A catastrophic injury is a severe
injury
Injury is physiological damage to the living tissue of any organism, whether in humans, in other animals, or in plants.
Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with ...
to the
spine,
spinal cord
The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...
, or
brain
The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...
. It may also include skull or
spinal fracture
A spinal fracture, also called a vertebral fracture or a broken back, is a bone fracture, fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate tr ...
s. This is a subset of the definition for the legal term ''catastrophic injury'', which is based on the definition used by the
American Medical Association
The American Medical Association (AMA) is an American professional association and lobbying group of physicians and medical students. This medical association was founded in 1847 and is headquartered in Chicago, Illinois. Membership was 271,660 ...
.
The National Center for Catastrophic Sport Injury Research in the United States classifies catastrophic injuries based on the three outcomes associated with them: fatality, those causing permanent severe functional disability, and those causing severe head or neck trauma with no permanent disability. A fatal injury may be a direct result of trauma sustained during an activity or may occur indirectly. The indirect nonfatal catastrophic injury may occur as a result of systemic failure from exertion during an activity, such as from cardiovascular conditions,
heat illness, exertional
hyponatremia
Hyponatremia or hyponatraemia is a low concentration of sodium in the Serum (blood), blood. It is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe hyponatremia being below 120 mEq/L. Symp ...
, or
dehydration
In physiology, dehydration is a lack of total body water that disrupts metabolic processes. It occurs when free water loss exceeds intake, often resulting from excessive sweating, health conditions, or inadequate consumption of water. Mild deh ...
, or a complication to a nonfatal injury. Indirect fatalities are usually caused by cardiovascular conditions, such as
hypertrophic cardiomyopathy and
coronary artery disease
Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of cardiovascular disease, heart disease involving Ischemia, the reduction of blood flow to the cardiac muscle due to a build-up ...
.
Fatal injury may reveal an unknown "underlying anatomical, or physiological abnormality". Individuals with certain anatomical anomalies should not participate in some activities. For example,
contact sport
A contact sport is any sport where physical contact between competitors, or their environment, is an integral part of the game. For example, gridiron football. Contact may come about as the result of intentional or incidental actions by the playe ...
s are
contraindicated
In medicine, a contraindication is a condition (a situation or factor) that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a rea ...
for individuals with an anomalous
odontoid process, as any violent impact may result in a catastrophic injury. This is because a malformed odontoid process may lead to instability between the
atlas
An atlas is a collection of maps; it is typically a bundle of world map, maps of Earth or of a continent or region of Earth. Advances in astronomy have also resulted in atlases of the celestial sphere or of other planets.
Atlases have traditio ...
and
axis
An axis (: axes) may refer to:
Mathematics
*A specific line (often a directed line) that plays an important role in some contexts. In particular:
** Coordinate axis of a coordinate system
*** ''x''-axis, ''y''-axis, ''z''-axis, common names ...
(the C1 and C2
cervical vertebrae
In tetrapods, cervical vertebrae (: vertebra) are the vertebrae of the neck, immediately below the skull. Truncal vertebrae (divided into thoracic and lumbar vertebrae in mammals) lie caudal (toward the tail) of cervical vertebrae. In saurop ...
). Those with
atlanto-occipital fusion should also avoid contact sports.
By activity
Participation in any sport or recreational activity may result in a catastrophic
sports injury
Sports injuries occur during participation in sports or exercise in general. Globally, around 40% of individuals engage in some form of regular exercise or organized sports, with upwards of 60% of US high school students participating in one or ...
, particularly if unsupervised or if engaged with little or no protection. Direct fatalities in sport are rare, as most sport fatalities are indirect and associated with non-sport cardiovascular problems.
In the United States,
American football
American football, referred to simply as football in the United States and Canada and also known as gridiron football, is a team sport played by two teams of eleven players on a rectangular American football field, field with goalposts at e ...
has the greatest incidence of catastrophic injury per population, whereas
cheerleading
Cheerleading is an activity in which the participants (called cheerleaders) cheer for their team as a form of encouragement. It can range from chanting slogans to intense Physical exercise, physical activity. It can be performed to motivate s ...
is associated with the greatest incidence of direct catastrophic injury at both the interscholastic and intercollegiate levels.
Cervical spine trauma is most common in sports and activities involving contact and collision, particularly American football,
rugby,
ice hockey
Ice hockey (or simply hockey in North America) is a team sport played on ice skates, usually on an Ice rink, ice skating rink with Ice hockey rink, lines and markings specific to the sport. It belongs to a family of sports called hockey. Tw ...
,
gymnastics
Gymnastics is a group of sport that includes physical exercises requiring Balance (ability), balance, Strength training, strength, Flexibility (anatomy), flexibility, agility, Motor coordination, coordination, artistry and endurance. The movem ...
,
skiing
Skiing is the use of skis to glide on snow for basic transport, a recreational activity, or a competitive winter sport. Many types of competitive skiing events are recognized by the International Olympic Committee (IOC), and the International S ...
,
wrestling
Wrestling is a martial art, combat sport, and form of entertainment that involves grappling with an opponent and striving to obtain a position of advantage through different throws or techniques, within a given ruleset. Wrestling involves di ...
, and
diving
Diving most often refers to:
* Diving (sport), the sport of jumping into deep water
* Underwater diving, human activity underwater for recreational or occupational purposes
Diving or Dive may also refer to:
Sports
* Dive (American football), ...
. A 2005 report by the National Center for Catastrophic Sport Injury Research in the United States stated that sports requiring attention for potential catastrophic injuries are American football, ice hockey,
baseball
Baseball is a bat-and-ball games, bat-and-ball sport played between two team sport, teams of nine players each, taking turns batting (baseball), batting and Fielding (baseball), fielding. The game occurs over the course of several Pitch ...
, wrestling, gymnastics, and
track and field
Track and field (or athletics in British English) is a sport that includes Competition#Sports, athletic contests based on running, jumping, and throwing skills. The name used in North America is derived from where the sport takes place, a ru ...
.
The incidence of catastrophic injury is four times higher in college than in high school in the United States. Sport accounts for between 5% and 10% of all cervical spine and
spinal cord injuries
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. It is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions.
Symptoms of ...
in the United States, and 15% in Australia. The incidence of catastrophic injury for all sports is low, less than 0.5 per 100,000 participants.
