Research Summary: Waterslide Safety

RESEARCH

This is a meta-analysis of 18 original studies on waterslide injuries in commercial and residential swimming pool environments between 1986 and 2021. Articles are presented in order of recency. 

 

Lee, K., Stanbouly, D. and Chuang, S. 2021. Are backyard waterslides as dangerous as public waterslides. A review of 1,823 head and neck injuries. The Journal of Craniofacial Surgery. 32(4), pp.1589-1591. 

A 20-year cross-sectional study of the US National Electronic Injury Surveillance System. 1,823 injury reports involving waterslides were reported. 725 (39.8%) occurred on backyard waterslides, and 1,098 (60.2%) occurred on public waterslides. Most patients were white (74.2%) and male (55.1%). The most common diagnosis was laceration (28.4%) and internal organ injury (27.2%). A greater proportion of backyard injuries involved the head and resulted in concussion or fractures. No fatalities were noted. Approximately 75% of cases involved injury to the head and face. Series head and neck injuries appear to be uncommon in cases involving waterslides. 

A waterslide is a recreational chute that uses water to reduce friction and increase the rider's travelling velocity.

 

Fletcher, C. and Fletcher, K. 2020. A water slide accident resulting in an open book pelvic injury and subsequent pulmonary embolus. A case report. Case Reports in Orthopedic Research. 3, pp.88-93. 

This case involved a 46-year-old female who suffered an open-book pelvic injury. 

We theorise that it is technically difficult for a patient with large thighs to maintain an abducted position at high speeds and that the lower limbs likely externally rotated, in addition, to being abducted while hitting the pool with significant force. The patient's mass, in combination with the high velocity, would account for the significant energy imparted to her by the water. Obese patrons who cannot cross their legs on rides or who lack the coordination to control their momentum during descent should avoid high-velocity thrill rides. The park should play an active role in warning patrons, especially where there is no universally agreed weight limit. 

 

Woodcock, K. 2019. Global incidence of theme park and amusement ride accidents. Safety Science. 113, pp.171-179. 

65 incidents were recorded as taking place in waterparks; 43 within swimming pools, and 22 on waterslides. 26 (60%) of 27 incidents involving submersion occurred in swimming pools. 7 (32%) of 22 waterslide incidents occurred in the landing area. Rider error accounted for 4 (18%) of 22 waterslide cases. A failure to clear the landing area accounted for 3 (14%) of 22 waterslide cases. Waterslide malfunction was rare, accounting for only 3 (5%) of waterpark cases. 

 

Alboudi, A., Sarathchandran, P. and Geblawi, S. 2018. Delayed presentation of neck arteries dissection, caused by water slide activity. BMJ Case Reports. 11, pp.1-5. 

Swimming, scuba diving and springboard diving have all been reported as water activities that can present cervical arteries dissection. The proposed mechanism of injury is the hyper-extension, hyperflexion and rotation of the neck, thought to be caused by impact with the water. Two patients were diagnosed with cervical artery dissection with delayed onset. A 16-year-old Korean boy and rider on a waterslide 12 days earlier. The second case was a 52-year-old Indian man who was a rider on a waterslide 3 hours earlier. 

 

Jennissen, C., Koos, M. and Denning, G. 2018. Playground slide-related injuries in preschool children. Increased risk of lower extremity injuries when riding on laps. Injury Epidemiology. 5(1), pp.11-21. 

A review of 7,448 slide-related incidents. In 379 cases, the child was confirmed as sitting on the parent's lap when descending the slide, compared with 7,069 cases where the child's position was unconfirmed.  2,734 (23%) cases of injury to a lower extremity were recorded where the child rode the slide alone, compared with 597 (93%) cases where the child rode on a parent's lap. 98% of those who rode on a parent's lap were also reported as having injured another part of their body. 

Children under 3 years of age were more than 40 times more likely to have a lower extremity injury than to other body parts when riding on an adult's lap. Children under 3 years of age were more than 50 times more likely to have a lower leg/ankle fracture than fractures to other bones as compared to pre-school-age children. The percentage of children riding on an adult's lap who injured a lower extremity rose from 15% of 3-year-olds to 82% of children under the age of 1 year of age. This should be viewed in the context that many tibia fractures in young children are missed or not diagnosed on their first visit to the emergency department. 

 

Foye, P., Abdelshahed, D., Kamrava, E., Enriquez, R. and D'Onofrio, G. 2018. Tailbone pain from coccyx injuries on water slides. A case series. The Journal of Emergency Medicine. 55(2), pp.e33-e35. 

A 37-year-old man had no previous coccyx pain until going down a bumpy waterslide. The pain began two to three days after riding the waterslide. A 40-year-old woman with no previous coccyx pain jarred her tailbone whilst riding a waterslide when she briefly became separated before being forcefully returned to her seated position. A 30-year-old woman with no previous coccyx pain descended a 16-foot inflatable waterslide over twenty times before reporting coccyx pain. A 42-year-old woman with a history of coccyx pain rode a waterslide during a spell where her pain had subsided. The ride triggered a relapse in coccyx pain. 

