The 2nd Annual Conference Surfing Medicine 2-5 October 2013 was granted 12 European CME credits (ECMEC) by the European Accreditation Council for Continuing Medical Education (EACCME). 

Right at the moment that European summer has finally seemed to start, we have an ice cold message for you. You may be familiar with the phenomenon that as soon as the winter wetsuits are stored back in the garage, the surfers who only surf in summer -and therefore might be less experienced- show up. But although snow has disappeared from the beaches in this time of the year, hypothermia is as common as in winters. A breezy summer day on the coast of Ireland, with a water temperature of 13 degrees can still provoke hypothermia and unexpected cold related injuries. At our next conference, Ove Oksfold, MD, from Sweden, will share his knowledge about cold induced injuries and hypothermia in surfing.

Ove Oksvold

I was born in Norway but raised in Sweden, and graduated from Medical School in Uppsala in Sweden in 2002. For the first few years I worked myself up through Sweden and Norway as a “remote area GP” until I came as far north as there was land. In 2006 I started my emergency physician career, initially in the Northern parts of Sweden but later in emergency departments in Australia and New Zealand. I had plenty of odd jobs like ski resort doctor, sport physician for a “Division 1” ice hockey team, motorcycle doctor in the Himalayas, expedition medic in Costa Rica, and all-round-doctor in Tanzania. I returned to Sweden in 2011 to round it all up in a training program in Family Medicine.

When did you start surfing?

In 1994 or 1995 while passing Biarritz on a road trip through Europe. Although I continued to try surfing back home and away as often as I could, it took me at least 10 years before I really rode my first wave. And I am still an amateur.

What kind of specific injuries occur in cold waters?

If you have a proper modern wetsuit that fits you well, you should be reasonably comfortable, even if the water temperature is down. That said, there are a few odd things that can happen to you in cold water or if you get cold. You can get a general cognitive impairment. Or in other terms, being cold makes you more stupid, weaker and slower. If you rupture a tympanic membrane you will get an extreme vertigo. It is like an augmented version of the caloric reflex test. Furthermore you can get motoric and sensoric dysfunctions in your hands or feet. Standing up on a board is very difficult if your feet are numb, and using your fingers and hands are difficult if they are cold (like holding onto something, or picking up your car keys). Last, but not least important, you may become be very tired once you reheat and get into your car. Poor driving can kill.

As a doctor in general, which typical Arctic experiences do you have? 

Apart from traffic accidents, I have seen surprisingly few cold related medical conditions in the Arctic. I guess people dress up and know their weather and conditions pretty well. The main medical problems up here are related to being many hours away from secondary or tertiary medical care, and the mentality that people don’t show up at the doctor’s office unless they are very sick. I find more cold related injuries at winter resorts where tourists get lost while cross-country skiing or snowmobiling. Frost bites are very common, caused for example by using too small ski boots. Multisport is a class of its own, particularly orienteering (one of the most popular sports in Sweden). During the spring competitions there are often people getting lost while wearing little more than running clothes. In cities hypothermia is a problem foremost among mentally ill (including dementia), homeless, elderly and the occasional ice-skater or drunken boat user.

How do you prepare for expeditions as a leader of these expeditions?

Communication is a medic’s best tool in case something really serious happens. I have been surprised of how often there is a working cellular network even at very remote locations, so don´t leave your (smart) phone at home. It might be a good idea to get a local SIM card. Some countries demand that you leave a passport photo in order to get a SIM card, so check that up prior to departure. A modern phone can also be used as GPS. The big bulk of medical problems are the common ones like athlete’s foot, minor infections, aches and pains, foreign bodies in eyes or ears, and minor injuries. Many of these problems can be prevented. Bring equipment and medicine for severe but treatable conditions (anaphylaxis, acute coronary syndrome, etc). Split up your medication and the medication of the participants, so all medication is not at one location. If you have the chance, get a crash course in basic emergency dentistry (at least in Swedish medical schools we don’t get that much hands-on experience in dentistry). There are quick fix kits that are cheap and useful. Why not consult your own dentist?

How did you get involved in the European Association of Surfing Doctors?

I heard about the association while on a surf trip to Guadeloupe in 2011.