A study in the
province
A province is an administrative division within a country or sovereign state, state. The term derives from the ancient Roman , which was the major territorial and administrative unit of the Roman Empire, Roman Empire's territorial possessions ou ...
of
Ontario
Ontario is the southernmost Provinces and territories of Canada, province of Canada. Located in Central Canada, Ontario is the Population of Canada by province and territory, country's most populous province. As of the 2021 Canadian census, it ...
in
Canada
Canada is a country in North America. Its Provinces and territories of Canada, ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, making it the world's List of coun ...
based on
epidemiological
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and Risk factor (epidemiology), determinants of health and disease conditions in a defined population, and application of this knowledge to prevent dise ...
data from 1986, 1989, 1992, and 1995 states that the greatest incidence of catastrophic injuries occurred in
snowmobiling
A snowmobile, also known as a snowmachine (chiefly Alaskan), motor sled (chiefly Canadian), motor sledge, skimobile, snow scooter, or simply a sled is a motorized vehicle designed for winter travel and recreation on snow.
Their engines normally ...
,
cycling
Cycling, also known as bicycling or biking, is the activity of riding a bicycle or other types of pedal-driven human-powered vehicles such as balance bikes, unicycles, tricycles, and quadricycles. Cycling is practised around the world fo ...
, ice hockey, and
skiing
Skiing is the use of skis to glide on snow for basic transport, a recreational activity, or a competitive winter sport. Many types of competitive skiing events are recognized by the International Olympic Committee (IOC), and the International S ...
. Of the 2,154 reported catastrophic injuries, 1,756 were sustained by males and 368 by females. The only activity in the study in which female casualties outnumbered males was
equestrianism
Equestrianism (from Latin , , , 'horseman', 'horse'), commonly known as horse riding ( Commonwealth English) or horseback riding (American English), includes the disciplines of riding, driving, and vaulting. This broad description includes the ...
. The study also stated that
field and floor sports had a relatively low incidence of catastrophic injury, and that July had the highest incidence of injury.
Drowning
Drowning is a type of Asphyxia, suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incidents. Most instances of fatal drowning occur alone or in situations where othe ...
was the cause of 357 fatalities, and there were 640 head and 433 spine injuries.
The study found 79.2% of the injuries were preventable; from over 1,500 responses, 346 involved
alcohol consumption
Drinks containing alcohol (drug), alcohol are typically divided into three classes—beers, wines, and Distilled beverage, spirits—with alcohol content typically between 3% and 50%. Drinks with less than 0.5% are sometimes considered Non-al ...
, and 1,236 were not supervised. Most alcohol-related injuries were sustained in snowmobiling (124),
fishing
Fishing is the activity of trying to catch fish. Fish are often caught as wildlife from the natural environment (Freshwater ecosystem, freshwater or Marine ecosystem, marine), but may also be caught from Fish stocking, stocked Body of water, ...
(41), diving (40), boating excluding canoeing (31), swimming (31), riding an
all-terrain vehicle
An all-terrain vehicle (ATV), also known as a light utility vehicle (LUV), a quad bike or quad (if it has four wheels), as defined by the American National Standards Institute (ANSI), is a vehicle that travels on low-pressure tires, has a seat ...
(24), and cycling (23). Other studies have concluded that alcohol consumption is a common
risk factor
In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection.
Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often use ...
"associated with all types of exposure" (that is, activities) for
traumatic brain injury
A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity ranging from mild traumatic brain injury (mTBI/concussion) to severe traumati ...
.
Classification of sports by contact
The
American Academy of Pediatrics
The American Academy of Pediatrics (AAP) is the largest professional association of pediatricians in the United States. It is headquartered in Itasca, Illinois, and maintains an office in Washington, D.C. The AAP has published hundreds of poli ...
has classified sports based on the likelihood of collision and contact. It recommends against participation in
boxing
Boxing is a combat sport and martial art. Taking place in a boxing ring, it involves two people – usually wearing protective equipment, such as boxing glove, protective gloves, hand wraps, and mouthguards – throwing Punch (combat), punch ...
.
Those classified as ''contact and collision'' sports include
basketball
Basketball is a team sport in which two teams, most commonly of five players each, opposing one another on a rectangular Basketball court, court, compete with the primary objective of #Shooting, shooting a basketball (ball), basketball (appro ...
, boxing, diving,
field hockey
Field hockey (or simply referred to as hockey in some countries where ice hockey is not popular) is a team sport structured in standard hockey format, in which each team plays with 11 players in total, made up of 10 field players and a goalk ...
, football, ice hockey,
lacrosse
Lacrosse is a contact team sport played with a lacrosse stick and a lacrosse ball. It is the oldest organized sport in North America, with its origins with the indigenous people of North America as early as the 12th century. The game w ...
,
martial arts
Martial arts are codified systems and traditions of combat practiced for a number of reasons such as self-defence; military and law enforcement applications; combat sport, competition; physical, mental, and spiritual development; entertainment; ...
,
rodeo
Rodeo () is a competitive equestrian sport that arose out of the working practices of cattle herding in Spain and Mexico, expanding throughout the Americas and to other nations. It was originally based on the skills required of the working vaqu ...
, rugby,
ski jumping
Ski jumping is a winter sport in which competitors aim to achieve the farthest jump after sliding down on their skis from a specially designed curved ramp. Along with jump length, competitor's aerial style and other factors also affect the final ...
,
soccer
Association football, more commonly known as football or soccer, is a team sport played between two teams of 11 Football player, players who almost exclusively use their feet to propel a Ball (association football), ball around a rectangular f ...
,
team handball
Handball (also known as team handball, European handball, Olympic handball or indoor handball) is a team sport in which two teams of seven players each (six outcourt players and a Handball goalkeeper, goalkeeper) pass a ball using their hands ...
,
water polo
Water polo is a competitive sport, competitive team sport played in water between two teams of seven players each. The game consists of four quarters in which the teams attempt to score goals by throwing the water polo ball, ball into the oppo ...
, and wrestling.
Those classified as ''limited contact'' include baseball,
bicycling, cheerleading, whitewater
canoeing
Canoeing is an activity which involves paddling a canoe with a single-bladed paddle. In some parts of Europe, canoeing refers to both canoeing and kayaking, with a canoe being called an 'open canoe' or Canadian.
A few of the recreational ...
and
kayaking
Kayaking is the use of a kayak for moving over water. It is distinguished from canoeing by the sitting position of the paddler and the number of blades on the paddle. A kayak is a low-to-the-water, canoe-like boat in which the paddler sits fac ...
,
fencing
Fencing is a combat sport that features sword fighting. It consists of three primary disciplines: Foil (fencing), foil, épée, and Sabre (fencing), sabre (also spelled ''saber''), each with its own blade and set of rules. Most competitive fe ...
,
floor hockey
Floor hockey is a broad term for several indoor floor game codes which involve two teams using a stick and type of ball or disk. Disks are either open or closed but both designs are usually referred to as "pucks". These games are played either on ...
,
flag football
Flag football is a variant of gridiron football (American football or Canadian football depending on location) where, instead of Tackle (football move)#Gridiron football, tackling players to the ground, the defensive team must remove a flag or ...
