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Parachuting: a sport of chance and expense
Injury, Int. J. Care Injured 34 (2003) 215–217
Parachuting: a sport of chance and expense D.S.R. Baiju∗ , L.A. James C/O L.A. James, Department of Orthopaedic and Trauma, Horton General Hospital, 47 Gospel Farm Road, Acocks Green, Birmingham B27 7JN, UK Accepted 24 April 2002
Abstract This paper seeks to determine the cost to the NHS associated with treating parachute-related injuries. More specifically, it compares the training received by civilians to that received by military personnel together with the types of parachutes used or the type of jump. It also reviews the information given to civilian jumpers prior to their first jump. Fifty-three jumpers suffered injuries in the period under review. Of these, 32 cases with 41 injuries were transferred to Accident and Emergency Department for treatment. Injuries involved most of the musculoskeletal system. Twenty-six (n = 32) patients were admitted for treatment, with an average length of hospital stay of 6.8 days. Post-discharge, the length of time lost from work was 42.8 days. The cost to the NHS was calculated at £4026.50 per patient treated. This did not include time lost from work, subsequent follow up or any other secondary procedures. Civilian parachute jumpers were trained for 6.5 h compared to 31.5 h for military personnel. Twenty-seven patients used rectangular rather than circular parachutes. Thirty of the 41 injuries occurred during static line jumps, with 7 occurring during tandem jumps and only 5 during free-fall jumps. Twenty-three of the 32 jumpers sustained the injury during their first jump. First-time civilian jumpers were given a minimum of information regarding risks and injuries prior to their jump and were inadequately insured against potential injuries. The cost of caring for these patients is substantial when compared to the money that is raised for charity during some of the jumps. Private insurance, with the NHS legally able to claim expenses would help to offset these medical costs. It is also possible that by increasing civilian training, there may be a reduction in the number of injuries sustained by first-time civilian jumpers from 1.1 to 1.2% (11% in charity jumps) to the military figures of 0.22–0.89%. © 2003 Elsevier Science Ltd. All rights reserved.
1. Introduction Parachute jumping has become a popular civilian activity as a sport and as a fund-raising activity. Papers have been published which have looked at the cost to the NHS of parachute-related injuries as well as the injuries occurring with the use of different types of parachutes. There is a suspicion that civilian parachute jumpers may be under-trained and inadequately insured against potential limb and life-threatening injuries. It is also unclear as to whether they are adequately advised about the risks associated with parachute jumping. To our knowledge, there have been no published articles that have attempted to address these peripheral issues related to parachuting. The aims of this paper were to determine the current cost of treating parachute-related injuries to the NHS, examine the differences between civilian and military training, the type of parachute used and the type of jumps done. The information given to jumpers prior to their jump and the suitability of their insurance were also reviewed. The paper ∗ Corresponding author. E-mail address: [email protected] (D.S.R. Baiju).
also proposes a means by which the NHS could recover some of the costs incurred when treating patients injured during parachute jumps.
2. Patients and methods We reviewed all patients with parachute related injuries in the Oxfordshire area who were treated at the local Accident and Emergency Department from January 2000 to April 2001. The notes of the patients were reviewed to obtain details of the injuries sustained and their subsequent management. Each patient was also individually contacted to obtain information about their particular parachute jump, training received, level of insurance obtained and information given to them about parachute related injuries. The training schedule for each type of jump was obtained from individual parachute centres in the Oxfordshire region as well as the parachute regiment. All data was entered onto an Excel spreadsheet. The results were analysed using normalisation and basic statistical
0020-1383/03/$ – see front matter © 2003 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 2 ) 0 0 1 0 0 - 6
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D.S.R. Baiju, L.A. James / Injury, Int. J. Care Injured 34 (2003) 215–217
methods. The cost of inpatient stay and the various operations performed was obtained from departmental heads and theatre managers.
3. Results Fifty-three injuries were reported to the British Parachute Association during the period January 2000–April 2001 for the Oxfordshire region. Thirty-two patients with 41 injuries were brought to a local Accident and Emergency Department for further treatment. The age range of patients was 16–50 years with a mean age of 28.4 years. Of those patients treated at hospital, 26 of the 32 patients had to be admitted, with the length of hospital stay ranging from 1 to 11 days, mean 6.8 days. Ankle fractures were the most common type of injury, accounting for 53.8% of all injuries. There was one death. After discharge, the average time off-work was 0–84 days, mean 42.81 days. The average cost to the NHS for the inpatient treatment of the injured patients was £4026.50 per patient. This works out as £10.68 per pound raised for charity in this study. Civilian training for a first static line or free fall parachute jump was 6.5 h compared to 36 h in the military training. Military parachutists were only allowed jumping after having completed basic military training which was at least a compulsory 2 weeks. Of the 23 first-time civilian parachutists, only 4 patients admitted to regular exercise and fitness training. The rectangular parachutes [11] were used in 27 of the 32 patients who were seen in Accident and Emergency. Thirty of the 41 injuries occurred during static line jumps, with 7 occurring during tandem jumps and only 5 during free-fall jumps. Twenty-three of the 32 patients were injured during their first jump. All first-time jumpers said the information given to them by the parachuting agencies regarding injuries was grossly inadequate with six receiving no information. The information received ranged from having had no major injuries to date to two minor injuries during the entire year. Twenty of the 23 first-time jumpers said they would not have jumped if they knew the actual incidence and severity of injuries which could be sustained. Half of the patients (16) jumped for charity. The insurance policy offered to civilian parachuters consisted of third party insurance and/or coverage for loss of life or limb only.
