Every emergency response has some element of danger involved, but imagine if that danger was extricating a victim safely out of the impact zone before the next 30-foot wave crashes on you both.
An EMS team based primarily out of San Diego does just that. They provide medical standby and rescue for the surfers on the Big Wave World Tour (BWWT), a professional surfing competition series that spans the globe with waves the size of tall buildings.
This specialized rescue team comprises professional paramedics, EMTs and lifeguards, who remain on call during the big wave competition season. Even with the latest swell-tracking technology, the BWWT is at the mercy of Mother Nature, so when the surf is up and their pagers go off, they may have a 48-hour response time criteria to arrive on another continent.
“It’s an aspect of EMS that really crosses a lot of areas: rescue, lifeguards, medical response,” says Ryan Levinson, NREMT-B, who works for Rural/Metro Ambulance in San Diego, who leads the EMS Rescue team for BWWT. “We’re operating in a very specific, narrow environment. The real challenge is that everything is moving all of the time. You’re used to doing all the stuff on flat ground, but it’s moving all the time.”
The BWWT holds competitions in such locations as Chile, Mexico, Peru, Oregon and Half Moon Bay, Calif. Surfers from across the world compete for cash prizes, but more importantly, they compete for bragging rights and the experience of conquering the heaviest waves in the world.
Tour operators determined early on that medical standby would be needed for a competition of this sort. Coordinating logistics for an international event with such short lead time would be challenging, and initially, some of the resistance for inviting EMS along came from the surfers themselves.
“To have the mind to surf big waves, you need confidence, and it’s that same mentality that says ‘We don’t need safety, we’re not going to drown,’” says Pierre Camoin, tour manager and chief financial officer for BWWT. “But the mentality changes little by little. Now safety is accepted and even requested.”
The BWWT has always employed an “assist team” who can swiftly remove surfers who go down from the impact zone before the next wave crashes. Although BWWT is a “paddle-in only” competition, the assist team usually comprises experienced big wave tow surfers without an EMS background. Tour organizers soon realized the EMS component was missing.
“Tow surfers make the best assist drivers, whereas a surfer is not the best paramedic,” says Scott Eggers, operations manager for the BWWT. In response to recent drowning incidents, Eggers is also working to establish a volunteer lifeguard service for the Half Moon Bay break where he lives.
EMS Rescue Team
Enter the EMS Rescue team. The EMS Rescue team responds if there’s a medical or traumatic emergency during the competition. In an emergency, one team member operates the PWC and deposits a rescue swimmer to secure the patient and airway and then circles around to make a pick up. The patient is then loaded on the sled, and they set off for the shore. All of this takes place in about 15–20 seconds before the next wave hits.
A lookout on shore communicates to the team in the water what’s going on and the best route to return to the beach because the responders on the PWC can’t see between waves. They also prepare any necessary equipment for the arrival of the patient (e.g., AEDs and trauma kits) and secure an ambulance or helicopter transport. These competitions can be miles offshore, so transport times to reach the beach may be lengthy (about 20 minutes at some competitions) as the PWC, loaded with three people, slowly winds its way through crashing waves.
Team member say one of the greatest challenges working EMS on the BWWT is procuring needed rescue equipment in third-world countries with scant EMS infrastructure at best.
Chad Cox, a firefighter/paramedic from Oceanside, Calif., who serves on the BWWT EMS team, says it’s always a surprise what equipment will be available when they arrive. He cites one time in Punta de Lobos, Chile, when they discovered the ambulance in the parking lot was actually being used for A/V equipment.
As a result, the team typically brings their own basic trauma supplies—C-spine, ice packs. Once they arrive, they conduct a rigorous inspection of local equipment and meet with local medical responders. They prioritize and assign the best functioning equipment to where it’s needed the most. A response kit is kept on the beach and basic supplies on the rescue sled.
These types of calls can have a variety of injuries, including loss of consciousness, fractures, lacerations, dehydration, motion sickness, head injury and barotraumas from the strong water pressure in the surf.
“These guys are athletes, so typically it’s not anything medical, more trauma,” says Cox.
Cox notes that a recent competition in South America was eye opening to see how EMS operates in other countries. He says due to the lack of a trauma center criteria in some countries, a patient may be taken by default to the local hospital. If the emergency is beyond the scope of the local hospital, the patient is transferred on to the next hospital and the next until necessary care is available—although the patient may also be transported by air if necessary. A transport from the competition to a major city, he says, may be four hours in duration and have two or three stops at hospitals along the way.
“We’re always flexible on our job. We learn to be,” says Cox regarding lessons he’s learned from working on the BWWT EMS Rescue team. “But I would say [what’s important is] being able to think outside the box and be flexible with the tools you are given, and use whatever you have in your hand and make it work.”
Other challenges the team faces includes language barriers and low compatibility between equipment brought by the team and used by local responders, says Jim Lockwood, EMT-B, San Diego City Lifeguard II and operations manager for the BWWT. It also can get cold for the responders, standing by on a PWC in the water for up to 14 or 15 hours straight.
Members of the BWWT EMS Rescue team must be an EMT or paramedic with five years experience, attend a United States Lifesaving Association (USLA)-sanctioned Ocean Lifeguard academy, have a PWC rescue certification and experience operating in a big wave environment. They must also be certified in at least two technical rescue specialties (e.g., rescue self-contained underwater breathing apparatus, swift water and cliff rescue). This job is separate from their duties as emergency responders in the municipalities they serve.
All members are responsible for training and must be able to serve in all roles on the rescue team. They also have to make themselves available to respond at a moment’s notice.
Each contest has a waiting period lasting a few months—historically when area has the biggest swell. Swells are tracked via offshore buoys, ships and satellite data up to a week before they arrive at shore. About 72 hours out, the team leaders are put on notice and begin mobilizing. About 48 hours out, the event is officially green-lighted and everyone—including surfers, tour organizers and the EMS Rescue team—begins travel to the area. The team has a short period of time to check equipment and meet with local response staff before the event.
“People all the time are wanting to be on this team, but I don’t think they realize all the work,” says Levinson, who also holds CPR/AED classes for the San Diego surfing community with his wife, Nicole, who’s also a San Diego City lifeguard. “You have to look out for other operators. [All people in the area, not just surfers] are potential drowning victims, and you have to operate in this environment in 18 seconds and the consequences are not insignificant. There’s no fluffy, little beach waiting for you on the inside.”
Why do the BWWT EMS Rescue team members do it? The reasons draw a close comparison to those of the surfers they protect.
“There’s always critiques with the big wave tour that we push them too far,” says Camoin. “Even if you put a huge amount of money in front of the surfers, it’s not about the money, it’s to ride the wave.”