, gymnastics,
handball
Handball (also known as team handball, European handball, Olympic handball or indoor handball) is a team sport in which two teams of seven players each (six outcourt players and a goalkeeper) pass a ball using their hands with the aim of thr ...
,
horseback riding,
racquetball
Racquetball is a racquet sport and a team sport played with a hollow rubber ball on an indoor or outdoor court. Joseph Sobek invented the modern sport of racquetball in 1950, adding a stringed racquet to paddleball in order to increase vel ...
, skating (
ice skating
Ice skating is the Human-powered transport, self-propulsion and gliding of a person across an ice surface, using metal-bladed ice skates. People skate for various reasons, including recreation (fun), exercise, competitive sports, and commuting. ...
,
inline skating
Inline skating is a multi-disciplinary sport and can refer to a number of activities practiced using inline skates. Inline skates typically have two to five polyurethane wheels depending on the style of practice, arranged in a single line by a ...
,
roller skating
Roller skating is the act of travelling on surfaces with roller skates. It is a recreation, recreational activity, a sport, and a form of transportation. Roller rinks and skate parks are built for roller skating, though it also takes place on s ...
),
skiing
Skiing is the use of skis to glide on snow for basic transport, a recreational activity, or a competitive winter sport. Many types of competitive skiing events are recognized by the International Olympic Committee (IOC), and the International S ...
(
cross-country skiing
Cross-country skiing is a form of skiing whereby skiers traverse snow-covered terrain without use of ski lifts or other assistance. Cross-country skiing is widely practiced as a sport and recreational activity; however, some still use it as a m ...
,
downhill skiing,
water skiing
Water skiing (also waterskiing or water-skiing) is a surface water sport in which an individual is pulled behind a boat or a cable ski installation over a body of water, skimming the surface on one or two skis. The sport requires sufficien ...
),
skateboarding
Skateboarding is an extreme sport, action sport that involves riding and Skateboarding trick, performing tricks using a skateboard, as well as a recreational activity, an art form, an entertainment industry Profession, job, and a method of tr ...
,
snowboarding
Snowboarding is a recreational and competitive activity that involves descending a snow-covered surface while standing on a snowboard that is almost always attached to a rider's feet. It features in the Winter Olympic Games and Winter Paralym ...
,
softball
Softball is a Variations of baseball, variation of baseball, the difference being that it is played with a larger ball, on a smaller field, and with only underhand pitches (where the ball is released while the hand is primarily below the ball) ...
,
squash,
ultimate frisbee,
volleyball
Volleyball is a team sport in which two teams of six players are separated by a net. Each team tries to score points by grounding a ball on the other team's court under organized rules. It has been a part of the official program of the Summ ...
, and
windsurfing
Windsurfing is a wind-propelled water sport that is a combination of sailing and surfing. It is also referred to as "sailboarding" and "boardsailing", and emerged in the late 1960s from the Californian aerospace and surf culture. Windsurfing gain ...
or
surfing
Surfing is a surface water sport in which an individual, a surfer (or two in tandem surfing), uses a board to ride on the forward section, or face, of a moving wave of water, which usually carries the surfer towards the shore. Waves suita ...
, and the track and field events
high jump
The high jump is a track and field event in which competitors must jump unaided over a horizontal bar placed at measured heights without dislodging it. In its modern, most-practiced format, a bar is placed between two standards with a crash mat f ...
and
pole vaulting.
Sports classified as ''non-contact'' include
archery
Archery is the sport, practice, or skill of using a Bow and arrow, bow to shooting, shoot arrows.Paterson ''Encyclopaedia of Archery'' p. 17 The word comes from the Latin ''arcus'', meaning bow. Historically, archery has been used for hunting ...
,
badminton
Badminton is a racquet sport played using racket (sports equipment), racquets to hit a shuttlecock across a net (device), net. Although it may be played with larger teams, the most common forms of the game are "singles" (with one player per s ...
,
body building,
bowling
Bowling is a Throwing sports#Target sports, target sport and recreational activity in which a player rolls a bowling ball, ball toward Bowling pin, pins (in pin bowling) or another target (in target bowling). Most references to ''bowling'' are ...
, flatwater
canoeing
Canoeing is an activity which involves paddling a canoe with a single-bladed paddle. In some parts of Europe, canoeing refers to both canoeing and kayaking, with a canoe being called an 'open canoe' or Canadian.
A few of the recreational ...
and
kayaking
Kayaking is the use of a kayak for moving over water. It is distinguished from canoeing by the sitting position of the paddler and the number of blades on the paddle. A kayak is a low-to-the-water, canoe-like boat in which the paddler sits fac ...
,
curling
Curling is a sport in which players slide #Curling stone, stones on a sheet of ice toward a target area that is segmented into four concentric circles. It is related to bowls, boules, and shuffleboard. Two teams, each with four players, take t ...
,
dancing
Dance is an art form, consisting of sequences of body movements with aesthetic and often symbolic value, either improvised or purposefully selected. Dance can be categorized and described by its choreography, by its repertoire of movements or ...
,
golf
Golf is a club-and-ball sport in which players use various Golf club, clubs to hit a Golf ball, ball into a series of holes on a golf course, course in as few strokes as possible.
Golf, unlike most ball games, cannot and does not use a standa ...
,
orienteering
Orienteering is a group of sports that involve using a map and compass to navigation, navigate from point to point in diverse and usually unfamiliar terrain whilst moving at speed. Participants are given a topographical map, usually a specia ...
,
power lifting
Powerlifting is a competitive strength athletics, strength sport that consists of three attempts at maximal weight on three lifts: Squat (exercise), squat, bench press, and deadlift. As in the sport of Olympic weightlifting, it involves the athle ...
,
race walking
Race walking, or racewalking, is a long-distance discipline within the sport of athletics. Although a foot race, it is different from running in that one foot must appear to be in contact with the ground at all times. Race judges carefully asses ...
,
riflery,
rope jumping,
rowing
Rowing is the act of propelling a human-powered watercraft using the sweeping motions of oars to displace water and generate reactional propulsion. Rowing is functionally similar to paddling, but rowing requires oars to be mechanically a ...
,
running
Running is a method of terrestrial locomotion by which humans and other animals move quickly on foot. Running is a gait with an aerial phase in which all feet are above the ground (though there are exceptions). This is in contrast to walkin ...
,
sailing
Sailing employs the wind—acting on sails, wingsails or kites—to propel a craft on the surface of the ''water'' (sailing ship, sailboat, raft, Windsurfing, windsurfer, or Kitesurfing, kitesurfer), on ''ice'' (iceboat) or on ''land'' (Land sa ...
,
scuba diving
Scuba diving is a Diving mode, mode of underwater diving whereby divers use Scuba set, breathing equipment that is completely independent of a surface breathing gas supply, and therefore has a limited but variable endurance. The word ''scub ...