How do you think the European Association of Surfing Doctors can make a contribution to the surf community?

I think we contribute to the surf community by being doctors. But we might contribute even more to the doctor community by surfing. 😉

Let us introduce Dr. Martin Neudorfer and Dr. Robbie Lendrum. They are dedicated Surfing Doctors and will provide both lectures and the day 2 workshop in Pre Hospital Care Medicine!

Meet Dr. Martin Neudorfer (Austria)

Consultant Anaesthesiology, Intensive Care, Emergency Medicine, Pre-hospital Care, Sport Medicine, General Practitioner.

Martin was born 1976 in Vienna, Austria and graduated at Medical University of Vienna in 2002. He finished his training for GP, followed by the graduation in sport medicine and emergency medicine 2007, before specializing in Anaesthesiology and Intensive care in the Regional Hospital Mistelbach (Austria). Currently he is Consultant at the department of Anaesthesiology and Intensive care covering also the local outpatients Pain-Centre. An important part of his work is his duty in the pre-hospital care emergency unit (Austrian Red Cross). 2013 he will be completing the Austrian diploma in pain management.

Martin’s special interest is in pre-hospital care and pain therapy. He operates a private parents & children first aid/emergency training in Vienna (Austria) and teaches pain therapy in nursery school. Martin started his surfing career while doing an internship in Brisbane 2001, Australia. While studying medicine he became a certified snowboarding instructor and gained a lot of experience in other board related sports as windsurfing, wakeboarding, water skiing and later on also in kite surfing.

Martin Neudorfer will lecture about pain management of the injured surfer and will teach you some useful skills in airway management packed in exciting emergency scenarios as part of the pre-hospital care workshop.

Meet Dr. Robbie A Lendrum (Scotland)

Dr Robbie A Lendrum MD FRCA Dip IMC is a final year specialty registrar in anaesthesia and pre hospital emergency medicine (PHEM) from Scotland.

He has trained in emergency medicine, anaesthesia and PHEM in the UK, Australia and New Zealand, most recently in London, having spent 12 months working for London’s Air Ambulance (London HEMS).  He was appointed as an Emeritus HEMS physician with London’s Air Ambulance this year and has significant ongoing clinical and research involvement with this organisation. He has also worked with the Otago Rescue Helicopter in New Zealand and with the Surfing Doctors Association, as the camp doctor at G-Land in Java. He completes his training in anaesthesia this year and is going to work as a trauma anaesthetist at the Alfred Hospital in Melbourne, Australia. His current research interests include novel methods of haemorrhage control and organ preservation, more specifically Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a torso hemorrhage control and resuscitative adjunct. It is a technique designed to provide proactive circulatory support in the hypovolaemic trauma patient at risk of cardiovascular collapse. He has developed and introduced this intervention in both the emergency department of the Royal London Hospital and with London’s Air Ambulance, the first organisations in the UK to offer this life saving procedure.

Robbie Lendrum will lecture on the approach of the critical ill/injured surfer in the pre-hospital care setting. Further he will guide you as instructor in the pre-hospital care workshop.

Meet William H. “Bill” Jones PhD, who will give us an overview of public health initiatives linked to us by surfing

Bill Jones is a retired Learning Disabilities Specialist, Counselor, Educator and Educational Diagnostician. He worked at Monterey Peninsula College and at California State University Monterey Bay in Monterey, California. Bill started as an elementary school teacher and has taught kindergarten to graduate school, as well as school administration.

Bill is dyslexic and has done many presentations and consulting in regards to dyslexia, learning styles, computer education for the disabled, staff development, community education and service learning. He has written numerous articles on learning and has worked as a consultant for Houghton-Mifflin, College Survival, Wadsworth, Teaching Resources, DLM and Hewlett-Packard.

Since 1987, Bill has worked as a volunteer doing Third World Optometry for Los Medicos Voladores (Flying Doctors), Rotary International Clinics, and the Surfer’s Medical Association. He has traveled extensively in Mexico and Central America, Indonesia and several Pacific Islands working in clinics and searching for the perfect wave. In retirement, he is the Executive Director of the Surfer’s Medical Association and is a surfing sports columnist for several central Californian newspapers.

