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How Dangerous is BASE Jumping? An Analysis of Adverse Events in 20,850 Jumps From the Kjerag Massif, Norway
Abstract
Extreme sports, including BASE (building, antenna, span, earth) jumping, are rapidly increasing in popularity. Associated with risk for injuries and deaths, this activity may pose a burden on the emergency system. Hitherto, no reports exist on accidents and deaths associated with BASE jumping.
We reviewed records of 20,850 BASE jumps from 1995 to 2005 at the Kjerag massif in Norway. Frequency of deaths, accidents, and involvement of helicopter and climbers in rescue are analyzed. Fatalities were scored for injury severity scores (Abbreviated Injury Scale score, Injury Severity Score, New Injury Severity Score) on autopsy.
During an 11-year period, a total of 20,850 jumps (median, 1,959; range, 400-3,000) resulted in 9 fatal (0.04% of all jumps; 1 in every 2,317 jumps) and 82 nonfatal accidents (0.4% of all jumps; 1 in every 254 jumps). Accidents increased with the number of jumps (r=0.66; p=0.007), but fatalities did not increase, nor did activation of helicopter or climbers in rescue (p>0.05). Helicopter activation (in one-third of accidents) in rescue correlated with number of accidents (r=0.76, p=0.007), but not climbers. Postmortem examination (n=7) of fatalities revealed multiple, severe injuries (Abbreviated Injury Scale score>or=3) sustained in several body regions (median, Injury Severity Score 75; range, 23-75). Most nonfatal accidents were related to ankle sprains/fracture, minor head concussion, or a bruised knee.
BASE jumping appears to hold a five- to eightfold increased risk of injury or death compared with that of skydiving. The number of accidents and helicopter activation increases with the annual number of jumps. Further analysis into the injury severity spectrum and associated hospital burden is required.
... BASE jumping, and especially BASE jumping with the help of wingsuits, is considered one of the most dangerous airborne sports [2]. Wingsuits are special jumpsuits with "wings" expanding between the extremities and inflatable pressurised cells. ...
... Publications on BASE jumping tend to concentrate on mortality, have low case numbers, or rely on data retrieved from BASE jumpers themselves [4,8,9]. A publication from the Kjerag massif in Norway estimated a risk of 0.4% for any injury and 0.04% for fatalities in BASE jumping [2]. In another study, the same authors estimated that the risk for an injury in BASE jumping was 5-8 times higher than in skydiving [10]. ...
... which is less than the value reported in previous studies. Soreide's series from a single jump site in the Kjerag Massif reported a rate of 0.4% [2]. A study by Monasterio and Mei-Dan of 35 experienced BASE jumpers also showed an estimated injury risk of 0.4% [8]. ...
Background:
BASE jumping, and especially BASE jumping with the help of wingsuits, is considered one of the most dangerous airborne sports. The valley of Lauterbrunnen in Switzerland has become infamous for the large number of BASE jumps and the high rate of accidents and fatalities. The aim of this study was to evaluate the morbidity and mortality of BASE jumping, to determine the severity of injuries and injury patterns of BASE jumping accidents and to compare preclinical assessment with clinical diagnoses to detect under- or overtriage.
Methods:
This retrospective, descriptive cohort study covers a period of 10 years (2007-2016). The evaluation covered all BASE jumping incidents in the valley of Lauterbrunnen that required either a helicopter mission by the local HEMS (Helicopter Emergency Medical Service) company of Lauterbrunnen, Air Glaciers, or medical care in the regional hospital, the level I trauma centre or the medical practice of the local general practitioner. Besides demographic data, experience in BASE jumping and skydiving as well as BASE jumping technique(s) and details about the rescue missions were collected. The medical data focused on the severity of injuries, as expressed by the National Advisory Committee of Aeronautics (NACA) score in the prehospital assessment as well as the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) retrieved from the clinical records in the hospital or medical practice setting.
Results:
The patients were predominantly young, experienced male BASE jumpers. Morbidity (injury risk) ranged from 0.05% to 0.2%, and fatality risk from 0.02% to 0.08%. Undertriage was low, with only two cases. Overtriage was significant, with 73.2% of all NACA 4-6 cases not qualifying for major trauma.
Conclusions:
BASE jumping remains a high-risk sport and is associated with significant rates of injuries and fatalities. Comparison with previous studies indicated that the injury rate may have decreased, but the fatality rate had not. In this known BASE jumping environment, prehospital assessment appears to be good, as we found a low undertriage rate. The high overtriage rate might be an expression of physicians' awareness of high-velocity trauma mechanisms and possible deceleration injuries.
... Typical activities include BASE and proximity flying, waterfall kayaking, bigwave surfing, extreme skiing, high-level mountaineering, and 'free solo' climbing. BASE jumpers use parachutes to safely land after jumping from solid structures (e.g., bridges, buildings, cliffs) that are only a few hundred feet from the ground (Bouchat & Brymer, 2019;Celsi, Rose, & Leigh, 1993;Soreide, Ellingsen, & Knutson, 2007). Proximity BASE jumpers wear winged suits to aid forward movement when jumping from similar solid structures (Holmbom, Brymer & Schweitzer, 2017). ...
... Extreme athletes conduct extensive planning, spend considerable effort developing profound knowledge of the environmental and task variables of their particular activity and work hard to hone skills (Pain, 2005). Epidemiological studies also suggest that extreme sports might be less dangerous that many socially accepted activities, such as motorcycle riding (Brymer & Feletti, in press;Soreide et al., 2007;Storry, 2003). The risktaking narrative is at the very least overemphasized: ...
... The risk narrative that has swamped extreme sport research has also meant a focus on negative outcomes. However there are many problems with this approach, including 1) Contemporary research is finding characteristics and statistics that do not reflect traditional assumptions of risk motivations (e.g., Celsi et al., 1993;Soreide et al., 2007;Storry, 2003); 2) the focus on risk has largely obscured other aspects of the extreme sport experience (e.g., Brymer & Oades, 2009;Kerr & Houge Mackenzie, 2012;Willig, 2008); and 3) traditional theory-driven perspectives often do not match the lived experiences of participants (Brymer & Oades, 2009;Holmbom et al., 2017;Willig, 2008). In the following sections, we highlight contemporary approaches to understanding motivations, processes, and outcomes of extreme sport participation. ...
... Typical activities include BASE and proximity flying, waterfall kayaking, bigwave surfing, extreme skiing, high-level mountaineering, and 'free solo' climbing. BASE jumpers use parachutes to safely land after jumping from solid structures (e.g., bridges, buildings, cliffs) that are only a few hundred feet from the ground (Bouchat & Brymer, 2019;Celsi, Rose, & Leigh, 1993;Soreide, Ellingsen, & Knutson, 2007). Proximity BASE jumpers wear winged suits to aid forward movement when jumping from similar solid structures (Holmbom, Brymer & Schweitzer, 2017). ...
... Extreme athletes conduct extensive planning, spend considerable effort developing profound knowledge of the environmental and task variables of their particular activity and work hard to hone skills (Pain, 2005). Epidemiological studies also suggest that extreme sports might be less dangerous that many socially accepted activities, such as motorcycle riding (Brymer & Feletti, in press;Soreide et al., 2007;Storry, 2003). The risktaking narrative is at the very least overemphasized: ...
... The risk narrative that has swamped extreme sport research has also meant a focus on negative outcomes. However there are many problems with this approach, including 1) Contemporary research is finding characteristics and statistics that do not reflect traditional assumptions of risk motivations (e.g., Celsi et al., 1993;Soreide et al., 2007;Storry, 2003); 2) the focus on risk has largely obscured other aspects of the extreme sport experience (e.g., Brymer & Oades, 2009;Kerr & Houge Mackenzie, 2012;Willig, 2008); and 3) traditional theory-driven perspectives often do not match the lived experiences of participants (Brymer & Oades, 2009;Holmbom et al., 2017;Willig, 2008). In the following sections, we highlight contemporary approaches to understanding motivations, processes, and outcomes of extreme sport participation. ...
Extreme sports such as BASE jumping, big wave surfing, and rope-free solo climbing are prime examples of activities undertaken in extreme environments where a mismanaged mistake or accident would most likely result in death. Traditional frameworks used to explore motivational, performance, and outcome issues have assumed a risk focus. However, in more recent years, these frameworks have been critiqued. Instead, a more positive approach has been proposed. In this chapter, we overview the traditional approach and present a more nuanced understanding that better reflects the lived experience of extreme sport participants. Finally, the latest research on the psychology of extremism highlights the need to distinguish between extreme sports (considered as research objects) and extreme practices of these sports (motivation-based mechanisms).
... head, neck, chest, upper and lower extremity) instead of by the type of injury (e.g. concussion, laceration, contusion, fracture etc.) (15,(24)(25)(26). As a result, there is a lack of concise data regarding rates of concussions alone. ...
... Furthermore, existing studies report primarily on emergency department visits and are not reflective of total injuries seen by all physicians who treat extreme sports athletes (e.g. sports medicine providers) (9,15,(24)(25)(26)(27). Within emergency departments, providers typically use templates to make the most efficient use of time. ...
... In an epidemiological study performed in Canada on 1332 reported snowblading, skiing and snowboarding injuries, it was observed that snowboarding related head injuries had a strikingly high incidence in beginners and during backward falling and jumping. In particular, most head injuries occurred during jumping when the surface of the ground was covered with icy packed snow (26). However, a high rate was also observed on well-marked slopes (29,30). ...
Background. As participation in extreme sports continues to grow internationally, the number of concussions sustained during these activities is predicted to increase. Due to the lack of organizational frameworks, governing rules, or regulated competitive structures, the incidence of concussion and its management specific to extreme sports athletes remains difficult to determine.
Methods. Relevant papers were screened from PubMed using a combination of terms related to extreme sports and concussion. After considering existing literature, papers that did not fit the authors’ agreed-upon definition of extreme sports were excluded.
Results. Eleven manuscripts met inclusion criteria. Of the eleven, only five studies reported on more than one extreme sport while the other six were sport-specific. Three were review papers that used sport-specific data to generalize about extreme sports.