,
swimming
Swimming is the self-propulsion of a person through water, such as saltwater or freshwater environments, usually for recreation, sport, exercise, or survival. Swimmers achieve locomotion by coordinating limb and body movements to achieve hydrody ...
,
table tennis
Table tennis (also known as ping-pong) is a racket sport derived from tennis but distinguished by its playing surface being atop a stationary table, rather than the Tennis court, court on which players stand. Either individually or in teams of ...
,
tennis
Tennis is a List of racket sports, racket sport that is played either individually against a single opponent (singles (tennis), singles) or between two teams of two players each (doubles (tennis), doubles). Each player uses a tennis racket st ...
,
weightlifting
Weightlifting or weight lifting generally refers to physical exercises and sports in which people lift weights, often in the form of dumbbells, barbells or machines. People engage in weightlifting for a variety of different reasons. These can ...
and
weight training
Strength training, also known as weight training or resistance training, is exercise designed to improve physical strength. It is often associated with the lifting of weights. It can also incorporate techniques such as bodyweight exercises ( ...
, the track and field events
discus,
javelin
A javelin is a light spear designed primarily to be thrown, historically as a ranged weapon. Today, the javelin is predominantly used for sporting purposes such as the javelin throw. The javelin is nearly always thrown by hand, unlike the sling ...
, and
shot put
The shot put is a track-and-field event involving "putting" (throwing) a heavy spherical Ball (sports), ball—the ''shot''—as far as possible. For men, the sport has been a part of the Olympic Games, modern Olympics since their 1896 Summer Olym ...
and all track events.
American football
From 1945 to 2005, there were 497 fatalities, of which 69% were a result of brain injury and 16% from spinal cord injury. Today, the most common catastrophic injury in American football is cervical spinal cord injury, which is also the "second leading cause of death attributable to football". The 84% reduction in head injuries and 74% reduction in fatalities is directly attributable to the implementation of
NOCSAE standards for
football helmet
A football helmet is a type of protective headgear used mainly in gridiron football, although a structural variation has occasional use in Australian rules football. It consists of a hard plastic shell with thick padding on the inside, a Face ma ...
s and rule changes for tackling.
Football has the highest incidence of cervical spinal cord injuries in the United States per population. From 1977 to 2001, the incidence of cervical spinal cord injury amongst high school, college, and professional participants was 0.52, 1.55, and 14 per 100,000 participants, respectively.
From 1982 to 1988, 75% of direct fatalities and 40% of indirect fatalities in college sports were associated with football; for high school athletes, the rates were 75% and 33%, respectively. Indirect fatalities were usually caused by
cardiac failure or heat exhaustion. Indirect fatalities in high school and college football have been attributed to
heat stroke
Heat stroke or heatstroke, also known as sun-stroke, is a severe heat illness that results in a body temperature greater than , along with red skin, headache, dizziness, and confusion. Sweating is generally present in exertional heatstro ...
, heart-related conditions,
viral meningitis
Viral meningitis, also known as aseptic meningitis, is a type of meningitis due to a viral infection. It results in inflammation of the meninges (the membranes covering the brain and spinal cord). Symptoms commonly include headache, fever, photop ...
, and even
lightning
Lightning is a natural phenomenon consisting of electrostatic discharges occurring through the atmosphere between two electrically charged regions. One or both regions are within the atmosphere, with the second region sometimes occurring on ...
strikes.
The most common mechanism for catastrophic cervical spinal cord injury in American football is axial loading or compression resultant from
spear tackling, in which a player uses the crown of the helmet as the initial point of contact for striking another player. This form of tackling was banned in 1976 for high school and college football, resulting in a significant reduction in catastrophic injuries of this type. For example, incidence of
quadriplegia decreased from 2.24 and 10.66 per 100,000 participants in high school and college football in 1976, to 1.30 and 2.66 per 100,000 participants in 1977. Since 1977, about 67% of all catastrophic injuries in football were the result of a player making a tackle.
In the paper ''Catastrophic Football Injuries: 1977-1998'' published in 2000 by the journal ''
Neurosurgery
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the specialty (medicine), medical specialty that focuses on the surgical treatment or rehabilitation of disorders which affect any portion of the nervous system ...
'', Robert Cantu and Frederick Mueller recommend that "players should use the shoulder for blocking and tackling" instead of "using the head as a battering ram". The purpose of rules against spearing, ramming, and butting is to protect both the tackler and the opponent from head trauma or catastrophic injury. Mueller also suggests that coaches remove players from a game if they exhibit symptoms of
concussion
A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include headache, dizziness, difficulty with thinking and concentration, sleep disturbances, a brief ...
, such as dizziness, headaches, nausea, or sensitivity to light.
Baseball
Baseball
Baseball is a bat-and-ball games, bat-and-ball sport played between two team sport, teams of nine players each, taking turns batting (baseball), batting and Fielding (baseball), fielding. The game occurs over the course of several Pitch ...
has a high incidence of catastrophic injury, the most common being cranial injuries usually sustained during a collision between a
baserunner diving head first and a fielder, resulting in an axial compression injury to the baserunner. Other causes included collisions, such as between a
catcher
Catcher is a position in baseball and softball. When a batter takes their turn to hit, the catcher crouches behind home plate, in front of the (home) umpire, and receives the ball from the pitcher. In addition to this primary duty, the catc ...
and baserunner, or being struck by a pitched, thrown, or batted ball.
Canoeing
In a 2008 study, all catastrophic injuries recorded for recreational
canoeing
Canoeing is an activity which involves paddling a canoe with a single-bladed paddle. In some parts of Europe, canoeing refers to both canoeing and kayaking, with a canoe being called an 'open canoe' or Canadian.
A few of the recreational ...
were fatal, and accounted for 4.3% of all sport and recreation fatalities in the province. Of the 27 cases, 24 fatalities resulted from drowning, and the others from cerebral contusions, cerebral lacerations, and skull fractures. Canoeing drowning fatalities are "often correlated with alcohol consumption", as it increases the probability of submersion and decreases the probability of recovery from submersion. They are often associated with young males inexperienced in canoeing.
Cheerleading

The primary cause of increased incidence of catastrophic injuries to cheerleaders is the "evolution of cheerleading to a gymnastic-like activity". It is the leading cause of catastrophic injuries to females, representing over 65% of the catastrophic injuries occurring in high school and college female athletes in the United States.
