10 Sept/Day 1
The Third Annual Conference of the European Association of Surfing Doctors (EASD) kicked-off with a morning of “Extremes”, with special focus on Drowning; Resuscitation following accidental Hypothermic Circulatory Arrest (Pre- and In-Hospital considerations); Extreme Environment Expeditions; and Traumatic Brain Injury in Surfing, filling a fascinating lecture schedule!
Dr. Patrick Morgan MD – Medical Advisor to Surf Lifesaving GB, Royal National Lifeboat Institute (RNLI) and the International Drowning Research commission, Member of the International Lifesaving Society (ILS) medical committee – started proceedings by giving an update in drowning. Showing results from research conducted at Extreme Environments Laboratory, Department of Sport & Exercise Science, University of Portsmouth, UK, he elucidated the potential role of hyperventilation and breath holding in triggering autonomic conflict which in turn predisposes to pro-arrhythmic states in myocardial cells following break of breath hold. In a rat model, this may be simulated, whereby atrial ectopics concordant with break of breath hold induce inherently unstable arrhythmogenic activity which may lead to cardiac arrest. Dr. Morgan offered this as another mechanism of death in cold water immersion and posed a challenging, and as yet unanswered question, to the audience: How does hyperventilation affect morbidity and mortality in the drowning casualty?
Dr. Steen Barnung MD – Consultant Anaesthetist at Rigshospitalet, Copenhagen University Hospital, Specialist in anaesthesia and advanced pre-hospital care – continued with a riveting presentation about the pre-hospital response to two cases of mass drowning in Denmark; the initial, experienced as a fledgling doctor, before current advances in pre-hospital medicine, and the second, over twenty years later, responding to the Praestø Fjord boating incident in 2011. He sketched an overview of the first responder experience at the scene where seven (7) teenagers were profoundly hypothermic (Median Temperature: 18.4°C; Range: 15.5-20.2°C) in a state of circulatory arrest. Furthermore, there were seven (7) other hypothermic victims (Minimum Core Temperature: 23°C) that did not suffer circulatory arrest. Issues of Transfer/Patient-Transportation, Communication with Trauma Centers/Centers of Excellence with requisite capability and capacity, and Coordination of the Pre-Hospital phase ala Disaster Medicine response methodology, where reinforced and highlighted as crucial to the outcome. Dr. Barnung’s message was crystal clear: “Train as you fight, fight as you train!”
Dr. Michael Wanscher MD PhD – Clinical Director, Cardiothoracic Intensive Care Unit, The Heart Center, Rigshospital, Copenhagen University Hospital – spoke on the In-Hospital treatment of six (6) of the patients of the same boating incident. He presented an impressive in-hospital resuscitation strategy using a management approach that employed extracorporeal membrane oxygenation (ECMO) rewarming, successive periods of therapeutic hypothermia and sedated normothermia, and intensive neurorehabilitation. He highlighted to the importance of and advantages of large trauma center expertise and capability in multi-casualty incident response and resuscitation. All six patients survived. Most of the patients have some form of physical/dexterous impairment by way of finger and/or hand contractures. The long-term psychological sequelae have yet to be determined.
Dr. Karina Oliani – President of ABMAR, the Brazilian Wilderness Medicine and Adventure Sports Society, Fellow of the Wilderness Medical Society (WMS), Medical Adviser for SOBRASA, the Brazilian Water and Surf Rescue Association, Expedition Doctor – shared her experience of the challenges facing an expedition doctor in a myriad of extreme environments, from the Amazonian jungle to the summit of Mount Everest, the Himalayan plateau, to the Arctic ocean!
Our final speaker of the morning, Dr. Terrance Farrell – Emergency Medicine Physician, USA; World Contest Tour Medical Support, delivered a comprehensive lecture on Head Trauma and Traumatic Brain Injury (TBI) in surfing. Noting the recent commencement of the Big Wave Tour (last year), Dr. Farrell’s lecture stimulated an interesting discussion on (pre-hospital) management and how protective headgear/helmet use in surfing could prevent TBI, and potentially improve morbidity and mortality.
The afternoon was filled with a wide variety of Expert-led Masterclasses in Expedition Medicine & Remote Ultrasound, Drowning, Surfing and Substance Abuse, Surf Physiotherapy, Orthopaedics, Training & Performance, Surfers Skin, and Surf-Head. Masterclass highlights/summaries will follow in due course, so check-in regularly on the homepage!
11 Sept/Day 2
The second day of Conference 2014 started with a brief overview of EASD achievements over the past year. Conference 2013 in Sagres and the second Advanced Surfing Medicine Life Support (ASLS) course in Ericeira facilitated many excellent additions to the Association, Surfing Medicine, and the quest to ‘Keep the Surfer Healthy and Safe’. Expertise and knowledge was strengthened and our global collaborative network enhanced. An augmented and refined ASLS course will be held in Ericeira from May 5th – 10th 2015. Registration is now open for the same, but don’t hang around, places are filling up fast!
The traditional Paddle Out gets bigger (and more fun) every year. This symbolic act signifies the growth of our family and the realisation of our vision to use our professional skills to positively affect the lives of surfers all over the world!
Following the paddle out, a series of workshops, delivered by Hans van den Broek, Peter Conroy, and Bart Haveman, demonstrated skills that any surfer, or water-user, should have. They showed how to retrieve a drowning victim taking possible C-spine injury into account; transport techniques in the water; positioning of a casualty on the beach, and the use of a surfboard as a rescue/floatation device.
Activities were wrapped up with an unforgettable demonstration and workshop of techniques employed for jet ski-assisted rescue by Peter Conroy and Paul O’Kane, using jet skis belonging to the Irish Tow Surf Rescue Club.
