A jump park is an interconnected network of trampolines designed for entertainment purposes

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2 A jump park is an interconnected network of trampolines designed for entertainment purposes One of fastest growing recreational-entertainment businesses in the U.S. Approximately 350 operating jump parks in the U.S. in 2014 Injury liability waiver- citing a 2002 report estimating a rate of 2 injuries per 1,000 jumpers to justify claims of superior safety profiles compared to other sports

3 AAOS and AAP recommend against multiple persons on a trampoline at the same time and suggest that independent use may significantly decrease risk. These statements suggest that there may be a higher risk of injury at jump parks where multiple jumpers across all ages commonly participate simultaneously.

4 Notable trend of substantial trampoline-related injuries Accurate safety profiles for assessment of injury risk and prevention Commercial jump park impact on incidence, severity, and economic burden of trampoline injuries may be underestimated No published studies examining traumatic jump park injuries in adults or comparing jump park to home trampoline injuries Bilateral open tibia shaft fractures

5 Retrospective review All patients presenting to ED after sustaining a trampoline related injury Urban Level 1 Trauma Center ICD-9 and ICD-10 injury codes for trampoline related injuries (E005.3 and Y93.44) January 2014 to December 2015

6 439 patients with trampoline injuries (3 EDs) in two-year period 150 (34%) jump park, 289 (66%) home trampoline Gender distribution similar between groups: jump parks and on home trampolines (children and adults) were males

7 Falling off Trampoline 16% Striking Edge/Metal Bar/Spring 10% 13% Collision with Obstacle 8% Collision with Other Participant 5% 15% Routine Jumping / Awkward Landing 59% 74% Home Trampoline Jump Park

8 Age Gender Mechanism Injury 2 F Foam Pit Midshaft Femur Fracture 2 M Routine Jumping Midshaft Femur Fracture 3 M Foam Pit Midshaft Femur Fracture 4 F Routine Jumping Supracondylar Humerus Fracture 9 M Routine Jumping Distal Femur Fracture 10 M Routine Jumping Forearm Fracture 11 F Routine Jumping Bilateral Forearm Fractures 12 F Routine Jumping Bimalleolar Ankle Fracture/Dislocation 14 M Routine Jumping Tibia Shaft Fracture 15 F Routine Jumping Knee Dislocation 19 M Landed On Metal Bar Open Ankle Fracture/Dislocation 22 M Routine Jumping Distal Third Tibial Shaft Fracture With Articular Extension 27 M Routine Jumping Trimalleolar Ankle Fracture 28 F Routine Jumping Subtalar Dislocation and Calcaneus Fracture 30 M Routine Jumping Trimalleolar Ankle Fracture/Dislocation 32 M Routine Jumping Knee Dislocation with Popliteal Artery Transection 33 M Routine Jumping Supracondylar/Intercondylar Distal Femur Fracture 34 F Routine Jumping Trimalleolar Ankle Fracture/Dislocation 43 M Trampoline Collapsed Bilateral Open Tibial Shaft Fractures

9 Age Gender Mechanism Injury 4 M Routine Jumping Midshaft Femur Fracture 4 F Fell Off Trampoline Supracondylar Humerus Fracture 5 F Collided With Another Jumper Supracondylar Humerus Fracture 5 M Fell Off Trampoline Lateral Condyle Humerus Fracture 5 F Struck Metal Bar Supracondylar Humerus Fracture 5 F Fell Off Trampoline Both-Bone Forearm Fracture 6 M Routine Jumping Lateral Condyle Humerus Fracture 6 F Fell Off Trampoline Midshaft Femur Fracture 7 F Fell Off Trampoline Supracondylar Humerus Fracture 9 M Fell Off Trampoline Supracondylar Humerus Fracture 9 M Routine Jumping Supracondylar Humerus Fracture 9 F Routine Jumping Supracondylar Humerus Fracture 10 M Collided With Another Jumper Supracondylar Humerus Fracture 12 F Routine Jumping Tilaux Ankle Fracture 13 F Routine Jumping Supracondylar Humerus Fracture 14 M Routine Jumping Both-Bone Forearm Fracture 17 F Routine Jumping Anterior Cruciate Ligament Tear 28 M Routine Jumping Orbital and Zygomatic Fracture 30 M Routine Jumping Knee Dislocation/Medial Patella Facet Cartilage Injury 35 F Routine Jumping Lateral Meniscus Tear