High-risk activities include the construction of pyramids, which result in several catastrophic injuries each year, the 'basket toss', and tumbling, all of which are usually performed over hard surfaces. Cheerleader pyramids are banned in
Minnesota
Minnesota ( ) is a U.S. state, state in the Upper Midwestern region of the United States. It is bordered by the Canadian provinces of Manitoba and Ontario to the north and east and by the U.S. states of Wisconsin to the east, Iowa to the so ...
and
North Dakota
North Dakota ( ) is a U.S. state in the Upper Midwest, named after the indigenous Dakota people, Dakota and Sioux peoples. It is bordered by the Canadian provinces of Saskatchewan and Manitoba to the north and by the U.S. states of Minneso ...
.
Other causes include inadequate supervision, poorly trained coaches, and the equipment used.
Fishing
In the Ontario study, fishing resulted in 126 catastrophic injuries, of which 117 were fatal, 110 from drowning. Of these, 119 events were associated with males, of which 112 were fatalities. Fishing had the highest rate of catastrophic injuries to all injuries for any activity in Ontario, as 2.54% of all fishing injuries were catastrophic.
Catastrophic injuries in fishing may be related to equipment, fish, alcohol, or the environment. Equipment issues generally involve penetrative injuries from the use of
hooks and
harpoon
A harpoon is a long, spear-like projectile used in fishing, whaling, sealing, and other hunting to shoot, kill, and capture large fish or marine mammals such as seals, sea cows, and whales. It impales the target and secures it with barb or ...
s, but may also be caused by the
fishing rod
A fishing rod or fishing pole is a long, thin rod used by angling, anglers to fishing, catch fish by manipulating a fishing line, line ending in a fish hook, hook (formerly known as an ''angle'', hence the term "angling"). At its most basic ...
,
lure,
sinker, or
bait. Fish-related injuries result from mishandling, poisoning, and contamination from consumption. Environmental causes may include
overexposure to solar radiation, lightning strikes,
hypothermia
Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe ...
during
ice fishing
Ice fishing is the practice of catching fish with lines and fish hooks or spears through an opening in the ice on a frozen body of water. Ice fishers may fish in the open or in heated enclosures, some with bunks and amenities.
Shelters
L ...
,
snakebites, and viral
infection
An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...
spread by
mosquito
Mosquitoes, the Culicidae, are a Family (biology), family of small Diptera, flies consisting of 3,600 species. The word ''mosquito'' (formed by ''Musca (fly), mosca'' and diminutive ''-ito'') is Spanish and Portuguese for ''little fly''. Mos ...
es.
Gymnastics
Gymnastics has a relatively low incidence of catastrophic injury, that is the number of catastrophic injuries with respect to the number of participants. In the United States from 1982 to 2007, nineteen catastrophic injuries were reported from 147 million high school and 8 million college participants.
Club-level injury surveillance data in Australia indicate no catastrophic injury to elite participants from 1983 to 1993. Elite gymnast catastrophic injuries to the spinal cord have been recorded in China, Japan, and the United States, the most notable being to
Sang Lan and
Julissa Gomez. There is an "absence of research reporting rate data" for catastrophic injury to club-level gymnasts in the United States.
Ice hockey
The most common catastrophic injury occurring in
ice hockey
Ice hockey (or simply hockey in North America) is a team sport played on ice skates, usually on an Ice rink, ice skating rink with Ice hockey rink, lines and markings specific to the sport. It belongs to a family of sports called hockey. Tw ...
is cervical spinal cord injury, which most often occur at
C5,
C6, or
C7. The most common cause is
checking from behind, resulting in a player falling headfirst into the glass or boards. Such checking was banned from hockey in 1985, which has resulted in a decreased incidence of catastrophic spinal injuries and a reduction of head and neck injuries.
Increased standards for
hockey helmets and the requirement that they be worn in competitive play has resulted in a decrease of serious head injury and fatalities. Although full facial protection (helmet with cage) did not reduce the incidence of catastrophic injuries or concussion compared to a standard helmet, it reduced the incidence of facial injuries and lacerations.
Porting
Porters who carry loads on their heads are subjected to axial strains that exacerbate degenerative change in the cervical spine, and has an
etiological
Etiology (; alternatively spelled aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek word ''()'', meaning "giving a reason for" (). More completely, etiology is the study of the causes, origin ...
role in
spondylosis
Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense, it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degener ...
.
In a 1968 study, Laurence Levy recorded six catastrophic injuries to porters at Harare Central Hospital in
Harare
Harare ( ), formerly Salisbury, is the Capital city, capital and largest city of Zimbabwe. The city proper has an area of , a population of 1,849,600 as of the 2022 Zimbabwe census, 2022 census and an estimated 2,487,209 people in its metrop ...
,
Zimbabwe
file:Zimbabwe, relief map.jpg, upright=1.22, Zimbabwe, relief map
Zimbabwe, officially the Republic of Zimbabwe, is a landlocked country in Southeast Africa, between the Zambezi and Limpopo Rivers, bordered by South Africa to the south, Bots ...
. Of these, one died instantaneously, and five became quadriplegic, one as a result of a herniated intervertebral disc and four from fractures or fracture-dislocations.
Rugby

For
rugby union
Rugby union football, commonly known simply as rugby union in English-speaking countries and rugby 15/XV in non-English-speaking world, Anglophone Europe, or often just rugby, is a Contact sport#Terminology, close-contact team sport that orig ...
, the incidence of catastrophic injury from 1952 to 2005 in England was 0.84 per 100,000 per year. In all other countries, from 1970 to 2007 the incidence was 4.6 per 100,000 per year. For
rugby league
Rugby league football, commonly known as rugby league in English-speaking countries and rugby 13/XIII in non-Anglophone Europe, is a contact sport, full-contact sport played by two teams of thirteen players on a rectangular Rugby league playin ...
, it was 2 per 100,000 per year. In
rugby union in France, the incidence of catastrophic cervical spine injuries decreased from 2.1 per 100,000 in the 1996–1997 season to 1.4 per 100,000 in the 2005–2006 season, which has been attributed to rule changes regarding the
scrum.
The most common causes are the
scrum, the
ruck or
maul, and the
tackle. Research from Australia states that injury prevention in youth rugby should focus on the scrum and the tackle, and that risk factors are level of play (age group) and
player position. It also indicated that "neck injuries in the scrum and to the front row are of great concern".
The use of a
scrum cap
The scrum cap is a form of headgear used by Rugby football, rugby players to protect the ears in the scrum (rugby), scrum, which can otherwise suffer injuries leading to the condition commonly known as cauliflower ears. Although originally design ...
or other padded headgear does not reduce the incidence of concussion or other head or neck trauma.
Skiing and snowboarding
In a survey of scientific literature from 1990 to 2004, 24 studies covering 10 countries indicated an increasing incidence of traumatic brain injury (TBI) and spinal cord injury amongst
alpine skiers and
snowboarders. The most common cause of death is head injuries, which can be mitigated by 22–60% by the use of
helmets
A helmet is a form of protective gear worn to protect the Human head, head. More specifically, a helmet complements the skull in protecting the human brain. Ceremonial or symbolic helmets (e.g., a Custodian helmet, policeman's helmet in the Unite ...
