A recent tragedy in Davenport, Tasmania, Australia, resulted in the death of six young school children and serious injury to three others when the jumping castle on which they were playing was lifted from the ground in a gust of wind. It became airborne to a maximum height of 10 m and travelled 50 m before becoming lodged in a tree. This incident highlights potential serious health consequences associated with jumping or bouncy castles or inflatable bouncers. Previous studies suggest that one child presents every 46 min to a US emergency department with an injury sustained on a jumping castle.1 We conducted a literature search of MEDLINE and EMBASE for journal articles and used Google to identify news articles on jumping castle-related injuries and deaths. We identified 10 relevant full text journal articles from the USA and Europe, comprising five cohort studies and five case series/reports including 131 164 children/adolescents and 65 429 injuries directly related to jumping castles (Table 1). Olsen2 prospectively identified 112 amusement-park injuries of which 78 occurred on jumping castles over a 7-month period: most were sprains, mainly ankle (37%), fractures (29%), contusions of the back and extremities (18%) and wounds (10%).2 A study reported 49 fractures among children and adolescents playing on jumping castles who presented to a hospital emergency department (ED), only two of whom (aged 4 and 10) required surgery.3 A study using a hospital ED database identified 521 children injured on inflatable bouncers between 2002 and 2013.4 Almost half had fractures (n = 246, 47%), the upper extremity being the most common site (80.5%). These were followed by sprains (31.3%), contusion/abrasion (5.8%), concussion (4.6%), joint dislocation (3.8%), laceration (1.7%) and multiple injuries (0.4%). There was a substantial increase in injuries over time from 1.4 per 1000 in 2002 to 24.4 per 1000 in 2013.4 A prospective study identified 114 children injured on jumping castles who presented to the ED with fractures of the upper limb (humerus, distal radius), ankle sprains and vertebral fractures. Almost 90% of injuries were unwitnessed, parents being alerted by a crying child.5 The largest study, from the USA, used a national database to identify 64 657 injuries due to inflatable bouncers over a 20-year period.1 As reported for other studies, the most common injuries were fractures (27.5%), sprains (27.3%), soft-tissue injuries (18.0%), concussion (7.0%) and lacerations (6.4%). In this large study, an increasing number of injuries were observed over time, the increase being most rapid in recent years.5 We also identified news articles from web-based sources reporting 484 injuries and 28 deaths since 2000, with a trend for increasing numbers over time (Fig. 1). The news media is a helpful source of information: deaths were reported in news items but not in the medical literature. Most reported deaths were associated with jumping castles/inflatable bouncers being lifted off the ground by strong gusts of wind. The median wind speed was 43 km/h (range 8–137 km/h). Some bouncers were not anchored to the ground. Causes of death were not provided. The only Australian report, in 2001, described that 15 children were injured and a 7-year old girl died when a dust devil (‘Willy-Willy’, whirlwind, dust storm) lifted a jumping castle. The USA has the largest number of accidents related to jumping castles (53%), followed by China (11%), the UK (10%) and Australia (8%). Of the 28 reported child deaths related to jumping castle accidents, 29% occurred in China, 11% in the USA and 7% in the UK. This information highlights the potential dangers of inflatable bouncers for children and adolescents. Injury prevention requires adult supervision by centre staff and parents, limiting the numbers of children on the device, and securing the device to the ground. The Australian Standard for owning and operating commercial jumping castles (3533.1.2009) states that the device should be securely anchored and should not be used in inclement weather when wind gusts exceed 40 km/h. However, many reported deaths have occurred when a jumping castle was lifted off the ground by a dust devil, which is extremely unpredictable. Once airborne, jumping castles are often unstoppable and some have travelled up to 1.6 km from their origin. Some countries have banned the use of inflatable devices. Perhaps Australia should follow? APSU activities are supported by the Australian Government Department of Health; the University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health; the Children's Hospital at Westmead; and the Royal Australasian College of Physicians. EJ Elliott is supported by an NHMRC-MRFF Next Generation Fellowship (#1135959).
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