The EASD crew then visited the Irish Coast Guard Helicopter hangar at Sligo Airport. This is Search and Rescue base for much of the mid-West, NW, Northern coastline of Ireland. Mick Tracey explained the importance of disseminating knowledge concerning helicopter rescue to the surfer and surfing doctors. If you find yourself in the winch, Never Forget to Keep Looking Up and take care to keep surfboards or any light, unsecured objects clear of the incredibly powerful downward draft of the helicopter. Relatively light objects, such as surfboards, can be hazardous when swept up by the helicopter wake. Remember: Boards can easily be replaced, LIVES cannot.
The evening programme started with poster presentations. This year, we accepted nine scientific posters to be presented at our Conference. Each year, the submissions improve in quality and scientific merit. The winning poster explored the medical problems encountered by surfers returning home from a foreign trip. Other interesting research projects presented, included: Several overviews of surfing injuries in different populations/nationalities, Malaria prevention and the travelling surfer, occupational hazards for surfboard shapers, and Surfing in Pregnancy.
We concluded the day with a Conference favourite, and one of the core strengths of our association, the ever popular ‘Meet the Experts’. A unique group of international medical professionals shared their experiences, knowledge, and opinions on surfing medicine topics in a semi-structured Q&A session. Interesting discussions, spanning numerous specialties and inter-professional disciplines were held, showcasing how an international multidisciplinary network can yield a vast pool of knowledge and expertise. Our challenge is to channel this into ‘Keeping the Surfer Healthy and Safe’: Are you up for it?
12 Sept/Day 3
The final day of Conference 2014 started with another round of masterclasses. Medical professionals in a variety of fields shared their knowledge with attendees through specifically-designed small group learning interventions on subjects like (surf) expedition medicine, surf-head: surfing, the wave cycle and lessons in life, surf science: training and performance, and the use of portable ultrasound in wilderness settings.
The programme resumed with a series of lectures. Dr. Patrick Scully MD – General Practitioner and MSc in Nutritional Medicine – delivered a strong anti-sugar message, emphasizing that in his personal opinion excessive sugar consumption may be associated with the development of Alzheimer’s disease. In a rat model, animals that were on a sugar-rich diet had more signs of Alzheimer’s disease on autopsy than those on low-sugar equivalent diets.
Dr. Clayton Everline MD – Sports Medicine Physician, Pipeline Masters Contest Doctor, and co-author of ‘Surf Survival’ – followed on with a lecture concerning the assesment of the surfing athlete. Drawing on his experiences as medical doctor at Pipeline, Hawaii, he outlined the effects of medical conditions, such as diabetes, on competitive surfers. Of note, Dr. Everline revealed that cardiac abnormalities are not uncommonly found in the elite surfing athlete. Such undiagnosed conditions may potentially be a cause of mortality in otherwise ‘presumed healthy’ individuals. He acknowledged Dr. Scully’s earlier assertion, recognizing the enormous effects of the sugar industry in his own practice. A dramatic rise in diabetes and obesity has been observed on the Hawaiian Islands since the adoption of a ‘modern’ diet, consisting as it does of highly processed (often high-content sugar-based) foodstuffs, by indigenous populations.
Dr. Miguel Moreira – Professor of Human Kinetics, Technical University of Lisbon; Technical Adviser to the Portuguese Surfing Associtation – illuminated the application of scientific principles of training and performance to surfing safely. By taking the correct approach to wave riding, reviewing one’s technique for several surfing manoeuvres, calculating the right moment to make your move, wipeouts may be avoided. Proper training and preparation are an important component of injury prevention.
Next up, Peter Conroy – Chairperson of the Irish Tow Surf Rescue Club, Paramedic & Firefighter, Big Wave Surfer – spoke about big wave rescue and retrieval of injured surfers using jet skis (also known as Personal Water Crafts, or PWCs). He debunked the negative perception of PWCs being noisy, irritating playthings, by showing how valuable a PWC may be for rescue in big waves settings. With insightful and breathtaking video footage of rescue techniques and equipment handling, the loop, opened the previous day during the practical PWC workshop, was now closed. Let’s get some surfing doctors involved in the Irish Tow Surf Rescue Club!
Dr. Nuno Lanca – Orthopaedic Surgeon; EASD ASLS Course Instructor – sketched an overview of the several mechanisms of injury that may lead to spinal injury and back complaints in surfers, illustrating some facts that ought to be familiar to every surfing doctor. Not only direct trauma can cause spinal injuries. When making turns on a wave and rotating your upper body, excessive forces on the vertebra can occur which may lead to spinal injuries. Positioning on your surfboard differs on paddling, dropping in, and during wave riding, which puts people with pre-existing conditions at risk.
Dr. Onno ten Berge – Consultant Dermatologist – and Dr. Till Geimer – Dermatology Resident – gave an update on surfers’ skin. Even if you’re not medically trained, it is prudent to be aware of skin diseases that may arise within a couple of days and/or weeks after surfing holidays. Keep in mind that several insect bites may present with different signs and symptoms, and that they may worsen over time. Dr. ten Berge emphasised how important consultation of local doctors may be, since certain local skin diseases may be relatively unknown. Rashes produced by several marine bacteria, various skin discomfort caused by insects and parasites were demonstrated in the presentation, underlining the importance of knowledge regarding different unfamiliar causes of skin disease. Dr. Geimer presented an update in UV-related skin disease. Surfers are a high risk population because they spend more hours in the sun than the average population. Therefore, it is particularly important for surfers to protect themselves against the sun. You should apply sunscreen at least 30 minutes before entering the water, and reapply regularly. Use a minimum of 30 SPF. Make sure that the sunscreen you use protects against both UVA and UVB, and regularly check your birthday suit!