Check out a recent article about Bill Jones’ passions for surfing and medicine:

Bill Jones: The Tao of surfing

http://www.montereyherald.com/sports/ci_23802766/bill-jones-tao-surfing

Lecture Sagres 2013: “Physiological indicators and training methods in perspective of the surfboard riding performance”

We are proud to announce Prof. Dr. Miguel Moreira who will lecture on the physiological indicators and training methods in perspective of the surfboard riding performance.

Prof. dr. Miguel Moreira, PhD, (Portugal, 1970) studied Physical Education & Sport in Lisbon, Portugal. He worked as a gymnastics coach (trampoline) in Ginásio Clube Português and afterwards he started a pioneer project (Surftec, 2000) with the aim on surf research & technical development, teaching & coaching, and competition support. As a coach and project manager he had some good sport results (2 European championships with the National team, 3 National cup winners, 1 European Clubs Cup, 3 National champions surf youth, 1 vice-champion U14, and 2 third places U18 Boys and Girls in Euro Juniors 2008 Morocco). At this moment he is the coordinator of the post-graduation surf course at the faculty of Human Kinetics University of Lisbon (PT). In October 2007 he was appointed as the Professor in Sport Coaching (surf) at the department of Sport & Health. The faculty has a bilateral agreement with both the Portuguese Surf Federation (FPS) and with Hydrographic Institute (IH, an agency of the Portuguese Navy). His major focuses of attention are sport performance and sport expertise including qualitative task analysis.

The scientific interest in surfing started when he worked as a coach in the Surftec project. During his career as a Professor he published a book (“Surf: from science to practice”) and several articles on surf characterization, training methods, and didactics. In 2007 he completed the PhD thesis “Matrix of Analysis for Sports Tasks. Structural classification system. Taxonomic Surf model”. He is a regular national and international invited speaker and teacher on these subjects, from a practical coaching level to the theoretical level. He is affiliated to the European College of Sport Sciences.

Dr. Miguel Moreira is also involved in research, education and strategy planning in several other fields such as gymnastics, diving and football refereeing. He has published several articles and presented scientific papers on these topics.

Conference Speaker Sagres 2013 – Onno ten Berge MD, PhD, Dermatologist

Lecture – (Tropical) skin infections

Onno ten Berge was born 26 March 1978 in Utrecht. After finishing grammar school at the Stedelijk Gymnasium Utrecht, he started studying medicine at the Utrecht University. During a scientific elective period at the dermatology department of the University Medical Centre Utrecht in 2005 he started doing research on UV related dermatologic problems. This work finally resulted in a thesis.

In 2008 he started his dermatological residency at the department of dermatology of the UMC Utrecht. In 2013 He started working at the Gelre Hospital in Zutphen as a general dermatologist with special interests in dermato-oncology, dermatosurgery and UV related dermatology.

Spending his free time in Dutch mushy waves for over  10 years, he is passionate about all surf related medicine.

Conference Speaker Sagres 2013 – Till Geimer, MD, Dermatology

Lecture – The surfer`s skin: UV- related skin disease. Aetiology, therapy and prevention

Till Geimer is  a resident in the Department of Dermatology and Allergology at the Ludwig Maximilians University in Munich, Germany. In this department, being one of the largest Dermatology departments in the world, health care with respect to cutaneous diseases is provided for large parts of southern Germany as well as for parts of Austria.

After having completed  3 years of training in general dermatology as well as an internship in an outpatient center for Moh`s Micrographic surgery in Miami, FL, Tills  main clinical and scientific focus lies on dermatosurgery, UV-related skin cancer (Melanoma and Non-Melanoma Skin cancer) and its surgical treatment. Till is lecturing on this topic as well as on the topic of pathophysiology and treatment of chronic wounds on national and international congresses. Despite being a dermatologist he is a stoked surfer and spends as much time as possible at his local spot the „Eisbach“ a stationary river wave in the heart of Munich or is travelling the world looking for good surf.

Lecture Sagres 2013 – Surf-Head: surfing as therapy

Greg Dillon is a psychiatrist specializing in General Psychiatry & Addiction, and a founder of Lower Fifth Psychiatric, a group practice in New York City.

