MMWR. 1998;47:354-356 Approximately 78 million persons engage in recreational boating annually in the United States.1 Several types of injury can occur during boating recreation, including drowning, falls, burns, and propeller-related injuries. Injuries from the propeller are typically multiple, deep, parallel lacerations that can result in permanent scarring, substantial blood loss, traumatic or surgical amputation, or death.2 Persons sustaining injuries from boat propellers can require long periods of hospitalization, recovery, and rehabilitation. In Texas, the extent of boat-propeller–related injuries is unknown; however, the existence of approximately 600,000 motorboats in the state exposes many Texans to the potential risk for propeller-related injury. To characterize the occurrence of boat-propeller–related injuries in Texas, the Texas Department of Health (TDH) and the Texas Parks and Wildlife Department (TPWD) investigated boat-propeller–related injuries that occurred in four lakes in Texas during May 24-September 1, 1997, the time of year when boating activities are most common. This report summarizes the results of the investigation. The investigation established active and hospital-based surveillance near four inland lakes in northern, central, and eastern Texas. Thirteen hospitals near the lakes reported to TDH data about patients treated in the emergency department (ED) or admitted to the hospital for a boat-propeller–related injury. The report form included data about age, sex, injury date, types of injuries, and injury circumstances. Bimonthly contact with sentinel hospitals was maintained by telephone. Additional data were reviewed from TPWD's Boating Accident Reports, TDH's Texas Trauma Registry, and newspaper clippings from across the state. During the study period, TDH identified 13 persons who sustained boat-propeller–related injuries; three of these persons died. Case Reports Case 1 In August 1997, a 36-year-old man was operating a motorboat when it turned sharply and ejected him. The boat ran over him, and the propeller cut his head and back. He surfaced and called for help before submerging again. He was not wearing a personal flotation device. The cause of death was open skull fracture. Cases 2 and 3 In August 1997, a 12-year-old boy and an 11-year-old girl were passengers on a pontoon boat during a family outing. The two children were dangling their feet over the front end of the boat when the front gate gave way and they fell in the water. The boat ran over the children, and the propeller struck the children. Both children drowned. They were not wearing personal flotation devices. Summary of Cases By month, most cases occurred in August (six), followed by June (three), July (three), and May (one). Of the 13 persons identified, nine were males. The mean age was 26 years (range: 6-44 years). Of the 10 nonfatal cases, seven persons sustained lacerations, and four sustained broken bones. The most common circumstances surrounding boat-propeller-related injuries were (1) getting into or out of the boat (five persons), (2) participating in a water activity (e.g., personal watercraft use or skiing) (four), and (3) falling or being thrown from the boat (four). Five of the injured persons were admitted to the hospital. Hospital information was available for four of these five. The length of hospital stay ranged from 4 to 8 days. Three persons were discharged in good condition, with full recovery expected, and one patient was discharged in a wheelchair and referred for physical therapy and orthopedic surgery follow-up. Reported by: K Leeper, Columbia Medical Center, Lewisville; J Willeford, Denton Community Hospital, S Conn, Denton Regional Medical Center, Denton; M Hoff, Trinity Medical Center, Brenham; S Amick, Harris Methodist Medical Center, Fort Worth; B Parsons, Palo Pinto General Hospital, Palo Pinto; J Buckley, Graham General Hospital, Graham; J Hazelwood, Columbia Medical Center, Conroe; E Victery, Huntsville Memorial Hospital, Huntsville; J Landers, Llano Memorial Hospital, Llano; B Shafer, Highland Lakes Medical Center, Burnet; S Janda, C Perez, Brackenridge Hospital, Austin; M Rast, D Cherry, J Hunteman, T Sajak, J Whitfield, E Svenkerud, M Weldon, D Zane, D Perrotta, PhD, D Simpson, MD, State Epidemiologist, Texas Dept of Health. C Vaca, Texas Parks and Wildlife Dept. Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control; and EIS officers, CDC. CDC Editorial Note: In 1996, the U.S. Coast Guard reported that 4442 persons were injured and 709 persons died in boating-related incidents in the United States; five (0.7%) of these deaths involved propeller injuries.3 A total of 171 persons were injured in incidents involving a propeller strike.4 In previous case reports, fatality rates ranged from 15% in a series of 77 cases to 23% in 223 cases.5,6 In an analytic study of boat-propeller–related injuries that used national, medically verified data, boat propellers were responsible for an estimated 1155 injuries during September 1991-August 1992.2 Of these, only 11.5% of injuries required hospitalization. In this report, 50% of the nonfatally injured persons were admitted to the hospital. Because the survey did not include all lakes and waterfronts in Texas, this report probably underestimates the number of boat-propeller–related injuries and deaths. Most boat-propeller–related injuries result from operator error, and many of them are preventable.3 To prevent injuries that occur through contact with boat propellers, the U.S. Coast Guard recommends that boat operators ensure that every passenger is wearing a personal flotation device. never operate a boat while under the influence of alcohol or drugs. keep the boat clear of marked swimming and diving areas and become familiar with the red and white or blue and white diagonally striped flags signaling that divers are in the area. ensure that passengers are properly seated before getting underway. never start a boat with the engine in gear. designate a passenger who will keep water skier(s) in sight at all times. never allow passengers to ride on a seat back, gunwale, or on the transom or bow. The findings in this report indicate that severe boat-propeller–related injuries may be more common than previously reported, underscoring the need to continue efforts to increase public awareness of safety measures and to improve surveillance for such injuries. Additional recommendations and information about boating safety is available from the Office of Boating Safety, U.S. Coast Guard Infoline; telephone (800) 368-5647, 8 a.m.-4:30 p.m., or the Office of Boating Safety's World Wide Web site, http://www.uscgboating.org. References 6 available.
JAMA – American Medical Association
Published: Jun 17, 1998
Keywords: lacerations,injury prevention,telephone,wheelchairs,wounds and injuries,length of stay,orthopedic procedures,physical therapy,radioallergosorbent test,surgical procedures, operative,ethanol,hemorrhage,amputation,fractures,burns,cicatrix,follow-up,skull fractures, open,surveillance, medical,rehabilitation,child,drowning,hospitals, community,internet,foot,analytic study,mechanical impact