ABSTRACT:
Objective: To gain a better understanding of how surfers view rescue experiences, surf safety, safety training options, as well as to learn ways to improve surf safety and medical care for surfers.
Design: Qualitative study design using semi-structured interviews of participants.
Setting: Surfers were recruited from British Columbia, Canada and Oahu, Hawaii.
Participants: A total of seven participants were recruited from British Columbia, Canada and Oahu, Hawaii.
Method: Study participants were asked to share their previous rescue experiences, views on surf safety, background safety training, and their ideas on how to improve medical care and safety in surfing. Demographic information of surfers was recorded. Interviews were recorded using an audio recorder and were transcribed. Transcripts were analyzed using standardized coding techniques for common themes.
Main findings: The majority of participants, six out of seven surfers, had been involved in assisting with a surf rescue. Four of the seven participants had been rescued by someone else in the water. Through the interviews, five main themes were emphasized including the benefit of previous safety training courses, communication, access to medical care, the importance of ocean and safety knowledge, and environmental concerns.
Conclusion: Surfers have numerous concerns regarding their safety in the ocean and medical care and find benefit in safety training courses. Given the sparse amount of research and resources in the area of surf safety, further studies looking into effectiveness of current surf safety training options would be of significant use to the field of surf medicine.
Key Words: Surfing; Safety; Risk Assessment; Surf Safety; Surf Medicine; Emergency Response.
Words: 246
INTRODUCTION:
Surfing is a widely enjoyed sport, with participants both at the recreational and professional level, and is gaining popularity worldwide.1 There are an estimated 37 million surfers worldwide, including 2.7 million surfers in the United States (2015), 2.3 million surfers in Australia (2013), and 500,000 surfers in the United Kingdom (UK).2 Since the 1960s, surfing as a sport has grown considerably, however there is very little research in comparison with other mainstream sports.3
Previous studies have approximated for recreational surfers, 2.2 to 3.5 injuries per 1000 hours of recreational surfing 4-6, and 6.6 injuries per 1000 hours of competitive surfing.7 A study by Furness et al (2015) showed that up to 33% of surfers suffer an acute injury requiring medical attention, missing work, or taking time off surfing each year.3 A study in UK surfers by Woodacre et al (2015) reported 93.8% of surfers sustained injuries during their life.8 As far as demographics, the majority of surf injuries occur in males in their late 20s with median age of 27.1,9
A study by Klick et al (2016) reported the most common injuries are lacerations, sprains and strains, contusions, and fractures.1 Mechanisms of injury include: collision with surfboard (especially the fins), contact with the ocean floor, hydraulic forces of waves, collisions with other surfers, drowning, and injuries related to marine animals.7,9 Risk factors for more severe injuries include age greater than 40 years, advanced surfers, and expert and professional surfers.7 Injuries more likely to require hospital admission included injuries to the trunk, closed head injuries, fractures (lower limb, skull, and cervical spine), older patient age, and drowning injuries.1,9
Several environmental factors increase the rate of surfing injuries. Wave size affects the injury rate with bigger or overhead waves more than doubling the risk of injury compared to smaller waves.7,9 In addition, the geomorphology of the sea floor also affects the injury rate with surfing over a reef or rocky bottom more than doubling the risk of injury compared to surfing a sand bottom.7,9 Marine hazards include marine envenomation, coelenterates, seabather’s eruption, stingrays, corals, and sharks.10 Coelenterates include true jellyfish, Portuguese man-of-war, and box jellyfish. Of particular medical importance, the box jellyfish contains deadly venom, and their stings can produce sudden cardiac arrest, cardiogenic shock, and dermonecrotic effects in humans.10,11 While shark attacks are popular in media headlines, they are rare.10 Statistics in 2003 reported 55 unprovoked shark attacks worldwide with only four deaths.