. The increased incidence coincides "with the development and acceptance of acrobatic and high-speed activities".
Most deaths are attributed to massive head, neck, or thoracoabdominal injury, of which TBI accounted for between 50% and 88% and spinal cord injury between 1% and 13%. Ski fatalities occur between 0.050 and 0.196 per 100,000 participants. Head injuries represent 28.0% of all injuries in skiers and 33.5% for snowboarders.
Snowmobiling
In the Ontario study, snowmobiling had the highest incidence and prevalence of recreational catastrophic injuries of any activity (290 incidents, 120 fatalities). It had the second-highest incidence of catastrophic injury per participant (88.2 per 100,000), the greatest incidence per 100,000 population (0.706), and the greatest incidence of fatality per 100,000 population (0.292). It was also the activity in which alcohol consumption was most prevalent in catastrophic events (124), representing more than one third of all events for which alcohol was a factor. Other contributing factors include "poor lighting, young age and inappropriate terrain".
Track and field
The majority of
track and field
Track and field (or athletics in British English) is a sport that includes Competition#Sports, athletic contests based on running, jumping, and throwing skills. The name used in North America is derived from where the sport takes place, a ru ...
-related fatalities in the United States is associated with
pole vaulting. Other fatalities and catastrophic injuries in track and field occur by a participant or bystander being struck by a discus, shot put, or javelin.
Water sports
Most catastrophic injuries related to diving and swimming in the United States occur when an individual dives into shallow water. It is the cause of 2.6% of all cervical spine injury admissions, and are chiefly sustained by recreational divers. The most common cause is diving into shallow water, inexperience, inadequate supervision, and alcohol consumption.
Catastrophic swimming injuries in the Ontario study were four times as prevalent in males than females. The incidence of catastrophic injury in
competitive swimming is very low, and almost all such injuries occur in recreational and non-competitive swimming.
Wrestling
From 1981 until 1999 in the United States, 35 catastrophic injuries related to wrestling were reported, one in college and the others in high school, an incidence of 1 per 100,000 per year. They were caused by three positions: defensive position during takedown (74%), down position (23%), and lying position (3%). Most occurred in the lower
weight classes, and 80% were incurred during a match. In
Iran
Iran, officially the Islamic Republic of Iran (IRI) and also known as Persia, is a country in West Asia. It borders Iraq to the west, Turkey, Azerbaijan, and Armenia to the northwest, the Caspian Sea to the north, Turkmenistan to the nort ...
from 1998 to 2005, the incidence of catastrophic injury was 1.99 per 100,000 participants per year.
Most injuries were cervical fracture or major cervical ligament injuries. One of the athletes died, one third became
tetraplegic, one
paraplegic
Paraplegia, or paraparesis, is an impairment in motor or sensory function of the lower extremities. The word comes from Ionic Greek ()
"half-stricken". It is usually caused by spinal cord injury or a congenital condition that affects the neura ...
, and six others had residual neurologic deficits.
Catastrophic wrestling injuries are preventable, and associated risk factors include incorrectly performing a manoeuvre, lack of supervision by the coach, and inappropriate injury management.
Other activities
In the United Kingdom, the incidence of catastrophic injury per year for work-related situations is 0.9 per 100,000. The incidence is highest in agriculture (6.0 per 100,000) and construction (6.0 per 100,000), and lowest in the service sector (0.4).
The incidence is 3.7 per 100,000 for pedestrians, 2.9 per 100,000 for automobile occupants, and 190 per 100,000 for motorcyclists.
Vehicular accidents account for 43% of catastrophic spinal injury in the United States and 45% in Australia.
In the Ontario study, recreational catastrophic injuries were most prevalent in snowmobiling (290 incidents, 120 fatalities), bicycling (289 incidents, 67 fatalities), fishing (126 incidents, 117 fatalities), boating (excluding canoeing, 112 incidents, 72 fatalities), diving (105 incidents, 5 fatalities) and swimming (100 incidents, 86 fatalities). The greatest incidence per participant was recorded for diving (511.0 per 100,000), snowmobiling (88.2 per 100,000),
parachuting
Parachuting and skydiving are methods of descending from a high point in an atmosphere to the ground or ocean surface with the aid of gravity, involving the control of speed during the descent using a parachute or multiple parachutes.
For hu ...
(62.9 per 100,000),
toboggan
A toboggan is a simple sled used in snowy winter recreation. It is also a traditional form of cargo transport used by the Innu, Cree and Ojibwe of North America, sometimes part of a dog train.
It is used on snow to carry one or more people (o ...
ing or sledding ( 37.7 per 100,000),
hang gliding
Hang gliding is an air sports, air sport or recreational activity in which a pilot flies a light, non-motorised, fixed-wing aircraft, fixed-wing heavier-than-air aircraft called a hang glider. Most modern hang gliders are made of an aluminium al ...
(29.4 per 100,000),
water polo
Water polo is a competitive sport, competitive team sport played in water between two teams of seven players each. The game consists of four quarters in which the teams attempt to score goals by throwing the water polo ball, ball into the oppo ...
(24.5 per 100,000), scuba diving (12.2 per 100,000),
hunting
Hunting is the Human activity, human practice of seeking, pursuing, capturing, and killing wildlife or feral animals. The most common reasons for humans to hunt are to obtain the animal's body for meat and useful animal products (fur/hide (sk ...
(12.2 per 100,000),
horseback riding (11.6 per 100,000),
archery
Archery is the sport, practice, or skill of using a Bow and arrow, bow to shooting, shoot arrows.Paterson ''Encyclopaedia of Archery'' p. 17 The word comes from the Latin ''arcus'', meaning bow. Historically, archery has been used for hunting ...
(11.1 per 100,000), and fishing (11.0 per 100,000). The greatest incidence per 100,000 population were recorded for snowmobiling (0.706), cycling (0.701), ice hockey (0.462), fishing (0.307), boating excluding canoeing (0.273), diving (0.256), swimming (0.243) and baseball (0.217). The greatest incidence of fatality per 100,000 population were recorded for snowmobiling (0.292), fishing (0.285), swimming (0.200), boating excluding canoeing (0.175), cycling (0.163), canoeing (0.066), riding an all-terrain vehicle (0.039), hunting (0.037), and horseback riding (0.024). Catastrophic cycling injuries were most prevalent in cities, particularly
Toronto
Toronto ( , locally pronounced or ) is the List of the largest municipalities in Canada by population, most populous city in Canada. It is the capital city of the Provinces and territories of Canada, Canadian province of Ontario. With a p ...
