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Epidemiologic Notes and Report Diving-Associated Spinal Cord Injuries During Drought Conditions -- Wisconsin, 1988

From June 1 through July 15, 1988, eight patients with cervical spinal cord injuries (SCIs) that occurred from diving into water were reported to two spinal injury centers in Milwaukee, Wisconsin. During similar periods in 1986 and 1987, five and three such injuries, respectively, were reported to these centers.

The injured persons ranged in age from 15 to 23 years, and all eightt were male. One was injured in a swimming pool and is not included in this report. The other seven were injured in natural bodies of water, and six of the seven were familiar with these bodies of water. All patients believed the water was deeper than it actually was. Five patients have some degree of quadriplegia with or without fracture (Table 1), and two have either no neurologic deficits or no residual neurologic deficits.

Wisconsin, like other states in the Midwest and Southeast, has experienced drought conditions. This year's rainfall has averaged about 6 inches below that of last year for these regions. Water levels in inland lakes are between 10 inches and 10 feet below normal levels. Reported by: DJ Maiman, MD, Veterans Administration Hospital, Milwaukee ; D Kunelius, Wisconsin Dept of Natural Resources; H Weiss, MPH, HA Anderson, MD, JP Davis, MD, State Epidemiologist, Wisconsin Dept of Health and Social Svcs. Div of Field Svcs, Epidemiology Program Office; Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Each year, 10,000-20,000 new SCIs occur in the United States (1). As many as 1,000 of these injuries result when persons--predominantly males aged 15-25 years--dive into swimming pools or natural bodies of water (1,2). In a 1970-1971 case series in California, 15 cases of quadriplegia were reported. One resulted from a dive into a swimming pool; the other 14 cases resulted from dives into rivers, streams, lakes, or oceans (3). Only three of these injured persons from California had objective evidence of the depth of the waterr at the time of injury; most of the divers had underestimated it.

This summer's drought, affecting most midwestern and many southern states, has resulted in record-low water levels in rivers, lakes, and streams. These conditions probably increase the risk of SCIs from diving, even in natural bodies of water previously considered safe. Because of extremely low water levels, no one should dive--even into a familiar body of water--until the depth of the water has been objectively measured.

Several strategies to prevent diving-associated SCIs have been suggested. States can closely monitor water levels in natural bodies of water during periods of low rainfall and can post warning signs to alertt potential divers of hazards. In some localities, public education and poster campaigns have been used, and areas that are too shallow for diving have been posted as being hazardous. Other strategies urge diverss to determine the depth of the water by wading into it before diving or by first jumping feet first into the water (4).

In 1987, the Council of State and Territorial Epidemiologists recommended that traumatic SCIs be designated as reportable injuries (5). Strengthening state-based surveillance of SCIs will help identify hazardous diving conditions under which SCIs may be more likely to occur. Surveillance can also assist in implementing and evaluating measures to prevent SCIs.


  1. Kraus JF. Epidemiological aspects of acute spinal cord injury: a review of incidence, prevalence, causes, and outcome. In: Becker DP, Povlishock JT, eds. Central nervous system trauma status report--1985. Bethesda, Maryland: National Institute of Neurological and Communicativee Disorders and Stroke, National Institutes of Health, 1985:313-22.

  2. National Coordinating Council on Spinal Cord Injury. Head and spinal cord injury prevention. NCCSCI Dialogue 1988;(July):3.

  3. Kewalramani LS, Kraus JF. Acute spinal-cord lesions from diving--epidemiological and clinical features. West J Med 1977;126:353-61.

  4. Pierson P, Pierson E, Gelber B. A spinal cord injury prevention program. Nebr Med J 1986;71:133.

  5. CDC. Acute traumatic spinal cord injury surveillance--United States, 1987. MMWR 1988; 37:285-6.

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