Conclusions. The results of our review indicate that the current literature available for concussion in extreme sports varies highly in study design and type of sports investigated. Due to the lack of knowledge regarding concussions in extreme sports, there needs
to be an emphasis to better document and record concussion incidence in extreme sports, as well as the need to develop specific return-to-play guidelines for healthcare professionals treating extreme sports athletes.
... 2,3 Uncontrolled parachute opening that results in collision with another object, termed object strike, is the most common cause of injury and death in BASE jumping. 1,4 However, injuries incurred during landings can also result in injury or death. 2 Wingsuit flying, a specialized form of BASE jumping, may be particularly dangerous and deadly. 5 We examined the epidemiology, morbidity, mortality, and emergency department (ED) and inpatient healthcare cost of BASE jumping injury in the United States. ...
... 13 Similarly, in 2008, a descriptive analysis of 106 fatal BASE jumps estimated the fatality risk to be 1 death per 60 participants per year, and reports from Norway estimate 1.1 fatality per 2500 jumps. 1,4 The absence of fatalities detected through NEDs can be interpreted in several ways. It is possible that no fatalities were detected secondary to sampling error inherent in survey data. ...
... BASE injury data from Norway support the latter hypothesis; among the 9 deaths from 1995À2005, 8 died immediately, and 1 died before contact with rescuers. 4 Similar fatality patterns have been observed among injured rock climbers. 14,15 There is scant data describing the healthcare cost of extreme sports, BASE jumping in particular. ...
Background
BASE (building, antenna, span, earth) jumping involves jumping from fixed objects with specialized parachutes. BASE jumping is associated with less aerodynamic control and flight stability than skydiving because of the lower altitude of jumps. Injuries and fatalities are often attributed to bad landings and object collision.
Methods
We performed a retrospective analysis of the 2010–2014 National Emergency Department Sample database, a nationally representative sample of all visits to US emergency departments (EDs). BASE jumping-associated injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes [E004.0]. Outcomes evaluated included morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed.
Results
After weighting, 1790 BASE-associated ED presentations were identified with 358±28 injuries annually. A total of 1313 patients (73%) were aged 18 to 44 y, and 1277 (71%) were male. Nine hundred seventy-six (55%) multiple body system injuries and 677 (38%) isolated extremity injuries were reported. There were 1588 (89%) patients discharged home from the ED; only 144 (7%) were admitted as inpatients. On multivariate logistic regression, only anatomic site of injury was associated with inpatient admission (odds ratio=0.6, P<0.001, 95% CI 0.5–0.8). Including ED and inpatient costs, BASE injuries cost the US healthcare system approximately $1.7 million annually. No deaths were identified within the limitations of the survey design.
Conclusions
Although deemed one of the most dangerous extreme sports, many patients with BASE injuries surviving to arrival at definitive medical care do not require inpatient admission.
... This sport developed out of skydiving and is considered as one of the most dangerous extreme sports because of the risk of accident or death involved in the practice (Brymer, 2010;Mei-Dan et al., 2012). The injury rate estimates of 0.2-0.4% (Søreide et al., 2007;Monasterio and Mei-Dan, 2008;Mei-Dan et al., 2012) and the fatality risk estimates of 0.04% per jump (Søreide et al., 2007) and 1.7% per participant and per year (Westman and Björnstig, 2007). In addition, more than 70% of the participants report that they have witnessed the death or serious injury of another participant in the sport Monasterio et al., 2012). ...
... This sport developed out of skydiving and is considered as one of the most dangerous extreme sports because of the risk of accident or death involved in the practice (Brymer, 2010;Mei-Dan et al., 2012). The injury rate estimates of 0.2-0.4% (Søreide et al., 2007;Monasterio and Mei-Dan, 2008;Mei-Dan et al., 2012) and the fatality risk estimates of 0.04% per jump (Søreide et al., 2007) and 1.7% per participant and per year (Westman and Björnstig, 2007). In addition, more than 70% of the participants report that they have witnessed the death or serious injury of another participant in the sport Monasterio et al., 2012). ...
... Epidemiological data and injury reports are still scarce and may be underestimates Søreide, 2012). BASE jumping is much more dangerous than skydiving (Søreide et al., 2007;Mei-Dan et al., 2012). ...
BASE jumping is an extreme adventure sport which consists of jumping from a fixed object with specially adapted parachutes. A few studies of the personality of BASE jumpers have been conducted, but little is known about how the women in this sport compare to the men. The purpose of this study is to compare the personality traits among a sample of men and women who are experienced BASE jumpers, as this provides an interesting and important opportunity to better understand the motivation for extreme sports. Eighty-three participants completed the Temperament and Character Inventory the day before the jump at the New River Gorge Bridge Day BASE Jumping event, West Virginia, United States. The sample included 64 men and 19 women. Results show that men and women BASE jumpers shared similar personality traits both in terms of temperament and character, except for the character trait of cooperativeness on which women scored higher than men. This suggests that the basic drive for participation in extreme sports is self-regulation of personal emotional drives and needs for self-actualization, rather than to oppose social pressure or cultural bias against female participation. These findings are discussed in relation with other studies conducted among extreme athletes and in terms of congruence between personality and activity.
... Very few studies have been conducted on this small unique population. Soreide et al. determined that BASE jumping is associated with a five-to eightfold risk for fatality or injury when compared to regular skydiving [19]. The fatality rate associated with BASE jumping was found to be 0.4 per 1000 jumps from a single site [19], although lacking information on demographic characteristics or jumpers' experience level. ...
... Soreide et al. determined that BASE jumping is associated with a five-to eightfold risk for fatality or injury when compared to regular skydiving [19]. The fatality rate associated with BASE jumping was found to be 0.4 per 1000 jumps from a single site [19], although lacking information on demographic characteristics or jumpers' experience level. In a study by Monasterio and Mei-Dan among 35 experienced BASE jumpers [20], an estimated injury rate of 0.4% was found in 9914 jumps, a finding similar to Soreide's results [19]. ...
... The fatality rate associated with BASE jumping was found to be 0.4 per 1000 jumps from a single site [19], although lacking information on demographic characteristics or jumpers' experience level. In a study by Monasterio and Mei-Dan among 35 experienced BASE jumpers [20], an estimated injury rate of 0.4% was found in 9914 jumps, a finding similar to Soreide's results [19]. Twenty-one (60%) jumpers in that study were involved in 39 accidents. ...
Extreme sports (ES) are usually pursued in remote locations with little or no access to medical care with the athlete competing against oneself or the forces of nature. They involve high speed, height, real or perceived danger, a high level of physical exertion, spectacular stunts, and heightened risk element or death.
Popularity for such sports has increased exponentially over the past two decades with dedicated TV channels, Internet sites, high-rating competitions, and high-profile sponsors drawing more participants.
Recent data suggest that the risk and severity of injury in some ES is unexpectedly high. Medical personnel treating the ES athlete need to be aware there are numerous differences which must be appreciated between the common traditional sports and this newly developing area. These relate to the temperament of the athletes themselves, the particular epidemiology of injury, the initial management following injury, treatment decisions, and rehabilitation.
The management of the injured extreme sports athlete is a challenge to surgeons and sports physicians. Appropriate safety gear is essential for protection from severe or fatal injuries as the margins for error in these sports are small.
The purpose of this review is to provide an epidemiologic overview of common injuries affecting the extreme athletes through a focus on a few of the most popular and exciting extreme sports.
... In the literature, the mortality rate was found to be approximately 45/100000 paragliding jumps [12] with one fatality in every 2317 BASE-jumps of which all deaths occurred on the scene and were not admitted to a hospital [13] . Since January 2013, all deaths of pilots who crashed during paragliding are reported to the Swiss Paragliding Association. ...
... This orientation of the body may also explain the high incidence of sacral-pelvic injuries due to the higher percentage of paragliders in our cohort compared to others [18] . Interestingly, in previous reports, injuries in those who performed BASEjumping and survived were generally minor from a musculoskeletal perspective, including sprained ankles or knees, with only few moderate injuries, although Table 3 Distribution of three most severe abbreviated injury codes by severity and location of injury Head/face 2.57 10 13 13 8 1 1 2 48 Thoracic 3.04 3 17 28 12 7 0 2 69 Abdomen 3.18 1 2 7 7 0 0 6 concussions were common [13,19] . Delta flyers suffer more from extremity injuries (100%). ...
Background:
Airborne sports have become more popular in recent years. The number of accidents has increased linearly as athletes take increasingly greater risks to experience the adventurous spirit of this kind of sports.
Aim:
To investigate the variety of injuries in airborne sport accidents, as well as which acute treatment these patients receive, both before and after admission to a level-one-trauma center.
Methods:
We performed a retrospective chart analysis at a major level-one-trauma center in Switzerland for 235-patients who were admitted following airborne sports injuries between 2010 and 2017. Patients' demographic data, injury patterns, emergency primary care procedures and intra-hospital care were recorded.
Results:
Overall, 718-injuries in 235-patients were identified; the spine was the most commonly affected region with 46.5% of injuries (n = 334/718) in 143-patients. In 69-patients (15.5%), the (non-spine) thorax was affected, followed by the lower and upper extremity, pelvis, head/face and abdominal injuries. Eleven-patients had to be intubated at the trauma site. Three patients were resuscitated after onset of pulseless-electrical-activity. Two-patients died in the resuscitation room. In 116-cases, surgery was indicated including 55-emergency surgeries. Another 19 patients (8.1%) were transferred to the intensive care unit.
Conclusion:
Paragliders are most commonly affected, although the highest injury severities were identified for Building, Antenna, Span and Earth-jumping athletes. First responders, treating physicians and pilots should be aware of the risk for potentially serious and life-threatening injury with an in-hospital mortality of 0.9%.
... In fact, such individuals may not be the ideal participants for AESs. Recent research is finding some relationship between individuals who look for risk and ineffective decision making in AESs (Woodman et al. 2013) A second problematic ramification of the current emphasis on risk is that there is an emerging literature base that reveals participant characteristics that suggests the risk focus is an over simplification (Cater 2006;Celsi, Rose, and Leigh 1993;Soreide, Ellingsen, and Knutson 2007;Storry 2003). The most effective participants are found to be careful, aware, highly prepared with a profound knowledge of the environment, the task requirements and their own capacities Feletti, Westman, and Mei-Dan 2016). ...
