Page 103 - Journal of Special Operations Medicine - Winter 2014

• Being struck by a seat, cockpit object, or the canopy • Intrinsic factors include female sex, greater body
can cause concussion or traumatic brain injury, head weight, older age, less upper-body muscular endur-
and neck lacerations, strains, compression fractures, ance, lower aerobic fitness, and prior injuries.
and extremity fractures and lacerations (especially of
the legs and feet). Altitude Injuries
Most altitude injuries occur to upper and lower extremi-
Airstream entry injuries can be categorized further as ties (66%). Upper extremity injuries are more common
7
windblast injuries and those due to temperature expo- than lower extremity injuries, but the latter are more
sure; tumbling, rotational stress, and ”flat spin”; and severe than the former. Altitude injuries occur on exiting
blunt or penetrating injury incurred when aircraft debris the aircraft, on parachute deployment, and on descent.
strikes the ejected pilot.
On exiting the aircraft, the pilot may be struck by the
• Windblast injuries include petechial, conjunctival, aircraft, may end up being towed by the aircraft (with
and/or retinal hemorrhage; flail injuries, comprising trauma occurring from hitting the plane repeatedly),
unconsciousness, neck strain or fracture from helmet and may experience static-line entanglement.
or head rotation, extremity fractures (especially the
humerus and tibia/fibula), and joint dislocations (es- On parachute deployment, injuries can occur from
pecially shoulder and knee); and “windblast erosion,” parachute “opening shock” deceleration, riser slap,
causing exposure injuries from torn clothes, boots suspension-line entanglement, strikes from unsecured
pulled off, a shattered helmet visor, and helmet loss. equipment, and from midair collisions with other
• Temperature exposure: Exposure to low temperatures parachutists.
is of little significance if protective equipment is prop-
erly fitted and worn and is not lost during the ejec- • Parachute “opening shock” deceleration can cause
tion. Third-degree burns can result from ejection-seat cervical fractures or sprains; cervical vertebral dislo-
launch. cations; shoulder trauma, including dislocation and
• Injuries resulting from tumbling, rotational stress in- soft tissue trauma to ligaments and the rotator cuff;
juries, and/or ”flat spin” include tearing and rupture and upper extremity muscle strains.
4
of thoracic and abdominal organs (cardiac injury is • Riser slap can cause facial fractures, contusions, and
especially critical), unconsciousness, and hemorrhage lacerations.
and edema in eyes, ears, sinuses, lungs, and brain. • Suspension line entanglement extremity injuries com-
prise 63% of severe injuries, including fractures,
7
Parachute-related injuries result from parachute deploy- shoulder and hip dislocations, intrasubstance biceps
ment and pilot descent and landing. (See parachute in- muscle tears, degloving injuries, compartment syn-
8
jury section for further details.) drome, and knee-ligament injuries (37%). 7
Parachute descent injuries result from high altitude and
Parachute Injuries
high-speed rotation and spinning.
The most common parachute injuries are closed head
5
injury/concussion (30%), fractures of the ankle and/ • At high altitude, the ejected parachutist may experi-
or back (15%), and sprains of the ankle and/or back ence frostbite, hypoxia, and hypothermia.
(15%). Injuries can be categorized as altitude injuries • High-speed rotation and spinning injuries (see also
and landing injuries. Extrinsic (not related to the in- section 5ciii in pilot ejection injuries) cause severe
dividual parachutist) and intrinsic (related to the indi- pain, hemorrhages, unconsciousness, and suspension-
vidual parachutist) factors increase risk of parachute line entanglement injuries
injury. 5
Parachute Landing Injuries
• Extrinsic factors include high wind speeds, night Ground impact and inability to execute a proper para-
jumps, and heavy loads. There is a significant in- chute landing fall account for 49% of all parachuting
crease in injury rates and severity when jumpers wear injuries. These include concussion or traumatic brain
5
combat equipment. Other extrinsic factors are rough injury; fractures of the ankle, tibia/ fibula, femur, pelvis,
6
landing zones; smaller diameter canopies; fixed-wing and spine; and knee ligament injuries.
aircraft exits (vs rotary wing); higher rate of injury
with side-door vs tailgate exits; extra equipment; the Tree landings can result in lacerations, fractures, and
number of jumpers (more jumpers in the air leads impalement by tree limbs. Parachute suspension for pro-
to entanglements); and higher temperatures, which longed period (a.k.a., “suspension trauma” and “hang-
cause less dense air and, thus, faster descent velocities. ing harness syndrome”) also can occur. This is poorly

Pilot Ejection, Parachute, and Helicopter Crash Injuries 93