London Bridge is falling down

Most of us probably remember the nursery rhyme “London Bridge Is Falling Down” from our childhoods. Many of us probably sang it or played the game. However, we probably did not know the origins of the rhyme.

Many theories exist to explain the origin of this 18th century rhyme.* The first London Bridge spanned the River Thames in the middle of the first century. The Romans constructed it of wood and mud at Londinium, now known as London. The London Bridge referenced in the song was commissioned by Henry II in the later part of the 12th century and took more than 30 years to complete. According to art historian Dan Cruickshank, once the bridge was built, it needed to be maintained. To cover the maintenance costs, tolls were placed on people and ships using the bridge and waterway. However, sometimes the money went astray. In the late 1200s, Henry III gave some of the revenue to his wife Queen Eleanor (referred to as “My Fair Lady” in the rhyme), which she spent on herself. Five years later, five of the 19 bridge’s arches came “falling down.”

America’s aging bridges

According to the The Fix We’re In For: The State of Our Nation’s Bridges 2013, the U.S. has more than 600,000 bridges, with an average age of 43 years. Of these bridges, 66,405 (11 percent) are structurally deficient and require significant maintenance, rehabilitation, or replacement. Approximately 260 million trips are made over deficient bridges across the U.S. each day. Most bridges are designed and constructed to last 50 years before a major overhaul or replacement. These structurally deficient bridges have an average life of 65 years. In just 10 years, one in four bridges (170,000) will be more than 65 years old. Earlier this year, the Interstate 5 Bridge collapsed into the Skagit River in Mount Vernon, WA. An overly tall tractor-trailer carrying a legal load for the interstate clipped an overhead support while crossing, and the bridge collapsed. Although this bridge was structurally sufficient, its design was noted to be fracture-critical—lacking redundant supporting elements—a design that was common in bridges before the interstate highway system was developed.

Bridge collapse injuries

Hospital discharge status

Hospital discharge status

To examine the occurrence of bridge collapse injuries in the National Trauma Data Bank® (NTDB®) research dataset for 2012, admissions medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Specifically searched was external cause of injury code (E-code) E882, fall from or out of a building or other structure (balcony, bridge, building, flagpole, tower, turret, viaduct, wall, window, fall through roof). Those injured due to bridge collapse would be included in this larger group of records. The search uncovered 10,197 records, of which 8,937 contained a discharge status, including 7,080 patients discharged to home, 991 to acute care/rehab, and 652 to skilled nursing facilities; 214 died. These patients were 83 percent male, on average 37.7 years of age, had an average hospital length of stay of 5.9 days, an intensive care unit (ICU) length of stay of 5.4 days, an average injury severity score of 12, and were on the ventilator for an average of 6.7 days. Twenty-one percent went directly to the operating room while another 37 percent went directly to the ICU from the emergency department (see figure).

Rehabilitation needed

As the infrastructure of America ages along with its population, we cannot put off to the future the funding and rehabilitation of our bridges. We cannot wait to cross that bridge when we come to it. Millions of people travel each day on bridges that may be structurally unsound. Let us learn from Henry III’s mistake regarding appropriations. After all, there is at least one London Bridge in America.

Throughout the year, we will be highlighting data through brief reports in the Bulletin. The NTDB Annual Report 2012 is available on the ACS website as a PDF file and as a PowerPoint presentation at In addition, information regarding how to obtain NTDB data for more detailed study is available on the website. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at

Statistical support for this article has been provided by Chrystal Caden-Price, data analyst, NTDB.

* Carlisle R, ed. Encyclopedia of Play in Today’s Society. Vol 2. Thousand Oaks, CA: SAGE Publications, Inc; 2009.
The Bridges That Built London with Dan Cruickshank . BBC Four; March 7, 2013.
‡ Transportation for America. The Fix We’re In For: The State of Our Nation’s Bridges 2013. Available at: Accessed August 4, 2013.

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