Golden parachutes. The sweet smell of failure.
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Chief Executive Officers, Hospital↗
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What is the risk associated with being a qualified military parachutist?
Military parachuting has been recognized as a hazardous activity since it was first introduced in World War II. Other risks associated with military service include actual war-fighting, training with weapons and explosives, operating with armoured vehicles or deployment to climatic extremes. These other hazards should be considered in any assessment of the additional risk associated with military parachuting. The aim of this study was to identify the risk attributable to parachuting amongst US Army enlisted soldiers. This study identified a cohort of infantry soldiers who served between 1990-94. They were separated by receipt of parachute hazardous duty pay. There was a total of 329,794 person-years (PY) available for study of which 18% were in the exposed group. The rate of hospitalization was very similar in both groups [123.9 per 1,000 PYs for the exposed group, 127 in the non-exposed group: relative risk (RR) = 0.98, 95% confidence interval (CI) = 0.96-1.00). The exposed group was 1.49 times (CI = 1.42-1.57) more likely to be admitted as a result of an injury as compared with the non-exposed group. Military parachuting was 20 times (CI = 16.6-24.3) more likely to be the cause of an injury. This study has shown that receipt of hazardous duty pay for military parachuting can be used as a marker in identifying significant additional risks to the health of infantry soldiers associated with military parachuting. This was reflected in an increased incidence of admission for acute injury and musculoskeletal trauma (particularly a trauma pattern associated with parachuting) as a result of military parachuting. Other risks, which are associated with parachute pay, are admission for the effects of heat, battle injury and helicopter accidents.
Adolescent↗
Study of PFT (parasail) in air training command.
Injuries in pilots following egress from disabled aircraft can be minimized by their ability to maneuver their parachutes during descent and to execute a proper parachute landing fall. USAF pilot and navigator trainees receive extensive ground training in parachute operation and parachute landing falls. They then undergo Parachute Familiarization Training (PFT) during which they experience descents by a parasail after being towed to altitude. The value of PFT was determined by evaluating questionnaires sent to approximately 700 crewmembers, including many ex-prisoners of war, who had made an emergency egress. Areas addressed included contribution of the training to overall confidence, ability to steer the parachute to avoid hazardous obstacles, execution of a proper parachute landing fall, and the role of PFT in avoiding injury or fatality in the post-egress environment. Responses indicated that PFT played a significant role in confidence-building and in avoiding or minimizing post-egress injury.
Aviation↗
Fatalities in Swedish 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.
Accidents, Aviation↗
Rise in landing-related skydiving 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.
Accidents↗
Injury among female and male army parachutists.
BACKGROUND: While military parachuting injuries have been well studied, the relationship between gender and risk of injury has not. Injuries among women may be different due to anatomic and physiologic differences, or due to exposure to different jump conditions. Training methods and equipment developed for men may not be as effective in preventing injuries among women. HYPOTHESIS: We hypothesize that the nature and distribution of parachute injuries will vary by gender. METHODS: This descriptive retrospective study used 10 yr of parachute injury data reported to the U.S. Army Safety Center at Fort Rucker, AL, and exposure data obtained from the Defense Manpower Data Center, Monterey, CA. RESULTS: Women appear to jump under less hazardous conditions (jump more often than men in daylight and in static-line, non-tactical environments), yet appear to be at greater risk of serious injury, particularly lower extremity fractures. Injured male parachutists are more likely to experience upper extremity injury. Women's injuries are more likely to be the result of an improper parachute landing fall or parachute malfunction, while men are more likely to be injured due to ground hazards. CONCLUSIONS: There are some provocative gender differences in patterns of injury. Further research is indicated starting with a comprehensive, prospective study, controlling for physical fitness and exposure differences, as well as for potential reporting bias, in order to better understand the apparent differences in reported injuries.
Adult↗
Comparative investigations on the retrieval capabilities of various baskets and graspers in four ex vivo models.
