292
Injury, 7, 292-294
Hang gliding injuries A preliminary report M. Bell A ccident Service, L utah and Dunstable Hospital Summary Six cases of injury associated with hang gliding are reported. The history and technique of the sport are briefly described. Fractures of the spine and limbs are the commonest injuries encountered in this highrisk activity and many of them could be avoided or reduced in severity by simple safety precautions.
INTRODUCTION HANG GLIDING injuries are at present u n c o m m o n in this c o u n t r y . However, this is a highLrisk sport, as is s h o w n by Krissoff a n d E i s e m a n ' s r e p o r t (1975) o f 4 fatal accidents in the U S A . H a n g gliding is rapidly growing in p o p u l a r i t y in G r e a t Britain a n d so, too, will the n u m b e r o f injuries associated with this pastime. Six patients with n o n - f a t a l h a n g gliding injuries are reported, followed b y a b r i e f description o f the history o f the sport, its t e c h n i q u e a n d the i m p o r t a n c e o f simple safety precautions.
CASE REPORTS Case I A 36-year-old man, a novice at hang gliding, was landing at normal speed in ideal wind conditions when he tripped and struck his left elbow against a tree stump. He sustained a transverse supracondylar fracture of the left humerus. It was reduced under general anaesthesia and immobilized in plaster for 6 weeks. Movement was slowly regained over the following 6 months. Case 2 A 22-year-old man, on his first flight in ideal wind conditions, stalled the craft at 50 ft, possibly from misuse of the control bar, and crashed. He was unconscious for several minutes and received softtissue injuries to the face and a fractured nose. He also sustained fractures of the left lateral maUeolus
and right 2nd and 5th metatarsals, his footwear being light desert boots. His main injury, however, consisted of a fracture-dislocation involving the 12th thoracic and 1st lumbar vertebrae with paraplegia and urinary retention. On admission there was loss of all voluntary movement in the legs, loss of anal and leg reflexes and sensory loss below the 2nd lumbar dermatomes. He was treated conservatively and 10 weeks following injury showed some recovery of voluntary movement in both quadriceps, but with autonomous bladder function. Case 3 A 28-year-old hang gliding pilot with 18 months experience stalled his glider at 30 ft and crashed. Winds were gusting at about 28 mph making any form of hang gliding hazardous. His injuries, apart from mild concussion and some damage to the incisor teeth, consisted of wedge compression fractures of the 6th and 7th cervical vertebrae. On admission he had bilateral weakness of the triceps, wrist extensors and interossei, more marked in the left arm, and loss of reflexes. There were no neurological signs in the legs though the abdominal reflexes were absent. There was sensory loss affecting light touch, temperature and pain sensation over an area from the 6th cervical to the l l t h thoracic dermatomes on both sides. He also had urinary retention though bladder function recovered after 10 days' intermittent catheterization. He was treated with skull traction for 8 weeks, and over this time motor and sensory function slowly returned to normal. Case 4 This patient was a 28-year-old man, a novice, who made a forced landing on his right leg and incurred an open comminuted fracture of the mid shaft of the right tibia and fibula. This was treated with skeletal traction for 4 weeks, followed by a further 16 weeks of plaster immobilization. At the end of this period radiological union of the fracture was established.
Bell: Hang Gliding Injuries Case 5
A 27-year-old man, a novice, stalled his glider and crashed, sustaining crush fractures of the 12th thoracic and 1st lumbar vertebrae without neurological damage. He developed a post-traumatic ileus that was treated conservatively and was discharged from hospital after 8 days. At out-patient review 1 month later, he was virtually symptom-free with full back movements. Case 6
A 37-year-old man, a novice, fell out of his glider before landing and sustained a displaced Colles' fracture of the left wrist. This required reduction followed by plaster immobilization for 6 weeks. He made an uneventful recovery from his injury.
H I S T O R Y OF THE SPORT The concept of hang gliding dates back to sketches made by Leonardo da Vinci in the sixteenth century (Jarrett and Kent, 1974). Towards the end of the nineteenth century, the work of Otto Lilienthal, who built a variety of hang gliders, is a landmark in aeronautics; but it was the development in the 1950s of the triangular sailwing by an American, Dr Francis M. Rogallo, originally for the recovery of spacecraft, that provided the impetus to the sport of hang gliding. The standard Rogallo aircraft with its derivations, remains the most popular machine amongst British gliders (James, 1974) though a variety of rigid-wing craft have been built. The sport developed in Southern California and the mountains of Colorado, and an estimated 38,000 people now participate in hang gliding in 17 countries throughout the world (Editorial, Flight International, 1975). The sport grew rapidly in Britain in 1974 and is now organized under the auspices of the British Hang Gliding Association, which has at present approximately 2300 members, and the Scottish Sailwing Association.
