(Figure 1) Nathanson, Bird, Dao, Tam-Sing American Journal of Sports Medicine, 2007
Risk is intrinsic to life. Essentially all of the sports, pleasures, and work you enjoy have some level of risk. Most of the time we don’t consciously think about it because we’ve become so used to it that our minds simple no longer acknowledge it as risky. Surfing, body boarding, paddle boarding, all other water sports, and telling your girlfriend she looks fat in those jeans are no exception. They are fundamentally dangerous, which is why our overcoming of their obstacles makes it fun. The first thing surfers think about when they hear surfing injuries is sharks, or if you happen to live in one of those tropical paradises possibly crocodiles too. However, while you should be prepared for a marine predator attack by carrying a marine tourniquet and or surfing with a tourniquet leash (leg rope) the statistical data shows that there are a lot of other injuries and mechanisms of injury surfers needs to be aware of when surfing.
In his book, Surf Survival (Surfers Health Handbook), Dr. Andrew Nathanson et al studied 473 injuries and determined the following:
While it may not seem like surfboard fins are sharp, under the right conditions and forces they are sharp enough to cut you. The cut or laceration may be deep enough to require a tourniquet, or you may be able to use pressure, or a pressure dressing to stop the bleed. Regardless, of the bleeding type, or first aid tool needed, you will always need to have the mindset and training to back you up so you are ready for anything. Furthermore, if you are lacerated while surfing ensure the wound is irrigated, cleaned, sterilized, and dressed properly to prevent infection.
According to Surf Survival: Surfers Health Handbook) laceration percentages by area are the following:
(Lacerations that are induced in the water should be checked out immediately to prevent infection)
Since the start of the Australian Summer 2017, Lifeguards in New South Wales have already had three incidents that required an ambulance. One incident involved a 12-year-old surfer who suffered a severe leg wound from his surfboard fin. http://www.canberratimes.com.au/act-news/south-coast-lifeguards-predict-rise-in-rescues-after-slow-start-to-summer-20171229-h0bgel.html
Roughly 66% of surfing injuries are caused by surfboard impact (Figure 1):
The primary areas of a surfboard most likely to be impacted with and cause injury:
Recently, British Big Wave Surfer Andrew Cotton broke his back while surfing at Nazare, Portugal, November 8, 2017.
Another possibly injury to contend with are fractures, which can be caused by finger entanglement in the leash prior to the leash lengthening, which subsequently fractures and or amputates the finger. Digital fractures, as they are serious painful injuries that require immediate attention. If the finger(s) are fractured and amputated you may also have a significant bleed that requires a tourniquet to be placed proximal to the wound. This is another case of why having a legitimate marine pre-hospital tourniquet immediately at your disposal is so important.
Fractures by Area of the Body:
Chest fractures are indicated as the area injured in surfers 23% of the time (Carrilero, 2017). More specifically the injury is the fracture of the first rib, which occurs in part due to the contraction of the scalene neck muscle, and the interaction of the wave force at the same time (Carrilero, 2017). Said injury may be isolated and secondary to the initial or actual trauma, so x-rays should be taken to rule out if it is present. Failure to address this injury may lead to complications or compensatory movement patterns that may cause additional injuries or dysfunctions in the future.
Contusions develop when the surfer impacts their surfboard, another person or their surfboard, the sea floor, etc. While generally not serious, they can limit mobility, and require time off from surfing. In addition, they may be secondary to other more serious injuries such as lacerations, fractures, and the like. Regardless, of severity ensure you address all injuries appropriately, and if needed seek medical attention. Using simple measures such as R.I.C.E. can fast track healing.
NSAIDS such as Motrin, Naproxen, and the like may assist with pain and recovery as well.
WAVE FORCE INJURIES:
Wave force injuries can be some of the most severe surf-related injuries, and may be the primary mechanism of injury related to fractures, sprains, strains, tears, and paralysis. Respect for the ocean is paramount every time you enter the water. Don’t turn your back to the ocean; just because you hit pause on what you were doing, doesn’t mean the ocean and its waves did the same. There are numerous cases of people turning their back to the surf, only to be slammed by waves and suffer severe life-changing injuries.
SPRAINS, DISLOCATIONS, AND TEARS:
Sprains, dislocations, and tears can occur due to wave forces, and or landing wrong. If you are one of the fortunate few that can and have the surf to do airs always take into consideration how to land properly.
As previously discussed surfboard leashes may be party to digital trauma or finger amputation. A leash that is too short may also cause a surfboard to snap back towards a surfer once the leash cord is stretched, thus hitting the surfer, and causing an impact injury. Jack O’Neil the founder of O’Neil actually lost an eye due to the tip of his surfboard.