... For example, statistical comparison between the death rates of motorcyclists, BASE jumpers and climbers in the U.K. found that the death rate for climbers was 1:4000 which compares favourably against motorcycle riding where the death rate is 1:500 (Storry 2003). An analysis of 20,850 BASE jumps in Norway over an eleven year period found that the death rate was 1:2317 and whilst the injury rate was higher they were in the main linked to sprains and bruises (Soreide, Ellingsen, and Knutson 2007). An analysis of a broad range of adventure tourism activities in New Zealand found that the prevalence of injury in adventure tourism for overseas visitors and domestic participants was similar to road traffic accidents, though the type and nature of injury depended on specific activities (Bentley and Page 2008). ...
Adventure and extreme sports (AESs) are associated with high risk of injury and even death. This has important ramifications for sport, education, medical and health professions and has led to discussions about the appropriateness of AESs for young people. For some, participation in AESs reflects social deviance. Research from this perspective has focused on testing this notion. However, in recent years research has questioned the perceived link to risk arguing that many acceptable activities might be ‘riskier’. Research from this perspective focuses on the positive side of AESs. Evidence points to a growing interest in AESs by young people and that AES activities might be useful to enhance the uptake of and adherence to physical activity, and support mental wellbeing in young people. This perspective suggests (1) AESs are important for the overall development of young people, (2) policy makers across sectors should recognize AESs when considering future interventions.
... Activities that typify this definition include BASE jumping, extreme skiing, waterfall kayaking, big-wave surfing, high-level mountaineering, and 'free solo' climbing. BASE jumping is a parachute sport where participants jump from solid structures (e.g., bridges, buildings, cliffs) that are only a few hundred feet from the ground [5,6]. In extreme skiing, participants ski down sheer cliffs where a fall would most likely result in an out of control tumble. ...
... Interestingly, statistical comparisons amongst the death rates of motorcyclists, BASE jumpers and climbers show that BASE jumping is far less likely to result in serious injury than motorcycle riding [6,61]. Perhaps, as Storry [61] recognised, the tendency to focus on 'risk' or 'thrill' motivations misses the point entirely. ...
The term ‘extreme sports’ has become synonymous with a variety of nontraditional adventure experiences. Terminologies such as ‘whiz sports’, ‘free sports’, ‘adventure sports’, ‘lifestyle sports’, ‘action sports’, ‘alternative sports’ and ‘extreme sports’ are often used interchangeably. One disadvantage of this proliferation is that accompanying definitions are imprecise or misleading. For example, white-water kayaking on grade two of the universal grading system can feel exciting and adventurous, but the results of an accident or mistake would be relatively innocuous in comparison to the consequences of an accident or mistake on grade six water. At the highest levels of difficulty, death is a real possibility. In addition to these semantic issues, theories used to explain extreme sport participation typically portray participants as risk or adrenaline seekers. Theorists have explained participants’ motivations through a range of analytical frameworks, including edgework, sensation seeking, psychoanalysis, neotribe or subcultural formation and masculinity theory. These risk-focused accounts are often formulated by non-participants and supported by theory-driven methodologies that may not fully capture the actual lived experiences of extreme sport participants. Problems with traditional approaches to studying extreme sports include (1) research revealing characteristics and statistics that are incongruent with traditional risk and sensation-seeking accounts, (2) a myopic focus on risk-seeking that largely ignores other key motives and benefits and (3) theory-driven perspectives that do not fully reflect the lived experiences of participants. In this chapter, the authors explore the psychology of extreme sports with the aim of illuminating additional perspectives on extreme sport experiences and motivations beyond risk and sensation seeking.
... 74,75,77 Overall Epidemiology BASE jumping injuries occur in 0.2% to 0.4% of jumps. [76][77][78] Demographics Most injuries occur to single men in their 30s. Most participants have witnessed the death or serious injury of another BASE participant. ...
... One study analyzing the deaths occurring from the Kjerag Massif cliff in Norway found the fatality rate to be 0.4 deaths per 1000 jumps. 78 Another analysis by Westman and colleagues 79 found that 1 fatality, on average, occurred per 60 participants per year (1.7%). ...
Adventure and extreme sports often involve unpredictable and inhospitable environments, high velocities, and stunts. These activities vary widely and include sports like BASE jumping, snowboarding, kayaking, and surfing. Increasing interest and participation in adventure and extreme sports warrants understanding by clinicians to facilitate prevention, identification, and treatment of injuries unique to each sport. This article covers alpine skiing and snowboarding, skateboarding, surfing, bungee jumping, BASE jumping, and whitewater sports with emphasis on epidemiology, demographics, general injury mechanisms, specific injuries, chronic injuries, fatality data, and prevention. Overall, most injuries are related to overuse, trauma, and environmental or microbial exposure.
... There is a significant mortality rate which has been estimated at one in 60 participants, making it 60 to 90 times more lethal than skydiving [5]. A Norwegian study found one fatality per 2,317 jumps off the Kjerag massif [6]. Deaths in these cases result from multiple injuries associated with cliff and ground strikes [5]. ...
Deaths at high altitudes may arise from a range of quite disparate entities including trauma (e.g. falls), environmental factors (e.g. hypothermia and hypoxia), and pre-existing medical conditions (e.g. coronary artery disease). Unique conditions include high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE) which may contribute to lethal mechanisms or precipitate a traumatic event. Forensic issues that may arise in these cases are logistical problems due to remote locations, sometimes with failure to find a body, delay in discovery and/or repatriation, prior local autopsies being performed with embalming, and the non-specificity of pathology markers. Traumatic deaths involve blunt force impacts, falls, suffocation, crush asphyxia and hypothermia. The assessment of cases requires careful integration of the autopsy findings with the medical history of the decedent and an accurate description of their behaviour in the hours leading up to death.
... Skydiving compares favorably with other extreme sports, such as kitesurfing, mountain biking, and rock climbing, with 10.1, 16.8 and 9.8 injuries per 1000 h of practicing the sport, respectively [22,23]. Regarding similar sports (e.g., BASE jumping and paragliding, with 393 and 1,080 injuries per 100,000 jumps, respectively), skydiving also compares favourably with 72 injuries per 100,000 jumps [24,25]. ...
Background
Skydiving is the fastest nonmotorized sport; and consequently is not without risk. In the last decades, skydiving has become considerably safer but injuries and fatalities still occur. Incidents are reported to and administered by the Royal Netherlands Aeronautical Association (KNVvL). From 1995 to 2020, 2715 incidents were reported; of which 1503 resulted in injury and 26 in fatality. There is a need for more information available on the particular type, severity, and factors which contribute to skydiving-related injuries worldwide. This study aims to investigate patterns in occurrence rates, examine demographic and skydiving-related factors linked to injuries, and analyze the types and severity of injuries relating to these contributing factors.
Methods
The Dutch KNVvL database – covering more than 25 years of data – was examined for contributing factors. An analysis of the severity and types of injury resulting from incidents over the last five years were matched with a search of hospital databases.
Results
The rate of injuries pattern increases starting from 2016, with novice jumpers having the highest risk of injury. Most injuries occur during the landing phase. The lower extremities and the spine are most affected, with fractures being the most prevalent type of injury. More than half of the patients were admitted to hospital, with 10% requiring surgery, resulting in months of rehabilitation.
Conclusion
This study is the first in the Netherlands, and only the second worldwide to analyze technical incident databases in combination with data from medical information systems. Skydiving accidents of experienced jumpers should be considered as ‘high-energy trauma,’ therefore treatment should follow standard trauma guidelines. In less experienced skydivers, it is critical to conduct a secondary survey to assess the extremities adequately. Clinicians should also pay attention to friction burns that can arise due to friction between the skin and skydive equipment, a phenomenom that is already known in road traffic accidents.
... The number of accidents increased with the number of jumps, but fatal injuries did not increase. Most non-fatal accidents resulted in injuries such as ankle sprains/fractures, minor head concussions, or bruising [76]. ...
Introduction
Summer alpine sports, including mountain biking, hiking and airborne pursuits, have experienced a recent surge in popularity. Accordingly, trauma associated with these activities has increased. There is a scarcity of literature exploring clinical aspects surrounding injuries. Specifically, no single article provides a general overview, as individual studies tend to focus on one particular sport. In the present study, we performed a systematic literature review to summarize existing knowledge and explore the potential for prevention and clinical decision making in this group.
Method
Literature searches were performed using the PubMed and Scopus database for the most commonly ventured sports associated with injury: mountain biking, climbing, airborne sports, paragliding, and base jumping. From this search, studies were identified for qualitative and quantitative analyses. These searches were done according to PRISMA guidelines for systematic reviews. Studies were then analyzed regarding epidemiology of injuries, relevant anatomical considerations and prevention strategies were discussed.
Results
A broad spectrum of injury sites and mechanisms are seen in mountain biking, climbing or airborne sports. Mountain biking related injuries commonly involve the upper extremity, with fractures of the clavicle being the most common injury, followed by fractures of the hand and wrist. Scaphoid fractures remain of paramount importance in a differential diagnosis, given their often subtle clinical and radiological appearance. Paragliding, skydiving, and base jumping particularly affect transition areas of the spine, such as the thoracolumbar and the spinopelvic regions. Lower limb injuries were seen in equal frequency to spinal injuries. Regarding relative risk, mountain biking has the lowest risk for injuries, followed by climbing and airborne sports. Male alpinists are reported to be more susceptible to injuries than female alpinists. Generally, the literature surrounding hiking and water-related mountain sports is insufficient, and further work is required to elucidate injury mechanisms and effective preventative measures. A helmet seems to decrease the likelihood of face and head injuries in mountain sports and be a meaningful preventive measurement.
... These risky leisuretime activities, such as rock or mountain climbing, surfing, stream skiing, rafting, skydiving, scuba diving, and parachuting, have become a global phenomenon (Oliver, 2006). Having initially been practiced primarily by professionals and "desperate" amateurs and despite causing serious injuries and risk of death, OAR activities have become sparetime activities of ordinary people (Creyer, Ross, & Evers, 2003), with growing worldwide interest and increasing popularity (Brymer, 2010;Soreide, Ellingsen, & Knutson, 2007). ...