T E C H N I Q U E OF THE SPORT The standard Rogallo machine consists of a triangular sail made of nylon or resin-bonded terylene sailcloth supported by an aluminium tubular frame. Below the sail is fixed a triangular bar that enables the pilot to control the movements of the glider. The pilot is suspended by a harness and seat and may sit or lie prone. Takeoff requires a gradient, a suitable wind and a run-up, most gliders requiring a take-off speed of 16 mph (James, 1974). Pushing forwards on the control bar lifts the nose and enables the glider to become airborne. Once airborne the movement of the craft is controlled by swinging the lower limbs, or body, in the direction required. To land, the pilot flies the glider a/most parallel
293
to the ground, moving his weight backwards to reduce speed,, and lands feet first.
ACCIDENTS Accidents may be due to a variety of causes, such as human error, technical faults in the machine, adverse conditions, air turbulence, and hazards of terrain. One fatal hang gliding accident in the United Kingdom was reported in the press in 1974 and 3 more in 1975. In non-fatal accidents, the above series of 6 cases reveals spinal and limb fractures to be the 2 most common forms of injury, and this pattern is confirmed by the cases of Krissoff and Eiseman (1975), three-quarters of which were in one of these two categories.
DISCUSSION There are a number of factors which may effect the safety of this sport: 1. Fitness of the pilot. The sport should be restricted to those who are physically and mentally fit and a medical examination is advised before taking part in this activity. Physical fitness is obviously important in a sport that entails pulling 30 lb or more of glider up steep slopes several times a day. 2. Experience. Both novices and experienced pilots are liable to injury, the novice by making technical errors, as in landing (Cases 1 and 4), or in use of the control bar (Case 2), and the experienced pilot by taking greater risks, such as gliding in a hazardous wind (Case 3). The sport is still in its infancy in this country and novices far outnumber experienced hang gliders. The development of responsible clubs with adequate supervision of beginners is essential to the healthy growth of the sport. To crash on one's maiden flight, with subsequent paraplegia, is indeed a tragedy (Case 2). 3. Protective clothing. A crash helmet should always be worn, and overalls, stout ankle boots, shin pads and gloves are recommended to lessen the risks of limb fractures. 4. Glider. The British Hang Glider Manufacturers' Federation have introduced safety standards for Rogallo craft. 5. Terrain. The site should be carefully chosen. The danger of tree stumps and ground obstacles is illustrated by Case 1. 6. Wind. Suitable winds are vital and the use of a wind gauge is advised. Wind speeds of over 20 mph make gliding hazardous (James, 1974), as illustrated by Case 3. 7. Air speed and height indicators are recommended since the estimation of these factors when airborne may be difficult and deceptive.
294
Injury : the British Journal of Accident Surgery Vol. 7/No. 4
In conclusion, hang gliding is a dangerous sport and strict standards of safety must be maintained in order to prevent serious injuries such as those described above.
Acknowledgements I should like to thank the Consultants of the L u t o n and Dunstable Hospital, and D r J. Silver of the N a t i o n a l Spinal Injuries Centre, Stoke
Mandeville Hospital, for permission to publish details of patients under their care. REFERENCES
EDITORIAL(1975) Flight International 17 July, 77. JAMES J. (1974) Free Flight Hang Gliding. West Wickham, Free Flight Publications, p. 17. JARRETT P. and KENT D. (1974) Hang gliding--the new sport. Flight International 9 May, 593. KRISSOFF W. B. and EISEMAN B. (1975) Injuries associated with hang gliding. J A M A 233, 158.
Requests for reprints should be addressed to: Mr M. Bell, FRCS, 70 Winterbourne Road, Abingdon, Oxon.
EMERGENCY MEDICAL SYSTEMS--TWO COURSES IN ADMINISTRATION
The Center for the Study of Emergency Health Services, University of Pennsylvania, will offer two intensive courses in emergency medical services systems administration. The courses are specifically designed for incumbent administrations who oversee the co-ordination of an emergency services system or some aspect of systems operation. The courses focus upon planning and evaluation. Courses are scheduled for the summer of 1976 and will be repeated in the autumn. Planning: Evaluation: Planning: Evaluation:
28 26 27 8
June-2 July July-30 July September-1 October November-12 November
For more detailed information please contact Martha Ledger, Educational Programs Co-ordinator, Center for the Study of Emergency Health Services, 4219 Chester Avenue, Philadelphia, Pennsylvania.
