Management of industrial high-pressure fluid injection injuries (IHPFII): the Water Jetting Association (WJA) experience with water driven injuries

BACKGROUND: Industrial high-pressure fluid injection injuries (IHPFII) are largely occupational in nature, where these injuries are most often sustained by male manual workers. Such traumatic injuries are largely sustained with water, grease, paint, gasoline or paint thinner. IHPFII are extremely serious injuries with life and limb-threatening potential carrying the risk of life-long disability. METHODS: We reviewed the Water Jetting Association© adverse incident database of advisory alerts detailing cases from around the world that have been brought to the association’s attention and the English-language literature on high-pressure hydrostatic injuries from 1937 to 2018. RESULTS: Accidents involving high-pressure water jets in the industry are uncommon. The clinical impact in all of the cases reviewed and the effects of water jet impacts range from instant fatalities at scene to loss of limb function and amputation. The majority of observed fatalities are due to major hemorrhage (exsanguination) secondary to the direct dissection of great vessels or high-energy blunt soft tissue injury and traumatic brain injury. CONCLUSIONS: As with any other trauma, IHPWJI commonly result in amputation or death. Nonetheless, a lack of comprehension of the potential severity of injuries and range of infective complications appears to be largely due to the apparent benignity of the initial presentation of the wound. This in turn leads to delays (both avoidable and unavoidable) in the transfer to appropriate medical facilities and definitive care. There is an identifiable need for education (including for health care providers across multiple levels), training and the availability of personal trauma kits for the timely and effective management of IHPWJI from the initial jet impact on the scene, as well as a need for an established referral system.