Literature review on hydrostatic vaginal and anorectal injuries caused by personal watercraft

Introduction The use of personal watercrafts (PWCs) has increased in popularity, size and engine power over time. Hydrostatic injuries when the passenger falls into water and the pelvic floor is directly hurt by the water jet remain rarely reported in literature but potentially lethal. Perineal, gynaecological and rectosigmoid regions present significant points of anatomical weakness to the force vector of the water. Biomechanical aspects on water-associated injuries on PWC may include disruption of the perineal soft tissues, inefficient anal sphincter and hydrodynamic insufflation. Methods This is a study involving a literature review from 1972 to 2020 using suitable search terms to identify all hydrostatic PWC injuries following PRISMA guidelines. Data were extracted from suitable articles on mechanism of injury, injuries sustained, treatment and outcomes. Results Thirty-two patients with major perineal, gynaecological and/or digestive injuries due to hydrostatic PWC traumas were identified. Major risk factors were female gender (84.4%), young age (25.5 years), being a rear passenger and wearing a standard swimsuit (100%). The injuries were digestive tract only (81.3%), gynaecological only (46.9%) or combined (28.1%). The interdisciplinary surgical management must include a vaginal and anal exploration under general anaesthesia and an exploratory surgery. Vaginal repair (41.9%) may be associated with a transanal anorectal suturing for lacerations of the intraperitoneal rectum (40.6%). A defunctioning stoma was performed in 62.5% and consisted of a loop sigmoidostomy (43.5%) or Hartmann’s procedure (34.8%) depending on laceration complexity. Conclusions PWC-related hydrostatic injuries are still rare but associated with a mortality rate of 6.3% which rises to 25% if initial haemodynamic instability was present. Expert guidelines such as adding an automated engine shut-off switch for the rear passenger and wearing a protective and safety clothing should be more widely respected.

When Natural Hazards Intersect with Public Health: A Preliminary Exploration of the Impact of Bushfires and the COVID-19 Pandemic on Australian Coastal Drowning Fatalities

Natural hazards combined with the COVID-19 pandemic have had significant global impacts to the community and the environment. This study explores the impact of the Australian 2019/20 bushfires followed by the COVID-19 pandemic on unintentional coastal drowning fatalities. Fatality data were collated using triangulation methodology. Percentage change in coastal drowning fatalities between 2019/20 financial year (FY) and the 15FY annual average (2004/5–2018/19) were calculated for the dominant bushfire period (August 2019–February 2020 inclusive) and COVID-19 restrictions in place for 2019/20FY (March–June 2020 inclusive). Relative risk (RR; with 95% confidence intervals [CI]) of coastal drowning was calculated against the average for overall, bushfire and COVID-19 periods, using coastal participation data as the denominator, weighted for the predicted decrease in the use of outdoor coastal areas due to these widespread events. Coastal drowning fatalities increased in 2019/20FY by 9% overall (bushfires: 6%; COVID-19: 9%). Swimming/wading drowning fatalities increased during the bushfire period (RR = 2.02; 95% CI: 1.13–3.63), while boating and personal watercraft (PWC)-related fatalities increased during both the bushfire (RR = 2.92; 95% CI: 1.41–6.05) and COVID-19 period (RR = 3.86; 95% CI: 1.64–9.11). Rock fishing fatalities also increased across both the bushfire (RR = 4.19; 95% CI: 1.45–12.07; p = 0.008) and COVID-19 (RR = 3.8;95% CI: 1.24–11.62; p = 0.027) periods. Findings indicate the activity patterns leading to coastal drowning fatalities changed despite significant public health events impacting freedom of movement and thus opportunity for coastal participation. Understanding, and preparing for, the impacts of natural hazards on drowning risk is vital for future preventive efforts.

Personal Watercraft Incident Court Decisions: The Plaintiff’s Odds?

A personal watercraft (PWC) is a vessel that uses an inboard motor powering a water jet pump as a source of power and is operated by a person sitting, standing, or kneeling. Maneuvering a PWC is different from operating a motor vehicle or boat. An obstacle cannot be avoided by slowing down and turning the watercraft; throttle power is required to turn or maneuver the PWC. The watercraft stops only by drifting or turning sharply. The study examined sixty court decisions published in LexisNexis databases of the United States over the last decade. Cases included individuals injured while operating a PWC as a driver, passenger, or as a result of contact with a watercraft. A content analysis identified items to be used in the study. Crosstab and logistic regression analyses were used to identify demographic information and the characteristics of those who succeeded in a court of law. One-third of the cases were successful; adults, males, and the party who sustained a severe injury were more successful in a court of law with the exception of the statistically significant factors (high risk maneuvers and sharp turns). Among the additional results, we should be aware that insurance companies may not pay; additionally, it is unwise to loan a PWC to a female who has no experience.

Anorectal injury related to a personal watercraft: a case report and literature review

Background Douche injury is a rare consequence of water recreation activities. Generally, this type of trauma occurs when people fall into the water in a sitting position during high-speed activities such as using a personal watercraft (PWC). Here, we report a rare case of anorectal injury caused by water jets from a PWC during sudden acceleration from rest. Case presentation A 21-year-old male passenger on a PWC fell off backward from the rear seat when the craft suddenly accelerated. He fell into the water in a supine position with his legs open, and the water jets of the PWC struck his perineum directly. Thereafter, bleeding from the anus was seen, and he was transferred to our hospital. On physical examination, there was a deep laceration interrupting the external anal sphincter in the posterior rectal wall. Abdominal computed tomography revealed a full-layer perforation of the posterior rectal wall and leakage of feces into the extraperitoneal space, but intraperitoneal free air was not seen. Laparoscopic sigmoid loop colostomy and primary suturing of the sphincter and mucosa were performed. He did not have any complications and was discharged from our hospital 16 days after the surgery. His anal function was almost perfectly preserved, and his diverting colostomy was closed 4 months later. Conclusion Anorectal injuries related to PWCs can occur not only while traveling at high speeds, but also when suddenly accelerating from rest. A diverting colostomy should be performed for this type of trauma. In these trauma cases, clinicians must suspect complex and life-threatening anorectal injuries early.

Seaworthiness Through Intelligent Trajectory Control

Navigation of autonomous surface vessels, less than 20 m in length, in large sea states is difficult and often precludes successful completion of the assigned mission or, in the worst case, survivability. Operation in high seas requires sensing of the local wave environment and determining a vessel trajectory that maximizes survivability based on knowledge of the vessel response functions and prediction of the incident wave field forward in time. To achieve this objective, new technologies are being developed and tested in full scale at the Marine Autonomy Research Site (MARS), located in central Lake Superior and operated by Michigan Technological University. In this initial set of experiments, a skilled human operator was used as a surrogate for an envisioned wave-adaptive autonomous control system. The test vehicle is a fully instrumented personal watercraft, operated by a U.S. Coast Guard-trained surf-boat operator in moderate sea states with Froude number (Fr) = 1.0 through a course consisting of up-wave, cross-wave, and down-wave legs. Results dramatically document that the wave-dodging maneuvers employed are designed to minimize vessel pitch (preserve propulsor and rudder control) while allowing increased vessel roll. Comparisons of the straight line with wave-dodging circuits during constant sea state conditions show that vehicle roll is at times twice greater in wave-dodging runs while vehicle pitch averages half to one third of that in the straight-line course. These data suggest that optimum paths do exist through steep, evolving incident wave fields and these optimum paths can produce significant improvements in vessel survivability.