about 44 confirmed cases per year, and many more go undiagnosed as people assume they have the flu or another virus.

The disease is spread from animals to humans via contaminated urine. The most common transmission media is fresh water – streams, ponds etc. or muddy or wet soil as the bacteria can survive for a long time in moisture (but die after a few hours in salt water). The bacteria normally enter through the mouth, nose, eyes or a cut/abrasion.

All the streams and rivers in Hawaii are contaminated. Warning signs are posted at some locations, but for the most part the disease receives little acknowledgment by residents.

We do not recommend swimming in fresh water at all. Be wary of muddy soil or pools of water when hiking. Streams can contain other pathogens as well (like Enterococcus) and thus swimming in the ocean at the mouth of a stream is not advised.

The Sun

Hawaii’s UV index is higher than any location in the U.S. with an average index of 6-7 in the winter and 11-12 for summer months. It’s best to be conservative until you get a feeling for how your skin reacts at a high UV index. For fair skinned people, 45 minutes in the sun using 30spf sun screen is a safe start if you’re swimming between 10am and 2pm during the summer.

Crime in Hawaii

Hawaii recently ranked 39th out of the 50 States for violent crimes (1st being the worst), but 6th for property crimes. From a more subjective stand-point, most visitors will undoubtedly feel safe and at ease during their visit. There are few spots that one would consider off-limits.

The most common crime is theft from cars. The obvious precautions apply: Don’t leave anything interesting in your car. Leave valuables in your trunk as a last resort, but place them there before you reach your destination.

Critters

Hawaii has few alarming insects or animals. Mosquitoes, ants, and the occasional flying cockroach are the most common annoyance encountered by tourists.