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Water tubing stirs safety concerns

Water Tubing Safety Tips

  • Boat drivers should know the shoreline, shallow areas, and obstructions in a lake where an inner tube is being pulled.
  • Two people should always be in the boat when pulling a water tuber: the driver and a spotter who regulates the rope length from boat to inner tube.
  • Before water tubing, inspect the rope for fraying and the inner tube for defects.
  • Water tube riders should always wear a life jacket.
Water tubing may seem like an easy, fun way to keep kids active on the waterfront, especially when they don't know how to water-ski. But a look at the injury statistics reveals that the sport poses some risks.

Water tubing is similar to waterskiing, except that the participant rides a rubber inner tube instead of a pair of skis.

After seeing a number of water tubing injuries, orthopedic surgeons from Children's Hospital of Eastern Ontario in Ottawa analyzed 6 years' worth of medical records from the hospital's pediatric trauma center. Eight children (ranging from 10 to 17 years) had been admitted to the hospital for water tubing injuries. The patients' cases (1) were reported in a poster presentation in February at the annual meeting of the American Academy of Orthopaedic Surgery in San Francisco.

Merv Letts, MD, the lead author of the study and chair of the Department of Surgery at Children's Hospital of Eastern Ontario, says that most water tubing injuries occur when water tube riders come too close to shore. When turning, a boat driver may misjudge the path of the tube, allowing it to strike a dock, or tubes may hit submerged objects, such as rocks. Inexperienced boat drivers also contribute to many injuries, according to Letts. Water tubing mishaps also can happen when an inner tube comes loose from the tow rope or explodes.

Safety guidelines for water tubing equipment might make the sport safer, Letts says, but there are currently no equipment standards. Although there are several commercial water tubes on the market, many people use homemade water tubes or rubber rafts. He says it's not unusual for participants to use old, deteriorating inner tubes; it's safer to use a newer tube that is properly inflated and has proper rope attachments.

Most water tubing injuries are musculoskeletal in nature, says Howard Backer, MD, emergency and sports medicine physician with the Kaiser Permanente Medical Group in Hayward and Walnut Creek, California. Backer attributes some injuries to the way individuals sit on the tube. When the rider is seated, the physes of the distal femur and proximal tibia are vulnerable when the knee receives a direct blow. "The combinations create the possibility of serious orthopedic injury. There is high risk for very serious outcomes," he says. Internal injuries, such as abdominal trauma, can also occur.

Backer says that some water tubing accidents involve small children, who are perhaps too young to water ski. "Parents may erroneously think they are easily available should anything happen in the water, not quite factoring in how long it takes to make a U-turn and rescue a child who's been knocked off a tube and injured," he says. "Not wearing a life jacket poses an additional risk of drowning."

In 1995 there were 3,262 water tubing injuries that required emergency room visits, according to an estimate by the US Consumer Product Safety Commission in Bethesda, Maryland. The age breakdown was as follows: up to age 4, 0.5%; 5 to 14, 18.2%; 15 to 24, 32.6%; 25 to 64, 48.1%; and 65 and over, 0.5%. Of those patients, 92.6% were treated and released, 6.9% were transferred to other hospitals, and 0.5% were hospitalized. Fatalities during water tubing included 10 drownings and 2 collisions with personal water craft.

To help prevent injuries, Letts says, physicians can advise patients who are water sports enthusiasts to observe simple, commonsense safety measures (see "Water Tubing Safety Tips," on the previous page). "If the child or boat driver had known some basic safety rules, each injury might never have occurred," he says.


  1. Letts L, Parmar P: Water tubing injuries in children. Presented at the 64th Annual Meeting of the American Academy of Orthopaedic Surgeons, San Francisco, February 15, 1997

Suzanne J. Schoenfelt
Minnetonka, Minnesota

Ephedrine safety rules proposed

In an effort to reduce the number of adverse reactions to the use of nutrition supplements that contain ephedrine, the US Food and Drug Administration (FDA) proposed safety measures in June that would result in marketing and labeling changes.

Dietary supplements containing ephedrine alkaloids are currently sold as aids to weight loss, energy enhancement, and body building. Many of the products contain ma huang, an herbal form of ephedrine called ephedra. Many nutritional supplements conbine ma huang with chromium picolinate, a popular reputed ergogenic aid. Systemic ephedrine use is banned by the International Olympic Committee (1).

Ephedrine alkaloids have a stimulant effect on the heart and central nervous system, similar to that of amphetamines. (See "Psychoactive Drugs and Athletic Performance," January 1997.) According to an FDA press release, since 1994 the agency has received and investigated more than 800 reports of adverse events related to ephedrine products, including high blood pressure, tachycardia, insomnia, nervousness, tremors, seizures, cardiac arrest, stroke, and death.

The proposal wouldn't ban the products, but would make consumers more aware of safety concerns. "Consumers should be aware that just because a product is labeled 'natural' or from an herbal source, it is not guaranteed to be safe," said FDA Deputy Commissioner Michael Friedman, MD. "We urge people to talk to their doctors before using dietary supplements containing ephedrine alkaloids, and to always use them with caution."

Under the proposal, ephedrine makers would have to:

  • Refrain from marketing dietary supplements that contain 8 mg or more of ephedrine alkaloids per serving;
  • Avoid using labels that suggest an intake of 8 mg or more of ephedrine alkaloid in a 6-hour period or a total daily intake of 24 mg or more;
  • Instruct consumers not to use the products for more than 7 days;
  • Warn consumers that taking more than the recommended serving may result in a heart attack, stroke, seizure, or death; and
  • Refrain from combining other stimulant ingredients, such as caffeine, with ephedrine alkaloids.

The FDA is accepting comments on the ephedrine proposal from consumers and industry until August 18, and will consider the feedback before making a final ruling.


  1. Fuentes RJ, Rosenberg JM, Davis A (eds): Athletic Drug Reference 1996. Durham, NC, Allen & Hanburys, Division of Glaxo Wellcome Inc, Clean Data, 1996

Lisa Schnirring


Charlotte "Toby" Tate, PhD, was named president and Paul D. Thompson, MD, was named president-elect of the American College of Sports Medicine (ACSM), based in Indianapolis. Their 1-year terms began in June at the ACSM meeting in Denver. Tate is vice provost for academic programs and faculty affairs at the University of Houston. She is the second female president in the ACSM's 43-year history. Thompson recently accepted the position of director of preventive cardiology at Hartford Hospital in Hartford, Connecticut. Previously, he practiced cardiology and was a professor of medicine at the University of Pittsburgh. He is an editorial board member of The Physician and Sportsmedicine. He will become ACSM president at the 1998 annual meeting in Orlando.



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