 

Williamson, M., Vanacore, F. and Hing, C. 2018. Pubic symphysis diastasis sustained from a waterslide injury. Journal of Clinical Orthopaedics and Trauma. 95, pp.S32-S34. 

A 50-year-old female on holiday in a Jamcian holiday resort rode a jet-flow closed waterslide without a tube ring. As she exited, her legs caught the sides of the slide resulting in hyper-abduction of her hips as she landed in the pool. Four days later, on returning home to the UK, she presented with 2cm diastasis of the pubic symphysis. 

In the UK in 1998, there were approximately 300 facilities with waterslides. 

 

Akbas, Y., Arhan, E., Serdaroglu, A. and Nazhel, B. 2016. Intracranial internal carotid artery dissection following waterslide use. The first case report. Child's Nervous System. 32, pp.411-413. 

A five-year-old girl presented to the emergency department with carotid arterial dissection one day after riding a waterslide. The authors surmised that the sudden deceleration, acceleration, and rotational forces stretch and compress the ICA against the transverse or styloid processes resulting in dissection. 

 

Hokanson, E., Brauer, A., Hokanson, J., Eldridge, M. and Maginot, K. 2016. Heart rate and rhythm responses of healthy young adults to modern water slides. International Journal of Cardiology. 214, pp.426-427. 

2 men and 7 women aged 20-24 years were screened and took part in riding waterslides in a US waterpark. In 38 of 43 waterslide descents, the maximum heart rate was observed before going down the slide. Riders consistently achieved around 90% of the age-predicted maximum heart rate. No significant clinical arrhythmias were observed. 

 

Swischuk, L. 2015. Musculoskeletal. What's different in children? Fall from water park slide. Limping. Emergency Radiology. 22(1), pp.S19-S20. 

An 18-month-old female arrived at the emergency department having fallen off a waterslide earlier that day. The patient was diagnosed with a buckle fracture of the left tibia. 

 

Olympia, R., Brady, J., Rupp, V. and Lansenderfer, C. 2011. Emergency department visits from a local amusement park. The Journal of Emergency Medicine. 41(1), pp.14-20. 

A retrospective chart review at two emergency departments in Pennsylvania from 5 May - 24 September 2006. A total of 296 visits were included in the study. Only 33 were waterslide cases, 18% were extremity fractures, 18% were lacerations, 15% were extremity sprains, 15% were head injuries/concussions, and 6% were contusions. Only 15% of slip and trip cases occurred on water-related rides compared with 45% on walkways or in the car park. 

 

Soyuncu, S. Yigit, O., Eken, C., Bektas, F., Akcimen, M. 2009. Water park injuries. Turkish Journal of Trauma & Emergency Surgery. pp.500-504. 

This prospective observational study was carried out from May 2005 - September 2006 in a university hospital emergency department with around 50,000 annual visits. 73 patients were enrolled on the study. The mean age of the patients was 23.92±15.05. 48 patients were male, and 25 were female. 23 patients were injured on waterslides, 16 were injured in pools, and 34 were injured slipping and falling on wet surfaces. 13 of those injured suffered head injuries. 13 also suffered maxillofacial injuries. Sprains and strains were the most common (14 patients, 53.8%), followed by fractures (4 patients, 15.4%), lacerations (4 patients, 15.4%) and dislocations (4 patients, 15.4%). Spinal trauma was diagnosed in 15 of 73 patients (20.5%). Two patients died, one from head trauma and another from an electrical injury. 

15 patients (65%) were male, and 8 (35%) were female. The main mechanism of injury was hitting the pool floor or the opposite wall. Of the 23 patients with spinal trauma, only 6 occurred on waterslides. 

By 2006, there were more than 1,000 waterparks in North America and around 1,600 globally. Waterparks have become more common in Turkey between 1996-2006. 

 

Gurkanlar, D., Yucel, E. and Altinors, N. 2008. Clinical Journal of Sports Medicine. 18, pp.464-466. 

A series of four case reports from spinal injuries on waterslides in Turkey in 2007. Case report 1 involved a 31-year-old man who descended a waterslide headfirst, sustaining a C7 burst fracture and damage to his C6 and C7 intervertebral discs. Case report 2 involved a 26-year-old man who descended a waterslide headfirst, sustaining a C5 burst fracture and C4-5 posttraumatic intervertebral disc herniation. Case report 3 was of a 30-year-old man who descended a waterslide head first, sustaining a C6-7 posttraumatic intervertebral disc herniation and C7 hypoesthesia.  Case 4 was of a 47-year-old man who dived into shallow water sustaining C6-7 dislocation and C6-7 posttraumatic intervertebral disc herniation. 

 

Blitvich, J. and McElroy, G. 2007. Waterslide exit velocity, user behaviour and injury prevention. International Journal of Injury Control and Safety Promotion, 14(1), pp.54-56. 