4. Discussion The overall incidence of civilian parachute injuries ranges from 0.12 to 0.2% [1,2], but is 1.1–1.2% in first-time jumpers [2,3]. In charity jumpers this figure is higher still, at 11% [4]. Of the people sustaining injuries, 63.0–81.8% [4,6] had se-
vere injuries requiring hospital admission. The incidence of injuries in military jumps ranges from 0.22 to 0.89% [5,7–9], with 23.5% [10] requiring admission for severe injuries. Our review has calculated the average cost of treating a parachute-related injury as £4026.50 per patient, costing the NHS £10.68 per pound raised for charity. This compares to the figures of £3593 and 13.75, respectively, as quoted in the literature [4]. Civilian jumpers receive less training than military personnel, which may account for the higher incidence of injuries in this subset of jumpers. A better and more stringent training scheme for civilian jumpers might help reduce the apparent discrepancy, although overall fitness is also a factor and cannot be changed easily without reducing the access for civilian. Baldwin [11] reviewed 3246 parachute jumps and showed that a change from a round parachute to a rectangular parachute, and from a static to free fall jump, decreased the injury rate from 1.1 to 0%. Therefore, consideration should be given to free fall jumps using the rectangular types of parachutes, particularly so in the first-time jumpers who appear to suffer a higher incidence of injuries. The information given to civilian jumpers seems to be haphazard at best and inadequate at worst according to our review. Many of the jumpers from our study said after they were injured that they would have liked a structured account of potential risks and the incidence of related injuries, to aid in their decision making process. The Road Traffic (NHS Charges) Act of 1999 allows the NHS to reclaim, through the Compensation Recovery Unit, the cost of treating patients involved in road traffic accidents from their insurance. With the increasing popularity of parachuting, the increasing numbers of injuries and the increasing cost to the NHS, we suggest the following: • All new sport parachute jumpers should be informed of the potential risks associated with this sport. • All civilian parachutists take out a fully comprehensive insurance policy prior to jumping to help compensate for loss of income, limb or life in the event of injury. • An Act similar to the Road Traffic (NHS Charge) of 1999 should be in place to recover costs to the NHS should an injury occur.
References [1] Ellitsgaard N. Parachuting injuries: a study of 110,000 sports jumps. Br J Sports Med 1987;21(1):13–7. [2] Straiton N, Sterland J. Sponsored parachute jumps—can they cause prolonged pain? Br J Sports Med 1986;20(2):60–1. [3] Dawson M, Asghar M, Pryke S, Slater N. Civilian parachute injuries: 10 years on and no lessons learned. Injury 1998;29(8):573–5. [4] Lee CT, Williams P, Hadden WA. Parachuting for charity: is it worth the money? A 5-year audit of parachute injuries in Tayside and the cost to the NHS. Injury 1999;30(4):283–7. [5] Ekeland A. Injuries in military parachuting: a prospective study of 4499 jumps. Injury 1997;28(3):219–22.
D.S.R. Baiju, L.A. James / Injury, Int. J. Care Injured 34 (2003) 215–217 [6] Amamilo SC, Samuel AW, Hesketh KT, Moynihan FJ. A prospective study of parachute injuries in civilians. J Bone Joint Surg Br 1987;69(1):17–9. [7] Farrow GB. Military static line parachute injuries. Aust N Z J Surg 1992;62(3):209–14. [8] Bar-Dayan Y, Shemer J. Parachuting injuries: a retrospective study of 43,542 military jumps. Mil Med 1998;163(1):1–2.
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[9] Craig SC, Morgan J. Parachuting injury surveillance, Fort Bragg, North California, May 1993–December 1994. Mil Med 1997; 162(3):162–4. [10] Lowdon IM, Wetherill MH. Parachuting injuries during training descents. Injury 1989;20(5):257–8. [11] Baldwin C. Parachuting injuries and type of parachute in a reserve rescue unit. Aviat Space Environ Med 1988;59(8):780–2.