Prevention strategies include personal protective equipment such as helmets, eyewear, earplugs, water boots, flotation vests and padded wetsuits.9 Other preventative measures include surfing with a companion and awareness of hazards including currents, water depths, and local marine life. While there are limited avenues for training in surf safety, this is crucial for injury prevention and emergency response. In a study of Australian surfers by Attard et al (2015), 81% of their survey participants had done at least two rescues over their surfing career, with 23% reporting they had performed more than five rescues.12 In particular, surfers who had received formal water safety training were more likely to perform a higher number of rescues. Studies of bystander rescues has shown that with no prior knowledge of performing a rescue or assessment of conditions, these rescues can lead to dangerous situations for both rescuer and rescue.12-14 In a review of online resources for surf safety training, there are scarce relevant courses, which includes cardiopulmonary resuscitation (CPR) training, lifeguard certification, Surf Lifesaving courses, breath training courses, and only one current internationally recognized and comprehensive course available specific for surfing, which is the Big Wave Risk Assessment Group (BWRAG) training.15,16
METHODS:
Design:
A qualitative study design was used with semi-structured interviews of seven surfers. One-on-one interviews were completed by the researcher with each study participant. A qualitative study design was chosen to help gain a greater understand of participants’ experiences with emergency response rescue situations in the surf and gain a better understanding on how to improve current surf safety preparedness. In comparison to quantitative study design, a qualitative approach was used to capture each participant’s experience in the rescue situations, as well as to discover new ideas on how to improve current surfing safety and emergency response training.
Informed consent was obtained from each participant. The risks and benefits, as well confidentiality, were discussed. Interviews took an average of 20 minutes to complete, with a range of interview times from seven to 37 minutes. Demographic information of each participant was recorded. Participants received a gift card renumeration of $20 for their participation in the study. Ethics approval was sought and granted by the University of British Columbia Office of Research Ethics Behavioural Research Ethics Board, with ethics identification H19-03284.
Setting:
Participants were recruited from British Columbia (BC), Canada and Oahu, Hawaii. Interviews were completed in person at the location of the study participant’s choice in BC, Canada or Oahu, Hawaii or via telephone interview.
Participants:
A total of seven participants were recruited for the study. A study recruitment poster and a short verbal explanation of the project was distributed to staff at surf schools and surf shops in BC and Hawaii, as well as at an annual safety meeting in Hawaii called the BWRAG Annual Safety Summit. The participants were recruited using third party recruitment, after which study participants voluntarily contacted the researcher through phone, email, or by approaching the researcher at surf beaches. Participants invited to participate included surfers or surf instructors in BC, Canada and Oahu, Hawaii. The inclusion criteria included fluency in English and age 18 and older.
Complete demographic information of the participants is included in Figures 1 to 4. Participants were identified as S01 to S07. Surfing level of participants included four recreational, three professional, and one instructor. The participants ranged in age from 27 to 67 years. The area each participant surfed the most in was quite diverse, as noted in Figure 1. The surf break type most commonly surfed by each participant is in Figure 4.
Data Analysis:
Interviews were recorded using an audio recorder (Sony ICD-BC140) and transcribed verbatim by the researcher. All identifiable indicators were removed. Transcripts were verified through comparison of the researcher’s field notes. The written transcripts were analyzed through qualitative data analysis using standardized coding technique for common themes. Two different coders analyzed the data, with 100% coder agreement achieved as indicated by identical coding sheets done independently of each other.
FINDINGS:
All seven participants reported that they had either been involved in helping with a surf rescue or had been rescued by another surfer in the water. The majority of surfers, six out of seven (86%), responded “Yes” to having been involved in helping with a previous surf rescue. The number of surf rescues each participant had assisted in is shown in Figure 5. Of note, one surfer in the 5+ rescue category, had assisted in over 200 rescues. Four out of seven participants (57%) responded that they had been rescued in the water by someone else at some point during their surfing career.