(64),
Ottawa
Ottawa is the capital city of Canada. It is located in the southern Ontario, southern portion of the province of Ontario, at the confluence of the Ottawa River and the Rideau River. Ottawa borders Gatineau, Gatineau, Quebec, and forms the cor ...
(21), and
London
London is the Capital city, capital and List of urban areas in the United Kingdom, largest city of both England and the United Kingdom, with a population of in . London metropolitan area, Its wider metropolitan area is the largest in Wester ...
(7). Drowning represented more than half of sport and recreation fatalities in the Ontario study.
In the United States, the
Consumer Product Safety Commission
The United States Consumer Product Safety Commission (USCPSC, CPSC, or commission) is an independent agency of the United States government. The CPSC seeks to promote the safety of consumer products by addressing "unreasonable risks" of injury ...
(CPSC) recorded nearly 1,000 fatalities between 1967 and 1987 as a result of riding an all-terrain vehicle, more than half of which were individuals less than 16 years old. This led to a filing of an action per the
Consumer Product Safety Act in 1987, which effectively ended the sale of three-wheeled ATVs. Since then, 35% of deaths were individuals less than 16 years old. The
American Academy of Pediatrics
The American Academy of Pediatrics (AAP) is the largest professional association of pediatricians in the United States. It is headquartered in Itasca, Illinois, and maintains an office in Washington, D.C. The AAP has published hundreds of poli ...
and CPSC recommend that individuals less than 16 years old should not ride ATVs.
Effects and management
The types of acute catastrophic spinal injuries are those associated with unstable fractures and dislocations,
intervertebral disc
An intervertebral disc (British English), also spelled intervertebral disk (American English), lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the ver ...
herniation, and transient
quadriplegia. These most commonly affect the cervical spine, but also affect the thoracolumbar spine (the
thoracic
The thorax (: thoraces or thoraxes) or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen.
In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main ...
and
lumbar vertebrae
The lumbar vertebrae are located between the thoracic vertebrae and pelvis. They form the lower part of the back in humans, and the tail end of the back in quadrupeds. In humans, there are five lumbar vertebrae. The term is used to describe t ...
) and
physis
Physis (; ; pl. physeis, φύσεις) is a Greek philosophical, theological, and scientific term, usually translated into English—according to its Latin translation "natura"—as "nature". The term originated in ancient Greek philosophy, a ...
, or cause cervical cord
neuropraxia and sometimes
spinal cord injury without radiographic abnormality (
SCIWORA).
Response to a non-fatal catastrophic spinal cord injury by the patient varies by "social, economic, and educational background".
The most common initial response is
depression. About 6% of patients with a spinal cord injury commit
suicide
Suicide is the act of intentionally causing one's own death.
Risk factors for suicide include mental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress (such as from financial or ac ...
, usually in the years immediately after sustaining the injury. By ten years after an injury, the rate of suicide is similar to that of the general population.
Many patients recover only partially from their injury, and must cope with
paralysis
Paralysis (: paralyses; also known as plegia) is a loss of Motor skill, motor function in one or more Skeletal muscle, muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory d ...
or
mental deficiency, usually requiring lifetime medical care.
About 90% of patients who are single when injured are still single five years after the injury. There is a high incidence of divorce and separation after an injury, though this decreases beyond the first year after injury.
Many catastrophic spinal cord injury patients improve their education. Immediately after injury, the average level of education is below that of the general population; fifteen years after injury, it is above that of the general population.
Survivors of catastrophic injury may also have catastrophic facial injuries, such as fractured facial bones, particularly those from events associated with ice hockey, cycling, and snowmobiling.
Medical problems
Numerous secondary medical problems are associated with catastrophic spinal cord injury. These include cardiovascular complications, such as
deep vein thrombosis
Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enl ...
,
pulmonary embolism
Pulmonary embolism (PE) is a blockage of an pulmonary artery, artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include dyspnea, shortness of breath, chest pain ...
,
orthostatic hypotension
Orthostatic hypotension, also known as postural hypotension, is a medical condition wherein a person's blood pressure drops when they are standing up ( orthostasis) or sitting down. Primary orthostatic hypotension is also often referred to as ne ...
,
bradycardia
Bradycardia, also called bradyarrhythmia, is a resting heart rate under 60 beats per minute (BPM). While bradycardia can result from various pathological processes, it is commonly a physiological response to cardiovascular conditioning or due ...
,
autonomic dysreflexia
Autonomic dysreflexia (AD) is a life-threatening medical emergency characterized by hypertension and cardiac arrhythmias. This condition is sometimes referred to as autonomic hyperreflexia. Most cases of AD occur in individuals with spinal cord ...
, altered
thermoregulation
Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. A thermoconforming organism, by contrast, simply adopts the surrounding temperature ...
, and changes to cardiac function as a result of injury to the
sympathetic nervous system
The sympathetic nervous system (SNS or SANS, sympathetic autonomic nervous system, to differentiate it from the somatic nervous system) is one of the three divisions of the autonomic nervous system, the others being the parasympathetic nervous sy ...
.
Other problems may include pulmonary and gastrointestinal problems,
heterotopic ossification,
osteoporosis
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk.
It is the most common reason f ...
, and other pathologic fractures.
Pneumonia
Pneumonia is an Inflammation, inflammatory condition of the lung primarily affecting the small air sacs known as Pulmonary alveolus, alveoli. Symptoms typically include some combination of Cough#Classification, productive or dry cough, ches ...
is a common cause of death among patients with spinal cord injuries.
A skull fracture occurs when a bone in the skull breaks, and may penetrate the brain, tearing
arteries
An artery () is a blood vessel in humans and most other animals that takes oxygenated blood away from the heart in the systemic circulation to one or more parts of the body. Exceptions that carry deoxygenated blood are the pulmonary arteries in ...
,
vein
Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and feta ...
s, or
meninges
In anatomy, the meninges (; meninx ; ) are the three membranes that envelop the brain and spinal cord. In mammals, the meninges are the dura mater, the arachnoid mater, and the pia mater. Cerebrospinal fluid is located in the subarachnoid spac ...
, leading to the functional impairment of walking, communication, thinking, or feeling.
Cerebral lacerations (tearing of brain tissue) or
cerebral contusions (bruising of brain tissue) usually damage the
cerebral cortex
The cerebral cortex, also known as the cerebral mantle, is the outer layer of neural tissue of the cerebrum of the brain in humans and other mammals. It is the largest site of Neuron, neural integration in the central nervous system, and plays ...
, resulting in permanent neurological deficits.
Life care plan
A life care plan is established for the patient to address the patient's needs. It is an individualized document describing the services, support, equipment, and ancillary requirements for the patient that is updated to reflect changes in the patient's condition. It usually contains target outcomes, dates, and timelines.
