Correspondence

Sudden Death from Collapsing Sand Holes

N Engl J Med 2007; 356:2655-2656June 21, 2007

Article

To the Editor:

During the summer-recreation and beach season, we believe it is timely to underscore a potential but underrecognized safety risk associated with leisure activities in open-sand environments.1,2 We assembled a series of 52 documented fatal and nonfatal cases, occurring primarily in the past 10 years, in which persons were submerged after the collapse of a dry-sand hole excavated for recreational purposes. These cases were assembled prospectively and retrospectively and were identified from news-media accounts, personal communications, Internet searches, and the LexisNexis database. Detailed information was obtained by interviewing rescuers and witnesses, when possible. The victims ranged in age from 3 to 21 years (mean, 12 years), with 15 persons (29%) 10 years of age or younger; 45 (87%) were male. Twelve U.S. states are represented, including those in the New England area, where nine events (17%) occurred.

The most common setting was a public beach in a coastal area, near the shoreline (in 41 cases), with the remaining cases (11 cases) occurring near the home. Dry-sand holes were excavated by the victim, friends, or relatives. The holes were generally 2 to 15 ft (0.6 to 4.6 m) in diameter and 2 to 12 ft (0.6 to 3.7 m) deep. Typically, victims became completely submerged in the sand when the walls of the hole unexpectedly collapsed, leaving virtually no evidence of the hole or the location of the victim. Collapse was inadvertently triggered by a variety of circumstances, including digging, tunneling, jumping, or falling into the hole. These collapses resulted in the death of 31 persons (60%). The other 21 persons (40%) survived by virtue of timely rescue involving extrication from the sand; many of them required cardiopulmonary resuscitation, performed by a bystander.

The collapse of a dry-sand hole, as reported here (and previously, for a small number of cases1,2) is uncommon, but it nevertheless constitutes an important risk of common leisure activities. The risk of this event is enormously deceptive because of its association with relaxed recreational settings not generally regarded as hazardous. However, we believe these personal and family tragedies probably are more common than this report suggests. Raising awareness on the part of the general public regarding the risk associated with creating tenuous excavations in dry sand should have a preventive effect, substantially reducing the frequency of these often-lethal events.

Bradley A. Maron, M.D.
Harvard Medical School, Boston, MA 02115
bmaron@partners.org

Tammy S. Haas, R.N.
Barry J. Maron, M.D.
Minneapolis Heart Institute Foundation, Minneapolis, MN 55407

2 References

1. 1

   Maron BA, Maron BJ. Sudden death and other risks associated with dry-sand beach holes. JAMA 2001;285:1964-1964
   CrossRef | Web of Science | Medline

2. 2

   Zarroug AE, Stavlo PL, Kays GA, Rodeberg DA, Moir CR. Accidental burials in sand: a potentially fatal summertime hazard. Mayo Clin Proc 2004;79:774-776
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Travis W. Heggie, Tracey M. Heggie, Colin Kliewer. (2008) Recreational Travel Fatalities in US National Parks. Journal of Travel Medicine 15:6, 404-411
   CrossRef