The number of safety equipment items regularly worn or brought on surf trips by each participant varied considerably. The maximum number of safety equipment brought by one participant was 13. Three participants brought only one item. The most common item brought was a leash. Safety equipment regularly worn or brought on surf trips by each participant is shown in Figure 6.
There were several primary safety concerns brought up by participants including social isolation, access to medical care, beginner surfers in the water, lack of cell phone coverage, and environmental concerns. Environmental concerns brought up by participants varied considerably with the diverse locations of participating surfers. Unique environmental concerns brought up by Canadian surfers included ice chunks, wildlife, and water quality. Primary safety concerns of each participant are shown in Figure 7.
There were several important themes that emerged throughout the seven participants’ rescue stories. The five main themes identified as important aspects to the rescue response: (1) benefit of previous safety training courses; (2) communication; (3) access to medical care; (4) the importance of ocean and safety knowledge; and (5) environmental concerns. Significant rescue stories shared in the interviews are summarized in Table 1.
Theme #1: Benefit of previous safety training courses
All seven participants reported benefit from previous safety courses. See Figure 8 for the types of training participants had completed. For example, participant S01 emphasized the importance of completing safety training (CPR, First Aid, lifeguarding) as well as repeating these courses more regularly than actually required for a surf coach in order to keep skills fresh. Participant S03 stressed the importance of education and safety training for all users of the ocean, both to help with prevention of injuries, as well as training for emergency response and resuscitation if needed. Four of seven participants were interested in furthering their safety training courses, including CPR, water safety training, and BWRAG training.
Theme #2: Communication:
This theme was highlighted by six out of seven participants. Several participants listed strong communication as an important aspect of the rescue response, or as a lesson they learned from the rescue that made them feel better positioned to help assist in future rescues. Participant S03 brought up the importance of this when discussing his experience with the BWRAG surf safety program and the importance of hand signaling in emergencies:
“I think that’s the biggest piece, seeing what you’re teaching is actually being used and saving lives. And it’s not just one person, but it’s creating an entire community that is educated to a very basic level to assist in those critical moments in the [event there is somebody down who needs help]. And even if that’s 100 people on the beach pointing in that direction, and there’s 3 people that decide to take action because they feel that their skills are there. So, the masses that know this is going on point everybody in that direction for higher care. But then, having a few people or whoever is there, do the care, is very beneficial and we’re seeing the response of the actual stories happen. So, if you could educate everyone in the world that had ocean contact at that level, you would see a lot of success in that. Look at Hawaii and Pipeline as a small microcosm of that, the majority of people around Pipeline have taken some kind of class like this and are educated enough to do those things. Being able to spread that message to a wider scope is only going to help save more lives at the beach.”
Participant S06 brought up the importance of strong communication and body language signals among surfers in the water. He shared a personal rescue story in which he did a hand signal when injured, after which he was able to get assistance from other people in the water (see rescue story S06 in Table 1).
Several other surfers brought up the difficulties with lack of communication when traveling in foreign countries. Of note are the stories of participants S04 and S05 when in Mexico and Nicaragua, respectively. Their stories emphasized the importance of having some way of communicating when unable to speak the local language.
Theme #3: Access to medical care
Concern around access to medical care was an important theme brought up by five out of seven participants. This was exemplified with the rescue experiences of S04 in Mexico, in which she had little choice but to seek the help of an intoxicated lifeguard for her dislocated shoulder due to a lack of first aid resources on site, as well as the distance to the nearest hospital. This was also emphasized in the safety planning stages by participant S03 in which he described the stark contrast between planning trips locally in the United States versus in areas of Mexico. He described concerns about being out of the country, in Mexico, in which he prepared “to tackle all the challenges ahead, so if someone gets hurt, [he] would try and handle it and expediate them back to the USA as quickly as possible for advanced medical care.”