This study investigated the death anxiety (DA) scores of participants in outdoor-adventure recreational (OAR) activities, and the relationship of the DA scores to several demographic features and experience of DA. The study included 589 individuals with various leisure-time OAR experience levels (131 women, 458 men; Mage=29.79±9.64). Their sports included climbing (n=200), scuba diving (n=142), and paragliding (n=247). DA was measured by the Thorson-Powell Death Anxiety Scale . Overall, the DA scores were low, with no significant differences between OAR activities. However, the DA scores were affected by age and gender, and length of OAR experience. More specifically, the DA scores were highest for 18-28-year-old participants, women, and participants with 4-6 years of middle-level OAR experience. Previous negative DA experiences did not increase the DA scores.
... In comparison to other sky extreme sports, the risk of deaths and of injuries in skydiving reported in our study were lower than in BASE (building, antenna, span, earth) jumping, for which the rates were reported to be 43 deaths and 393 non-fatal accidents (that we would interpret as injuries) per 100,000 jumps. 12 These risks in skydiving were also lower than in paragliding for example for the Free Flight French Federation (FFVL) with 118 deaths among 386,955 licensees over 8 years, number needed to harm of 3279 (https://federation.ffvl.fr/pages/fiches-pdagogiques-et-documentation). Although these risks in skydiving were reported to be lower compared to other sky extreme sports, deaths and injuries still exist in skydiving, justifying continuing epidemiological surveillance and development of risk reduction approach. ...
Objectives:
To analyse the data on skydiving deaths and injuries collected prospectively by the French Parachuting Federation (FFP) between 2010 and 2019.
Design:
Prospective cohort study.
Methods:
Data on number of skydiving deaths and injuries were collected prospectively between January 2010 and December 2019, among all skydivers licensed to the FFP, via a standardised report form that included the skydiver's sex and level of experience (classified as tandem, student, or experienced), deaths, injuries, and injury location. The number of licensees, jumps, skydiving deaths and injuries were analysed descriptively and expressed as rates per 100,000 jumps and per 1000 skydivers with 95% confidence intervals (95%CI).
Results:
Among the almost 6.2 million jumps performed by 519,620 skydivers over 10 years between 2010 and 2019, 35 deaths and 3015 injuries were reported, corresponding to 0.57 deaths (95%CI 0.38 to 0.75) and 49 injuries (95%CI 47.0 to 50.1) per 100,000 jumps. Male skydivers had a five times higher deaths rate than women (RR=4.8, 95%CI 1.5 to 15.6). There was no death in tandem skydivers. Student skydivers had a six times higher risk of injuries than experienced skydivers (RR=6.1, 95%CI 5.7 to 6.6) and tandem skydivers had a significant lower risk of injuries than experienced skydivers (RR=0.07, 95%CI 0.06 to 0.08). 83.3% of the injuries occurred during the landing phase and 64.3% concerned the lower limb.
Conclusions:
This large survey shows that the highest risk of death concerned experienced and male skydivers, and the highest risk of injuries concerned student skydivers. It also shows the safety of tandem skydiving. These results can be of help to develop skydiving-related deaths and injuries risk reduction strategies, and thus improve the global skydiving safety and the skydivers' health.
... Airborne sports are associated with severe injuries including a high mortality for BASE jumping and paragliding with a reported fatality of one per 2,317 jumps and 45 per 100,000 jumps, respectively [15,16]. Airborne sports are particularly dangerous during takeoffs and landings. ...
Background
Spinopelvic dissociation which is also called U-type or referred to H-type sacral fractures with a transverse fracture line is an infrequent injury that results mainly from high-energy accidents. This results in an osseous dissociation of the upper central segment of the sacrum and the entire spine from the lower sacral segments.
The purpose was to investigate the incidence of spinopelvic fracture in general among airborne injuries.
Patients and methods
Using our electronic patient records, we retrospectively investigated all sacral fractures related to airborne sports between 2010 and 2017. All injuries were classified according to the Roy-Camille, Denis, AOSpine and the Tile classification system.
Results
During the period of interest, 44 patients (18.7%) were admitted with sacral fractures after accidents obtained from airborne sports, including 16 spinopelvic dissociations (36.4%). The majority of these injuries were obtained from paragliding (75.0%), followed by BASE jumping (21.4%) and parachuting (4%). The mean injury severity score (ISS) in the spinopelvic dissociation group was significantly higher compared with other sacral fracture group (38.1 vs. 20.0; p < 0.001). Six lambda-type, four T-type, four H-type and two U-type injuries were identified. In total, four patients (25%) were found to have neurological impairment. For treatment, 87.5% of patients underwent subsequent surgical stabilization.
Conclusion
Airborne sports have high potential for serious, life-threatening injuries with a high incidence of spinopelvic dissociation. In the literature, the prevalence of spinopelvic dissociation in sacral fractures is described to be between 3 and 5%. In our series, the prevalence is 36.4%. It is important to identify the potential injuries promptly for the further treatment.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material. Open image in new window
... Concomitant injuries were identified in 95 patients (64.2%) with 162 different injuries including a variety of other fractures, abdominal or thoracic injuries including aortic rupture. To achieve the highest survival rate, a quick admission to the hospital and primary diagnosis is essential such as by air rescue [32,33]. In our center, 83.1% of patients were admitted by air rescue as life-threatening injuries were assumed and 5 patients had to be intubated at the site of accident. ...
Purpose
The purpose of this study was to investigate the type and severity of spinal injury in airborne sports, as well as patients demographics in this unique set of athletes. Paragliding is one of the most popular airborne sports in Switzerland, which thought to be no less dangerous with a high potential for spinal injury. Few studies on spinal column injuries have been performed in these high-risk athletes with only inconsistent findings.
Methods
Patient charts were analyzed for all airborne sports injuries affecting the spine from 2010 to 2017 at a level-1 trauma center in Switzerland. To classify the injuries, we used the newest AOSpine classification, ASIA-grading and the injury severity score (ISS). In total, 235 patients were admitted to the emergency department due to an airborne injury. A total of 148 patients (148/235, 63.0%) which were predominantly male (125/235, 84.5%) at a mean age of 39.4 years suffered 334 spinal fractures and 5 spinal contusions. The mean ISS was 17.3, and the L1 vertebra was most commonly affected (47.6% of cases, 68/148).
Results
A total of 78 patients (54.5% or 78/148) required spine surgery due to instability or neurological deficits (31/148 patients; 20.9%). Concomitant injuries were identified in 64.2% of cases (n = 95).
Conclusion
Due to the increasing popularity of airborne sports, age of patients and severity of injuries (ISS) increased compared with the literature. The thoracolumbal spine is at especially high risk. To prevent further complications, the treatment procedure has to be sought carefully and algorithm should be introduced in clinics to avoid delay in diagnostics and surgery.
Level of evidence
III, retrospective comparative study.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material. Open image in new window
... The stimuli (see Table 1) were words indicating activities extracted from micromort research (Blastland and Spiegelhalter 2013;Fry et al. 2016;Irwin and Kong 2014;Soreide et al. 2007). Four low-risk, four high-risk and two referent micromort activities were selected. ...
When thinking about quantifiable domains such as numbers, pitch, and size, they are implicitly mapped on to representational space with small/low/less and large/high/more of the respective domain represented on the left and right sides of representational space, respectively. Recent research has also demonstrated that more abstract domains (colours, language, political party names) are also mapped in the same way. This study investigated a new abstract domain, risk, to examine if this same pattern of effects is apparent (left = low risk/right = high risk) to get a better understanding of how risk magnitudes are processed. Experiment 1 (n = 26) presented objective, statistically calculated risk stimuli (micromorts) to participants, who indicated if the stimuli had lower or higher risks than a referent, with their left and right hands. Experiment 2 (n = 25) utilised the same task, but the risk stimuli were generated by the participants themselves. Both experiments found the expected association of risk with space—indicated by faster left-hand responses to low-risk stimuli and faster right-hand responses to high-risk stimuli. Risks appear to fit onto a standard left–right spatial association; however, the effect sizes for all analyses were small. The results of this study are not only in line with the idea of a generalised magnitude processing system, but might also inform best practices in effective communications of risks.
... bpa.org.uk/staysafe/how-safe/), while doing a competitive marathon race incurs 7 micromort (Kipps, Sharma, & Pedoe, 2011). Base jumping, usually perceived as a very dangerous activity, requires when performed at the Kjerag massif in Norway roughly 432 micromort (Soreide, Ellingsen, & Knutson, 2007). It is difficult to tell, but maybe the fatality risk (by triggering an avalanche only) of a skier and competent decision-maker in avalanche terrain on a moderate avalanche level warning, is a little high given this wider context. ...
In this article, I explore a Bayesian approach to avalanche decision-making. I motivate this perspective by highlighting a version of the base-rate fallacy and show that a similar pattern applies to decision-making in avalanche-terrain. I then draw out three theoretical lessons from adopting a Bayesian approach and discuss these lessons critically. Lastly, I highlight a number of challenges for avalanche educators when incorporating the Bayesian perspective in their curriculum.
... Since wingsuit flying fatality ranges from 1 per 10,000 on the upper bound and 1 per 750[17] on the lower bound and injury rate of 1 per 254. [14], the human powered flying is likely to be at 1 per 1,000,000 on the upper bound and 1 per 75,000 on the lower bound, and injury rate of 1 per 25,400. The upper bound shows a fatality rate somewhat lower and safer than bicycle riding and half as safe as bus riding. ...
A New Approach to Human Powered Flight and Beyond
... Non-participants and researchers often portray extreme sport participants as deviant, selfi sh, risk-taking, adrenalineseeking and crazy hedonists out to conquer nature (Elmes and Barry, 1999;Monasterio, 2007;Allman et al., 2009;Brymer, 2010). As a result, extreme sports such as BASE jumping have been banned in many areas of the world (Ewert et al., 2006;Soreide et al., 2007). The US National Parks Service (NPS) policy prohibits BASE jumping (US Department of the Interior, 2006), although the NPS allows occasional BASE jumping events in practice. ...
