Diving Into Shallow End Turns Disastrous

In a tragic incident, pool fun turned disastrous for a 17-year-old Swapnil Gupta last summer, when he suffered an acute neck injury after diving into the shallow end of the pool head down.

The injury was so crippling that downwards from their neck; all the 4 limbs were paralysed, with no mobility and loss of control over urine and stool. The boy immediately had become immobile and was rushed to a Kota Hospital where he was stabilized. Later, he was shifted to Indian Spinal Injuries Centre (ISIC) for advanced treatment.

“After complete investigation, we conducted a conservative surgery on Swapnil where through lateral mass screw fixation posterior stabilization of cervical spine was performed. Our primary objective was cut-out, which was to ensure that the patient regains as much independence as possible considering the nature and severity of injury. In fact, injuries of such severity result in 9% to 13% mortality rate,” said Dr. HS Chhabra, Medical Director and Chief of Spine Services, at ISIC.

In a period of 2 months post-surgery, there was some neurological recovery visible in the lower limbs of the patient. However, after some more time further improvement stopped, with muscle power not being appropriate to have functionally useful recovery.

“Noting stagnancy and no further improvement, we decided to focus on aggressive rehabilitation, including hydrotherapy, treadmill therapy, and bodyweight suspension. There was much resistance from Swapnil initially for hydrotherapy because he had developed hydrophobia after his accident. So much so that noting no further improvement the family was contemplating to take the boy home. However, our team guided and convinced Swapnil’s family, and initiated counselling and psychiatric medication, which contributed significantly in getting his rehabilitation routine back on track,” said Dr. HS Chhabra.

Around 6 months down the line since the day he was admitted, Swapnil was discharged from the hospital this February. He had regained significant mobility to enable him perform activities of daily living such as writing, using laptop, brushing his teeth, and most importantly to walk with support of a walker.

Today, Swapnil is preparing to rejoin school, with his life changing twice in past 6 months. However, there remains a serious lesson for all of us to learn.

“In another case, a 15-year-old Kolkata boy named Mohd Adil sustained neck fractures on March 13th for the similar reason, which paralyzed his 4 limbs. Like Swapnil, he too had lost control over urine and stool. While the fractures to C5,C6 vertebrae was stabilized elsewhere with surgery, screw and rod insertion in the neck, we received him for rehabilitation and further management. Medical examination revealed the lack of any movement below C6 neurological level where also it was only Grade 2 power (normal is 5). There was no sensation below C5 level and complete numbness in the perianal area. After detailed assessment, comprehensive rehabilitation has been started. Bowel and bladder training has been initiated. Comprehensive medical management has been initiated in the form of respiratory as well as cardiovascular management.   We constantly encounter severe injury cases from various situations in life, and most have two things in common: carelessness and non-adherence to rules and safety guidelines. This is most evident from the fact that Adil was a professional swimmer. The initial goal of treating such cases is to make the patient as independent as possible according to the level of injury. Some neurological recovery in shoulder and elbow muscles (C5 & C6 neurological levels) is expected. He should be able to do most of the activities of daily living if he gains shoulder and elbow power. The team ISIC is working with full efforts to realize the goals and to make him as self-dependent as possible,” said Dr. HS Chhabra.

As summers are around, enjoying a dive into the pool is all well, but one must not be ignorant of safety measures. Diving towards shallow end head-first may cause severe injuries because the head may hit the bottom/ floor. These injuries may be life-crippling or may prove to be fatal.

Diving head first in shallow water can cause enough impact to break the neck and cause paralysis. Not that diving foot folded is a good idea because sometimes the depth of water is so low that the feet or a body parts end-up hitting the pool floor, especially for adults. This too can cause fracture. Therefore, it is important to know the water level as well as the dos and don’ts around the pool area or water bodies and follow them well.

“It is highly important that professionals play a key role in not only educating people and spreading awareness of safety measures but also seeing that these guidelines are implemented and are being followed. Professionals need to follow rules themselves at all times because otherwise it is a bad precedent. The healthcare providers should be taking a lead in reaching out to people with various awareness programs. As organizations that cater to physical trauma cases, hospitals have the right mix of experience and knowledge to sensitize people. Government need to not only draft, upgrade, and implement safety standard and polices, but also they should duly perform safety audits and checks. In addition to these stakeholders, media which has the highest reach amongst common people should take-up such stories more often and deliver the message to the masses. It is they who can play a key role in bringing about a major transformation”, Dr.  HS Chhabra concluded.

In separate cases, a 17-year-old Swapnil Gupta was paralysed neck down after diving into shallow end of swimming pool and a 15-year-old Mohd. Adilgot injured after diving into the shallow end of the river.

Their treatment was undertaken by doctors of Indian Spinal Injuries Center, which specializes in providing high quality treatment and rehabilitation services for spinal injury patients.

Swapnil underwent surgery and aggressive rehabilitation at ISIC to regain the ability to walk and move, while Adil is undergoing post-surgery management and rehabilitation.