In February 2022, 64-year-old Ray Johnson drowned on a beach in Maui, despite being an experienced snorkeler. His cause of death was attributed to drowning, but his attorney believes he likely died from Rapid Onset Pulmonary Edema (ROPE), a condition where the lungs fill with fluids, leading to hypoxia. Johnson’s wife, Patti Johnson, believes that an awareness campaign about this condition could have prevented her husband’s death and has filed a lawsuit against the Hawaii Tourism Authority and the Hawaii Visitors Convention Bureau.

ROPE can occur suddenly and without warning, causing snorkelers to panic, become weak, and lose consciousness rapidly. The condition can be fatal in just minutes, making it difficult for the individual to signal for help. Risk factors for ROPE include recent air travel, with the change in elevation affecting the permeability of the lung’s membranes, predisposing individuals to the condition. Patti Johnson believes that if her husband had known about the risks and been advised to wait after flying before snorkeling, his death could have been prevented.

Despite the prevalence of ROPE-related deaths among tourists in Hawaii, the state’s tourism authority and other organizations have not taken significant steps to warn visitors about the dangers. Between 2012 and 2021, 184 tourists died in snorkeling accidents, while only 20 local residents experienced the same fate. According to the lawsuit, despite having knowledge of the risks and available warnings from industry-funded studies, the authorities have failed to disseminate this information to tourists through their websites, brochures, or other promotional materials.

The design of snorkeling equipment, such as the narrow tube of snorkels, can also contribute to the occurrence of ROPE-related deaths. A study found that the prone position of snorkelers in the water, combined with the resistance created by the narrow snorkel tube, makes ROPE more common among snorkelers than other water activity participants. Full face masks, while providing convenience, can pose risks in urgent situations as they cannot be easily removed to improve breathing. Efforts have been made to gather data on the types of snorkels used by tourists who drowned, but legislation requiring this information was not passed by the Hawaii House of Representatives.

Patti Johnson has taken it upon herself to educate prospective snorkelers about the dangers of ROPE by printing small cards with information about the condition. She distributes these cards to individuals planning snorkeling trips, urging them to wait after flying and follow other safety tips to prevent a tragic outcome. While Patti’s efforts have been commendable, she believes that the state of Hawaii and the tourism industry should do more to educate tourists about the risks associated with snorkeling and the precautions they can take to stay safe. The lawsuit filed by Patti against the Hawaii Tourism Authority and Hawaii Visitors Convention Bureau aims to hold them accountable for failing to warn tourists about the dangers of ROPE.

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