Transformational tourism is about a change in thinking and behaviour through travel and tourism. In contrast to the first volume which focuses on tourist perspectives, this second volume focuses on host community perspectives of transformational tourism. This volume shows that through the tourist-host relationships, interacting with other people and learning about other places, host communities can critically reflect on life, and shift the course of their knowledge and the meaning perspective. By experiencing tourism and tourists, host communities can generate new thoughts and ideas, create new meanings, change their social, cultural, political and environmental beliefs and, most importantly, move towards new values of openness, tolerance, sharing, empathy, compassion, justice and peace, unity and oneness, and service to others. This volume contains 14 chapters. Most of the chapters concentrate on a particular type of host experience and report on research studies conducted in various parts of the world. The volume is aimed at tourism students and academics in business and non-business schools. Studies presented in this volume are also likely to appeal to tourism businesses because they show what tourism products should be developed in order for the host communities to grow and the industry to be successful. In addition, this volume is aimed at students, academics and professionals from other disciplines that deal with human development and behavioural changes.
... BASE jumpers rely on a single canopy with no reserve parachute. Estimates of injury rate are 0.2-0.4% per jump [2,3] and fatality rates of 0.04% per jump or 1.7% per participant per year [3,4], suggesting that this is one of the most dangerous sporting activities. BASE jumping is 20 to 40 times more dangerous than skydiving, so it is legally prohibited in many areas. ...
... BASE jumpers rely on a single canopy with no reserve parachute. Estimates of injury rate are 0.2-0.4% per jump [2,3] and fatality rates of 0.04% per jump or 1.7% per participant per year [3,4], suggesting that this is one of the most dangerous sporting activities. BASE jumping is 20 to 40 times more dangerous than skydiving, so it is legally prohibited in many areas. ...
This is the first report of the psychobiology of stress in BASE jumpers, one of the most dangerous forms of extreme sport. We tested the hypotheses that indicators of emotional style (temperament) predict salivary cortisol reactivity, whereas indicators of intentional goal-setting (persistence and character) predict salivary alpha-amylase reactivity during BASE jumping. Ninety-eight subjects completed the Temperament and Character Inventory (TCI) the day before the jump, and 77 also gave salivary samples at baseline, pre-jump on the bridge over the New River Gorge, and post-jump upon landing. Overall BASE jumpers are highly resilient individuals who are highly self-directed, persistent, and risk-taking, but they are heterogeneous in their motives and stress reactivity in the Hypothalamic-Pituitary-Adrenal (HPA) stress system (cortisol reactivity) and the sympathetic arousal system (alpha-amylase reactivity). Three classes of jumpers were identified using latent class analysis based on their personality profiles, prior jumping experience, and levels of cortisol and alpha-amylase at all three time points. “Masterful” jumpers (class 1) had a strong sense of self-directedness and mastery, extensive prior experience, and had little alpha-amylase reactivity and average cortisol reactivity. “Trustful” jumpers (class 2) were highly cooperative and trustful individuals who had little cortisol reactivity coincident with the social support they experienced prior to jumping. “Courageous” jumpers (class 3) were determined despite anxiety and inexperience, and they had high sympathetic reactivity but average cortisol activation. We conclude that trusting social attachment (Reward Dependence) and not jumping experience predicted low cortisol reactivity, whereas persistence (determination) and not jumping experience predicted high alpha-amylase reactivity.
... "BASE" is an acronym that stands for the 4 categories of fixed objects that one can jump from: building, antenna, span (a bridge, arch, or dome), and Earth (a cliff or other natural formation). Injury rate estimates of 0.2 to 0.4% per jump 1,2 and fatality rates of 0.04% per jump or 1.7% per participant and year 2,3 suggest this is one of the most dangerous sporting activities in practice. ...
To analyze fatality data associated with wingsuit use in an international case series of fixed-object sport parachuting (BASE jumping) to identify incident and injury mechanisms and to form a basis for potential prevention measures and future safety recommendations.
A descriptive epidemiological study was performed of fatal injury events occurring in wingsuit BASE jumping. Fatalities (n = 180) were sequentially analyzed assessing human, equipment, and environmental factors from 1981 to 2011. Main outcome measures included descriptions of typical fatal incident and injury mechanisms.
Of the 180 fatal events, 39 (22%) were related to use of wingsuits; 38 (97%) launched from cliffs and 1 (3%) from a building. Of the 39 fatalities, 19 (49%) were caused from cliff strikes, 18 (46%) from ground impact, and 1 (3%) from a building strike. Thirty-eight (97%) of the fatalities were male. During 2002 to 2007 there was a total of 61 BASE jumping deaths, 10 (16%) of which were related to the use of wingsuits, whereas during 2008 to 2011 there was a total 59 fatal events, of which 29 (49%) were related to the use of wingsuits. Seventeen fatalities (39%) were attributed to wingsuit path miscalculation. In the first 8 months of 2013, 17 of 19 (90%) fatalities were wingsuit related. Most fatalities occurred between April and October, reflecting a seasonal increase in activity in the northern hemisphere summer.
Wingsuit-related BASE jump fatalities appear to be increasing as wingsuit BASE jumping increases in popularity. Most fatalities are attributed to cliff or ground impact, and are mostly the result of flying path miscalculation.
... Recent studies have calculated the annual fatality risk as one death per 60 participants, and the serious injury rate (requiring hospital care) as 0.2%-0.4% per jump; BASE jumping is therefore associated with a five-to 16-fold risk for death or injury when compared with skydiving (Monasterio & Mei-Dan, 2008;Soreide, Ellingsen, & Knutson, 2007;Westman, Rosen, Berggren, & Bjornstig, 2008). Monasterio, Carmont, & Mei-Dan (2012) found that 72% of experienced BASE jumpers had witnessed the death or serious injury of other participants in the sport in which 76% had at least one-near miss incident and only 6% had not sustained an injury, near-miss or witnessed a fatality from BASE jumping. ...
BASE jumping is an extreme sport, which is associated with significant risk of injury and death. We aimed to determine whether BASE jumpers have different personality characteristics to an age-matched, normal control population. An international population of BASE jumpers was examined using the Temperament and Character Inventory (TCI). Mean age was thirty-four years; 59 (87%) jumpers were male; 28 (41%) jumpers had sustained a significant injury. A substantial proportion of the BASE jumper presented extremely low scores in the temperament measure of Harm Avoidance (p < 0.001); the extent of which has not been reported in any other population.
Sports take place in a spectrum of environments which may create significant physical and practical barriers to emergency medical care. Whether the sport is played on unusual playing surfaces, on ice, in the water, in environmental extremes, or at challenging locations, sport physicians must be able to reach an acutely injured athlete within a reasonable time frame so as not to delay necessary treatment. Medical care must be tailored to the unique environment and the provider must avoid putting themselves at risk while providing necessary urgent care. The over-arching philosophy of being prepared for the unique environment that a specific sport introduces will hopefully assist in optimizing the response should an emergency occur.
Broken Bones contains 434 individual cases and 1,101 radiologic images illustrating the typical and less typical appearances of fractures and dislocations throughout the body. The first chapter describes fractures and dislocations of the fingers, starting with fractures of the phalangeal tufts and progressing through the distal, middle, and proximal phalanges and the DIP and PIP joints. Subsequent chapters cover the metacarpals, the carpal bones, the radius and ulna, the elbow and upper arm, and the shoulder and thoracic cage. The cervical spine and the thoracic and lumbosacral spine are covered in separate chapters, followed by the pelvis, the femur, the knee and lower leg, the ankle, the tarsal bones, and the metatarsals and toes. The final three chapters cover the face, fractures and dislocations in children, and fractures and dislocations caused by bullets and nonmilitary blasts.
The definition of extreme sports (ES) inhabits any sport featuring high speed, height, real or perceived danger, a high level of physical exertion, highly specialized gear or spectacular stunts, and elements of increased risk. These ES activities tend to be individual and can be pursued both competitively and noncompetitively. Examples of popular ES include skydiving, BASE jumping, climbing, skiing, snowboarding, and several other sports. Participation in ES is associated with risk of injury or even death and therefore the extreme athlete – amateur or professional – as well as the medical personnel treating these athletes must consider the risk of injury and measures for injury prevention. The purpose of this chapter is to provide an epidemiologic overview of the available literature on common injuries affecting extreme athletes, the risk of their occurrence, and available prevention measures in this athletic population.
Extreme aerial sports are a large subgroup of extreme sports. Participation in these activities has grown exponentially in the last decades, often surpassing traditional sports. Although fatalities related to extreme aerial sports are often generically ascribed to polytrauma, an autopsy can reveal unexpected elements in many cases. Forensic studies may lead us to ascertain different causes of death, such as anaphylaxis or myocardial infarction and together with eyewitness reports, they may make it possible to clarify the chain of events that led to an accident. This review paper may be critical not only for medico-legal reasons but also to provide useful information for the development of preventive measures, specific recommendations and safety systems. The paper aims to review available data about fatality rates, causes and dynamics in extreme aerial sports and to draw some possible conclusions about the role of forensic examinations in these sports.
Risk perception has recently been shown to reveal a mental spatial representation, with people responding faster to low-risk items on the left side, and high-risk items on the right side. Subjective risk perception has a stronger spatial representation than objective risk perception; however, both reveal small effect sizes. With risk magnitude being a new domain within spatial mapping literature, we sought to explore its nuances. Following discussion surrounding the relationship between spatial mapping and level of expertise, this study investigated the effect of training an objective risk magnitude sequence on mental spatial representations. Participants (n = 34) used their left and right hands to indicate whether eight risk stimuli were lower or higher risk than a referent activity, both before and after training. Training involved repetitively learning the objectively correct order of the same eight risk stimuli for approximately 15 min. Pre-training results demonstrated the expected spatial representations. Contrary to our predictions, the spatial representation did not get stronger post-training, but instead disappeared. Previous research has demonstrated a loss of spatial-numerical mappings with increased task load. An increase in post-training reaction times could reflect an increase in task load due to a lack of adequate knowledge of risk stimulus order; thus revealing no mental spatial representation. However, failure to find training effects highlights the flexibility of weaker spatial representations, and supports research demonstrating spatial representation flexibility.
