title: Hot-air balloon tours: crash epidemiology in the United States, 2000-2011.
abstract: BACKGROUND
  Hot-air balloon tours are FAR Part 91-governed balloon rides conducted for compensation or hire. Part 91, General Aviation, in general involves the least strict federal regulations and accounts for the majority of aviation crashes and fatalities.
  
  
  METHODS
  National Transportation Safety Board reports of hot-air balloon tour crashes in the United States from 2000 through 2011 were read and analyzed.
  
  
  RESULTS
  During the 12-yr period, 78 hot-air balloon tours crashed, involving 518 occupants. There were 91 serious injuries and 5 fatalities; 83% of crashes resulted in one or more serious or fatal outcomes. Of the serious injuries characterized, 56% were lower extremity fractures. Most crashes (81%) occurred during landing; 65% involved hard landings. Fixed object collisions contributed to 50% of serious injuries and all 5 fatalities. During landing sequences, gondola dragging, tipping, bouncing, and occupant ejection were associated with poor outcomes. Of the crashes resulting in serious or fatal outcomes, 20% of balloons were significantly damaged or destroyed.
  
  
  CONCLUSIONS
  The incidence of morbidity and mortality is high among hot-air balloon tour crashes, and the proportion of balloon crashes attributed to paid rides appears to have increased over time. In addition to examining the role of restraint systems, personal protective equipment, and power line emergency procedures in ballooning, injury prevention efforts should target factors such hard landings, object strikes, gondola instability, and occupant ejections, which are associated with balloon injuries and deaths. Crash outcomes may also improve with vehicle engineering that enables balloons themselves to absorb impact forces.
authors.affiliation: Department of International Health, and Johns Hopkins Center for Injury Research and Policy, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Rm. W519, Baltimore, MD 21201, USA. sballard@jhsph.edu
authors.forename: Sarah-Blythe
authors.initials: SB
authors.lastname: Ballard
authors.forename: Leland P
authors.initials: LP
authors.lastname: Beaty
authors.forename: Susan P
authors.initials: SP
authors.lastname: Baker
mesh_terms: D000060:Accidents, Aviation / Q000706:statistics & numerical data*; D006260:Head Protective Devices; D006801:Humans; D007899:Leisure Activities; D014481:United States