01 January 2000

Head and Neck Injuries in Sports

Head and Neck Injuries in Sports: Papers presented at the symposium of the same name, held in Atlanta, 1993, published 1994.

Milton Gabrielsen, PhD and Arthur H. Mittlestaedt, Jr. EdD, for the CPSC

Causes of Pool Diving Accidents. Head and Neck Injuries in Sports, ASTM STP 1229, Earl F. Hoerner, Ed, American Society for Testing and Materials, Philadelphia.

Increasing research into diving injuries and fatalities as revealed in litigation over the years, can provide an insight into prevention and correction fo the causes. These causes have been divided into the following categories:
1. Victim Performance…
2. Victim Unawareness….
3. Pool Facility Non-Compliance….
4. Other:

As these statistics provided by the database relate to diving safety issues, the information is more remarkable for what variable it does not include. There is no information in this national database concerning depth of the water in which diving injuries occurred. For clarification, we must then look elsewhere for additional information. The 1988 White Paper on Diving Accidents from the National Spa and Pool Institute executive summary of the Arthur D. Little studies diagrams the annual number of spinal cord injuries. 75% of the ‘diving’ SCI occurred in the natural environment. Competitive divers use swimming pools, not oceans, lakes and rivers. Only 25% of the ‘diving’ SCI resulting in quadriplegia occurred in swimming pools. Approximately 95% of these occurred in the shallow end of the pool. Careless diving into shallow and mid-range water depths is the aspect of user behavior that needs to be addressed.
The shotgun approach to removing diving boards is not the cure-all to reduce the real risk of ‘diving’ SCI injury. There is no justification to remove competitive diving boards in sites with excellent safety records that provide appropriate supervision (lifeguard and or diving coach) and sufficient room to maneuver.

Removing competitive diving boards in supervised sites with excellent safety records is unwarranted. Although there is a risk of injury in any practically built diving area, the real risk statistically comes from diving into shallow water five feet deep or less. There is a more subtle aspect of user behavior that needs to be addressed to reduce the risk of shallow water diving injuries. Although learning to dive in shallow water may be safe for youngsters 4-8 years old, the risk of injury from head impact with the bottom increases as the child matures into an adult-sized body with increased height and weight. Facility users need to appreciate this increased risk and adjust their behavior accordingly.

Given the facts, removing shallow water, not diving boards, is the obvious solution. However eliminating shallow water, like elimination diving boards, is a Catch 22 situation. Overall, ‘diving’ accounts for only 8% of the risk for spas, pool and associated equipment. Drowning accounts for 75% of risk. The shallow water cannot be removed to prevent diving SCI without increasing the risk of drowning. Likewise, removing diving boards used by instructional, competitive and recreational programs eliminates programs with excellent safety records that teach safe water entry skills.

Providing appropriate supervision is a key factor in reducing the risk of injury. Providing appropriate supervision enables continual monitoring of user behavior. A classic ‘diving’ injury profile based on over 200 ‘diving’ SCI that occurred in pools, presented by Milton Gabrielsen, PhD., at the 1984 National Pool and Spa Safety Conference, points to the lack of supervision as a prominent predisposing factor:
- In 89% of the time the location of the spinal cord injury was a residential, motel, hotel or apartment pool.
- In 85% of the accident sites, no qualified lifeguard, instructor or coach was present.
- In 57% of the cases, there was evidence the victim had consumed some form of alcoholic beverage, mostly beer.

Impact on Competitive Programs

Throughout the country, divers are having the diving boards taken out from under them. The big community pool, country club or resort pool with diving boards seems to be a thing of the past. Only 15.2% of nonresidential pools have diving boards of any kind. Diving programs have been canceled in Parks and Recreation, YMCA, high school, club and local pools in (many states). One mother of two prospective young divers wrote to express her concern. The local YMCA permanently removed the diving boards because the insurance company would no longer cover them. …Olympic gold medalist, Greg Louganis, says, “the sport of diving has the potential of becoming extinct”.

The removal of diving boards throughout this country comes at a crucial time for USD’s future Olympic efforts. While the numbers of young Americans with access to diving boards is diminishing, the Chinese have developed a large base of young age group athletes from which to field their future Olympic teams....

The Liability Crisis

The problem is not simply limited to the issue of ‘diving’ safety, but is part of a greater liability crisis this country is now experiencing. “Over the years, courts have “increasingly based liability more on the theory that the defendant has deep pockets or the insurance coverage to pay and not because they have really done anything wrong” said Richard K. Willard, US Assistant attorney general and chairman of the Justice Department’s Tort Policy Working Group....

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