The popularity of extreme sports has grown dramatically over the past several decades, despite knowledge of the higher risk of injury associated with such activities [1]. There is no specific definition of what categorizes something as extreme versus as a more conventional sport such as baseball, basketball, or football. However, the essential aspects of extreme sports are high speed, extreme height, real or perceived danger, a high level of physical exertion, and highly specialized gear or spectacular stunts. One quality that is universal across all extreme sports is the adrenaline rush involved by the inherent danger in the activity. Whether the athlete is parachuting from the sky, pulling a double backflip off a Moto X freestyle jump, or attempting a frontside double cork 1440 in the halfpipe on a snowboard, part of the appeal appears to be the fact that such activities are not safe. This chapter will explore specific injuries and safety considerations involved in some of the most popular extreme sports.
Extreme sports are growing in popularity, and physicians are becoming increasingly aware of injuries related to these activities. Imaging plays a key role in diagnosing and determining clinical management of many of these injuries. This article describes general imaging techniques and findings in various injuries specific to multiple extreme sports.
The term 'B.A.S.E jump' refers to jumping from a building, antenna, span (i.e., bridge) or earth (i.e., cliff) structure, and parachuting to the ground. There are numerous hazards associated with B.A.S.E jumps which often result in injury and, occasionally, fatality. This case report details the skeletal trauma resulting from a fatal B.A.S.E jump in Australia. In this case, the jumper impacted the ground from a fall of 439m in a feet-first landing position, as a result of a partially deployed parachute, under extreme vertical deceleration. Skeletal trauma was analyzed using full-body post mortem computed tomography (PMCT) and contextual information related to the circumstances of the jump as reported by the Coroner. Trauma to 61 skeletal elements indicates the primary impact was to the feet (i.e., feet-first landing), followed by an anterior impact to the body (i.e., fall forwards). Details of the individual fracture morphologies indicate the various forces and biomechanics involved in this fall event. This case presents the types of fractures that result from a B.A.S.E jump, and highlights the value of using PMCT and coronial data as tools to augment skeletal trauma interpretations.
Extreme sports, defined as sporting or adventure activities involving a high degree of risk, have boomed since the 1990s. These types of sports attract men and women who can experience a life-affirming transcendence or "flow" as they participate in dangerous activities. Extreme sports also may attract people with a genetic predisposition for risk, risk-seeking personality traits, or underlying psychiatric disorders in which impulsivity and risk taking are integral to the underlying problem. In this report, we attempt to illustrate through case histories the motivations that lead people to repeatedly risk their lives and explore psychiatry's role in extreme sports. A sports psychiatrist can help with therapeutic management, neuromodulation of any comorbid psychiatric diagnosis, and performance enhancement (eg, risk minimization) to cultivate improved judgment which could include identifying alternative safer recreational options. Because flirting with death is critical to the extreme sports ethos, practitioners must gain further understanding of this field and its at-risk participants.
We are witnessing an unprecedented interest in and engagement with extreme sport activities. Extreme sports are unique in that they involve physical prowess as well as a particular attitude toward the world and the self. We have scant understanding of the experience of participants who engage in extreme activities such as Buildings Antennae Span and Earth (BASE) jumping, big wave surfing, extreme skiing, waterfall kayaking, extreme mountaineering, and solo rope-free climbing. The current study investigates the experience of people who engage in extreme sports utilizing a phenomenological approach. The study draws upon interviews with 15 extreme sports participants across 3 continents to explicate 3 unique themes: extreme sports as invigorating experience, inadequacy of words, and participants’ experience of transcendence. The findings provide a valuable insight into the experiences of the participants and contribute to our understanding of human volition and the range of human experiences.
In this chapter we discuss both the moral and constitutional conception of children’s rights. The moral conception has been debated since the seventeenth century by Thomas Hobbes, John Locke, John Stuart Mill and Herbert Spencer. All except Spencer accept the idea that children have none of the so-called “liberty rights” possessed by adults. This idea is reflected in state laws denying such rights to children, including the right to freedom of expression when at school. But in a series of Supreme Court cases beginning in 1967, the U.S. Supreme Court declared that children are persons who are possessed of fundamental rights that the state must respect. Included among these rights is the right to freedom of expression. In this chapter we consider several Supreme Court cases introducing this right and later restricting its scope because of its inevitable conflict with another idea: children are human beings who are always in custody of their parents, of the school they attend, or ultimately of the State. We conclude the chapter by discussing several theories that attempt to resolve the dilemma of conceiving children as both persons with fundamental rights and as human beings who are always in some form of custody.
Deaths associated with parachuting are very uncommon. However, these deaths do tend to be "high profile" in the traditional and social media. When forensic pathologists examine the deceased after a fatal parachuting incident, the anatomical cause of death is usually not in question. For most forensic pathologists, it is usually the case that we will have very limited knowledge of parachuting equipment or the mechanics of a typical successful parachute jump. As such, the investigation of the death should involve a multidisciplinary approach with an appropriate expert providing the formal forensic examination of the parachuting equipment. We have endeavored to describe, in simple terms, the usual components of a typical parachute rig, a précis of the sequence of events in a routine skydive and BASE jump, and the various types of malfunctions that may occur. Last, we present a case report of a BASE jump fatality to illustrate how an expert examination of the BASE jumper's gear aided the medicolegal investigation of the death with some important aspects in the forensic examination of the jumper's equipment.
This chapter focuses on rehabilitation tactics specific to extreme sports participants and covers various aspects relative to the approach, type of exercises, and progression of the rehabilitative process.
Since it would be unrealistic to provide systematic coverage of such a vast topic in the space of a few pages, this chapter aims to cover the fundamental aspects of extreme sports injury rehabilitation by illustrating a select number of conditions which commonly affect extreme sports participants.
This chapter will deal with four conditions often seen in the rehabilitation clinic. For the purposes of variety, we have chosen to focus on four different areas of the body – the head, the upper limbs, the lower limbs, and the spine, looking specifically at concussion, traumatic anterior dislocation of the shoulder, rupture of the anterior cruciate ligament of the knee, and acute low back pain.
In this chapter, the main features of BASE jumping and wingsuits flying are discussed, focusing in particular on those aspects which mainly influence risk, such as equipment, exiting, and jumped objects.
Moreover, a comprehensive review of medical literature has been carried out in order to provide an overview on rates and patterns of injuries and fatalities in these extreme sports.
The most important preventive measures, which include protective clothing and specific physical training are also presented.
Worldwide adventure tourism and adventure sports are important leisure activities of growing popularity. In this context, commercial adventure tourism has become increasingly important to the world economy. Adventure sports encompass a number of outdoor activities including rock climbing, mountaineering, skydiving, white water rafting, mountain biking, and BASE jumping. Some of these sports are performed by novice athletes, whereas others are only practiced by experienced athletes.
Recent reports have highlighted significant risk of injury and death associated with mountaineering 30, 33, 40, skydiving 6, white water rafting, and mountain biking 8. This chapter reviews the published literature on these new sports from an injury perspective. There is a brief description of the origins of the sport, the equipment used together with injury and fatality rates and specific types of injury related to each sport.
BASE jumping is a sport that evolved out of skydiving while using specially adapted parachutes to jump from fixed objects.
Extreme risk-taking sports such as mountaineering, kayaking, rock climbing, downhill mountain biking, and BASE jumping have increased in popularity in recent years and capture increasing public interest [1]. These activities court significant dangers and attract individuals who are prepared to put their personal safety, and at times their life, in search of a rush of excitement or an unusual accomplishment.
Designing an injury prevention plan for extreme sports participation is a multifaceted task. Essential to any plan is for the participant to possess or otherwise develop the capacity to objectively assess themselves on a number of key physiological, psychological, and behavioral factors as they relate to unique features of the specific extreme sport that they perform. For example, in addition to having endurant grip strength for rock or mountain climbing [1-5], the climber needs to possess a high strength/mass ratio and have sufficient joint flexibility to enable their whole-body center of mass to be positioned close to the climbing surface as forces are applied (Fig. 16.1). This simple characteristic decreases the resistance moment arms developed through their upper and lower extremities, thereby reducing neuromuscular activation demands. Having a sufficient power/weight ratio is similarly important in mountain biking [6]. In addition to evaluating their inherent physical characteristics (including the influence of their current and past medical or injury histories), the extreme sports athlete needs to be able to honestly appraise their actual versus perceived skill level and risk-taking tendencies, the influence of central and peripheral fatigue on activity performance and cognitive decision-making capability [7], and have a thorough understanding of the most likely injury risk factors associated with their sport [8]. For example hang gliding, base jumping, and paragliding are associated with a high frequency of back and lower extremity injuries (often resulting in vertebral fracture and/or spinal cord injury) due to improper landing techniques [9-12]. In contrast, whitewater kayaking is more likely to predispose the extreme sports athlete to glenohumeral joint injuries, particularly anterior-inferior labral and rotator cuff injuries, both from chronic and acute injury mechanisms. Downhill skiing on the other hand often results in knee injuries through sudden improper postural alignment when landing on one lower extremity, peripheral and/or central fatigue that compromises lower extremity neuromuscular shock absorption system function, poor decision-making, or any combination of these factors. Because of the influence of anxiety [13-15], fatigue, and other stressors on performance capability, the extreme sports athlete is advised to always underestimate their skill and expertise levels prior to participation. All too often, the spur-of-the-moment thrill factor which can occur at anytime during extreme sports participation supersedes sound judgment resulting in serious injury or death [16-18]. The extreme sports athlete is challenged with avoiding the seduction or rapture of the event, never letting it override sound judgment.
Some extreme sportsmen are also extremely famous, as e.g. Reinhold Messner, Alexander Huber or Felix Baumgartner. Do olympic or worldcup sportsmen perform extreme sports as well? Or does extreme sports implies (death) risk? And what about ultra-endurance sports? The interested reader dives into a world of extremes. Training, preparation, surveillance and physiological and mental abilities contribute to the safety of the athlete. Age and gender effects have been studied systematically in extreme endurance sports during the past years and first studies started to characterize psychological and physiological characteristic of extreme sportsmen. Man is capable of extreme performance, intellectually but also physiologically.
