SPINALCORD: Prevention of Spinal Cord Injuries that Occur in Swimming Pools

This article is from the Pushin' On Newsletter, Vol 15[1], Winter, 1997.

by Michael DeVivo, DrPH

You may participate in organizations in your community that ask you to speak about spinal cord injury and prevention issues. The following are the results from a recent Model SCI Care System and sponsored by the National Swimming Pool Foundation. You are welcome to use the information as you speak to groups to encourage safety at swimming pools or SCI prevention.

Goals

The purpose of this study was to

Determine the usual circumstances surrounding spinal cord injuries resulting from swimming pool mishaps;
Identify typical demographic characteristics of persons who get these injuries; and
Document the consequences of these injuries.

Method

The initial design of the study was to use data from the Model Systems database to identify all persons whose spinal cord injury was the result of a diving mishap. Individuals included in this study were only those treated at a currently funded Model System since 1973 and presumed alive. However, the Model System database does not contain information on the location of the diving accident.

The next step was to review the medical records of each person injured in a diving mishap to learn if the injury occurred in a swimming pool. Researchers then contacted by phone those individuals whose medical records indicated the injury occurred in a swimming pool and those where the location of the accident was not recorded. The research staff gave those whose spinal cord injury occurred in a swimming pool a 21 item multiple choice questionnaire.

Results

The study identified 1106 persons injured in a diving accident.

631 were injured in a natural aquatic environment (river, lake, ocean)

341 were injured in swimming pools. Records for 134 injuries did not give the location.

Of the 341 persons injured in swimming pools, complete survey information was obtained for 196 or 57.5% of the persons.

The data collected provided information on some of the circumstances surrounding these injuries.

Type of pool - 64% of injuries occurred in below-ground swimming pools. 36% occurred in above-ground pools. The majority of injuries occurred in private residential swimming pools. Only 8% occurred in public pools and only 4% at country or swimming clubs.
Water depth - The majority of injuries occurred in shallow water of 4 feet or less. Very few injuries occurred in water depths greater than 8 feet.
Knowledge of the Pool - The injury occurred during the person's first visit to that pool in 44% of the cases. In 28% of the cases, the injury occurred on the personþs first dive into that pool.
Type of Dive - Approximately 70% of injuries occurred as a result of an ordinary dive. Unusual dives accounted for almost 17% of injuries. Unintentional pushes accounted for 6% of injuries.
Event at the Pool - Almost half of these injuries occurred during a party. Respondents admitted that alcohol was involved in almost half of these injuries, however, drugs were rarely involved.

Consequences of a Spinal Cord Injury

All injuries occurred in the cervical region, with the usual level between C4 and C6. Over half were neurologically complete, with only 4% long term ventilator dependent. Other associated injuries, such as head injury, hemo/pneumothorax, and other broken bones were rare.

The hospital charges excluding physician fees in 1994 dollars averaged $192,414 for the initial stay for acute care and rehab.

Missing Safety Measures

The following conditions existed at the locations of the accident:

No warning signs posted in 87% of cases.
No water depth indicators present in 75% of cases.
No lifeguard on duty in 94% of cases.
Dives generally occurred from the side of the pool rather than a diving board or other diving device.
No artificial lighting available in 53% of cases. When lights turned on, the amount of light provided was inadequate in about half of the cases.

Other statistics collected in the study were age; sex; race; marital status; employment; and education.

Pool Rules

. . . .for Users

Be familiar with the pool where you swim.

Know the water depth in the pool before you dive.

Avoid drinking alcohol when swimming or diving.

Do not swim or dive in pools that are poorly lit.

Do not swim alone.

Know proper diving techniques.

. . . for Owners

Have adequate fencing to keep people away from the pool when you are not there to supervise.

Provide adequate lighting when the pool is being used.

Have supervision or a lifeguard present, particularly during parties.

Clearly mark the depth of the pool.

Avoid serving alcohol to those who are using the pool

For additional information about this project, contact Michael DeVivo, DrPH, Dept. of Physical Medicine and Rehabilitation, UAB, Birmingham, AL, 35233-7330 or call (205) 934-5359.

c 1997. Board of Trustees of the University of Alabama
For permission to reprint for further distribution contact the SPINALCORD Information Manager.
This publication is supported in part by a grant (#H133B80012) from the National Institute on Disability and Rehabilitation Research, Dept of Education, Washington, D.C. 20202. Opinions expressed in this document are not necessarily those of the granting agency.