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 2nd annual conference on Surfing Medicine of the EASD in Sagres, Portugal.

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