He is also a Clinical Assistant Professor of Psychiatry and Public Health at the Weil Cornell Medical College and New York Presbyterian Hospital. In addition to his work as a pharmacologist and dynamic psychotherapist, Dr. Dillon has special interests in the uses of experiential therapy, particularly surfing, as a visceral and metamorphic point of access to intra-psychic processes.

He has written and lectured on his theories for Psychology Today, and is working on a book and seminar series called Surf-Head, exploring the lessons of surf and sea towards a better self understanding. He lives in Brooklyn with his wife Samantha, daughter Reed, and son Clive.

Please let us introduce to you Dr. Andrew Nathanson who will be present as a speaker at our coming conference.

Dr. Nathanson is an Associate Professor at the Department of Emergency Medicine, Brown University Medical School (Alpert), Providence Rhode Island, United States. He is one of the pioneers of Surfing Medicine and he will discuss wound care and prevention in a presentation called “Surfing Injuries”. 

Andrew has had a career long academic interest in Marine Medicine, with a focus on water  sports injuries and prevention. Dr. Nathanson has conducted numerous studies on injuries and illnesses related to surfing and sailing, as well as lifeguard assisted rescues and first aid.  He is one of the authors of the Surf Survival Guide and recently wrote the surfing chapter for a book called “Adventure and Extreme Sports Injuries: Epidemiology, Treatment, Rehabilitation, and Prevention” published by Springer-Verlag, London. Dr. Nathanson lectures internationally on a variety of topics in Wilderness & Marine Medicine and he is the faculty advisor for a 2-week Wilderness Medicine elective at the Alpert Medical School of        Brown University.

How did you get involved in Surfing Medicine?

So it started of being in windsurfing, I did a lot of windsurfing when in my younger years and got into surfing when I travelled to Hawaii. I met my wife in Hawaii, when I was windsurfing there on Maui Hookipa. When the wind wasn’t good, sitting around on the beach, waiting for the wind picking up, I saw all these guys out surfing. I triggered me to get in to surfing.

In my twenties we did a lot of road trips to Baja, California and camped on the beaches, that was great surfing in Mexico. Over time I injured myself a couple of times, stepping on a sea urchin in California, and then a friend broke his foot. In that same time I heard about an incident with a surfer with a cervical spine fracture, and so I thought “how dangerous is this sport?”. What kind of injuries are most common?

In that time we didn’t have the internet, just an archive of a collection of books. You had to blow the dust of it. You could search things, something about Medline, paper bound volumes, but basically nobody had written anything about (wind) Surfing injuries. So I did a little study, I made a paper survey and distributed it, I went to the beaches and after 2 years I had 50 completed surveys. When internet starting coming in play, I put the study on internet and very quickly got 200 surveys filled out and published a paper.

The interesting about the paper, back in 1993, was that there was a real question about whether it was valid to do a study by the internet. Were these participants really surfers or just people who filled it in out of boredom with no surfing experience at all? We compared the paper versus the internet survey, and it showed that the responses where identical. So it was a valid way of doing research.

I also did a prospective study on professionals surfers during events. This gave me a clear overview of the relation between exposure time (time of practicing the sport) and the risk of injuries in surfing.

Tell us about the process of writing a book in Surfing Medicine?

For a longer time I had the idea to write a book and we already had an outline for the book, but no define plan yet. I organized some conferences for the Wilderness Medicine Society and one of them was in Marine Medicine. On this conference I met Dr. Clayton Everline from Hawaii, who had a specific interest in Surfing Medicine, but from a Rehabilitation & Sports Medicine perspective. He approached me to get together and write the book. I told him it would be hard to get a publisher and a lot of work. When we first started thinking about the setup of the book, we had some discussion about the public we wanted to reach, Surfing Doctors or the general Surfing Population. We chose for the last one, because we thought it would be great to reach the entire surf population. Very quickly we found a publisher and they said “Yes”! We gave a brief outline and two complete chapters. They came back to us and said “We want you to have it done in 9 months” which was a really short deadline.