A total of 267 waterslide descents were observed during a 30-minute, non-fee paying session. Exit velocity was measured using a radar gun. Lifeguards actively supervised the session but did not intervene to correct unsafe riding positions. 

Exit velocity ranged from 1.69 m/s to 5.63 m/s. 57% of riders remained in the recommended position throughout the descent. 25% of descents were head first; 19.5% laid on their front, and 6% laid on their back. 12 occasions where riders formed a chain to descend the waterslide. In the 90 minutes before the free session, there were only 84 descents. One collision occurred in the splashdown pool but did not result in injury. 

 

Bell, D. 1998. Some observations on waterslide injuries. Injury Prevention. 4, pp.225-227. 

A random sample of 250 rider descents of a 90-metre-long waterslide was observed. The waterslide used a traffic light control system for entry. 1% of descents presented a hazard of inter-person collision. 

 

Centre for Disease Control and Prevention. 1984. Injuries at a water slide - Washington. Morbidity and Mortality Weekly Report, 33(27), pp.379-382. 

Between 13 July - 31 August 1983, 65 persons who rode a waterslide in Washington sought medical attention, and 178 riders sought first aid treatment on-site. The rate of injury was 8.1 per 10,000 riders. 30 (66%) of the 46 riders interviewed were injured on their first or second descent of the waterslide. 

 

Davies, P. 1990. Water slide aquaplaning injury. British Medical Journal, 300, 1401. 

Mr P Davies descended a waterslide from an 18-metre height and gradient of 1 in 5 in a large rubber ring facing forwards. Upon landing, he aquaplaned straight across the splashdown pool and collided with the wall opposite, fracturing his right femur and an undisplaced fracture of the head of the right radius.  

 

Stevens, T. and Jenkins, I. 1990. Improving the safety of waterslides. Recommendations for their design and management in the UK. The Safety in Leisure Research Unit. pp.1-36. 

A survey of 136 slide operators operating 165 waterslides in the UK. A second survey with 1,600 waterslide user responses was also conducted. Incident rates vary between 1 in 10,000 to 1 in 20,000 descents. Injuries to the face and head accounted for 54% of injuries. 29% of injuries occurred in the landing area. Slipping was a cause of 24% of incidents. Slides of 6.9 m/s yielded twice as many accidents as those reaching 5.8 m/s.  Centres which reported more than 200 incidents on waterslides showed that 46% of incidents occurred on waterslides that use ride enhancement devices compared with only 15% of incidents occurring on waterslides where ride enhancement devices were not used. Slides where ride-enhancement devices were used generally achieved higher average and maximum speeds.  

Collision with the splashdown pool floor or its surround accounted for 41 (41%) of 98 incidents. 48 (71%) of 67 collision incidents occurred in the landing area. The rider stopping (19, 31%) or incorrect spacing (12, 19%) accounted for a significant proportion of incidents. 55 (33%) of 165 waterslides had a splashdown pool with a water depth of less than 1 metre. 86 (52%) of 165 had a splashdown pool with a water depth of 1-1.5 metres. 

 

Gordon, C. and Stevens, K. 1988. Waterslides - are safety standards sliding? Archives of Emergency Medicine, 5, pp.216-222. 

A study of 194 injuries involving two waterslides in the UK. 95% of injuries on Slide B were to the head and face. 54% of injuries on Slide A were to the lower limbs. 

In August 1986, Blackburn Borough Council closed a 200-foot waterslide after it was discovered a 15-foot section of the waterslide was causing people to flip over and injure themselves as they entered an S bend. Several similar incidents have led the UK Health and Safety Executive to call a working party together to look at the safe operation of swimming pools. The working group is expecting to publish its recommendations in 1986. 

 

Paulozzi, L., McKnight, B., and Marks, S. 1986. A cluster of injuries at a water slide in Washington state. American Journal of Public Health. 76, pp.284-285. 

 A waterslide is a stationary amusement ride that provides a descending ride on a flowing water film through a trough or tube into a splashdown pool. By 1986, there were at least 600 waterslides in the USA. In 1983, the CPSC stated that waterslides accounted for 30% of amusement ride injuries treated in emergency departments.

This case-control study was undertaken to identify risk factors for injury at a 110-metre-long waterslide in Washington State. Riders averaged 8.5 metres per second. Cases were interviewed and recorded between 12 July-31 August 1983. One friend control was identified in each case. Interviews were successfully completed for 46 of 65 cases and 46 controls. Of the injured riders, 16 (35%) were male, and 30 (65%) were female. Of the controls, 27 (60%) were male, and 18 (40%) were female. The age range of injured riders was 10-45 years and 9-44 years for controls. 

Cases involved 10 head lacerations, nine concussions, seven lumbar compression fractures, one fractured coccyx, two other fractures, 10 contusions, four sprains, one renal contusion, one abrasion, and one dental injury. All eight with spinal fractures were hurt when they became airborne during 45-degree drops. Three of these had a child between their legs. 

 

Citation: Jacklin, D. 2022. Research summary: Waterslide Safety. Water Incident Research Hub, 8 October.