OBJECTIVES: The increasing application of ureterorenoscopy for the treatment of urolithiasis has produced a myriad of different help-tools for stone retrieval. In this study, we compared the retrieval capabilities of different baskets and graspers in ex vivo models and attempted to find the most appropriate tool for stone extraction considering the location and size of stone, number of stones and potential harm to urinary tract tissue. METHODS: We created four different ex vivo models with porcine kidneys and ureters and natural human stones: (1) single ureteral stone (4mm); (2) single impacted ureteral stone (6mm); (3) Steinstrasse; (4) single lower-pole stone (5mm). With the aid of four baskets of different design (flat-wire basket Segura and Nitinol basket Zerotip, helical Gemini, and Parachute) and three graspers (two-prong, three-prong Tricep, and Nitinol grasper Graspit) we performed repeated stone extraction 10 times in each model. The time for complete stone removal was calculated. Macroscopical evaluation of tissue damage was performed after each series. In the Steinstrasse model the frequency of instrument reinsertion into the ureter was also calculated. RESULTS: In the single ureteral stone model, the fastest stone removal was achieved with the two-prong graspers, three-prong graspers and helical basket (20, 26 and 31s, respectively). Segura and Parachute needed more time (55 and 86s, respectively). Impacted stones were removed fastest with the two- and three-prong graspers (38 and 52s, respectively), Segura and Gemini were slower (89 and 114s, respectively). The Steinstrasse was cleared fastest by the helical basket with the lowest frequency of endoscope reinsertion (66s, 1.4 reinsertion). The Segura, 149s with 3.2 reinsertion was needed for the same procedure. With the Parachute and two-prong graspers 163s, 1.8 reinsertion and 261s, 4.6 reinsertion were needed, respectively. During postprocedural macroscopical evaluation of uretral tissue, the Parachute basket and three-prong graspers demonstrated the highest risk of mucosal and muscle damage. In the lower-pole kidney model, the poor deflectability of the ureterorenoscope prevented access to the lower-pole with the two- and three-prong graspers. There was no significant difference in stone retrieval time between the remaining Nitinol basket Zerotip and Nitinol grasper Graspit (87 and 61s, respectively ). The number of failures was 4/10 for Zerotip and 5/10 for Graspit. No significant mucosal damage was noted with these tools. CONCLUSIONS: Our ex vivo models demonstrated that the design of graspers and baskets affects the time of stone retrieval in different situations and causes the various grades of tissue damage.
Animals↗
The spine in sport and veteran military parachutists.
Spinal injuries and symptoms were studied in 109 ex-military parachutists and 112 sport (free fall) parachutists by means of postal questionnaires. 46 ex-military parachutists aged 50 years or over had a radiological examination of the lumbar spine and 58 sport parachutists had a radiological examination of the cervical spine as part of the survey. A history of back pain was significantly (P<0.01) associated with body weight in sport parachutists but not with the number of descents or with the subject's age. In the older ex-military group neither age, weight, nor the number of descents was significantly associated with backache. Of those ex-military parachutists x-rayed, 10 (21.7%) were found to have vertebral body fractures (most frequently at D12), and 8 of these were unaware of these lesions. Vertebral fractures caused no disability and did not permanently curtail parachuting activities in either the sport or ex-military group. Of the ex-military parachutists x-rayed, 84.7% had lumbar disc degeneration of all grades of severity, 17.4% had moderate changes, and 10.8% had severe changes. The frequency of moderate and severe disc degeneration was significantly related to age but not to body weight or to the number of descents. Spondylolysis was found in 2 subjects (4.3%) and spondylolisthesis unassociated with spondylolysis in 4 (8.7%). Spondylolisthesis was always associated with a history of back pain.A low prevalence of radiological cervical intervertebral disc degeneration of all grades of severity of 8.7% was found among the free fall parachutists (mean age 33 years). 2 cases of cervical vertebral body fracture were seen, one related to a parachute landing injury and the other to a parachute opening injury. This study does not implicate parachuting as a cause of intervertebral disc degeneration, either cervical or lumbar, nor as a cause of spondylolysis or spondylolisthesis. Serious long-term disability from pain appears to be uncommon among parachutists despite the frequency of the spinal trauma they sustain.
Adult↗
[Congenital mitral stenosis. Report on 33 patients].
Thirty-three patients with congenital mitral stenosis are presented. Congenital mitral stenosis occurs as an isolated malformation and in combination with additional cardiac lesions. A new classification into 5 groups is suggested. It is possible to classify congenital mitral stenosis with and without additional lesions according to these 5 groups. This is of particular clinical advantage. Isolated congenital mitral stenosis is a rare malformation. In combination with additional obstructive left-sided cardiac malformations mitral stenosis occurs more frequently. In infancy and early childhood the so-called parachute valve is a stenotic lesion. According to our experience the parachute valve tends to the development of additional mitral incompetence in older children. This observation is of clinical and diagnostic importance. In patients with additional valvular aortic stenosis the mortality is very high. The operative treatment of congenital mitral stenosis with a parachute valve in combination with other obstructive lesions of the left ventricular outflow tract and the aorta without removal of the parachute valve seems to be unable to improve the hemodynamic situation and the prognosis of these patients. There is not enough experience with artificial valves in congenital mitral stenosis in early childhood.
Adolescent↗
Survivability and injuries from use of rocket-assisted ejection seats: analysis of 232 cases.