Components of the life care plan may include:
*architectural renovations to the patient's home, including tub, toilet, and ingress and egress
*transportation, such as an adaptive van
*
assistive technology
Assistive technology (AT) is a term for assistive, adaptive, and rehabilitative devices for Disability, people with disabilities and the elderly. Disabled people often have difficulty performing activities of daily living (ADLs) independently, ...
and
adaptive equipment, including
wheelchair
A wheelchair is a mobilized form of chair using two or more wheels, a footrest, and an armrest usually cushioned. It is used when walking is difficult or impossible to do due to illnesses, injury, disabilities, or age-related health conditio ...
s
*case management
*supervisory care and nursing
*medication, medical supplies (such as
catheter
In medicine, a catheter ( ) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. ...
s), and medical equipment
*facility care and services
*home care and services
This is in addition to information regarding surgical intervention and treatment, diagnostic testing, therapeutic interventions (speech therapy, rehabilitation, etc.), counselling, and dealing with complications. It may also include educational and vocational services.
In the United States, 2.55% of hospitalized catastrophic injury patients enroll in
Medicaid
Medicaid is a government program in the United States that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by U.S. state, state governments, which also h ...
to cover their medical bills. In ''Catastrophic Injuries in Sports and Recreation: Causes and Prevention : A Canadian Study'', Charles Tator states that the average case of non-fatal catastrophic injury costs about $7.5 million (Canadian dollars, normalized to 2006) in lost earnings, lifetime care, and rehabilitation services, and cost the economy of Ontario about $2.125 billion annually.
Prevention
One paradigm used in
injury prevention is the
Haddon Matrix developed by William Haddon Jr. of the
National Highway Safety Bureau in the late 1960s. The matrix was designed to categorize highway safety phenomena, and applied a
public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the de ...
model to traffic-related
epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and Risk factor (epidemiology), determinants of health and disease conditions in a defined population, and application of this knowledge to prevent dise ...
. It consists of ten strategies that are implemented based on temporality, that is pre-event strategies (primary prevention), event strategies (secondary prevention), and post-event strategies (tertiary prevention). The purpose of injury prevention is to decrease the "burden of injury to the individual and to society", which includes
mortality,
morbidity
A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...
,
disability
Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be Cognitive disability, cognitive, Developmental disability, d ...
, and economic cost.
The ten strategies are:
*pre-event strategies
**prevent the creation of the hazard
**reduce the amount of hazard
**prevent the release of the hazard
**modify the rate or distribution of release of the hazard
*event strategies
**separate the potential victims from the hazard, in time or space
**separate the potential victims from the hazard with a barrier
**modify the hazard
**improve individual resistance to the hazard
*post-event strategies
**counter incurred damage
**stabilize, treat, and rehabilitate the injured individual
In ''Catastrophic Head Injuries in High School and Collegiate Sports'', Frederick Mueller states that the frequency of catastrophic injuries may be reduced by:
*requiring all participants to submit medical histories and have an obligatory pre-participation examination
*requiring all schools, colleges, and universities to have a certified athletic trainer on faculty
*enforcement of game rules by officials and coaches, and player education about head contact
*removing a player exhibiting symptoms of concussion or head trauma from a game
*educating players, parents, coaches about the symptoms of head injury and dangers of recurrent injury
*athletic trainer must be prepared to respond to a catastrophic injury event
Preparation for a catastrophic injury event includes a written emergency plan, which should incorporate an evacuation, transportation and communication plan, as well as notifying hospital emergency departments about game and practice schedules for teams and clubs. Response to a catastrophic injury event should reduce its severity, such as via the administration of
first aid
First aid is the first and immediate assistance given to any person with a medical emergency, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is gener ...
. In ''Catastrophic Injuries in Sports and Recreation: Causes and Prevention : A Canadian Study'', Charles Tator states that effective injury prevention programs involve education, engineering, and rule enforcement. Education is intended to inform the participants of potential dangers of risky behaviour in the activity, and engineering "involved modifying the environment to create safer surroundings", such as maintaining playing fields or improving the design of equipment.
Response
Sports organizations, leagues, and associations have integrated a catastrophic injury plan as part of their
emergency action and
emergency management
Emergency management (also Disaster management) is a science and a system charged with creating the framework within which communities reduce vulnerability to hazards and cope with disasters. Emergency management, despite its name, does not actu ...
plans, and have also changed rules to prevent or reduce the incidence of catastrophic injuries. Such plans include a notification system, which may be used to contact the family of the injured athlete, athletic coordinators, officials, legal and risk management offices, and institutional insurance carriers. It may also include the formation of a catastrophic injury team, which may include athletic directors, head athletic trainer, team physicians, legal counsel, and media relations.
In 1985, the
National Collegiate Athletic Association
The National Collegiate Athletic Association (NCAA) is a nonprofit organization that regulates College athletics in the United States, student athletics among about 1,100 schools in the United States, and Simon Fraser University, 1 in Canada. ...
created an insurance plan for member institutions to provide benefits for student athletes who sustain a catastrophic injury, in response to an increase in
workers' compensation
Workers' compensation or workers' comp is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her emp ...
claims filed by students. This was designed to protect member institutions "against the sudden and substantial costs of injury benefits", typically obtained by the student via worker's compensation claims and litigation. The injured student receives benefits immediately and does not incur litigation costs, but retains the right to litigation in cases of negligence by the institution. In 2005, 25% of funds for insurance claim payouts were associated with cheerleading.
The National Federation of High School Associations instituted a medical plan for high school athletic associations and their member schools and districts. This allows a catastrophically injured student athlete to receive "medical, rehabilitation, and work-loss benefits" until death by waiving rights to litigation. The institution thereby need not invest the human and financial resources associated with litigation, in addition to a potential award to the plaintiff, and the student receives immediate and lifelong benefits.
Athletic associations, organizations, and leagues update their rules based on research regarding catastrophic injuries. The amount of enforcement of the rules may explain variations in incidence of catastrophic injuries between jurisdictions.
Litigation
In Canada, as of May 2012 the largest award to a plaintiff of a catastrophic brain injury was $18.4 million, and the largest award to a plaintiff of a catastrophic spinal cord injury was $12.33 million.
In the US, as of 2021 the largest award to plaintiff was $20 million.
In
South Africa
South Africa, officially the Republic of South Africa (RSA), is the Southern Africa, southernmost country in Africa. Its Provinces of South Africa, nine provinces are bounded to the south by of coastline that stretches along the Atlantic O ...
, the largest malpractice settlement for the
Medical Protection Society as of 2011 was for
R17 million, awarded to a patient who had catastrophic neurological damage as a result of a surgical procedure.
Notes
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Injuries
Neurotrauma
Disability by type