TABLE 1.

Common Public Health and Clinical Management Issues Involving Watercraft-Related Injury and Proposed Solutions

Problem	Proposed Solutions
Public Health
Propeller injuries are dangerous and disabling	• Install propeller guards on outboard motors
	• Implement educational programs for boaters on how to approach swimmers while minimizing the chance of contact with propeller blades
Inconsistent lifejacket uses among recreational boaters	• Educational programs for parents and other role-models to increase usage among youth
	• Advertisement campaigns normalizing lifejacket use to decrease perceived social stigma
	• Increase minimum age requirements for lifejacket use
Physical engine cutoff switches (ECOS) are easily circumvented	• Convert to wireless kill switches that automatically connect and are difficult to disable
	• Increase surveillance, enforcement, and cost of noncompliance
Bow riding is common and dangerous	• Improved consistency in legislature across states
	• Increased public outreach and education about the dangers of bow riding
	• Use of cameras or sensor technology to improve visibility and warn boat drivers of an impending collision when vision is obstructed by bow riders
Inexperienced boaters commonly decrease throttle when attempting to evade an impending crash, but their ability to maneuver is inhibited by the lack of thrust	• Required educational class before buying or renting a boat that details how to maneuver watercraft in emergency situations
	• Use of visual graphics on watercraft warning labels to attract attention and increase understanding of proper boating technique
Excessive speeding and reckless boating	• Increased surveillance and consequences for boating under the influence
	• Improve awareness of reporting systems and encourage bystanders to report instances of unsafe boating
Clinical Management
Gynecologic and colorectal water-force injuries can be life threatening and can be missed during patient evaluation	• Have high index of suspicion for orifice water-force injuries for patients with risk factors (peritoneal area impact with water, falls off rear of PWC, and waterskiing injuries at high velocity) and presenting with clinical signs and symptoms (bleeding from rectum or vagina, abdominal pain, and urge to defecate)
	• Incorporate orifice examinations with informed consent into trauma algorithms for patients with these risk factors and clinical signs
Soft tissue injuries can become infected when exposed to aquatic microorganisms	• Emphasize early irrigation with sterile saline and debridement during management
	• Cultures and biopsies should be collected from infected soft tissue injuries
	• Early communication with laboratory to ensure necessary media and stains are readily available
	• Antimicrobial prophylaxis should be specific to the water type exposed to the wound

ECOS, engine cutoff switches; PWC, personal watercraft.