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Burial by Sand: Summer Play Gone Awry
Mayo Clin Proc, June 2004, Vol 79
Editorial
733
Editorial
Burial by Sand: Summer Play Gone Awry
A
s the summer season draws near, the article by Zarroug et al1 concerning accidental burials in sand in Minnesota is timely and important. The authors describe 4 boys, aged 10 to 13 years, who were accidentally buried in sand, 2 of whom died as a result of the accident. The mechanism of injury in this report is somewhat different from that in previous publications that focused on sand aspiration and its management. The current study indicates that the 2 boys died of asphyxia from thoracic compression due to the weight of the sand. The first boy was digging a tunnel in a backyard sandbox that collapsed on him. He was buried for about 10 minutes in dry sand and was unable to extricate himself. The boy had been playing unsupervised. The other 3 boys jumped into a large (30 feet) pile of wet sand at a construction site. As they ran down the sandpile, it collapsed and completely buried 1 boy and partially buried the other 2 boys. The completely buried youngster was under 12 feet of wet sand; he could not be rescued in time and died of thoracic compression asphyxia. One boy extricated himself and successfully sought help for his partially buried friend. These 3 boys were also unsupervised, and there was no information regarding the security or safety factors in place at the construction site. Neither of the 2 boys who died had evidence of sand aspiration. Sand is composed of aluminum silicate, silicon dioxide, and calcium carbonate and is defined as sedimentary particles with a diameter of 0.05 to 2.0 mm. This distinguishes sand from larger particles such as gravel and smaller particles such as silt and clay. What is significant in the current report is the calculated weight of wet sand (in tons) that restricted the boys’ attempts at breathing, resulting in compressive thoracic asphyxia. Although highly unusual, these occurrences document a previously undescribed mechanism of injury in childhood sand burial. Of interest is the fact that all 4 were boys. It is well-known that boys are more frequently involved in accidents, presumably due to more adventurous and risky behavior. During the summer months, newspapers, magazines, and television commercials often show youngsters building sand castles or instances of intentional sand burial up to the shoulder level, suggesting these activities are popular playtime
Figure 1. Child playing in the sandbox in his backyard. Photograph courtesy of Dr David Byer, Rochester, Minn.
pursuits (Figures 1 and 2). The current report unmasks the potential dangers associated with these activities. Publication of the report by Zarroug et al should increase public awareness of a potential health hazard and alert authorities and safety officials at parks, beaches, and other public play areas. Safety precautions at potentially dangerous construction sites and industrial sand storage facilities should be instituted as part of an accident-prevention program with appropriate inspections to ensure compliance. Protective fences and security personnel are reasonable considerations in attempts to achieve this goal. Areas at risk include large sand dunes (often associated with sand holes), deep beach diggings, and large sand castles or tunnels. Such activities could be limited to specific sites in recreational areas that are well supervised by parents, lifeguards, or other beach or park personnel. The fact that 1 of the boys died in a deep sandbox in his backyard also suggests that a limitation in the depth of domestic sandboxes for children needs to be addressed. See also page 774. An important message is that young children need to be supervised. If either of the 2 reported events had been observed, the chance of prompt extrication and survival would have been better. The authors are to be praised for
Address reprint requests and correspondence to Jay L. Grosfeld, MD, Pediatric Surgery Division, Riley Hospital for Children, 702 Barnhill Dr, Indianapolis, IN 46202. Mayo Clin Proc. 2004;79:733-734
733
© 2004 Mayo Foundation for Medical Education and Research
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
734
Editorial
Mayo Clin Proc, June 2004, Vol 79
making this information available to their medical colleagues. However, the message also needs to reach public health and accident-prevention officials in the community. Reporting these instances to the National Trauma Data Bank of the American College of Surgeons Committee on Trauma may be of value.2
1. 2.
Zarroug AE, Stavlo PL, Kays GA, Rodeberg DA, Moir CR. Accidental burials in sand: a potentially fatal summertime hazard. Mayo Clin Proc. 2004;79:774-776. American College of Surgeons Trauma Program. National Trauma Data Bank™ (NTDB). Available at: www.facs.org/trauma/ ntdbwhatis.html. Accessibility verified May 4, 2004.
Jay L. Grosfeld, MD Lafayette Page Professor of Surgery Indiana University School of Medicine Surgeon-in-Chief, Riley Children’s Hospital Indianapolis, Ind
Figure 2. Children playing in the sand at the beach. Left, Photograph courtesy of Dr John C. Sill, Rochester, Minn. Middle and right, Photographs courtesy of Drs Mark A. and Mary Ellen Warner, Rochester, Minn.