Theme #4: Environmental concerns
Concern over environmental factors was brought up by six out of seven participants. Large wave size was the most common environmental concern brought up. Environmental factors causing concern for safety varied depending on the location where the participant usually surfed. All three surfers from Canada noted several environmental concerns including ice chunks, currents and rips, water quality, and wildlife. One Canadian surfer who mainly surfs on the Great Lakes in Ontario noted ice chunks as a major safety concern, as he is surfing mainly freshwater lakes. Canadian surfers also expressed concerns over the lack of lifeguards at surf beaches on Vancouver Island. See Figure 9 for a breakdown of environmental concerns of participants.
Theme #5: The importance of knowledge
The importance of knowledge of both the surf and surf safety was emphasized by six out of seven participants. For example, participant S01 stressed the importance of strenuous water training, including carrying rocks under water and breath training, the importance of knowledge of the beaches and ocean, as well as repeating safety courses often to keep skills fresh. Several participants, including S03 and S06, reported a great deal of planning and preparation prior to surf trips. Some of these plans included knowledge of closest access to medical care, knowledge of environmental conditions, and emergency response training, knowledge of beaches and surrounding areas including road access (back roads, kilometer markings, access and distance to care) in case of emergencies. Several participants stressed the importance of knowledge of ocean currents, rips, tides, and the surf beach.
In stark contrast, three of the seven participants noted that they had significant gaps in knowledge on how to handle a surfing emergency situation. One participant noted: “I haven’t thought about safety plans” and then after the interview, he reported that he was inspired to seek out opportunities to develop a First Aid kit as well as take some extra safety training.
How to Improve Medical Care for Surfers:
In discussing the current medical care for surfing injuries and participants experience receiving medical care from health professionals, there were several important points brought up by the participants. Participants identified areas for improvement at the public health level, doctor level, as well as the field medicine level. At the public health level, the importance of improving education to the general population of surfers and ocean users was brought up, as well as improving access to lifeguards at Canadian beaches. At the doctor level, there were several key points emphasized. Participant S03 expressed concerns over the lack of knowledge of some coastal doctors in caring for marine life injuries, such as stingray injuries. The care of elite athletic surfers was also emphasized as an area for improvement for doctors, including knowledge of the prevalence of breath apnea training injuries and concussions due to wave force. One participant, S06, noted a desire to learn more from doctors on drownings and secondary drownings. See Table 2.
Figures & Data:
Figure 1. Location and Classification of Respondents
* Each colored circle represents 1 response.
Note: The professional category included professional surfers, big wave surfers, professional surf coaches, and World Surf League (WSL) water safety personnel.
Figure 2. Gender Breakdown of Respondents
Figure 3. Respondents’ Age Range and Frequency
Figure 4. Usual Surf Break Type
Figure 5. Number of Rescues Each Participant Has Helped With
Figure 6. Overview of Safety Equipment Utilized
Figure 7. Primary Safety Concerns When Surfing
Figure 8. Type and Frequency of Safety Training Among Respondents
Figure 9. Primary Environmental Concerns When Surfing
Table 1. Significant Rescue Stories
|
Significant Rescue Stories |
|
|
S01 |
It was a few years back – he was a doctor … He had a stroke in the water at Pu’ena Point. Right here. Anyway, I was there teaching surfing, and I saw something going on. I told some people in the water, go take the students in, I’m going over to help. I got over there, and the surfer was saying that he couldn’t feel one side of his body. I asked one of the surfers that paddled over to go get 911 right now. Another surfer and I put him on his side on his board, so he could throw up as he had taken on water and we paddled him in. Before we got him in, the ambulance and fire truck were already there. The good thing was that we had kept him talking to keep him up. The ambulance took him, and he called me from the hospital, thanking me for saving his life. “Are you kidding me? That’s my job. That’s what I’m trained to do … to respond. Luckily I was close enough to help. Like I said, always be aware of what’s going on around you. Be observant. Look around. Look around. You never know when you could save someone. A lot of people are having fun, but hey, always look around … You never know. People get out there, and they can’t even swim, they shouldn’t be out there.” (S01) |
