Sword Swallower Survey

   
As a service to SSAI members, as well as other sword swallowers and the medical community around the world, the Sword Swallowers Association International is conducting a comprehensive survey to collect statistical information and update our database on sword swallowers and the art of sword swallowing. As a fellow sword swallower, your input to these questions is invaluable to us and the medical community at large. The information you submit is confidential and will be used for our internal records only, and none of the information from this questionnaire will be released to the general public without your written permission.

SSAI has been approached by professionals in the medical community who are interested in studying the physiology of sword swallowing from the medical standpoint, as well as researching the medical complications, side effects, and injuries sustained as a result of sword swallowing. They are very interested in conducting a more indepth study of volunteers regarding sword swallowing techniques, injuries, symptoms, diagnosis, and treatments for submission to the British Medical Journal.

Historically, a legitimate medical research study of this scope has never been compiled on sword swallowers before, so this study is historical as the first ever of its kind. This study will prove invaluable, not only to the international medical community, but also to current and future sword swallowers for the information we glean from it about the physiology of swallowing swords, and the side effects and injuries from sword swallowing. Most of all, this information will be especially important as a reference for emergency room and other attending physicians as they treat sword swallowing injuries in the future.

In order for this study to be as accurate and comprehensive as possible, it is important to get complete, detailed responses from as many sword swallowers around the world as possible. If you are willing to take part in this important study, please complete the entire questionnaire, as well as the appropriate fields granting your written permission as a volunteer at the end of the questionnaire.

Please complete the survey below, and click submit at the end of the survey to send the completed results. If you have any questions on completing the survey, please contact us at dan@swordswallow.com

   
   
Personal Data
Your First Name: Last Name
Stage Name:
Address:
Address (line 2):
City: State/Province:
Zip Code: Country:
Contact Phone: Contact Fax:
E-mail: Website URL:
   
Date of Birth (dd/mm/yyyy): Sex:
Current Age: Blood Type
(if known):
Current Height: Current Weight:
Smoking preference:
   
   
SSAI Conventions
Are you interested in attending any SSAI Sword Swallowing Conventions
to perform, speak on a panel, or join us in the mass SSAI "Big Swallow"?
European SSAI Convention
    Liseberg Amusement Park and Hotel, Göteborg, Sweden
Sideshow Gathering
    Ramada Hotel, Wilkes-Barre, Pennsylvania USA
West Coast SSAI Convention
    Las Vegas, Nevada USA
SSAI Convention OK Steampunk Expo
    Tulsa, Oklahoma USA April 15-17, 2011
   
   
Your Sword Swallowing History
What is your current status as a sword swallower?
What year did you begin sword swallowing?
At what age did you begin sword swallowing?
How did you learn sword swallowing?(check all that apply)  
Self Taught
Book or Article
Another Sword Swallower
Other Resource



   
Please describe how your learned and what implements you used for learning:
How long did it take you to learn?
   
   
While learning sword swallowing, did you suffer any injuries, symptoms, side effects or other complications related to sword swallowing?
If yes, please describe the injury, including the cause:
Date of initial injury while learning:
Location of initial injury:
Symptoms of initial injury:
Name and contact info of attending doctor, if known:
Diagnosis of initial injury:
Treatment of initial injury
(including prescriptions, dosage, recommendations, etc):
Please describe the diagnosis, treatment and recovery in detail:
   
   
After Learning Sword Swallowing
How many years have you been swallowing swords?
Have you taught anyone else how to swallow swords?
If yes, who did you teach? What year?
Are you actively performing sword swallowing regularly?
Approximately how many times have you swallowed a sword in the past 3 months?
What is the longest blade length you swallow?
How deep do you feel the swords go?
Do you feel they pass into the stomach?
Do you swallow multiple swords at once?
What is the most number of swords you have swallowed at once?
Do you swallow a neon tube?
Do you swallow a curved sword?
Do you swallow a serpentine/flamberge blade?
Do you perform fire-eating?
Do you eat glass?
Do you perform the human blockhead?
Please list any other unusual objects you swallow:
   
   
Injuries After Learning Sword Swallowing
AFTER learning sword swallowing, have you suffered any later injuries, symptoms, side-effects, or other complications related to sword swallowing?
If yes, please describe the injury and cause of the injury:
Date of injury:
Location of injury:
Symptoms of injury:
Name and contact info of attending doctor, if known:
Diagnosis of injury:
Treatment of injury
(including prescriptions, dosage, recommendations, etc):
Please describe the diagnosis, treatment and recovery in detail:
   
After encountering mild sword swallowing injuries, what do you do, eat, drink, or recommend to help improve or speed up the recovery process?
   
   
Do you suffer from:(check all that apply)
    chronic sore throats stomach ulcers
    chronic heartburn pleurisy
    acid reflux disease dysphagia
    hiatal hernia esophagial cancer
   
   
British Medical Survey
Would you be willing to volunteer to take part in an unpaid medical study on the side-effects of sword swallowing? This would involve you being contacted by e-mail and asked more in-depth medical questions like these. The answers would be retained in confidence but you would need to give written permission for your results to be published anonymously in British medical literature in a research project supervised by a British radiologist in conjunction with SSAI.
   
Yes, I volunteer to take part in an unpaid medical study on sword swallowing
No, I am NOT interested in taking part in a medical study on sword swallowing
   
If yes, please type your full legal name in lieu of your signature as your written permission that you are willing to take part in a more in-depth survey.
   
SSAI is honored to provide valuable benefits such as research in conjunction with the medical community and support for sword swallowers around the world, and we appreciate your help in completing this survey. This study will prove invaluable, not only to the medical community, but also to current and future sword swallowers and their attending physicians for the information we may glean from this study about the physiology of swallowing swords, the side effects and injuries from sword swallowing, as well as treatments of these injuries.
   
Would you like to be notified when the survey is completed and the final results are released?
   
We look forward to receiving your response. Thanks for your input!