Participation in extreme sports is continuing to grow, yet there is still little understanding of participant motivations in such sports. The purpose of this paper is to report on one aspect of motivation in extreme sports, the search for freedom. The study utilized a hermeneutic phenomenological methodology. Fifteen international extreme sport participants who participated in sports such as BASE jumping, big wave surfing, extreme mountaineering, extreme skiing, rope free climbing and waterfall kayaking were interviewed about their experience of participating in an extreme sport. Results reveal six elements of freedom: freedom from constraints, freedom as movement, freedom as letting go of the need for control, freedom as the release of fear, freedom as being at one, and finally freedom as choice and responsibility. The findings reveal that motivations in extreme sport do not simply mirror traditional images of risk taking and adrenaline and that motivations in extreme sports also include an exploration of the ways in which humans seek fundamental human values.
Between 1993 and 1999, 241 people died while participating in civilian recreational skydives in the United States. A taxonomy of skydiving fatalities was developed and used to categorize the fatalities.
The purpose was to assess whether adoption of potentially dangerous skydiving gear and skydiving practices has led to an increase in fatalities. Beginning in the early 1990s, civilian skydivers began to utilize high performance parachutes that fly much faster and are much more responsive than older style parachutes. Also, skydivers began to fly these parachutes in a more aggressive manner. An analysis of data from the 507 skydiving fatalities in the USA between 1986 and 2001 indicated that this shift toward high performance parachutes and aggressive flying techniques was temporally associated with an increase in parachute-landing deaths. During the same time period, the total number of fatalities remained fairly stable.
To examine the efficacy of an outside-the-boot parachute ankle brace (PAB) in reducing risk of ankle injury to army paratrooper trainees and to identify inadvertent risks associated with PAB use.
The authors compared hospitalization rates for ankle, musculoskeletal, and other traumatic injury among 223,172 soldiers trained 1985-2002 in time periods defined by presence/absence of PAB use protocols. Multiple logistic regression analysis estimated adjusted odds ratios (OR) and 95% confidence intervals for injury outcomes, comparing pre and post brace periods to the brace protocol period.
A research database consisting of training rosters from the US Army Airborne training facility (Fort Benning, GA) occupational, demographic, and hospitalization information.
Injuries were considered training related if they occurred during a five week period starting with first scheduled static line parachute jump and a parachuting cause of injury code appeared in the hospital record.
Of 939 parachuting related hospitalizations during the defined risk period, 597 (63.6%) included an ankle injury diagnosis, 198 (21.1%) listed a musculoskeletal (non-ankle) injury, and 69 (7.3%) cited injuries to multiple body parts. Risk of ankle injury hospitalization was higher during both pre-brace (adjusted OR 2.38, 95% CI 1.92 to 2.95) and post-brace (adjusted OR 1.72, 95% CI 1.27 to 2.32) periods compared with the brace protocol period. Odds of musculoskeletal (non-ankle) injury or injury to multiple body parts did not change between the brace and post-brace periods.
Use of a PAB during airborne training appears to reduce risk of ankle injury without increasing risk of other types of traumatic injury.
A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than two thousand persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life-threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma.
Extreme sports (including in-line skating, snowboarding, mountain bicycling, extreme skiing, rock climbing, indoor tackle football, kickboxing, skateboarding, and ultra-endurance racing) are growing in popularity. Often these sports are designed to expose athletes to greater thrills and risks than are found in traditional sporting activities. Despite this increased risk of injury, athletes competing in these sports often have little or no formal medical coverage. This article reviews what is known about this emerging area of sports medicine to assist physicians in preparing for medical coverage of these athletes and their competitions.
Background: Ankle injuries account for 30 to 60% of all parachuting injuries. This study was designed to determine if outside-the-boot ankle braces could reduce ankle sprains during Army paratrooper training. Methods: The randomized trial involved 777 volunteers from the U.S. Army Airborne School, Fort Benning, Ga. Of this group, 745 completed all study requirements (369 brace-wearers and 376 non-brace-wearers). Each volunteer made five parachute jumps, for a total of 3,674 jumps. Results: The incidence of inversion ankle sprains was 1.9% in non-brace-wearers and 0.3% in brace-wearers (risk ratio, 6.9; p = 0.04). Other injuries appeared unaffected by the brace. Overall, 5.3% of the non-brace group and 4.6% of the brace group experienced at least one injury. The risk ratio for injured individuals was 1.2:1 (non-brace to brace groups; p = 0.65). Conclusion: Inversion ankle sprains during parachute training can be significantly reduced by using an outside-the-boot ankle brace, with no increase in risk for other injuries.
The weights and heights of 1,880 male military parachutists were recorded, and landing injury rates were calculated according to the weights and heights of the jumpers. Only the weight significantly influenced the injury rate. The set of data (weight, injury rate) are best fitted with a parabola of the form: y = 43.14 - 1.22x + 0.01x2. The concept of the maximal operating weight of a parachute is discussed with its implications for medical standards and for jumps with extra equipment.
Military parachuting is relatively safe. Most injuries involve vertebral bodies or the lower extremity, and fatalities are rare. We studied 49 military parachute accident facilities occurring during 1964-1989. Causes of the accidents included accidental deployment of reserve parachute in aircraft, static line failures and entanglements, equipment (canopy) failures, in-air collisions, landing injuries, drowning, and dragging. Rarely, preexisting illness such as coronary artery disease caused or contributed to an accident. Pathologic findings revealed a high proportion of deceleration and blunt force injuries: cardiac, aortic and liver laceration, and skull, pelvic and extremity fractures. Isolated head injury, strangulation, and post traumatic pulmonary embolus were occasionally noted. Toxicological examination demonstrated contributing factors such as alcohol intoxication or antihistamine use in a small number of cases. Background investigations, scene inspections, autopsy and toxicology studies all yielded important data or pertinent negatives during investigations. We propose an investigation protocol.
An analysis of the injuries sustained during a series of 51,828 military training parachute descents and which were treated at the John Radcliffe Hospital is presented. The significant casualty rate was 0.22 in every 100 descents. There were 4 deaths, 5 multiple injuries and 104 single fractures, dislocations or head injuries. The injury rate is lower than that reported for training descents made by sports parachutists, despite more difficult conditions. Serious injuries and deaths were often the consequence of interactions between two jumpers.
On the basis of a study of the literature and a description of the parachute jump, the injury producing factors of civil parachuting is described. The majority of injury happens during landing; the assuming of a correct "prepare to land attitude" and the execution of a good parachute landing fall may prevent a great part of the injuries to the spine and the lower extremities. The factors mentioned are often correlated to ignorance, inexperience or to willful neglect of current regulations. A revision of the education of student parachuters and instructors in order to meet the same quality demands in all parachuting centres is proposed. Safer parachutes and a simplification of the parachute landing fall may also reduce the incidence of casualties.
The parachutist injured in a dramatic accident often describes the injury in an incomplete and biased way and evaluation of materials based solely upon subjective information of this kind can be misleading and of no value for recommendations. As the relation between the mechanical factors of the injury and the lesion in ankle fractures is well documented, an investigation of clinical, radiological and operative findings in 46 parachutists with ankle fractures was conducted. Classification was possible in 44 of 46 fractures. The description of the cause of the trauma in 21 supination-eversion fractures and in 13 pronation-eversion fractures was most frequently faulty landing position or obstacles. The cause of seven supination fractures was oscillation of the parachutist whilst descending with sudden impact against the lateral aspect of the foot. For prophylaxis we recommend improvement of landing and steering techniques and the support of semi-calf boots.
A study was undertaken to examine the type, location, incidence and mechanism of injury sustained by amateur parachutists in Denmark during a five-year-period. A total of 110,000 parachute jumps resulted in six (0.005%) fatalities and 155 (0.14%) cases, requiring medical treatment. The latter group sustained 176 injuries of which 36.9% were significant soft tissue lesions and 63.1% fractures. Landing is the most dangerous part of the parachuting procedure, causing 83.8% of the accidents, while 9.3% were caused by faults during opening of the parachute. Based on the injury pattern, some modifications to the procedures and equipment are mentioned. A simplification of the parachute landing fall and the development of safer parachutes may reduce the incidence of casualties. An enforcement of the present regulations is necessary as many injuries are the result of noncompliance with regulations due to ignorance, inexperience or carelessness.
In a retrospective study of 201,977 jumps, carried out by male military parachutists, over a 10-year period, landing injury rates were calculated according to the time of jump (day or night), the type of parachute, and meteorological data. Also, the wind speed, temperature, and the relative humidity at ground level were taken into account. The two types of parachutes used were both static line deployed, non-steerable canopies. The landing injury rate was found to be influenced by the darkness, surface area of the parachute, wind speed, and possibly temperature when higher than 25 degrees C. The influence of surface wind was best described by two segments of line with a cut-off point. The wind speed at the cut-off point is 12.75 k (6.56 m X s-1) for day jumps and 6.75 k (3.47 m X s-1) for night jumps.
A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than 2,000 persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma. The score is easily derived, and is based on a widely used injury classification system, the Abbreviated Injury Scale. Use of the Injury Severity Score facilitates comparison of the mortality experience of varied groups of trauma patients, thereby improving ability to evaluate care of the injured.
Alcohol is a major contributing factor in adult trauma and may adversely affect decision-making in other safety areas such as use of seatbelts and motorcycle helmets. The magnitude of risk-taking behavior and poor decision-making among adolescent trauma patients is not fully appreciated. Our objective was to determine the prevalence and pattern of risk-taking behavior among adolescents (age < or = 20 years) admitted to an adult Level I trauma center.
The trauma registry was used to identify patients. Data collected included age, mechanism of injury, blood alcohol and urine toxicology results, seatbelt and helmet use, Glasgow Coma Score, Injury Severity Score, and outcome.
