LAD dissection following parachute belt trauma during BASE jumping

BASE Jumping in the Lauterbrunnen Valley: A Retrospective Cohort Study from 2007 to 2016

BACKGROUND

BASE jumping, and especially BASE jumping with the help of wingsuits, is considered one of the most dangerous airborne sports. The valley of Lauterbrunnen in Switzerland has become infamous for the large number of BASE jumps and the high rate of accidents and fatalities. The aim of this study was to evaluate the morbidity and mortality of BASE jumping, to determine the severity of injuries and injury patterns of BASE jumping accidents and to compare preclinical assessment with clinical diagnoses to detect under- or overtriage.

METHODS

This retrospective, descriptive cohort study covers a period of 10 years (2007-2016). The evaluation covered all BASE jumping incidents in the valley of Lauterbrunnen that required either a helicopter mission by the local HEMS (Helicopter Emergency Medical Service) company of Lauterbrunnen, Air Glaciers, or medical care in the regional hospital, the level I trauma centre or the medical practice of the local general practitioner. Besides demographic data, experience in BASE jumping and skydiving as well as BASE jumping technique(s) and details about the rescue missions were collected. The medical data focused on the severity of injuries, as expressed by the National Advisory Committee of Aeronautics (NACA) score in the prehospital assessment as well as the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) retrieved from the clinical records in the hospital or medical practice setting.

RESULTS

The patients were predominantly young, experienced male BASE jumpers. Morbidity (injury risk) ranged from 0.05% to 0.2%, and fatality risk from 0.02% to 0.08%. Undertriage was low, with only two cases. Overtriage was significant, with 73.2% of all NACA 4-6 cases not qualifying for major trauma.

CONCLUSIONS

BASE jumping remains a high-risk sport and is associated with significant rates of injuries and fatalities. Comparison with previous studies indicated that the injury rate may have decreased, but the fatality rate had not. In this known BASE jumping environment, prehospital assessment appears to be good, as we found a low undertriage rate. The high overtriage rate might be an expression of physicians' awareness of high-velocity trauma mechanisms and possible deceleration injuries.

Parachute Deaths in Southern Arizona

Introduction

Parachuting is said to be a relatively safe activity. We sought to undertake a study to assess parachute-related deaths in our jurisdiction.

Methods

A retrospective study of parachute-related deaths in Southern Arizona was conducted by searching the Pima County Office of the Medical Examiner database between 2001 and 2016. This search revealed 24 deaths.

Results

The decedents ranged from 19 to 61 years of age, with a median age of 36 years. Twenty-two of the decedents were male. The racial breakdown was 22 white, one Asian, and one not recorded. The manner of death in all cases was classified as an accident. All deaths were due to multiple blunt force injuries and only one case was found to have no injuries to the head or neck. The most common circumstances were failure of chute deployment (seven), mid-air collisions (three), and becoming entangled with other parachutists (three). Six deaths occurred during military training. Four of the nonmilitary decedents were described as "experienced" parachutists and one case involved a tandem jump team with a survivor. Natural disease was found in four cases with three having moderate coronary artery atherosclerosis. Toxicology was performed in 21 of the deaths with three positive for cannabinoids, one positive for 7-aminoclonazepam, and one positive for 3, 4-methylenedioxymethamphetamine (MDMA).

Discussion

Parachuting is a relatively safe activity, with very few deaths. Investigation of these deaths should include a complete autopsy with toxicology as well as a thorough scene investigation and evaluation of the jumper's equipment.

Traumatic Coronary Dissection: Case Presentation and Literature Review

In posttraumatic coronary dissection, a small intimal tear occurs due to the sudden compression of the thoracic wall during the chest trauma, this being sometimes fatal. We present the case of a 56-year-old truck driver with chest trauma after a car crash. The 12-lead ECG showed signs suggestive of an acute anterior myocardial infarction, and the coronary angiography confirmed an arterial dissection of the left anterior descending coronary artery. A stent was inserted the same day, and the patient was treated accordingly. He survived for a total of three days. The autopsy and histological examination confirmed the MI and the coronary dissection. The chest trauma was linked to the patient’s death. The literature review reveals 46 cases in which the most frequent cause of chest trauma was a car or motorcycle accident; also, young male subjects were more frequently involved. Stent placement was the main course of treatment, and a delay in the onset of symptoms was also frequent.