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Original Article
Retrospective Study of Injuries in Military Parachuting
D Dhar*
Abstract
Background: This paper analyses the rate and patterns of parachuting injuries at the Sultans Oman Parachute Unit (SOPRA) in
Oman.
Methods: Data on 150 patients referred to Rustaq Regional Referral Hospital was collected and analysed. The injuries were
defined as severe (fractures, dislocation, head trauma) or minor (contusion, bruises, sprains).
Result: The rate of severe injuries was 9% and ankle fractures were the commonest. The minor injury rate was 13.5%. The injury
rate increased in relation to age (p < 0.001). The type and possible mechanisms of injury are discussed with the recommendation
for reducing the injury rates.
Conclusion: We conclude that our data compares favourably with other studies except for higher incidence of severe injuries.
MJAFI 2007; 63 : 353-355
Key Words : Parachute; Paratrooper; Parachuting injuries
Introduction
arachuting as a sport or military exercise is
regarded as one of the most challenging and
demanding effort which require high degree of mental
and physical fitness. Literature shows injury rates
between 2-20 injuries per 1000 jumps [1-8]. Military
parachuting involves everything from training jumps over
flat terrain in daylight to tactical jumps with combat
equipment over unknown terrain at night. Hallel et al
[2], found a corresponding variation in injury rates from
2.2 injuries per 1000 jumps for easiest to 25.7 injuries
per 1000 jumps for the most difficult jumping conditions.
Similar observations were reported by Farrow [3].
The purpose of this study was to obtain a profile of
the injuries and risk factors for paratroopers from Gulf
region and compare them with those of other western
studies.
P
Material and Methods
This is a case study conducted at Rustaq Hospital (Referral
Hospital for South Batinah Region), Oman. All paratroopers
referred for parachute related injuries from local and military
unit even after days of injury were classified as having
sustained parachuting injury.
Internationally, paratrooper injury rate is defined as
“number of injuries related to paratrooping per 1000 jumps”
[1,4]. Injuries were classified depending on the site, type and
severity. Parachute injuries were also studied in relation to
age, experience (number of previous jumps) and cause of
accidents as narrated by injured paratrooper.
A total of 150 cases were retrospectively analysed from
the medical records of all patients treated in Rustaq Hospital
with parachute related injuries in the last seven years. Patients
were categorized in two groups. First group consisted of
those with severe injuries (fractures, dislocations, head injury,
spinal and visceral injuries) and second group with minor
injuries (contusion, sprains, bruising). The data is presented
as percentage and statistically evaluated.
Results
Out of 150 patients, 99 (66%) were treated as inpatients
and the hospitalisation period varied from 3 - 20 days (average
12.2 days). The time off work ranged from 4 -40 weeks. (average
20 weeks)
Majority (63.3%) of injured were in age group of 18-25
years (Table 1). Of the severely injured 63.6% patients were
in old age group as compared to 26.3% in younger age group,
which was statistically significant (Table 2).
Most (60%) of the injuries were contusion and sprains,
followed by fractures which accounted for 26.6 % cases.
Twelve paratroopers suffered varying degrees of spinal
injuries (Table 3). Most common sites of sprains were ankle
and knee and about 80% injuries were confined to lower limbs.
Forty paratroopers sustained fractures that included ankle,
calcaneum, lower leg, femur and pelvis (Table 4).
Hundred paratropers were jumping for the first time and
rest for second time and above. The incidence of severe
injuries was same in both groups (Table 5). There were 13.5 %
minor injuries as compared to 9% severe injuries per 1000
jumps (Table 6).
Improper landing accounted for 53.5% cases and no cause
could be ascertained in 51.5% cases. Improper parachute
handling or limb getting caught in parachute rope accounted
for 25% cases (Table 7).
Specialist in Orthopaedics, Department of Orthopaedics, Rustaq Hospital, South Batinah Region, Ministry of Health, Sultanate of Oman
Received : 05.09.2006; Accepted : 21.01.2007
354
Dhar
Table 1
Age of injured paratroopers (n=150)
Age (years)
Table 4
Type of fractures (n=40)
Number of cases
Percentage
Fracture type
Number of cases
Percentage
95
55
63.3
36.6
Ankle / Foot
Lower Leg
Hip / Femur
Pelvis
Upper Limb
14
10
5
8
3
35
25
12.5
20
7.5
18 - 25
26 - 35
Table 2
Severity of injuries related to age groups
Old (26-35 years)
Young (18-25 years)
Severe (%)
Minor (%)
Total
35 (63.6)
25 (26.3)
20 (36.4)
70 (73.7)
55
95
60
90
150
Total
Table 5
Injury severity and experience
Number of previous jumps Severe (%)
Total
60 (60)
30 (60)
100
50
χ2 value = 20.2 ; p = < 0.001
First time
Second time and above
Table 3
Type of injuries (n=150)
Table 6
Parachute injury rate (number of injuries per 1000 jumps)
Injury
Fractures
Head injuries
Abdomen / Thorax
Contusion /Sprains
Spinal injuries
Number of cases
Percentage
40
5
3
90
12
26.7
3.3
2
60
8
Injury type
Minor injuries
Severe injuries
40 (40)
20 (40)
Minor (%)
Number
Rate
90
60
13.5
9
Table 7
Cause of parachuting injuries
Main cause
Discussion
All military paratroopers are selected after vigorous
physical and medical examination in contrast to a
candidate for recreational parachuting who is expected
to have only reasonable physical fitness.