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
Editorial
733
Editorial
Burial by Sand: Summer Play Gone Awry
A
s the summer season draws near, the article by Zarroug et al1 concerning accidental burials in sand in Minnesota is timely and important. The authors describe 4 boys, aged 10 to 13 years, who were accidentally buried in sand, 2 of whom died as a result of the accident. The mechanism of injury in this report is somewhat different from that in previous publications that focused on sand aspiration and its management. The current study indicates that the 2 boys died of asphyxia from thoracic compression due to the weight of the sand. The first boy was digging a tunnel in a backyard sandbox that collapsed on him. He was buried for about 10 minutes in dry sand and was unable to extricate himself. The boy had been playing unsupervised. The other 3 boys jumped into a large (30 feet) pile of wet sand at a construction site. As they ran down the sandpile, it collapsed and completely buried 1 boy and partially buried the other 2 boys. The completely buried youngster was under 12 feet of wet sand; he could not be rescued in time and died of thoracic compression asphyxia. One boy extricated himself and successfully sought help for his partially buried friend. These 3 boys were also unsupervised, and there was no information regarding the security or safety factors in place at the construction site. Neither of the 2 boys who died had evidence of sand aspiration. Sand is composed of aluminum silicate, silicon dioxide, and calcium carbonate and is defined as sedimentary particles with a diameter of 0.05 to 2.0 mm. This distinguishes sand from larger particles such as gravel and smaller particles such as silt and clay. What is significant in the current report is the calculated weight of wet sand (in tons) that restricted the boys’ attempts at breathing, resulting in compressive thoracic asphyxia. Although highly unusual, these occurrences document a previously undescribed mechanism of injury in childhood sand burial. Of interest is the fact that all 4 were boys. It is well-known that boys are more frequently involved in accidents, presumably due to more adventurous and risky behavior. During the summer months, newspapers, magazines, and television commercials often show youngsters building sand castles or instances of intentional sand burial up to the shoulder level, suggesting these activities are popular playtime
Figure 1. Child playing in the sandbox in his backyard. Photograph courtesy of Dr David Byer, Rochester, Minn.
pursuits (Figures 1 and 2). The current report unmasks the potential dangers associated with these activities. Publication of the report by Zarroug et al should increase public awareness of a potential health hazard and alert authorities and safety officials at parks, beaches, and other public play areas. Safety precautions at potentially dangerous construction sites and industrial sand storage facilities should be instituted as part of an accident-prevention program with appropriate inspections to ensure compliance. Protective fences and security personnel are reasonable considerations in attempts to achieve this goal. Areas at risk include large sand dunes (often associated with sand holes), deep beach diggings, and large sand castles or tunnels. Such activities could be limited to specific sites in recreational areas that are well supervised by parents, lifeguards, or other beach or park personnel. The fact that 1 of the boys died in a deep sandbox in his backyard also suggests that a limitation in the depth of domestic sandboxes for children needs to be addressed. See also page 774. An important message is that young children need to be supervised. If either of the 2 reported events had been observed, the chance of prompt extrication and survival would have been better. The authors are to be praised for
Address reprint requests and correspondence to Jay L. Grosfeld, MD, Pediatric Surgery Division, Riley Hospital for Children, 702 Barnhill Dr, Indianapolis, IN 46202. Mayo Clin Proc. 2004;79:733-734
733
© 2004 Mayo Foundation for Medical Education and Research
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
734
Editorial
Mayo Clin Proc, June 2004, Vol 79
making this information available to their medical colleagues. However, the message also needs to reach public health and accident-prevention officials in the community. Reporting these instances to the National Trauma Data Bank of the American College of Surgeons Committee on Trauma may be of value.2
1. 2.
Zarroug AE, Stavlo PL, Kays GA, Rodeberg DA, Moir CR. Accidental burials in sand: a potentially fatal summertime hazard. Mayo Clin Proc. 2004;79:774-776. American College of Surgeons Trauma Program. National Trauma Data Bank™ (NTDB). Available at: www.facs.org/trauma/ ntdbwhatis.html. Accessibility verified May 4, 2004.
Jay L. Grosfeld, MD Lafayette Page Professor of Surgery Indiana University School of Medicine Surgeon-in-Chief, Riley Children’s Hospital Indianapolis, Ind
Figure 2. Children playing in the sand at the beach. Left, Photograph courtesy of Dr John C. Sill, Rochester, Minn. Middle and right, Photographs courtesy of Drs Mark A. and Mary Ellen Warner, Rochester, Minn.
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.