Objective:To describe injuries sustained by participants in commercial whitewater rafting.Analysis of injury reports submitted by commercial outfitters to the West Virginia Division of Natural Resources.Customers of commercial rafting outfitters who sustained injuries in the 1995–1997 whitewater seasons on the New, Gauley, Cheat, and Shenandoah Rivers and for whom injury reports were submitted as required by the West Virginia Legislative Rules.A total of 200 rafting injuries were reported from 1995 through 1997, with a resulting overall injury incidence rate of 0.263 per 1,000 rafters. Incidence rates ranged from 0.145 per 1,000 on the Shenandoah to 0.381 per 1,000 on the Gauley River. The average age of injured persons was 33.14 years, 53.3% were male, and 59.8% had previous rafting experience. The body part most frequently injured was the face (33.3%), including the eye (12.1%), mouth (6.6%), other facial parts (5.1%), nose (4.5%), and teeth (4.0%), followed by the knee (15.3%), arm/wrist/hand (11.6%), other parts of the leg, hip, or foot (10.5%), ankle (7.4%), torso (6.8%), shoulder (6.3%), and head/neck (5.3%). Predominant injury types included lacerations (32.5%), sprains/strains (23.2%), fractures (14.9%), contusions/bruises (9.8%), dislocations (8.2%), and two deaths. On-site administration of first aid included bandages (29%), ice (26.9%), splinting/immobilization (17.7%), antiseptic (11.3%), direct pressure (4.2%), elevation (2.1%), cardiopulmonary resuscitation (1%), and treatment for shock (0.4%). No first aid was administered for 4.6% of injuries. Most injuries occurred in the raft (51.3%) as a result of collisions among passengers, being struck by a paddle or other equipment, or entanglement of extremities in parts of the raft; 40.3% of injuries occurred in the water after falling from the raft. Types of injuries were independent of where they occurred, but differences were found in injured body parts by location of occurrence. Injuries occurring in the raft more commonly were to the face, and injuries occurring in the water involved the extremities and face. Injuries requiring evacuation to an outfitter's base camp or to a medical facility occurred at a higher rate among persons without previous rafting experience. Gender differences were not found for types of reported injuries, but body part injured did vary by gender. Female boaters more frequently sustained facial injuries, whereas male boaters more frequently sustained injuries to the limbs and torso.Overall injury rates were low, but verification limitations render a determination of unreported injuries difficult. Because most injuries occur in the raft while running rapids, involve injuries to the face, and result from contact among passengers or paddling equipment, preventive measures such as attaching face protection to paddling helmets, carrying fewer passengers per raft, or portaging dangerous rapids are suggested. More research is needed to verify injury rates and severity, and to document related medical costs.