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Accidental burial in sand is a tragically unrecognized risk associated with a popular childhood recreational activity. We describe 4 boys, aged 10 to 13 years, who were accidentally buried by sand. One boy died after his self-made tunnel in a sandbox collapsed. In a separate incident at a construction site, 1 boy died, and 2 were injured after a 30-foot sandpile collapsed as they ran down the embankment; all 3 were buried by the sand. In both incidents, play was unsupervised, and burial was sudden and complete. The calculated weight of the sand exceeded the expected maximal muscle effort of the chest, leading to traumatic asphyxiation secondary to restrictive compression of the chest. Only 15 accidental burials have been reported in the literature. To our knowledge, this is the first report describing children who died of respiratory asphyxia due to overwhelming thoracic compression after sand burial. Greater awareness by public health and safety officials at beaches, sandboxes, sandpiles, and natural play areas may prevent potentially lethal accidents.
Mayo Clin Proc. 2004;79:774-776
Death and injury while playing in sandboxes, at construction sites, or on beach dunes are rare but potentially catastrophic hazards of childhood summer activities. Respiratory injury from sand aspiration with asphyxia has been the most commonly reported mechanism.1 We describe 2 cases of children who died after the sand they were playing in collapsed, causing overwhelming restrictive respiratory insufficiency. Two other children were partially buried and sustained minor extremity injuries.
REPORT OF CASES
Case 1
A previously healthy 10-year-old boy who weighed 40 kg was accidentally buried in a sandbox for approximately 10 minutes when the tunnel he was excavating collapsed. A mobile emergency response team was called while family and bystanders initiated cardiopulmonary resuscitation. On arrival, emergency medical technicians confirmed unresponsive pupils, no pulse, and no signs of life. The child had no evidence of trauma or sand debris in the mouth, pharynx, or airway. After resuscitation, air entry was good with an appropriately rising chest bilaterally. A weak pulse correlated with sinus bradycardia and hypotension on the cardiac monitor. During transport, the child again became asystolic and remained without signs of life after arrival at our institution. A chest x-ray film showed normal findings (Figure 1) with no evidence of a...