Aetiology and occurrence of diving injuries. A review of diving safety.

This paper examines multifaceted aspects of diving entries into water which are the cause of many critical injuries (costed at $A150 million) and therefore have important safety ramifications. Wedge and compression fractures are most commonly found in the cervical area of the spine with off-centre impacts with the pool or sea bottom. Diving-related injuries range from 2.3 in a South African study to 21% of spinal cord injuries in Poland. Alcohol and diving do not mix because of diminished awareness and information processing. Children aged under 13 years suffer fewer cervical injuries (1 to 4%), but complication rates are relatively high for this group. Sports trauma (diving-related in particular) is one of the more prevalent causes of spinal cord injury in children aged 6 to 15 years. The highest incidence occurs among those aged 10 to 14, followed by the group aged 5 to 9 years. This contradicts the common perception that 15-to 19-year-olds comprise the highest risk group. Boys are more frequently injured, and swimming pools are more common as an injury location then is the case with adults. The role played by water depth has been conclusively ascertained; technique, and therefore education, appear to be more important considerations in injury prevention. Although 89% of injuries occur in water < 1.52m, injuries are rare in water of 0.46 to 0.61m. Care with pool design to avoid sudden depth changes and the resultant "spinal wall' is necessary. Minimum depth values for diving vary from 1 to 1.52 m. Velocities and angles of entry are considered to ascertain the body's decelerative capacity upon entry. The scoop, racing start dive has been shown to require at least 1.22 m of water even when practised by trained divers; the risks involved must therefore be weighed against the fact that it may be no faster than more conventional dives. While it may be safe to perform kneeling and crouching dives into shallowers water, standing dives by untrained divers require a greater margin of error. Lack of education is an issue which needs to be addressed and this paper makes recommendations for safety practices such as steering up to the surface, head protection with the arms and only diving when absolutely necessary.