Military parachuting involves upto four weeks of
training, culminating in eight qualifying jumps in the last
week, as compared to recreational parachuting where
landing techniques involve practice jumps from two and
four feet high platform over a weekend course lasting
for eight to twelve hours [5,6].
Our definition of severe injury corresponds to that of
Ekeland [4] ("fractures and knee ligament ruptures were
defined as severe injuries") and that of moderate and
severe injury in the study of Hallel et al [2] ("all ligament
injuries were labelled as moderate injuries and fractures
as severe injuries"). The severe injury rate of 9% in our
study was higher as compared to that for military
parachuting in other series. Tobin et al [1] , reported an
incidence of 2.4%, Hallel et al [2], 0.62%, Ekeland [4]
1.6%, Bar-Dayan [7] 0.89%, and Essex-Lopresti [8]
2.1%. Higher injury rates in our series may be caused
by jumping induced stress or lack of jumping experience.
Lord et al [9], stated statistically, any parachutist had
only 1% chance of being injured in any one descent.
The overall admission rate of 66% in our series was
higher than that reported in other studies. Tobin et al [1]
reported rates of 25% while Essex-Lopresti [8] recorded
24%. The admission rate however was lower as
Improper jumps from aircraft
Improper landing
Rough landing terrain
Windy weather
Improper parachute handling
Exact cause could not be ascertained
Number of cases
3
53
10
8
25
51
compared to civilian admission rate of 81.8% as reported
by Amamilo et al [6].
In our series we found an increase in severe injury
rate in older age group of paratropers (Table 2) which
is in agreement with other studies [1-3,5,6], probably
due to greater elasticity of tissues in young people to
absorb impacts.
Majority (60%) of injuries in our series were minor
injuries in form of contusions and sprains followed by
severe injuries (26.7%). Ankle and foot were the most
vulnerable site of injury accounting for 35% fractures.
These rates are comparable to those of Hallel et al [2],
who reported 35.6% severe injuries but lower incidence
of sprain 17.8%. In contrast most (65.8% ) of the civilian
injuries reported by Steinberg and Amamilo [5,6], were
severe probably due to lack of jumping experience. The
injury rates were same for the first jumps and
subsequent jumps (Table 5). Ekeland [4] observed that
increasing number of jumps did not protect against injury.
This may be due to increasing exposure time to risk of
jumping.
Most (53%) of the injuries occurred during landing
MJAFI, Vol. 63, No. 4, 2007
Retrospective Study of Injuries in Military Parachuting
(Table 6). Essex-Lopresti [8] remarked “that the
euphoria accompanying the glorious sense of isolation
whilst floating down is tempered by anticipation of the
technical difficulties of meeting the ground. During the
last 50 feet, the ground rushes up at an increasing speed
and at an angle due to horizontal drift. Quick thinking
and determined efforts are necessary to make a correct
and safe landing, a challenge to a beginner”. Interview
of the injured parachutists yielded five probable causes
of injuries (Table 7) and improper landing was the
commonest cause. There were increased injuries during
night jumps probably due to poor visibility and mental
fatigue after a full day’s training.
Findings from our study suggest that more time during
training should be devoted to demonstrating landing
techniques.Simplification of parachute landing fall and
development of safer parachutes will help reduce
casualties [10] and make parachuting a safer means of
conveyance [11]. Other factors such as high wind speed,
presence of obstacles in the landing zone, jumps wearing
additional equipment and without ankle braces are risk
factors relevant to all parachutists.
Acknowledgement
The contribution of Dr. PJ Kurup in statistical analysis of
data is gratefully acknowledged.
355
Conflicts of Interest
None identified
References
1. Tobin WJ, Cohen LJ, Vandover JT. Parachute Injuries. JAMA
1941; 117:1318-21.
2. Hallel T, Naggan L. Parachuting Injuries : A retrospective study
of 83818 jumps. J Trauma 1975; 15:14-9.
3. Farrow GB. Military Static Line Parachute Injuries. Aust NZ
J Surg 1992; 62:209-10.
4. Ekeland A. Injuries in Military Parachuting a prospective study
of 4499 jumps. Injury 1997; 28:219-22.
5. Steinberg PJ. Injuries to Dutch Sport Parachutists. Br J Sports
Med 1988; 22:25-6.
6. Amamilo SC, Samuel AW, Hes Keth KT, Moynihan FJA.
Prospective study of Parachute Injuries in Civilians. J Bone
Joint Surgery (Br) 1987; 69: 17-9.
7. Bar-Dayan Y, Shemer J. Parachuting Injuries: A retrospective
study of 43,542 military jumps. Mil Med 1998; 163: 1-2.
8. Essex-Lopresti P. The hazards of parachuting. Br J Surg 1946;
34:1-13.
9. Lord CD, Coutts JW. Typical parachute injuries: Study of
those occurring in 250,000 jumps at the Parachute School.
JAMA 1944; 125: 1182-7.
10. Knapik JJ, Craig SC, Hawret KG, Jones BH. Risk Factors for
Injuries During Military Parachuting. ASEM 2003; 74: 76874.
11. Keil FW. Hazards of Military Parachuting. Mil Med 1965;
130:512-21.
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MJAFI, Vol. 63, No. 4, 2007
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