INTRODUCTION: Ejection injury has been documented with respect to non-rocket-assisted seats, but there is little information on injuries associated with rocket-assisted seats. This study analyses the survivability of military accidents and the injuries associated with rocket-assisted ejection. METHODS: A total of 232 Royal Air Force accident reports were accessed and aircrews' injuries were related to the aircraft parameters of ejection, aircrew anthropometry, and the ejection seat and parachute dynamics. Ejection sequences were simulated using a computerized modeling tool to provide information relating to the dynamic response index, acceleration of the ejection seats, and performance of the parachutes. RESULTS: Ejection survival was 89.2% overall, 95.7% for within envelope ejections and 23.8% for out of envelope ejections. There were 29.4% of aircrew who sustained spinal fractures. Another 14.2% of aircrew sustained a head injury and the incidence of head injury in Tornado ejectees was higher than the other aircraft types. Compared with 5.8% of ejectees from aircraft with an arm restraint system, 11.2% of aircrew sustained upper limb flail injuries from ejecting from aircraft without an arm restraint system. Arm flail injuries occurred at a higher aircraft speed at ejection compared with ejections where no arm flail injuries were sustained. There was also 18% of aircrew who sustained lower limb parachute landing injuries. DISCUSSION: Information from this study has lead to a redesign of the Tornado ejection seat headbox, an improvement in the Tornado ejection catapult dynamics, an upgrade of escape system parachutes, and provided evidence that future aircraft should be fitted with an arm restraint system.
Accidents, Aviation↗
An unusual airplane crash--deadly life saver. Unintentional activation of an automated reserve opening device causing airplane accident.
A Pilatus PC 6 "Turbo-Porter" crashed after having dropped skydivers. The interdisciplinary investigation of the crash revealed that the automated reserve opening device "Student-CYPRES" which the passenger wore on his parachute system had been set off during the landing approach. The parachute pulled the passenger out of the airplane. Subsequently the parachute got caught at the horizontal tail, and its wearer was instantly killed by internal decapitation. The airplane crashed because of its damaged horizontal tail, and the pilot lost his life.
Accidents, Aviation↗
Braced for impact: reducing military paratroopers' ankle sprains using outside-the-boot braces.
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.
Adult↗
Sequential FISH analysis with rDNA genes and Ag-NOR banding in the lady beetle Olla v-nigrum (Coleoptera: Coccinellidae).
We have characterized the meiosis of Olla v-nigrum by standard analysis, performed a NOR study using NOR banding, FISH of rDNA genes and sequential FISH/AgNOR analysis, and adapted the FISH methodology to Coccinellidae. The chromosome number determined at metaphase I was n = 9 + Xyp. At zygotene it was possible to identify the sex vesicle which presented a deeply stained heteropycnotic block. Chromosome X is much larger than the y and the two combine, forming a "parachute" in metaphase I. FISH analysis using a probe of rDNA genes 18S, 28S and 5.8S of D. melanogaster was used to map the genes in the sex vesicle. The NOR band showed high gene activity in this region. These results were confirmed using sequential FISH/Ag NOR analysis. The data obtained for Olla v-nigrum agree with the classical hypothesis raised to explain the type of sex chromosome association in a parachute format (Xyp) as being due to the presence of nucleolar material. The chromosome number and parachute configuration during metaphase I in this species agree with the basic karyotype of most Coleopterans. The major adaptation of the FISH method was the simultaneous denaturation and hybridization that permitted preservation of chromosome morphology, an essential factor when the chromosomes are small.
Animals↗
The knees and ankles in sport and veteran military parachutists.
112 actively parachuting sport (free fall) parachutists with more than 200 descents each and 109 veteran military parachutists no longer active returned a postal questionnaire about their parachuting activities, injuries, and current and past musculoskeletal symptoms. A high frequency of fractures and injuries was reported by each group, both in relation to parachuting and to other activities. 58 sport parachutists aged 23 to 57 years (mean 33 - 3 years) had weight-bearing anteroposterior and lateral radiographs taken of each knee. These showed a prevalence of radiological osteoarthrosis of 10 - 4% which was mild in degree in all but one knee in one subject. 46 ex-military parachutists aged 50 to 70 years (mean 55 - 2 years) had weight-bearing anteroposterior radiographs taken of both knees and showed a prevalence of radiological osteroarthrosis of 41 - 3%. Moderate and severe changes were found in 10 - 9%. In both groups of parachutists six of the eight knee joints showing either moderate or severe radiological osteroarthrosis had been subjected to a previous meniscectomy. Forty ex-military parachutists had anteroposterior radiographs of the ankles (talotibial articulation) and showed a prevalence of osteoarthrosis of 17 - 5%, with the majority showing mild changes. There was a poor correlation between radiological osteoarthrosis, ankle symptoms, and previous fractures. With the reservation that the great majority of the sport group are still young (95% aged less than 50 years), it is concluded that parachutists as a group do not show an increased prevalence of radiological osteoarthrosis of the knee or ankle.