Parachuting: a sport of chance and expense D.S.R. Baiju∗ , L.A. James C/O L.A. James, Department of Orthopaedic and Trauma, Horton General Hospital, 47 Gospel Farm Road, Acocks Green, Birmingham B27 7JN, UK Accepted 24 April 2002
Abstract This paper seeks to determine the cost to the NHS associated with treating parachute-related injuries. More specifically, it compares the training received by civilians to that received by military personnel together with the types of parachutes used or the type of jump. It also reviews the information given to civilian jumpers prior to their first jump. Fifty-three jumpers suffered injuries in the period under review. Of these, 32 cases with 41 injuries were transferred to Accident and Emergency Department for treatment. Injuries involved most of the musculoskeletal system. Twenty-six (n = 32) patients were admitted for treatment, with an average length of hospital stay of 6.8 days. Post-discharge, the length of time lost from work was 42.8 days. The cost to the NHS was calculated at £4026.50 per patient treated. This did not include time lost from work, subsequent follow up or any other secondary procedures. Civilian parachute jumpers were trained for 6.5 h compared to 31.5 h for military personnel. Twenty-seven patients used rectangular rather than circular parachutes. Thirty of the 41 injuries occurred during static line jumps, with 7 occurring during tandem jumps and only 5 during free-fall jumps. Twenty-three of the 32 jumpers sustained the injury during their first jump. First-time civilian jumpers were given a minimum of information regarding risks and injuries prior to their jump and were inadequately insured against potential injuries. The cost of caring for these patients is substantial when compared to the money that is raised for charity during some of the jumps. Private insurance, with the NHS legally able to claim expenses would help to offset these medical costs. It is also possible that by increasing civilian training, there may be a reduction in the number of injuries sustained by first-time civilian jumpers from 1.1 to 1.2% (11% in charity jumps) to the military figures of 0.22–0.89%. © 2003 Elsevier Science Ltd. All rights reserved.
1. Introduction Parachute jumping has become a popular civilian activity as a sport and as a fund-raising activity. Papers have been published which have looked at the cost to the NHS of parachute-related injuries as well as the injuries occurring with the use of different types of parachutes. There is a suspicion that civilian parachute jumpers may be under-trained and inadequately insured against potential limb and life-threatening injuries. It is also unclear as to whether they are adequately advised about the risks associated with parachute jumping. To our knowledge, there have been no published articles that have attempted to address these peripheral issues related to parachuting. The aims of this paper were to determine the current cost of treating parachute-related injuries to the NHS, examine the differences between civilian and military training, the type of parachute used and the type of jumps done. The information given to jumpers prior to their jump and the suitability of their insurance were also reviewed. The paper ∗ Corresponding author. E-mail address: [email protected] (D.S.R. Baiju).
also proposes a means by which the NHS could recover some of the costs incurred when treating patients injured during parachute jumps.
2. Patients and methods We reviewed all patients with parachute related injuries in the Oxfordshire area who were treated at the local Accident and Emergency Department from January 2000 to April 2001. The notes of the patients were reviewed to obtain details of the injuries sustained and their subsequent management. Each patient was also individually contacted to obtain information about their particular parachute jump, training received, level of insurance obtained and information given to them about parachute related injuries. The training schedule for each type of jump was obtained from individual parachute centres in the Oxfordshire region as well as the parachute regiment. All data was entered onto an Excel spreadsheet. The results were analysed using normalisation and basic statistical
0020-1383/03/$ – see front matter © 2003 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 2 ) 0 0 1 0 0 - 6
216
D.S.R. Baiju, L.A. James / Injury, Int. J. Care Injured 34 (2003) 215–217
methods. The cost of inpatient stay and the various operations performed was obtained from departmental heads and theatre managers.
3. Results Fifty-three injuries were reported to the British Parachute Association during the period January 2000–April 2001 for the Oxfordshire region. Thirty-two patients with 41 injuries were brought to a local Accident and Emergency Department for further treatment. The age range of patients was 16–50 years with a mean age of 28.4 years. Of those patients treated at hospital, 26 of the 32 patients had to be admitted, with the length of hospital stay ranging from 1 to 11 days, mean 6.8 days. Ankle fractures were the most common type of injury, accounting for 53.8% of all injuries. There was one death. After discharge, the average time off-work was 0–84 days, mean 42.81 days. The average cost to the NHS for the inpatient treatment of the injured patients was £4026.50 per patient. This works out as £10.68 per pound raised for charity in this study. Civilian training for a first static line or free fall parachute jump was 6.5 h compared to 36 h in the military training. Military parachutists were only allowed jumping after having completed basic military training which was at least a compulsory 2 weeks. Of the 23 first-time civilian parachutists, only 4 patients admitted to regular exercise and fitness training. The rectangular parachutes [11] were used in 27 of the 32 patients who were seen in Accident and Emergency. Thirty of the 41 injuries occurred during static line jumps, with 7 occurring during tandem jumps and only 5 during free-fall jumps. Twenty-three of the 32 patients were injured during their first jump. All first-time jumpers said the information given to them by the parachuting agencies regarding injuries was grossly inadequate with six receiving no information. The information received ranged from having had no major injuries to date to two minor injuries during the entire year. Twenty of the 23 first-time jumpers said they would not have jumped if they knew the actual incidence and severity of injuries which could be sustained. Half of the patients (16) jumped for charity. The insurance policy offered to civilian parachuters consisted of third party insurance and/or coverage for loss of life or limb only.