Fifteen percent of all admissions to an adult trauma center were adolescents (648 of 4,291). Twenty-one percent of adolescents (138 of 648) and 30% of adults (1,067 of 3,643) tested positive for blood alcohol on admission. Seatbelts were worn by only 19% of adolescent motor vehicle crash admissions versus 30% of adults. Only 7% of adolescents (6 of 83) with detectable alcohol used restraints, compared with 22% (67 of 310) without documented alcohol ingestion (p < 0.05). Adults were somewhat better at restraint use (16% of alcohol-positive patients and 36% without alcohol). Eight of 23 minors (35%) in motorcycle/bicycle crashes were wearing a helmet, compared with 95 of 168 adults (57%). Overall, 6.7% of adolescents and 8.6% of adults had positive toxicology screens. Adolescents with known alcohol consumption were twice as likely to have a positive toxicology screen for illegal drugs (15 vs. 7%; p < 0.05). Alcohol was also frequently detected among adolescents with mechanisms of injury other than motor vehicle and motorcycle crashes, such as violence (25%) and falls (44%).
Alcohol is frequently involved in all types of trauma, for adolescents as well as adults. This is often compounded by poor decision-making and multiple risk-taking behaviors.
The Injury Severity Score (ISS) has served as the standard summary measure of anatomic injury for more than 20 years. Nevertheless, the ISS has an idiosyncrasy that both impairs its predictive power and complicates its calculation. We present here a simple modification of the ISS called the New Injury Severity Score (NISS), which significantly outperforms the venerable but dated ISS as a predictor of mortality.
Retrospective calculation of NISS and comparison of NISS with prospectively calculated ISS.
The NISS is defined as the sum of the squares of the Abbreviated Injury Scale scores of each of a patient's three most severe Abbreviated Injury Scale injuries regardless of the body region in which they occur. NISS values were calculated for every patient in two large independent data sets: 3,136 patients treated during a 4-year period at the American College of Surgeons' Level I trauma center in Albuquerque, New Mexico, and 3,449 patients treated during a 4-year period at the American College of Surgeons' Level I trauma center at the Emanuel Hospital in Portland, Oregon. The power of NISS to predict mortality was then compared with previously calculated ISS values for the same patients in each of the two data sets.
We find that NISS is not only simple to calculate but more predictive of survival as well (Albuquerque: receiver operating characteristic (ROC) ISS = 0.869, ROC NISS = 0.896, p < 0.001; Portland: ROC ISS = 0.896, ROC NISS = 0.907,p < 0.004). Moreover, NISS provides a better fit throughout its entire range of prediction (Hosmer Lemeshow statistic for Albuquerque ISS = 29.12, NISS = 8.88; Hosmer Lemeshow statistic for Portland ISS = 83.48, NISS = 19.86).
NISS should replace ISS as the standard summary measure of human trauma.
Ankle injuries account for 30 to 60% of all parachuting injuries. This study was designed to determine if outside-the-boot ankle braces could reduce ankle sprains during Army paratrooper training.
The randomized trial involved 777 volunteers from the U.S. Army Airborne School, Fort Benning, Ga. Of this group, 745 completed all study requirements (369 brace-wearers and 376 non-brace-wearers). Each volunteer made five parachute jumps, for a total of 3,674 jumps.
The incidence of inversion ankle sprains was 1.9% in non-brace-wearers and 0.3% in brace-wearers (risk ratio, 6.9; p = 0.04). Other injuries appeared unaffected by the brace. Overall, 5.3% of the non-brace group and 4.6% of the brace group experienced at least one injury. The risk ratio for injured individuals was 1.2:1 (non-brace to brace groups; p = 0.65).
Inversion ankle sprains during parachute training can be significantly reduced by using an outside-the-boot ankle brace, with no increase in risk for other injuries.
The Maidstone Hospital provides trauma services to one of the largest parachute clubs in the United Kingdom. We studied injuries sustained at the club in 1994 and compared results with equivalent data from 1984. The injury rate for first time jumpers in the current study was 1.2%; half of these cases required admission for an average of 10 d. Individual morbidity and loss of productivity lasted far longer. No lessons had been learned from the first study. We question parachuting as a fund-raising venture and suggest re-evaluating the training of novice parachutists, perhaps with mandatory use of the safer rectangular parachute. At a time when healthcare rationing is an issue, individuals engaging in activities such as these might be required to indemnify themselves against the medical costs of injury currently met by the state.
All parachute injuries from two local parachute centres over a 5-year period were analysed. Of 174 patients with injuries of varying severity, 94% were first-time charity-parachutists. The injury rate in charity-parachutists was 11% at an average cost of 3751 Pounds per casualty. Sixty-three percent of casualties who were charity-parachutists required hospital admission, representing a serious injury rate of 7%, at an average cost of 5781 Pounds per patient. The amount raised per person for charity was 30 Pounds. Each pound raised for charity cost the NHS 13.75 Pounds in return. Parachuting for charity costs more money than it raises, carries a high risk of serious personal injury and places a significant burden on health resources.
Adolescents participate in sports for a variety of reasons. Some seem to enjoy participating in what some might consider very-high-risk or "extreme" sports activities. For some adolescents risk taking becomes pervasive and can be detrimental to normal health and development. The majority of adolescents will do well in the context of athletics, and the many positive benefits of regular physical activity and sports participation should be appropriately emphasized. However, a subset of adolescents may be at greater risk for adverse consequences. This article reviews the reasons for participation and attrition from sports, the phenomenon of thrill seeking in sports, certain risk-taking behaviors of athletes, and studies comparing health risk behaviors in athletes and non-athletes.
Risk behaviors and psychological problems may limit recovery after trauma, may be related to injury recidivism, and may limit the effectiveness of alcohol interventions in trauma patients. The aim of the current study was to evaluate the prevalence of behaviors associated with injury and their relationship with alcohol use in adult trauma patients.
A prospective cohort of 301 adult patients admitted to a single Level I trauma center were interviewed regarding risk behaviors and alcohol use.
There was evidence of acute and/or chronic alcohol use in 48.2% of cases. Over three fourths of patients (77%) engaged in one or more high-risk driving practices, 40% engaged in one or more violence-related behaviors, and 19% reported suicidal ideation in the last year. These risk behaviors were more common in patients who evidenced acute and/or chronic alcohol use.
Behaviors that place an individual at greater risk for traumatic injury are common among seriously injured adult patients admitted to an urban Level I trauma center and frequently coexist with alcohol use. Their importance to injury, injury recidivism, and recovery after trauma requires further investigation.
Extreme sports (including in-line skating, snowboarding, mountain bicycling, extreme skiing, rock climbing, indoor tackle football, kickboxing, skateboarding, and ultra-endurance racing) are growing in popularity. Often these sports are designed to expose athletes to greater thrills and risks than are found in traditional sporting activities. Despite this increased risk of injury, athletes competing in these sports often have little or no formal medical coverage. This article reviews what is known about this emerging area of sports medicine to assist physicians in preparing for medical coverage of these athletes and their competitions.
The purpose of this study is to describe the prevalence and types of injuries incurred by civilian skydivers using contemporary equipment under conventional conditions. Injury data were collected at the World Freefall skydiving convention (WFFC), during two consecutive periods of operation, August 4-13, 2000 and August 3-12, 2001. During the study periods, 8976 skydivers made 117,000 skydives. The First Aid Station at the WFFC treated 204 patients for injuries related to skydiving, at a rate of 17.4/10,000 (injuries/skydives). Most injuries were minor (66%) and required only simple first aid. Significant injuries, defined as those requiring treatment in the emergency department, occurred at a rate of 6.0/10,000 (injuries/skydives). The rate of hospitalization was 1.8/10,000 skydives. There was one fatality during this study. We believe these results provide a current update regarding the risk and types of injury related to recreational skydiving.
Exact risk patterns in skydiving fatalities are not well known, but incomplete world injury data indicate that many are preventable. A comprehensive national material for Sweden of 37 skydiving fatalities 1964-2003 were reviewed to identify risk factors. In relation to jump volume, the period 1994-2003 had a fatality rate 11 times lower than 1964-1973. Student skydivers had the highest risk of fatal outcome, often caused by instability in freefall leading to unstable parachute activation with subsequent line entanglement, or parachute activation failure. Unintentional water landings also contributed to student fatality, with life jacket malfunctions, neglect to use life jackets, and automatic reserve parachute activation devices activated by water as aggravating factors. One-third of all fatalities had an inflated and operational parachute at some point prior to injury. A drastic worldwide increase in fatal landing incidents with fast wing parachutes during the 1990s did not occur in Sweden. Every fourth fatality caused by rapid deceleration against ground or water survived impact and died during transports or in hospitals. Rescue units and health care providers can improve management of skydiving incidents from knowledge about the incident and injury mechanisms we have described, and the skydiving community can target risk factors in preventive safety work.
Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this effect is questioned. In contrast to bicycling or inline skating, there is no policy of mandatory helmet use for recreational alpine skiers and snowboarders.
To determine the effect of wearing a helmet on the risk of head injury among skiers and snowboarders while correcting for other potential risk factors.
Case-control study at 8 major Norwegian alpine resorts during the 2002 winter season, involving 3277 injured skiers and snowboarders reported by the ski patrol and 2992 noninjured controls who were interviewed on Wednesdays and Saturdays. The controls comprised every 10th person entering the bottom main ski lift at each resort during peak hours. The number of participants interviewed corresponded with each resort's anticipated injury count based on earlier years.
Injury type, helmet use, and other risk factors (age, sex, nationality, skill level, equipment used, ski school attendance, rented or own equipment) were recorded. A multivariate logistic regression analysis was used to assess the relationship between individual risk factors (including helmet wear) and risk of head injury by comparing skiers with head injuries with uninjured controls, as well as to skiers with injuries other than head injuries.
Head injuries accounted for 578 injuries (17.6%). Using a helmet was associated with a 60% reduction in the risk for head injury (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.30-0.55; adjusted for other risk factors) when comparing skiers with head injuries with uninjured controls. The effect was slightly reduced (OR, 0.45; 95% CI, 0.34-0.59) when skiers with other injuries were used as controls. For the 147 potentially severe head injuries, those who were referred to an emergency physician or for hospital treatment, the adjusted OR was 0.43 (95% CI, 0.25-0.77). The risk for head injury was higher among snowboarders than for alpine skiers (adjusted OR, 1.53; 95% CI, 1.22-1.91).
Wearing a helmet is associated with reduced risk of head injury among snowboarders and alpine skiers.
- Hart