10 Jump Park Injuries 18 (12%) arrived by EMS 40 (27%) adult patients (18-51yrs) 110 (73%) pediatric patients (16mos-17yrs) Average age of patients= 15 years old *(p<.0001) Home Trampoline Injuries 24 (8%) arrived by EMS 29 (10%) adult patients (18-65yrs) 260 (90%) pediatric patients (1-17yrs) Average age of patients= 10 years old

11 Number of Injuries Jump Park Home Trampoline Lower Extremity Upper Extremity Spine/Torso/Head

12 Closed Head Injury 5% Laceration 8% Sprain/Strain/Contusion 43% 45% Closed Fracture/Dislocation 44% 53% Open Fracture/Dislocation 2% Home Trampoline Jump Park

13 Jump Park Injuries 55% of ED visits were a fracture/dislocation *(p=.02) 3 open fractures Adults= 45% fracture rate *(p=.02) Children= 59% fracture rate *(p=.04) Adults= 43% of injuries were lower extremity fractures *(p=.001) Children= 43% of injuries were lower extremity fractures *(p=<.0001) (All ages) Percentage of LE injury= 73% (OR=3.24, p=<.0001) Home Trampoline Injuries 44% of ED visits were a fracture/dislocation No open fractures Adults= 17% fracture rate Children= 47% fracture rate Adults= 7% of injuries were lower extremity fractures Children= 16% of injuries were lower extremity fractures (All ages) Percentage of LE injury= 45%

14 Number of Fractures/Dislocations Jump Park (n=65) Home Trampoline (n=123)

15 Number of Fractures/Dislocations Jump Park (n=18) Home Trampoline (n=5)

16 Jump Park Injuries (All ages) Operative intervention= 13% *(p=.052) Operative intervention: Adults= 23% vs. Children= 9% *(p=.04) 13 (9%) hospital admit with overnight stay (range, 1-23 days) Peak incidence: 1) March 2) October Home Trampoline Injuries (All ages) Operative intervention= 7% Operative intervention: Adults= 10% vs. Children= 7% 13 (4%) hospital admit with overnight stay (range, 1-2 days) Peak incidence: 1) April/May 2) September

17 Number of Injuries Jump Park Home Trampoline

18 To our knowledge, this is the first report evaluating trampoline related injuries in adults. Children and adolescents represented the majority of jump park injuries with an average age of 15 years. Adults may have higher participation rates at jump parks than in the domestic setting. The majority of adult fractures and dislocations occurring at jump parks involved the lower extremity (94%).

19 Children and adults experience fractures and dislocations, hospital admissions, and surgical intervention secondary to jump park related injuries. A higher percentage of total fractures, lower extremity fractures, open fractures, adult fractures, and operative fractures was found among patients with commercial jump park injuries. Our data supports that there is a high potential for severe disabling injuries involving jump parks.

20 1. Sarris T. Indoor trampoline parks continue to be one of the fastest growing indoor entertainment attractions worldwide. Play Meter Magazine April Smith GA. Injuries in the United States Related to Trampolines, : A National Epidemic. Pediatrics. 101(3 Pt 1):406-12, 1998 March. 3. Radelet MA, Lephart SM, Rubinstein EN, Myers JB. Survey of the injury rate for children in community sports. Pediatrics. 110(3):e28, 2002 September. 4. United States Consumer Product Safety Commission. NEISS Data Highlights Accessed 2015 November Alltucker K, Hansen RJ, Berry J. Trampoline parks face scrutiny over safety. The Arizona Republic February Larson BJ, Davis JW. Trampoline-related injuries. The Journal of Bone and Joint Surgery. 77(8): August. 7. Loder RT, Schultz W, Sabatino M. Fractures from trampolines: results from a national database, 2002 to Journal of Pediatric Orthopaedics. 34(7): October-November. 8. America Academy of Orthopaedic Surgeons. Position Statement: Trampolines and Trampoline Safety. September Accessed 2016 August American Academy of Pediatrics. AAP Advises Against Recreational Trampoline Use. September Advises-Against-Recreational-Trampoline-Use.aspx. Accessed 2016 August Kasmire KE, Rogers SC, Sturm JJ. Trampoline park and home trampoline injuries. Pediatrics /peds Aug 1.