4. Discussion The overall incidence of civilian parachute injuries ranges from 0.12 to 0.2% [1,2], but is 1.1–1.2% in first-time jumpers [2,3]. In charity jumpers this figure is higher still, at 11% [4]. Of the people sustaining injuries, 63.0–81.8% [4,6] had se-
vere injuries requiring hospital admission. The incidence of injuries in military jumps ranges from 0.22 to 0.89% [5,7–9], with 23.5% [10] requiring admission for severe injuries. Our review has calculated the average cost of treating a parachute-related injury as £4026.50 per patient, costing the NHS £10.68 per pound raised for charity. This compares to the figures of £3593 and 13.75, respectively, as quoted in the literature [4]. Civilian jumpers receive less training than military personnel, which may account for the higher incidence of injuries in this subset of jumpers. A better and more stringent training scheme for civilian jumpers might help reduce the apparent discrepancy, although overall fitness is also a factor and cannot be changed easily without reducing the access for civilian. Baldwin [11] reviewed 3246 parachute jumps and showed that a change from a round parachute to a rectangular parachute, and from a static to free fall jump, decreased the injury rate from 1.1 to 0%. Therefore, consideration should be given to free fall jumps using the rectangular types of parachutes, particularly so in the first-time jumpers who appear to suffer a higher incidence of injuries. The information given to civilian jumpers seems to be haphazard at best and inadequate at worst according to our review. Many of the jumpers from our study said after they were injured that they would have liked a structured account of potential risks and the incidence of related injuries, to aid in their decision making process. The Road Traffic (NHS Charges) Act of 1999 allows the NHS to reclaim, through the Compensation Recovery Unit, the cost of treating patients involved in road traffic accidents from their insurance. With the increasing popularity of parachuting, the increasing numbers of injuries and the increasing cost to the NHS, we suggest the following: • All new sport parachute jumpers should be informed of the potential risks associated with this sport. • All civilian parachutists take out a fully comprehensive insurance policy prior to jumping to help compensate for loss of income, limb or life in the event of injury. • An Act similar to the Road Traffic (NHS Charge) of 1999 should be in place to recover costs to the NHS should an injury occur.
References [1] Ellitsgaard N. Parachuting injuries: a study of 110,000 sports jumps. Br J Sports Med 1987;21(1):13–7. [2] Straiton N, Sterland J. Sponsored parachute jumps—can they cause prolonged pain? Br J Sports Med 1986;20(2):60–1. [3] Dawson M, Asghar M, Pryke S, Slater N. Civilian parachute injuries: 10 years on and no lessons learned. Injury 1998;29(8):573–5. [4] Lee CT, Williams P, Hadden WA. Parachuting for charity: is it worth the money? A 5-year audit of parachute injuries in Tayside and the cost to the NHS. Injury 1999;30(4):283–7. [5] Ekeland A. Injuries in military parachuting: a prospective study of 4499 jumps. Injury 1997;28(3):219–22.
D.S.R. Baiju, L.A. James / Injury, Int. J. Care Injured 34 (2003) 215–217 [6] Amamilo SC, Samuel AW, Hesketh KT, Moynihan FJ. A prospective study of parachute injuries in civilians. J Bone Joint Surg Br 1987;69(1):17–9. [7] Farrow GB. Military static line parachute injuries. Aust N Z J Surg 1992;62(3):209–14. [8] Bar-Dayan Y, Shemer J. Parachuting injuries: a retrospective study of 43,542 military jumps. Mil Med 1998;163(1):1–2.
217
[9] Craig SC, Morgan J. Parachuting injury surveillance, Fort Bragg, North California, May 1993–December 1994. Mil Med 1997; 162(3):162–4. [10] Lowdon IM, Wetherill MH. Parachuting injuries during training descents. Injury 1989;20(5):257–8. [11] Baldwin C. Parachuting injuries and type of parachute in a reserve rescue unit. Aviat Space Environ Med 1988;59(8):780–2.