|
S02 |
Lots of rescues every day, throughout a lesson I’m teaching, I’m doing small rescues. Being very patient with teaching ensures safety. A lot of patience, a lot of observation, as well as the physical aspect of surfing. (S02) |
|
S03 |
I had one rescue as a lifeguard where I took somebody to the hospital because they had a bad stingray barb still in their foot after being rescued from the surf in California. The doctor basically looked at it and said, “we’re going to remove this, and then beyond that, you tell me what to do.” (S03) |
|
S04 |
It was my first time I was surfing in Puerto Escondido, the first time I was getting on a hard board, I was with my instructor. It was a longer wave, I went out pretty far, far out from everyone else. I remember coming down, tumbling down onto the sea floor. I remember not being able to swim, this sudden pain, I couldn’t really register what happened. All I could remember was that I couldn’t reach the ground with my feet, the waves were coming at me, I was terrified, flailing my arms. Then the next thing I know someone hauled me onto my board, and pulled the board with me to shore, then I realized my shoulder had fallen out. I had dislocated my left shoulder. It was the first time I had gotten into a big accident in a foreign country, especially a third world country as well … especially Puerto Escondido, which is a rural Mexican city, there’s not a lot of people who speak fluent English. I was just in so much pain. I went to get help from a surf instructor’s brother who used to be a lifeguard, but a sketchy lifeguard as he was drunk all of the time. He did these crazy maneuvers to put my shoulder back in. I think I was just shocked by the entire incident. I didn’t think to go to the hospital right away. I used a 30-year-old Nikon camera thing as a makeshift sling. It wasn’t until the next day I realized I should go to the hospital. I only felt comfortable going to the hospital with my local friend that could translate, especially in a foreign country and the hospital was in a bad area of town. I didn’t feel safe at all. I got checked out by the doctors there, I didn’t really know what they were saying about too many things, I’m just used to the Canadian standard of care. Then I had to get my flight back to Canada, my friend and I were stuck at this rural Mexico town. (S04) |
|
S05 |
I took a fin to the back of the head when I was in Nicaragua in 2008. I was duckdiving, and a girl was surfing over me, and her fin clipped me in the back of the head. For 5-10 seconds, I saw stars and felt disoriented. I was really fortunate. I was staying at a surf hostel, luckily my friends, immediately drove me back into town, right to a hospital and they stitched me up. My friend that ran the surf hostel was much more experienced in Spanish than I was, so I had someone there to help with translation. (S05) |
|
S06 |
I sprained my ankle once. We had the hand signal, you know what I mean, when something’s up. I just did the hand signal then my mate ran to the water’s edge and straight away asked me what happened. We definitely always have a plan in place. Me and my friend, when we surf all those slabs over here, we always watch each other’s waves from behind and stuff like that, and always give the thumbs up and acknowledgment after each other’s waves. (S06) |
|
S07 |
It was in Sombrio, British Columbia. Someone took off on a medium-sized wave and there was a person below them, that person threw away their board, but while that happened, the surfer jumped in the board’s direction and it hit him square in the chest, knocking the wind out of him. He was gasping, struggling, panicking in the water. I came over to them, helped move their boards out of the way, and someone supported the surfer’s head until he got his air back. (S07) |
Table 2. How to Improve Medical Care for Surfers
| On the public health & population level, improving: |
|
| On the doctor and healthcare professional level, improving: |
|
| On the field medicine side (surfers/surf instructors/lifeguards), improving: |
|
DISCUSSION:
As surfing gains popularity and grows as a sport worldwide, it is crucial to examine the safety, health, and medical aspects of the sport. There is sparse research on surf safety or medical care for surfers. This study emphasized the importance of surf safety, the benefit of safety training programs, as well as areas for improvement to help make the ocean safer.
