A trend of increasing number and severity of injuries associated with use of personal watercraft (PWC) has been noted as the use and popularity of PWC also rises. The rate of injuries secondary to PWC use is greater than that from other water sports. Multiple etiologies of injury have been reported, including closed head trauma, spinal injuries, facial fractures, chest trauma, abdominal injuries, and drowning. These injuries may occur from collision with other objects, falls from the PWC, and encounters with the hydrostatic jet stream. The most significant contributing factors to injury seem to be carelessness and inattention. However, some studies show that substance abuse may also contribute. Recommendations to reduce morbidity and mortality include using U.S. Coast Guard-approved personal flotation devices (PFD), limiting use of PWC to trained adults, and improving recognition of significant PWC injury by medical personnel.