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Like surf, sand can kill, says doctor

Holes collapse, researchers warn

Relentless undertows, stinging jellyfish -- the beach can be a dangerous place. Now a Harvard medical resident wants sunbathers to pay attention to yet another threat: collapsing sand holes, which he says have killed dozens of young people in the past two decades, several of them in New England.

Some might see them as freak accidents, but Dr. Bradley Maron has spent years studying the threat, after twice seeing children nearly suffocate to death on a Martha's Vineyard beach. In a letter in this week's New England Journal of Medicine, he warns that a pastime as innocent as building a sandcastle could lead to a family tragedy.

Maron was a 23-year-old lab technician with dreams of a medical career when he came across a scene of "total chaos" during an afternoon walk on Edgartown's South Beach in 1998, he said in an interview. Children at a birthday party had dug a 7-foot-deep hole in the sand and were trying to jump over it when one fell in. The walls of the hole caved in, obliterating any sign of the 8-year-old girl.

Digging frantically, a lifeguard located the child's mouth and cupped his hand over it, creating an air pocket. She survived, but the accident made an impression on the young Maron, who had witnessed a similar event as a student lifeguard three years earlier. "I was probably at that moment of the opinion that most people are, that this must be an isolated, extremely uncommon problem," he said. "In medicine we call it a case report -- something you might see once in your whole life."

But as Maron began to investigate, urged on by his father, a cardiologist who researches sudden death in athletes, he quickly uncovered similar sand cave-ins around the country. Though the accidents are rare -- you're about as likely to die from a shark attack in the United States as by falling into a beach hole -- they fit a tragic pattern, according to Maron's research: A buildup of pressure causes the sides of a hole to crumble suddenly, burying alive a child or teenager playing inside. The victim, usually a boy, remains submerged for several minutes as bystanders panic and rescuers, afraid to use a shovel because they might hit the person, struggle to reach them by hand.

"Granulated sand runs just like when you open your sugar bowl; it just slides right in and fills up awful quick," said Dennis Arnold, director of the beach patrol for South Beach, where it's illegal to dig a hole deeper than the waist-height of the shortest person nearby.

Combing through media accounts and interviewing witnesses, Maron; his father, Barry; and a nurse at the Minneapolis Heart Institute, Tammy Haas, have documented 52 sand immersions in the United States, Britain, Australia, and New Zealand since 1985. Six occurred in New England. Thirty-one of the victims died.

One of those was Matthew Gauruder , a 17-year-old playing football at a postprom party on a Westerly, R.I., beach in 2001. Running backward to catch a pass, Gauruder fell into a hole friends had dug. As his stunned friends walked toward him, the hole caved in. He died at a local hospital. His mother, Mavis Gauruder , said she grew up playing on New England beaches and never could have anticipated what happened to her son.

"As a parent of a teenager, the first thing you think of is has there been a car accident," said Gauruder. "This was a total shock."

Her son's death was so unusual, said Gauruder, that it is difficult to explain to others. Even Maron, a resident at Brigham and Women's Hospital, acknowledges that the threats he's spent years studying pose a very small risk to most people. Still, he cringes when he sees YouTube videos of people posing in massive trenches they've excavated or sunscreen advertisements featuring children up to their necks in sand.

Maron, who has two children too young to dig, recommends that parents not allow their children to carve out holes deeper than their knees. He continues to collect data on sand submersions and hopes to create an official national registry of the accidents.

Gauruder said she's thankful for Maron's diligence . "If one person thinks twice about digging a hole on the beach, that would be well worth it," she said. "I would not want any other family to go through what we've experienced."