But before we started the process of writing the book, we wanted someone with more experience. So I called Mark Renneker, the Father of Surfing Medicine, founder of SMA and the author of the “Ask the Surf Docs “ book.  I didn’t know Mark very well, never met him before. I called him and asked him, because he has expertise like big wave surfing that we didn’t have. We couldn’t  write a chapter without having experience in big wave surfing, so we asked “Mark do you want to help writing this book?”. In the beginning he was very cautious to join the process, because he had some bad experiences over the past with publishing new material. I said “Mark here’s the deal: I have this really nice old longboard, from 1960, a Hobie Balsa stringer in pristine condition. I found it when I was 13 years old when I was helping a friend cleaning his studio. In the stairwell of the building, was all this crap: chairs and stuff, including this really nice surfboard. You can have this surfboard. I guarantee that this project will happen and if this book will not get published, I will give you the surfboard”.

Finally he wrote back to me: “It is a deal”. And then Mark and I went to New York, to meet the publishers, we told them what we wanted.  We all contributed and the book was published.

What are  the most common surfing related injuries for you as Emergency Physician in a level 1 trauma centre?

I work in a very busy level 1 trauma centre, in Providence where we see 100,000 patients a year, 300 a day. We see a number of people with cervical spine fractures, with surfing or just people who were playing on the beach in the beach break and they didn’t understand how waves work. Further we see very nasty fin lacerations to the leg, and other cuts and bruises of the board. Besides acute injuries, during travels marine and coral infections are common and general stuff like seasickness. Overall surfing is a relatively safe sport. One of the articles I published, had the tag line that “Surfing saver than soccer”. That was an eye opener for a lot of people, and it got carried in a lot of newspapers, because most people think that surfing is a dangerous and risky sport.

What is the current status of Surfing Medicine?

There are  a couple of different fields where you can be active in Surfing Medicine:

• physician at an event or surf camp
• researcher in a field of Surfing Medicine
• physician with hands-on treatment like physiotherapy & Rehabilitation & Sports Medicine
• instructor to teach basic skills and knowledge to bare-foot and general surfing population

Is the surf sport ready for professionalization and development of Surfing Medicine?

Surfing is a much smaller sport then main stream sport with less money and the number of full professionals is not very big. But  I think there’s room for growth and development, particularly in ways of training. The beautiful thing about surfing is the freedom of the sport and the independent minded culture: you can do it when you want and where you want. A lot of the sport is practiced in the non-competitive arena, by it’s very nature.

I think it s going to be a gradual development. There is a lot to gain in the recreational population of surfers. They are at risk when travelling in remote areas. How do you teach surfers who have an interest in traveling to remote areas to care for themselves?  How to be self sufficient on a boat trip or a road trip to Mexico?  There s a lot of stuff they can do with limited resources.

What is your future in Surfing Medicine?

Primarily in teaching surfers who travel to remote locations basic skills to manage in the wilderness. Furthermore I would like to continue doing  research and collaborate with other people who have interest in research in the field of Marine and Surfing Medicine. At the moment I am writing an article on Sailing injuries and fatal incidents in cooperation with the US Coast Guard. And of course I will be joining the 2^nd annual conference on Surfing Medicine of the EASD in Sagres, Portugal.

We are very happy to announce that Dr. Clayton Everline, from Hawaii, USA will be present at our conference.

Dr. Everline is the co-founder of Waves of Health, an organization with a focus on bringing medical care to underserved areas. He found inspiration to start the foundation through his studies and while traveling around the world where he saw poor medical care in many communities. Currently he is working as a specialist in Sports Medicine in Hawaii.

Dr. Everline is one of the authors of the Surf Survival Guide. Previously he has been working in several major events of the ASP World Tour as one of the Medical Directors:

• Quiksilver Pro, New York, USA (2011)
• Vans Triple Crown of Surfing (2009-2012)
• Billabong Pipe Masters, Oahu, Hawaii (2009-2012)
• US Open of Surfing, Huntington Beach, CA, USA (2010-2012)
• Hurley Pro Lower Trestles, CA, USA (2010-2011)

At the conference he will share his experiences in a presentation called “Trauma on Pipeline”.

Meet other conference speakers!

– Andrew Nathanson – MD, Emergency Physician and co-author of the Surf Survival Guide