Adult↗
Attention to detail: injuries at altitude among U.S. Army Military static line parachutists.
Altitude injuries, defined as injuries sustained by military static line parachutists before ground impact, have not been reviewed for 50 years. There are indications that these injuries are increasing at Fort Bragg, North Carolina. Between May 1, 1994, and April 30, 1996, surveillance was conducted for parachute-related injuries and altitude injuries at Fort Bragg. The incidence of all jump-related injuries was 8.1/1,000 aircraft exits. Significant risk factors for injury included being 30 years of age or older (p < 0.001) and being female (p = 0.003). The overall incidence of altitude injuries was noted to be 0.46/1,000 aircraft exits. Risk factors for altitude injury included being 40 years of age or older (p = 0.005) and in the rank of E-1 to E-3 (p = 0.0001). Fifty-four percent of injuries occurred during exiting before complete parachute deployment, and 46% occurred during the opening shock of the parachute. Mechanisms of injury included static line entanglement (33%), riser/suspension-line entanglement (46%), aircraft strikes (21%), unsecured equipment strikes (1%), and opening shock deceleration (1%). The majority of severe altitude injuries are caused by riser/suspension-line entanglement (63%) and involve the knee joint (37%). Although the incidence of altitude injury is quite small, the potential risk for career-threatening and/or life-threatening injury is great. This risk can be reduced by appropriate training and attention to detail.
Adolescent↗
Rupture of the pectoralis major muscle in a paratrooper.
Rupture of the pectoralis major muscle is a very rare injury. Excessive contraction of muscle fibers during certain forms of sports, such as weightlifting and bench pressing, is the most common cause. Among the 150 reported cases in the literature, in only 1 case did the injury happen during the landing phase of parachuting. Here we report a case of pectoralis major muscle rupture caused by a different mechanism than published previously. A paratrooper was injured during a tactical jump out of an aircraft after becoming entangled with the risers. The mechanism of injury was excessive traction and malpositioning of his shoulder when the parachute deployed. A three-phase conservative treatment regimen was performed and results were assessed by dynamometry. The patient was satisfied with the treatment and the dynamometric results were good at 9 mo after injury and at the end of a 20-mo follow-up period. We suggest that three-phase rehabilitation can be an effective treatment option for pectoralis major muscle rupture in selected patients. Prevention of this type of altitude injury would be possible by applying the fundamentals of parachuting.
Accidents, Occupational↗
Army Ranger casualty, attrition, and surgery rates for airborne operations in Afghanistan and Iraq.
INTRODUCTION: Although numerous articles have been published documenting parachute injuries, a search of the medical literature revealed none that detail casualty, attrition, and surgery rates for airborne operations conducted into actual combat. This study examines observed airborne casualty, attrition, and surgery rates in U.S. Army Rangers during combat operations in order to identify risk factors attributed to static-line parachute injuries and provide a comparison to estimated attrition rates. METHODS: Data were recorded on standardized manual casualty cards and tracking forms while treatment was provided during two missions into Afghanistan during Operation Enduring Freedom and two missions into Iraq during Operation Iraqi Freedom, and then consolidated onto an electronic database for further analysis. RESULTS: There were 4 airborne missions totaling 634 jumpers that resulted in 83 injuries sustained by 76 Rangers (12%). Of those, 27 Rangers (4%) were unable to continue the mission and were subsequently evacuated. There were 11 Rangers (2%) who required surgery following evacuation. The overall observed attrition rate differed from the estimated rate (p = 0.04). Although observed attrition rates did not differ from estimations in Afghanistan (p = 0.75), attrition rates in Iraq were greater than estimated rates (p = 0.02) and observed rates in Afghanistan (p = 0.05). DISCUSSION: Many factors impact casualty, attrition, and injury patterns. Terrain and equipment load were notable associations analyzed in this study. CONCLUSIONS: Medical, logistical, and operational personnel can optimize support for airborne forces through improved estimation of casualty, attrition, and surgical rates. Risk factors associated with military parachuting can potentially provide further accuracy in estimating attrition and are recommended for integration into current models.
Adolescent↗
Ripcord release capability of female parachutists.
With the growth in popularity of skydiving as a sport has come an associated increase in parachuting accidents, some of them due to failure to deploy the main or reserve parachutes. The absence of appropriate strength data has prompted a study of the pull force capabilities of female parachutists on a ripcord release in varying positions. Pull forces exerted for periods of 0.25, 1, 1.5, 2, and 2.5 s during a 5-s pull are presented in percentile form. A substantial percentage of female parachutists could not exert the maximum ripcord release pull force permitted by the relevant parachute specification. The relatively low level of strength exhibited by the weakest groups of the population emphasizes the need for such basic information in equipment design.
Adult↗