Monday, November 2, 2009

Death From Above: No Laughing Matter

This month marks the twenty-fifth anniversary of Dr. Peter Barss’ landmark paper, “Injuries due to Falling Coconuts,” published in Journal of Trauma 1984;24(11):990–991. Although this paper received an “Ig Nobel Award” from the Annals of Improbable Research in 2001, its “ignominy” should not overshadow the fact that it stands as possibly the most recent literature to deal with this isolated, yet dangerous, phenomenon. Sadly, the very antiquity of Dr. Barss’ article reflects the medical discipline’s unfortunate neglect of such tragic injuries.

As Dr. Barss noted, considering the Cocos nucifera’s normal height (24–35 m) and its fruit’s weight (1–4 kg unhusked), a coconut falling at 32 ft/s2 can exert a crushing force exceeding 1 metric ton.1 With an annual yield of anywhere from 50 to 80 nuts per tree,2 it is evident that to stand in the general proximity of a coconut tree is to stand in a death zone. Personally, I wouldn’t get within half a mile of a coconut grove without donning a steel army helmet and the very latest in foam-insulated crash pads. It is a wonder that Pacific Islanders have managed to survive for millennia under such potentially lethal bombardment. Indeed, anecdotal evidence from combat soldiers at Bougainville states that the devastating effect of coconuts plunging on the enemy had as much to do with taking the island as did armored infantry. (“It was like the Japanese were sitting in an upside-down minefield,” recalled one GI. “They never had a chance.”3)

My concern is that the potential increase in coconut-related injuries and fatalities since Dr. Barss’ paper has yet to be addressed. The present population of Papua New Guinea—a segment of which on whom Dr. Barss based his data and case studies—is now 5.67 million inhabitants.4 Furthermore, the current total population of Oceania is approximately 31 million.5 Dr. Barss’ 2.5% rate of hospital admissions in Papua New Guinea for coconut-related injuries2 may seem trivial at first glance, but when extrapolated across the whole of Oceania, a region thick with coconut palms, the numbers of potential dead and injured become alarming—even pandemic.

This is not a hazard indigenous only to a far-flung corner of the world. The southern and western United States, of course, is rife with coconut trees, as is much of the Western Hemisphere in general. Transplanted coconut palms have even become abundant in such unlikely locales as Ireland, continental Europe, and Canada. Untold millions now live in close proximity to the coconut palm’s murderous canopy.

We stand at a critical juncture in the treatment and prevention of coconut-related head trauma. Perhaps for the first time in the history of medicine, we not only possess the understanding of such a natural threat to human existence, but also hold at our disposal the armamentarium to effectively strike at the root of this threat.

But to do so, we need more research into the mechanics of free-falling coconuts and their high-speed impaction into the human body. We need more awareness so that government offices will fund these studies, and so that they will educate the public as to the dangers of the apparently tranquil coconut. We need warning signs adequately lining coconut groves and, at bare minimum, first-aid stations close enough to treat unfortunate victims.

We can render nil a lethal threat in our lifetime—a medical rarity for any era. We can save untold lives and preserve life for those few who still fall prey to coconut-inflicted tragedy. But we cannot do so if we allow twenty-five years to elapse between studies and permit such threats to fade into the background until wide-scale calamity illustrates our ignorance. Let ours be the generation that stamps out once and for all the carnage of the coconut.

1. Barss P. Injuries due to falling coconuts. J Trauma. 1984;24:990–991.
2. Chan E, Elevitch CR. Specific profiles for Pacific Island agroforestry: Cocos nucifera (coconut). April 2006, v.2.1. Available at: Accessed November 2, 2009.
3. Franks M. Personal communication, June 2009.
4. WorldAtlas.Com facts and figures. Available at: Accessed November 2, 2009.
5. Caldwell J, Missingham B, Marck J. The population of Oceania in the second millennium. Paper from the Australian National University, Canberra. Canberra, Australia, September 26, 2001; p 1. Available at: Accessed November 2, 2009.

(Article cover page copyright The Williams & Wilkins Co.)

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