Safer on the Playground

A montage of videos of playground accidents ranging from the funny to the cringeworthy kicked off the session “Playground Injury Prevention” March 4 at EMS Today in Tampa, Fla. Shaun Fix, PMD, NRP, retired EMS captain for Boca Raton Fire Rescue and president of Emergency Medical Consultants in Port Saint Lucie, Fla., outlined some common injury patterns related to playgrounds and the causative hazards that can lead to them.

“People do dumb stuff,” said Fix, adding that children have few inhibitions, limited life experience and poor judgment compared to adults. While nothing can erase the reckless abandon of youth, improvements in the design of playground equipment and awareness of some common risk areas can help lower the overwhelming incidence of emergency room visits caused by mishaps on the playground, according to Fix.

Scope of the Problem

Playgrounds are places where children can run, laugh, take risks and explore possibilities, said Fix. They foster agility, strength, self-expression, social skills, independence and creativity. And playgrounds are everywhere—at schools, parks, multiple-family communities, and resorts.

But each year, over 200,000 children end up in the ER as a result of playground-related injuries, according to the CDC. And injury rates are likely much higher, as children also visit their family physician for treatment, Fix pointed out.

In a recent 10-year period, 147 children died from playground injuries, according to the CDC. There were 82 strangulations and 31 falls in that period. Further research revealed that the overall rate of ER visits for playground-related TBI significantly increased between 2005 and 2013. Fall heights on the nation's playgrounds are increasing, said Fix.

Two-thirds of injuries involve monkey bars, climbing equipment and swings. Common injuries include fractures, sprains/strains, internal organ injury, spinal cord injuries, dislocations, concussions, crushes and amputations, said Fix. He continued his presentation by highlighting common causative factors to these serious events.

Ground Surfaces

Over 80 percent of playground injuries are caused by falls, Fix said. Proper surface areas on playgrounds can help reduce the incidence of life-threatening and debilitating injury. Surface areas around playground equipment should have at least 12 inches of fill, according to commonly accepted standards—wood chips, pea gravel, sand, and similar materials are preferred. Wood products provide good cushion for falls above 9 feet, while sand and pea gravel are better for falls under 9 feet.

Shredded rubber mulch is durable and is best for fall heights over 10 feet. It tends to be more expensive than other surfaces, however, and does not displace weight during a fall as well. The CDC recommends that asphalt, grass, packed dirt or rocks should never be used under playground equipment.

Equipment Hazards

Poorly maintained equipment is another significant cause of playground injury, continued Fix. Rusty equipment can break and lead to a life-threatening fall. Exposed nails, unprotected protrusions, and S-hooks with wide openings can snag on skin or loose clothing. Spaces between guardrails or fence posts can trap a child’s head if they are between 3.5 and 9 inches wide.

Unconditioned, aging wood is prone to splinters. Steel-belted radial tires can age and expose metal wires, and can collect standing water, a potential drowning hazard. Hot surfaces can cause burns, even with air temperatures in the low 70s.

Cargo nets can be a safe climbing environment but should have holes of less than 17 inches or greater than 28 inches to minimize the risk of head entrapment, Fix said. Rings are for kids over 4 years old and should be coated with non-slip substances. Swings, which are disappearing from many playgrounds because of safety concerns, should be spaced more than two feet from each other and far enough from other playground equipment to avoid colliding or entanglements.

Lesser-known Dangers

Fix wrapped up his talk by highlighting some additional hazards and lesser-known considerations not related to equipment or surfaces:

• Users of illegal substances are likely to use playgrounds at night, leaving needles and other paraphernalia behind;
• Older playgrounds might still contain lead-based paints;
• Trampolines should never be used at home, according to the American Academy of Pediatrics. As many as 92,000 ER visits annually result from trampoline use;
• Only 30% of playgrounds have partial shade protection, so sunscreen is a must;
• Human traffickers often target play areas for potential victims.

To summarize, the most important factors in playground injury prevention are focused supervision by a responsible adult and routine equipment inspections and maintenance. The National Program for Playground Safety’s SAFE Model: Supervision, Age-appropriate design, Fall surface conditioning and Equipment maintenance can be located at www.playgroundsafety.org and is a valuable resource when speaking to your municipality about playground safety—which you should do if you begin to see common injuries at your local playgrounds, Fix said.

For more information visit www.cpsc.gov

Jonathan Bassett is editorial director at EMS World. Reach him at jon@emsworld.com