Re: Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
For many years a meta-analysis written by Smith and Pell (1) and published in your journal is the keystone and most referred article when discussing that many interventions in health care have not been subjected to rigorous assessment by using randomised controlled trials. They were unable to identify randomised controlled trials whether parachutes are effective in preventing major trauma related to gravitational challenge. (1)
The authors conclude that we have the choice to accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. (1) The other option according to the authors is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial.
Until today only accidental falls from height with large morbidity are reported. (2)
The survivor of the highest falls was a 23 years female from Yugoslavia and she was admitted in hospital for 16 months after this fall without parachute. Recently, a male skydiver from the US became the first to jump from a plane without a parachute or wingsuit. (3) After a free-fall of 25000 feet, he was able to land in a net spread out 200 feet above ground without any injuries. We realize that this is a case report and only Level V evidence. However, this case will probably lead to future case series and Level IV evidence. It may even open up ways for Level 1 evidence proving that a net, if not missed upon landing, is more effective for untrained skydivers compared to a parachute to prevent injury. Although it was undisputed for more than 200 years that a parachute prevents major trauma when falling from a great height, it maybe less essential than we think.
We conclude that statements made in 2003 may not be valid anymore in the future. We have to be open minded and stay critical to “old” dogmas in medicine. Issue that were common sense in the past may be less ordinary in the future.
Michel P. J. van den Bekerom
Department of orthopedic surgery. OLVG, Amsterdam, the Netherlands
1. Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ. 2003;327(7429):1459-61
2. Highest fall survived without a parachute. In: Cunningham A. Guinness world records 2002. London: Guinness World Records, 2002.
Competing interests: No competing interests