BACKGROUND: The rapidly increasing number of spas, hot tubs, and saunas intensifies the potentials for deaths from hyperthermia and drowning. METHODS: I analyzed 54 such deaths reported to me by 55 medical examiners and coroners in the United States and 104 deaths reported to the US Consumer Product Safety Commission (CPSC). RESULTS: Only seven of the 158 deaths analyzed occurred in saunas. All of the remaining deaths occurred in spas, jacuzzis, or hot tubs, which were far more numerous. The chief risk factors identified were alcohol ingestion, heart disease, seizure disorders, and cocaine ingestion (alone or in combination with alcohol ingestion). These factors accounted for 71 or 44.7% of the 159 fatalities. Of these risk factors, alcohol represented 38%; heart disease, 31%; seizure disorders, 17%; and cocaine ingestion, alone or in combination with alcohol, 14%. Sixty-one of the 151 spa-associated deaths occurred in children under 12 years of age. Accidental drownings from uncovered or improperly covered spas and, to a lesser extent, entrapment by suction, were the chief causes of childhood drownings. CONCLUSIONS: Children and older persons who have heart disease or seizure disorders or who use alcohol or cocaine are especially vulnerable. Recommended preventive measures include shortening the time of exposure, lowering the temperature, establishing safety standards for covers and for baffles for suction outlets, and using warning notices.

A report is presented on a five-state study of 1,201 drownings during a 12-month period ending June 30, 1966. More than a score of variables involved were analyzed and the findings are discussed. The need for more valid information and for further studies along various lines is emphasized. AN

No abstract

Two hundred and ninety-three wringer machine injuries in Chicago and Evanston were reviewed. Many of these were serious enough to warrant hospitalization. Frequency and seriousness of wringer injuries requires development of further safety standards. The authors suggest the value of the "instinctive" release mechanism on these machines.

A co-operative study of the ingestion of kerosene and other petroleum distillate products was carried out among 46 participating hospitals in various cities in the United States and Canada. The basic objectives of the study were the evaluation of gastric lavage as a treatment for the ingestion of petroleum products and the development and formulation of a pattern for the co-operative exchange of information pertaining to poisoning problems. Reports were obtained on a total of 760 patients; 299 of these were submitted by seven participating hospitals that alternated the use and the omission of gastric lavage on even and odd dates of the month in accordance with protocol, and it is primarily on these alternated cases that conclusions regarding the relationship between gastric lavage and the development of complications were based. The other cases were used to examine various epidemiologic characteristics of the problem. Gastric lavage was not harmful to the patients, but there was no conclusive evidence that it was beneficial. The presence of pulmonary complications and of pulmonary complications associated with fever were more closely correlated to the presence of vomiting and to the ingestion of amounts greater than one ounce of petroleum distillates than to the use or omission of gastric lavage. Patients developed complications in the absence of both vomiting and lavage, thus allowing the inference that bloodstream absorption is a factor in the toxicity of these products to humans. Although the case fatality rate is relatively small (only 2 fatalities in the 760 cases) the incidence and the morbidity is substantial. On the basis of National Health Survey figures and reports to the National Clearinghouse for Poison Control Centers it is estimated that about 28,000 such ingestions occur annually in the United States, and in the current series of 760 patients, 62% were hospitalized. Kerosene was by far the commonest type of petroleum distillate product ingested, although mineral seal oil, gasoline, lighter fluid, and a variety of others were involved. Mineral seal oil is the most dangerous from the standpoint of the frequency of toxic manifestations. Treatments reported other than gastric lavage were oxygen, oxygen under pressure, penicillin and other antibiotics, and corticosteroids. In order to determine conclusively whether or not gastric lavage is useful in the treatment of petroleum distillate ingestions it is recommended that an additional co-operative study be carried out. Such a study should include in addition to the factors recorded in this study, the following items: 1. A uniformly recommended specific technique for lavage (with perhaps one additional alternative). 2. Sharper definition of, and closer adherence to, criteria for complications including a history of the presence of cough or gagging at the time of ingestion, and the routine use of serial x-ray. 3. The use of electroencephalography to explore and delineate central nervous system complications. 4. The preservation and analysis of the various types of kerosene and petroleum distillates involved and if possible, quantitative analysis of constituents of kerosene in these samples, in the blood and perhaps in the expired air of the patients ingesting the substances.