Injury, 7, 292-294
Hang gliding injuries A preliminary report M. Bell A ccident Service, L utah and Dunstable Hospital Summary Six cases of injury associated with hang gliding are reported. The history and technique of the sport are briefly described. Fractures of the spine and limbs are the commonest injuries encountered in this highrisk activity and many of them could be avoided or reduced in severity by simple safety precautions.
INTRODUCTION HANG GLIDING injuries are at present u n c o m m o n in this c o u n t r y . However, this is a highLrisk sport, as is s h o w n by Krissoff a n d E i s e m a n ' s r e p o r t (1975) o f 4 fatal accidents in the U S A . H a n g gliding is rapidly growing in p o p u l a r i t y in G r e a t Britain a n d so, too, will the n u m b e r o f injuries associated with this pastime. Six patients with n o n - f a t a l h a n g gliding injuries are reported, followed b y a b r i e f description o f the history o f the sport, its t e c h n i q u e a n d the i m p o r t a n c e o f simple safety precautions.
CASE REPORTS Case I A 36-year-old man, a novice at hang gliding, was landing at normal speed in ideal wind conditions when he tripped and struck his left elbow against a tree stump. He sustained a transverse supracondylar fracture of the left humerus. It was reduced under general anaesthesia and immobilized in plaster for 6 weeks. Movement was slowly regained over the following 6 months. Case 2 A 22-year-old man, on his first flight in ideal wind conditions, stalled the craft at 50 ft, possibly from misuse of the control bar, and crashed. He was unconscious for several minutes and received softtissue injuries to the face and a fractured nose. He also sustained fractures of the left lateral maUeolus
and right 2nd and 5th metatarsals, his footwear being light desert boots. His main injury, however, consisted of a fracture-dislocation involving the 12th thoracic and 1st lumbar vertebrae with paraplegia and urinary retention. On admission there was loss of all voluntary movement in the legs, loss of anal and leg reflexes and sensory loss below the 2nd lumbar dermatomes. He was treated conservatively and 10 weeks following injury showed some recovery of voluntary movement in both quadriceps, but with autonomous bladder function. Case 3 A 28-year-old hang gliding pilot with 18 months experience stalled his glider at 30 ft and crashed. Winds were gusting at about 28 mph making any form of hang gliding hazardous. His injuries, apart from mild concussion and some damage to the incisor teeth, consisted of wedge compression fractures of the 6th and 7th cervical vertebrae. On admission he had bilateral weakness of the triceps, wrist extensors and interossei, more marked in the left arm, and loss of reflexes. There were no neurological signs in the legs though the abdominal reflexes were absent. There was sensory loss affecting light touch, temperature and pain sensation over an area from the 6th cervical to the l l t h thoracic dermatomes on both sides. He also had urinary retention though bladder function recovered after 10 days' intermittent catheterization. He was treated with skull traction for 8 weeks, and over this time motor and sensory function slowly returned to normal. Case 4 This patient was a 28-year-old man, a novice, who made a forced landing on his right leg and incurred an open comminuted fracture of the mid shaft of the right tibia and fibula. This was treated with skeletal traction for 4 weeks, followed by a further 16 weeks of plaster immobilization. At the end of this period radiological union of the fracture was established.
Bell: Hang Gliding Injuries Case 5
A 27-year-old man, a novice, stalled his glider and crashed, sustaining crush fractures of the 12th thoracic and 1st lumbar vertebrae without neurological damage. He developed a post-traumatic ileus that was treated conservatively and was discharged from hospital after 8 days. At out-patient review 1 month later, he was virtually symptom-free with full back movements. Case 6
A 37-year-old man, a novice, fell out of his glider before landing and sustained a displaced Colles' fracture of the left wrist. This required reduction followed by plaster immobilization for 6 weeks. He made an uneventful recovery from his injury.
H I S T O R Y OF THE SPORT The concept of hang gliding dates back to sketches made by Leonardo da Vinci in the sixteenth century (Jarrett and Kent, 1974). Towards the end of the nineteenth century, the work of Otto Lilienthal, who built a variety of hang gliders, is a landmark in aeronautics; but it was the development in the 1950s of the triangular sailwing by an American, Dr Francis M. Rogallo, originally for the recovery of spacecraft, that provided the impetus to the sport of hang gliding. The standard Rogallo aircraft with its derivations, remains the most popular machine amongst British gliders (James, 1974) though a variety of rigid-wing craft have been built. The sport developed in Southern California and the mountains of Colorado, and an estimated 38,000 people now participate in hang gliding in 17 countries throughout the world (Editorial, Flight International, 1975). The sport grew rapidly in Britain in 1974 and is now organized under the auspices of the British Hang Gliding Association, which has at present approximately 2300 members, and the Scottish Sailwing Association.