As noted earlier, the benefit of safety training programs was of great importance to all study participants. In general, participants who had completed more water and surf specific safety training felt more comfortable assisting with rescues. Interestingly, while 86% of study participants had assisted in a surf rescue, and 57% reported that they had been rescued in the water, the level of safety training varied considerably among participants. Four participants desired more opportunity for safety training courses including CPR, water safety, and BWRAG. Barriers to accessing this training may include rural location, financial expense of courses, and lack of local opportunities for water and surf safety training.
Interestingly and unexpectedly, one participant (S03) noted the lack of knowledge of doctors along the coastline on how to treat marine life injuries. He suggested: “I think it would helpful for [doctors] to take the [BWRAG] class and see what the field medicine side looks like. It’s so hard to say because they have such a high level of training but understanding what that person goes through in the water, I think would benefit them in how the treatment is done.” Furthermore, the role of doctors at the preventative level could make a significant difference in surf safety. Studies show 33% of surfers each year suffer an acute injury requiring medical attention, missing work, or taking time off surfing, with 98% of surfers suffering at least one injury over their lifetime.3,8 For patients who surf, educational counselling regarding surf and ocean safety can limit and prevent injuries. Family doctors could also discuss with their surfer patients various options on developing more emergency response skills to help patients gain confidence on how to react if things do not go as planned. This could be similar to how physicians counsel new mothers on safety with newborns, youth on safety with helmets for cycling and skating, and passengers wearing seatbelts in motor vehicles.
The benefit of water safety training has been shown by prior studies, including the study in Australian surfers by Attard et al (2015) which found surfers were performing rescues on par with numbers of surf lifesavers. This study also found that surfers with prior water safety training were more likely to perform a higher number of rescues.12 Similar to the study by Attard et al, this qualitative research study reaffirmed that surfers regularly perform water rescues. This study showed that surfers with more safety training performed more rescues and felt more comfortable to help in those situations.
Additionally, this study also brought up the importance of improving safety at the public health level. Education of the surfing population on a whole regarding surf risk assessment and accident prevention would be beneficial. The lack of lifeguards at Canadian beaches was brought up all three Canadian surfers. While there are likely financial barriers to this, adding lifeguard coverage to busy Canadian beaches may show benefit in health outcomes and saving lives. Another option would be offering more surf safety and emergency response courses in Canadian beach towns, as well as supplying basic rescue equipment in common beach areas. This would allow regular surfers to gain skills in surf safety and emergency response, so in the event there was an emergency situation, they could respond. The goal would be for all surfers in the area to have surf safety and emergency response skills. There could be common areas at the beach access with basic rescue equipment including a rescue float, first aid kit, defibrillator, tourniquet, and a radio or some way of communicating to the nearest emergency response personnel or hospital. This would also be a good idea in addition to lifeguard coverage, as many surfers are in the water before and after lifeguard hours.
Study Limitations:
This research study focused on safety and medical care for surfers, and while this is common in many areas worldwide, it may not be as applicable for doctors working in areas with no nearby ocean access or in populations where surfing is not popular. As it is a qualitative study focused on in-depth interviews, it only has seven participants which may not encompass the views of all surfers.
Future Directions:
It would be interesting to develop a surf safety resource that family doctors could distribute to their patients. This resource could focus both on prevention of surf injuries as well as information on emergency resuscitation. Additionally, these surf safety guidelines could be used to develop surfing emergency response simulation courses, similar to those done in wilderness medicine courses and emergency departments. Such surf simulation courses could be used in adjunct to current surf safety courses, and comparisons among these courses could be studied in the future.
CONCLUSION:
Surfers have numerous concerns about their safety in the ocean, rescue experiences, safety training options, and medical care in the sport. Regarding rescue experiences, surfers emphasized the importance of previous safety training courses, communication, access to medical care, and location-specific ocean and environmental knowledge. Given the sparse research and resources in the area of surf safety, further studies on the effectiveness of current surf safety training options would be beneficial and insightful to the field of surf medicine and sports medicine as a whole.