Many great surf breaks are surrounded by cliffs, especially in California, in the United States, therefore, it’s paramount to take caution when surveying the surf from the cliffs pre-surf. For example, a San Diego surfer died while on a surf trip with friends in Mexico in early 2015, while camping near a surf break with cliffs. The surfer woke up in the middle of the night to pee, and unfortunately fell to his death. Slips and falls can be equally as dangerous too, so watch your footing and pick your path down the cliffs to the shore carefully. If you happen to be one of the hard chargers who surfs big waves, the risk of falling from the crest of the wave to the trough is another unique surfing hazard. Falling from 20-40-100 feet, impacting the water, and then going over the falls again is a horrifying scenario that is all too familiar to big wave surfers, and one that could end your life if you’re unprepared.
Car accidents to and from the water are another likely scenario that could cause injury or death for surfers, divers, and marine professionals alike. An info graphic from Cars.com by Paul Dolan shows that of the 2.6 million fatalities in the USA in 2013 1 in 77 was related to car accidents.
The tourniquet is a life-saving tool that has been proven to save lives. When it comes to bleeding or crushed limb injuries it is the best tool to stop bleeding, and or the spread of sepsis. A person has a limited blood supply with the average being give or take 5 liters. Studies show that a person can bleed to death in as little as 3 minutes, so having the correct tool to keep as much blood in the body is paramount to survival. Many myths still exist regarding tourniquets, which have been slowly dispelled with the advent of tourniquets becoming designated as basic life support devices. Contrary to the myth perpetuated by the mis-informed the use of a tourniquet does not mean you will lose a limb. In contrast, the statistical amputation rate is something like 16% - 19%. So there is a less than 20% chance of having to amputate the limb, but if your injury is already bad enough to need a tourniquet, the loss of a limb may have already happened, or is more likely caused by the trauma and not the tourniquet use.
Regarding surfers, a tourniquet is a great tool to be carried in the line-up and in your car. The majority of tourniquets are not designed for surfers, and water sports in general, with the sole exception being OMNA’s Amphibious Tourniquet and Tourniquet Leashes. All of the components used by OMNA Tourniquets are corrosion resistant and made for marine environments. In addition, having the tourniquet integrated into your leash or leg rope cuts the time of injury to tourniquet application exponentially. Considering, that 75% of improvised tourniquets fail to fully occlude bleeding, and that the single determining factor of shark bite survival is the rapid application of a commercial pre-hospital tourniquet it’s a no-brainer to evolve the traditional surfboard leash into an actual medical device. In the past, all a leash could do was retain your surfboard (Kragh et al, 2008) (Ballas et al, 2017). With OMNA’s innovation your leash now retains your surfboard, it’s also a tourniquet for first aid / surf life saving.
A.C.J. Ruijs, L.C. Langenberg, and J. Rezzouk, J Hand Surg Asian-Pac Vol 22, 10 (2017).
Ballas, R., Saetta, G., Peuchot, C., Elkienbaum, P., & Poinsot, E. (2017, May). Clinical features of 27 shark attack cases on La Réunion Island. Retrieved December 31, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/28248805
Carrilero, L. (n.d.). Rib and Sternum Injuries in the Athlete - ResearchGate. Retrieved December 31, 2017, from https://www.bing.com/cr?IG=21F5461386F64016BE90A1BF1B15AF39&CID=1147B8DF53E46C340AA4B3B6524B6DDD&rd=1&h=nnhknuKxqHEbvou2jyBoKoU4rDwDRc9Kug9OjyjHn_k&v=1&r=https%3a%2f%2fwww.researchgate.net%2fpublication%2f305734588_Rib_and_Sternum_Injuries_in_the_Athlete&p=DevEx,5064.1
Kragh, J. R., Walters, T. J., Baer, D. G., Fox, C. J., Wade, C. E., Salinas, J., & Holcomb, J. B. (2008, February). Practical use of emergency tourniquets to stop bleeding in major limb trauma. Retrieved December 31, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/18376170
Nathanson, A., Everline, C., & Renneker, M. (n.d.). Surf Survival: Surfer's Health Handbook. Retrieved December 31, 2017, from https://books.google.com/books?id=wHB_oIsXmOYC&printsec=frontcover&dq=surf%2Bsurvival%2Bcitation&hl=en&sa=X&ved=0ahUKEwiGkM-Bw7TYAhVHyoMKHR3XDr4Q6AEIJzAA#v=onepage&q&f=false