Several dozen stakeholders — including lifeguards, tour boat operators, doctors and members of the tourism industry — convened at the Hilton Hawaiian Village Waikiki Beach Resort on Wednesday to discuss the prevention of snorkel-related drownings among visitors in Hawaii.

As visitors splashed in the lagoon outside, the indoor workshop presented serious topics, including the epidemiology and physiology of drowning, along with possible causes of the snorkel-­related drownings. The state Health Department’s snorkel safety subcommittee, which has been meeting for about a year, is trying to identify the risk factors, as well as prevention strategies.

“I think it’s a great start,” said Ralph Goto of the Hawaiian Lifeguard Association, which organized the workshop.

Ocean drownings are among the top three causes of death among non-residents in Hawaii, according to state epidemiologist Daniel Galanis in a presentation.

During the 10-year span from 2007 to 2016, there was an average of 65 ocean drownings per year. During that same time period, there were 156 snorkeling-related ocean drownings among non-residents, outnumbering fatalities from motor vehicle crashes (85), swimming (78) and falls (60). The majority were among older individuals, and more than half of victims ages 60 and older suffered from diseases of the heart.

Chief medical examiner Christopher Happy presented data that also showed more tourists than residents — 53 out of 60 cases — died from snorkeling-related drownings in the past seven years. The ages ranged from 6 to 82 years old; the average age was 54.6.

Some frequent locations for these drownings include Kauai’s north shore, Hanauma Bay and Electric Beach on Oahu and the west side of Hawaii island. But the highest rates have occurred on Maui.

More specific data from tourist surveys, and a new resident survey underway, are needed for the subcommittee to determine risks of snorkeling versus other activities, Galanis said.

One of the questions raised often was whether or not the type of snorkel masks, including variations of the increasingly popular full-faced masks, are a possible factor in drowning incidents. Goto and participants in the workshop were careful to say they were neither endorsing nor censuring any particular products – just examining the risk factors.

Dr. Philip Foti, a pulmonologist who serves on the subcommittee, said he thought it was important to “think outside of the box.”

Some factors to examine, he said, include the importance of experience; detailed travel history of the snorkeler, including length of flight; underlying medical conditions and selection of equipment. In his own research, Foti is interviewing near-drowning survivors and examining the snorkel masks of individuals who got into trouble.

Colin Yamamoto, retired Maui Fire Department battalion chief of ocean safety, presented findings from his own “amateur test” of four different full-­faced masks and one old-­fashioned snorkel mask, measuring the balance of oxygen to carbon dioxide. He said there was a need for more professional, independent testing.

After listening to morning presentations, participants in breakout groups brainstormed strategies for preventing snorkeling-related drownings, including the best way to get safety messages to visitors. They also spent the afternoon testing the various types of snorkeling equipment in the lagoon.