T E C H N I Q U E OF THE SPORT The standard Rogallo machine consists of a triangular sail made of nylon or resin-bonded terylene sailcloth supported by an aluminium tubular frame. Below the sail is fixed a triangular bar that enables the pilot to control the movements of the glider. The pilot is suspended by a harness and seat and may sit or lie prone. Takeoff requires a gradient, a suitable wind and a run-up, most gliders requiring a take-off speed of 16 mph (James, 1974). Pushing forwards on the control bar lifts the nose and enables the glider to become airborne. Once airborne the movement of the craft is controlled by swinging the lower limbs, or body, in the direction required. To land, the pilot flies the glider a/most parallel
293
to the ground, moving his weight backwards to reduce speed,, and lands feet first.
ACCIDENTS Accidents may be due to a variety of causes, such as human error, technical faults in the machine, adverse conditions, air turbulence, and hazards of terrain. One fatal hang gliding accident in the United Kingdom was reported in the press in 1974 and 3 more in 1975. In non-fatal accidents, the above series of 6 cases reveals spinal and limb fractures to be the 2 most common forms of injury, and this pattern is confirmed by the cases of Krissoff and Eiseman (1975), three-quarters of which were in one of these two categories.
DISCUSSION There are a number of factors which may effect the safety of this sport: 1. Fitness of the pilot. The sport should be restricted to those who are physically and mentally fit and a medical examination is advised before taking part in this activity. Physical fitness is obviously important in a sport that entails pulling 30 lb or more of glider up steep slopes several times a day. 2. Experience. Both novices and experienced pilots are liable to injury, the novice by making technical errors, as in landing (Cases 1 and 4), or in use of the control bar (Case 2), and the experienced pilot by taking greater risks, such as gliding in a hazardous wind (Case 3). The sport is still in its infancy in this country and novices far outnumber experienced hang gliders. The development of responsible clubs with adequate supervision of beginners is essential to the healthy growth of the sport. To crash on one's maiden flight, with subsequent paraplegia, is indeed a tragedy (Case 2). 3. Protective clothing. A crash helmet should always be worn, and overalls, stout ankle boots, shin pads and gloves are recommended to lessen the risks of limb fractures. 4. Glider. The British Hang Glider Manufacturers' Federation have introduced safety standards for Rogallo craft. 5. Terrain. The site should be carefully chosen. The danger of tree stumps and ground obstacles is illustrated by Case 1. 6. Wind. Suitable winds are vital and the use of a wind gauge is advised. Wind speeds of over 20 mph make gliding hazardous (James, 1974), as illustrated by Case 3. 7. Air speed and height indicators are recommended since the estimation of these factors when airborne may be difficult and deceptive.
294
Injury : the British Journal of Accident Surgery Vol. 7/No. 4
In conclusion, hang gliding is a dangerous sport and strict standards of safety must be maintained in order to prevent serious injuries such as those described above.
Acknowledgements I should like to thank the Consultants of the L u t o n and Dunstable Hospital, and D r J. Silver of the N a t i o n a l Spinal Injuries Centre, Stoke
Mandeville Hospital, for permission to publish details of patients under their care. REFERENCES
EDITORIAL(1975) Flight International 17 July, 77. JAMES J. (1974) Free Flight Hang Gliding. West Wickham, Free Flight Publications, p. 17. JARRETT P. and KENT D. (1974) Hang gliding--the new sport. Flight International 9 May, 593. KRISSOFF W. B. and EISEMAN B. (1975) Injuries associated with hang gliding. J A M A 233, 158.
Requests for reprints should be addressed to: Mr M. Bell, FRCS, 70 Winterbourne Road, Abingdon, Oxon.
EMERGENCY MEDICAL SYSTEMS--TWO COURSES IN ADMINISTRATION
The Center for the Study of Emergency Health Services, University of Pennsylvania, will offer two intensive courses in emergency medical services systems administration. The courses are specifically designed for incumbent administrations who oversee the co-ordination of an emergency services system or some aspect of systems operation. The courses focus upon planning and evaluation. Courses are scheduled for the summer of 1976 and will be repeated in the autumn. Planning: Evaluation: Planning: Evaluation:
28 26 27 8
June-2 July July-30 July September-1 October November-12 November
For more detailed information please contact Martha Ledger, Educational Programs Co-ordinator, Center for the Study of Emergency Health Services, 4219 Chester Avenue, Philadelphia, Pennsylvania.
