The Journal of Emergency Medicine, Vol 13, No S, pp 629-631, 1995

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THE PERILS OF BUNGEE JUltiWW4G

Marc J. Shapiro, MD, Boyd Marts, MD, Anthony Berni, MD, and Mary J. Keegan, RN. MSN

Division of Trauma Services, Department of Surgery, Saint Louis University Health Sciences Center, St. Louis, Missouri
Reprint Address: Marc J. Shapiro, MD, St. Louis University Health Sciences Center, Department of Surgery.
3635 Vista Ave. at Grand Blvd., P.O. Box 15250, St. Louis, MO 6311 O-0250

0 Abstract -Bungee jumping is a relatively new recre-
ational sport. Most emergency physicians and trauma sur-
geons have limited experience with its associated injuries.
We report the case of a bungee cord attachment apparatus
malfunctioning, resulting in a free fall of the jumper of
approximately 24fl feet. The presence of an air cushion on
the ground prevented sig&ficant injury. Knowledge of the
potential iqjuries of this new sport is crucial for effective
management.
April Fool’s Day in 1979 (4). Presently, most bungee
jumpers wear a vest attached to a bungee cord, which
stretches up to twice its length; cords attached to
ankles are still used in some locations. Recently, fa-
talities and injuries have been reported, and a recent
experience related to mechanical failure resulting in a
free fall to an air cushion below prompts this report
and a review of the medical literature.

0 Keywords- bungee; jump; fall; trauma; sport

CASE DESCRIPTION

INTRODUCTION A 39-year-old male performed a forward bungee

Bungee jumping is the sport of jumping while
attached to elastic cords from a high platform on a
crane, tower, bridge, hot air balloon, or fixed object,
allowing a free fall ( 1). The object is not to strike the
ground, but rather to rebound a significant distance
and then fall once or twice further before being either
lowered to the ground or pulled back up to the origi-
nal platform. Bungee jumping originated on the
South Pacific island of Pentecost, where vines were
secured to the ankles of the island’s inhabitants, who
then dove off elevated platforms, becoming sus-
pended in air, barely touching the ground (2,3).
Tribal customs have used forms of bungee jumping
as rights of passage to manhood, providing men a
chance to demonstrate their courage, to show off in
front of women, and to get a public hearing for their
troubles. The Dangerous Sports Club in Bristol, Eng-
land, recognized this sport with its first jump on
jump from a platform suspended from a crane ap-
proximately 240 feet above the ground. The jumper
was securely fastened in a vest that passed over the
shoulders and between the legs and attached to the
bungee cord. Upon reaching the full stretched nadir
of the cord, the attachment of the cord to the crane
parted and the jumper plummeted to the ground
(Figures 1 & 2). He landed on a large infiatable air
mattress (Figure 3). He complained of pain in the
lower abdomen and left knee and was transported
by Emergency Medical Services to our Emergency
Department. Evaluation disclosed a patient in mod-
erate distress with a pulse of 100 beats/r&n, respira-
tory rate of 20 breaths/min, and blood pressure of
142/90 mmHg. On examination, he had mild supra-
pubic tenderness and minimal tenderness and swell-
ing of the left knee. The rem&&r of the examina-
tion was noncontributory. Plain rad@r&phs of the
chest, pelvis, left knee, and cervical, thoracic and

RECEIVED: 6 July 1994; FINALSUBMISSIONRECEIVED: 18 January 1995;

ACCEPTED: 15 February 1995
630
Figure 1. Crane is in the right upper hand corner with patient
falling head first with cord (arrow) following.
lumbar spine showed no acute injury. Computed to-
mography (CT) scans of the abdomen and pelvis
were unremarkable, as were urinalysis, serum chem-
istries, and hematologic studies.
With no acute injury found, the patient was dis-
charged on nonsteroidal anti-inflammatory agents
and a left knee immobilizer. Six months after evalua-
tion, the patient was noted to have resolution of his
knee swelling and has returned to work, although he
is receiving physical therapy for lower thoracic and
upper lumbar myalgias.
Figure 2. As patient approaches the ground, he rights him-
self and the cord (arrow) is actually below him.
M. J. Shapiro et al.
Figure 3. Patient in the large inflatable air mattress with
arrow pointing to the patient’s foot.
DISCUSSION
There have been well over one million bungee jumps
in the United States since the first commercial opera-
tion opened in 1988. In that period of time, there
have been seven fatalities and a score of serious injur-
ies, usually due to operator error (5-13). Fatalities
occurred because of incorrect connections [ 21, the
basket falling to the ground [ 31, or the balloon losing
altitude with the jumper impacting the ground [2]
(5,6). Injuries have included paralysis from spinal
cord injury, cerebral concussion, ankle fracture,
abrasions, bruises, peroneal nerve palsy, sprained
fingers, visual loss, gluteal hematoma, subconjuncti-
val chemosis and hemorrhage, and cord burns on
hands (5-11).
The risk of bungee jumping has been compared to
parachute jumping. The U.S. Parachute Association
reports that about 30 skydivers are killed each year
in North America, or approximately 1.2 deaths per
100,000 jumps, which is at least five times the death
rate for bungee jumping. In addition, about 10% of
skydivers suffer injuries requiring medical attention,
which is at least 1,000 times higher than the serious
injury rate for bungee jumping (6). However, be-
cause of the spectacular nature of the deaths and
injuries, some states have set up bungee jumping leg-
islation and, in fact, Massachusetts and Florida at
one point banned bungee jumping. The sport is not
cheap, occasionally costing one hundred dollars for
a single jump (1,6).
Bungee Jumping
One author personally evaluated stress reaction to
bungee jumping, finding that cortisol levels in-
creased, although beta-endorphins, growth hor-
mone, prolactin, testosterone, and follicular stimu-
lating hormone did not increase during bungee
jumping (14,15). In an evaluation of 12 novice
jumper volunteers, saliva cortisol levels increased, as
did beta-endorphin immunoreactivity after jumping.
The observation of the rise in positive feelings such
as euphoria prior to the jump correlated with beta-
endorphin rise but not cortisol and is consistent with
the concept that beta-endorphins mediate the feelings
of euphoria. Pretreatment prior to jumping with Nal-
oxone, a beta-endorphin antagonist, could conceiv-
ably block this euphoria, allowing the more timid to
participate in this sport ( 16).
Many physical contact sports such as hockey or
football are regulated with safety in mind. Most of
the injuries seen are predictable and equipment is
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4. Hite PR, Greene KA, Levy DI, et al. Injuries resulting from
bungee-cord jumping. Ann Emerg Med. 1993;22:1060-3.
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6. Sullum J. Leaping to conclusions. Reason. 1992;24:46-9.
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631
used to decreaserisk of injury. Guidelines with physi-
cian input need to be established for bungee jumping.
It must be mandatory to place a large air cushion on
the ground below the bungee jumper. Jumpers
should be secured to a multicord system using cov-
ered and safety cords in addition to the main cord. A
maximum height of jumping must be set (at least no
more than 200 feet), and employees should adhere
to the same standards of safety as their customers.
Inspection of all equipment must be regular and fre-
quent. That mechanical failure can occur is a risk
that needsto be explained to all bungee jumpers. The
appeal of bungee jumping, at least in part, is the
thrill from its risks (1,17).
It is highly unlikely that bungee jumping will be
outlawed in the United States; however, common
sense, practicality, and safety are crucial. Liability
will continue to be an issue and will be responsible in
part for the cost encountered in bungee ,jumping.
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