A coroner has warned that full-face snorkel masks could be putting ‘millions of people’ at risk, following the death in 2020 of a tourist brought on by Immersion Pulmonary Oedema (IPO) while snorkelling near the Red Sea Resort of Hurghada.
IPO is a build-up of fluid in the lungs caused by an increase in pressure in the pulmonary capillaries, leading to a lack of oxygen (hypoxia) which can be fatal if not treated rapidly. People suffering from high blood pressure (hypertension) are particularly at risk due to the additive effects of being submerged in cool water.
The 63-year-old snorkeller, Angela Kearn, had recently been diagnosed with high blood pressure and was also undergoing hormone replacement therapy, which the coroner reported had also contributed to her death.
Ms Kearn had been wearing an ‘Easybreath’ full-face snorkel mask that she had purchased five years earlier and had previously used without incident. However, she began experiencing difficulties while snorkelling during her trip in January 2020, and died at Hurghada’s Nile Hospital after being taken from the water.
Full-face snorkel masks have long been thought to be the underlying cause of a number of snorkelling fatalities. Concerns were raised in 2018 following a series of snorkelling deaths in Hawaii, widely reported at the time to have been caused by an excessive build-up of carbon dioxide in the mask.
Egypt’s Chamber of Diving and Watersports (CDWS) warned against the use of full-face snorkel masks in August, 2020.
The larger volume of the full-face snorkel masks makes it more difficult to expel exhaled carbon dioxide from the mask, causing the wearer to breathe more heavily in an attempt to bring more oxygen-rich air into the mask. The increase in respiratory effort creates a pressure imbalance in the lungs, which exacerbates the effect of immersion pulmonary oedema.
Similar problems can occur when diving using a closed-circuit rebreather.
In a report to the General Medical Council, National Trading Standards and Decathlon, assistant coroner Caroline Topping wrote: ‘Many millions of the full-face masks have been sold and the safety concerns about their use by those with ongoing cardiovascular and respiratory issues has not been widely publicised or brought to the attention of those who already own the masks.’
‘Those purchased before 2017 had no warning in relation to these matters and the warning included in the instructions from 2017 onwards was not prominent nor sufficient to alert prospective purchasers to the hazards of use which have now been identified.’
First described by UK Divers Medical Committee chair, Dr Peter Wilmshurst, IPO is increasingly thought to be responsible for the greatest number of medically-related scuba diving fatalities. High blood pressure is a common disease, particularly amongst people over the age of 40, and often goes unrecognised as it has no symptoms.
Word of the impact of IPO, however, has been slow to spread among both the diving and medical communities, a point recognised by Dr Topping in her report.
‘Concerns were raised by the medical witnesses that there is very little awareness of immersion pulmonary oedema in the medical profession and that it is not addressed in medical training, as a consequence, it can be missed by those treating the condition and is often mistaken for drowning.’
Following the report into Ms Kearn’s death, Decathlon has updated its website with a warning that its full-face snorkel masks are not recommended for people who suffer from ‘respiratory or cardiovascular issues including but not limited to chest infection, asthma, high/raised blood pressure (hypertension), heart disease or angina.’