Authorship:
Dr. Willsey is a family practice resident at the Coastal Site of the University of British Columbia, and a keen surfer. She is responsible for developing the research question, literature review, designing the study, data collection, and is the single author of the written report. Data analysis was done by both Dr. Willsey and statistician, Dr. Andrew Buskard.
Acknowledgements:
The author wishes to thank the following people for their contribution: Dr. Timothy Hsia for his input, guidance, and revisions throughout the course of the resident scholar project; Dr. Andrew Buskard for his help with statistics and qualitative data analysis; Ms. Chantalle Jack for her help with library resources; Dr. Dean Brown for his support of surf medicine in family practice; and to the surfers who participated in this study, as well as all surfers around the world working towards improving safety in the water.
Funding Support:
The researcher would also like to thank the UBC Family Practice Residency Program for financial support to provide gift cards for study participants, as well as for funding for statistical assistance.
Key Points:
- Surfing is gaining popularity worldwide, however relatively there is a lack of research in the surf safety and surf medicine field
- There are numerous important safety concerns brought up by surfers in this study
- Five main themes were emphasized including the benefit of previous safety training courses, communication, access to medical care, the importance of ocean and safety knowledge, and environmental concerns.
- There were several key ideas identified for how to improve safety and that would reduce risk of this growing sport at the public health level, doctor level, and field medicine level
REFERENCES:
- Klick C, Jones C, Adler D. Surfing USA: an epidemiological study of surfing injuries presenting to US EDs 2002 to 2013. American Journal of Emergency Medicine 2016;34:1491-6.
- Dimmick S, Gillett M, Buchan C, et al. Prospective analysis of surfing and bodyboard injuries. Trauma 2019;21:113-20.
- Furness J, Hing W, Walsh J, Abbott A, Sheppard J, Climstein M. Acute Injuries in Recreational and Competitive Surfers: Incidence, Severity, Location, Type, and Mechanism. The American Journal of Sports Medicine 2015;43:1246-54.
- Lowdon B, Pateman N, Pitman A. Surfboard-riding injuries. Med J Aust 1983;2:613-6.
- Nathanson A, Haynes P, Galanis D. Surfing injuries. Am J Emerg Med 2002;20:155-60.
- Allen R, Eiseman B, Straehley C, Orloff B. Surfing injuries at Waikiki. JAMA 1977;237:668-70.
- Nathanson A, Bird S, Dao L, K T-S. Competitive Surfing Injuries: A Prospective Study of Surfing-Related Injuries Among Contest Surfers. The American Journal of Sports Medicine 2007;35:113-7.
- Woodacre T, Waydia S, Wienand-Barnett S. Aetiology of injuries and the need for protective equipment for surfers in the UK. Injury: International Journal of the Care of the Injured
2014;46:162-5. - Gomez AT, Rao A. Adventure and Extreme Sports. Medical Clinics of North America 2016;100:371-91.
- Zoltan T, Taylor K, Achar S. Health Issues for Surfers. American Family Physician 2005;71:2313-7.
- Marcus E, Isbister G. Jellyfish stings: UpToDate; 2019.
- Attard A, Brander R, Shaw W. Rescues conducted by surfers on Australian beaches. Accident Analysis and Prevention 2015;82:70-8.
- Pearn J, Franklin R. The impulse to rescue: rescue altruism and the challenge of saving the rescuer. International Journal of Aquatic Research and Education 2012;6:325-35.
- Moran K, Stanley T. Readiness to rescue: bystander perceptions of their capacity to respond in a drowning emergency. International Journal of Aquatic Research and Education 2013;7:290-300.
- Big Wave Risk Assessment Group (BWRAG). (Accessed Sept 16, 2019, 2019, at https://www.bwrag.com/.)
- Surf Life Saving. (Accessed Oct 15, 2019, 2019, at https://sls.com.au/.)