New York City doesn't always come to mind when speaking of surfing. But with the approach of Hurricane Bill, surfers flocked in droves to the beaches to get in on the action. The U.S. National Hurricane Center downgraded Bill to a Category 1 storm as it approached the shores of the northeastern U.S. However bathers and surfers alike still faced the dangers of rip tides and extreme overhead waves.
Under normal conditions, the waters off Rockaway Beach claimed six swimmers this year alone. However, on Aug. 23, when surf conditions at Rockaway Beach were "epic" due to Bill_s approach, one local surfer almost became the seventh on the list. He was attempting to enter the 12' surf off a rock jetty and misjudged the wave timing. When he entered the water he immediately found himself being thrown into the rocks and tossed in the turbulent crashing waves. Observing the surf conditions of the day, Fire Department New York (FDNY) EMS Paramedic 47Z was yards from the unfolding situation, calling in the water rescue and running to assist.
Paramedics Tom McCarthy and Jason Verspoor directed surfers to bring the patient onto the beach and away from the crashing surf. While they began treating the patient, the arriving EMS officer assessed the situation and ensured all members were accounted for, and that no other surfers or lifeguards had gone missing or were injured during the rescue effort.
The patient was a 24-year-old man who had bilateral tibia/fibia fractures, one of which was a compound fracture. The patient complained of pain to the lumbar area with no instability or obvious signs of trauma or neurological derangement. He also had multiple abrasions and lacerations from the jagged rocks and encrusted barnacles and mussels.
The patient was cut out of his wetsuit, and care was taken to remove the attached hood without manipulating the patients' C-spine. After he was removed from the crashing surf zone, he was placed in C-spine precautions and assessed for the possibility of salt water aspiration or worse, near drowning. A large-bore IV was established, and the patient's pain was managed with aliquots of morphine. Since sand and boardwalk surfaces are notoriously uneven, the pain management made transport to the ambulance less traumatic for the patient.
The patient was transported to local area trauma center, where he underwent immediate surgery to reduce the leg fractures.
In one study of 1,237 acute surfing injuries, 37% were to the lower extremity and 37% to the head and neck. The other 26% were systemic internal injuries, such as splenic ruptures, small bowel performations and thoraces. Seventeen percent of acute surfing injuries were caused by contact with the sea floor. Sixty-seven percent came from contact with the surfboard's nose, fins, rails or deck, 55% of which resulted from contact with one's own board and 12% from another surfer's board. (1)
Most surfing injuries are laceration and contusions, evenly divided between the head and neck region, and the lower extremity. The findings of this study echo those in a study of Australian surfers in which 41% the injuries observed were lacerations and 35% other soft tissue injuries.(2) These are consistent with my experiences of lacerations from "fin cuts" and contusions in less-treacherous conditions.
Lessons learned from this incident include knowing your response area well. Crews should be cognizant of which sports are common in their response districts, and they should pre-plan for access and egress accordingly. The beach where this surfer was injured is known by local surfers by a name not officially recognized by the local parks or city officials.
Recognition and proper size-up of technical rescue situations (water rescues fall into this category) will keep first responders safe and better assist the public. The response of specialty resources may have extended estimated times of arrival, so calling early for special resources is also paramount to successful outcomes. In this case, the FDNY dispatched the Water Rescue Matrix, and a New York Police Department (NYPD) helicopter also responded.
In situations such as this one, removal of the patient's wetsuit needs to be accomplished with as little manipulation as possible. The suits can range in thickness from millimeters of neoprene to three-quarter-inch, fleece-lined winter suits. Having sturdy shears and an extra pair of hands to pick the form-fitting suit off the patient, as well as providing tension to the cutting area, makes short work of this job. An extra pair of shears will help if the cutting shears become fouled with material. As with all trauma victims, the axiom of "strip and flip" is a priority.
Always assess patients for the possibility of water aspiration in injuries occurring in or near the water.
Even in the heat of summer, hypothermia can occur in the wet patient. Plan to manage the victim's needs relative to the ambient environmental conditions. Our patient was cut out of the wetsuit and then covered to prevent shivering.
Finally, resisting the urge to enter the surf or any body of water for a rescue cannot be stressed enough for all first responders. Don't become a victim. Call for help, and then act in accordance with your training level and operating procedures.
Lt. Louis Cook,AS, EMT-P, is a 22-year veteran of EMS. Assigned to Rockaway Battalion 47, he was previously assigned to the FDNY Special Operations Command - Haz Tac Battalion. Lt. Cook is a certified rescue paramedic and haz mat technician 2 and diver medical technician.
- Nathanson A, Haynes P, Galanis D: "Surfing injuries." American Journal of Emergency Medicine. 20(3):155Ï160, 2002.
- Lowdon BJ, Pateman NA, Pitman AJ: "Surfboard-riding injuries." Medical Journal of Australia. 2(12):613-616, 1983.