Protective Head Gear: How come this never caught on?
We know surfing has a relatively low risk of injury in comparison to a range of other sports. Nathanson et al. reported an acute injury rate of 0.9 injuries/person/year (1) in an observational, retrospective study of acute and chronic surfing-related injuries using a web-based multiple choice survey. In a later study by the same lead author an injury rate of 5.7/1000 athlete exposures, or 13/1000 hours of competitive surfing (2), was reported in a prospective study of competitive surfing injuries at 32 professional and amateur surfing contests worldwide between 1999 and 2005. Lowden et al. reported an acute injury rate of 3.5 injuries/1000 surfing days (3) and Taylor et al. 2.2 injuries/1000 surfing days (4). The latter suggesting a surfer could expect significant acute injury once every four years, deemed acceptable by the authors given the considerable exposure risk over the same period – median expected days of surfing: 400.
Although injury to all body regions is possible, head and facial injuries are commonly reported. Research suggests that head and facial injuries comprise somewhere between 25% and 37% of all surﬁng-related injuries (1–9), and 42% to 49% of surﬁng injuries treated in the emergency room (4,5). Nathanson et al (1) reported that the face and scalp were the most commonly implicated anatomy. Injuries vary from superficial head and facial injury to significant laceration, fractures, contusions, and closed head injury (1–9,13,14). Ophthalmic injury has also been reported (10–12). Whilst the above injuries may be signiﬁcant in their own right, sequela (e.g. loss or change in level of consciousness) combined with the hazards arising from being in a maritime environment (e.g. drowning) must also be considered. A range of protective headgear is readily available for surfing. Yet, anecdotally, observation would suggest surfers decline its use. Published data appears to support this assertion. Figures of 1.9%, and 8%, have been reported by Taylor et al. (15), and Nathanson et al. (1), respectively, in relation to the proportion of surfers who routinely use protective headgear.
Exploring the use of protective headgear by surfers, perceptions of its usefulness, and barriers to its use, Taylor et al. (15) carried out a cross-sectional survey of surfers at eight of the most popular beaches in east and west Victoria, near Melbourne, Australia. Over a 4-month period, surfers who were aged 18 years or older, and had been surfing actively for a minimum of one year, were invited to enroll.
What they found…
The response rate was 96.7%, equating to 646 surfers. Most participants were male (90.2%) and young (Mean Age: 28.2 years) with a mean surfing experience level of 11.6 years. Only 38.0% (95% CI 34.2–41.9) ranked the risk of head injury during surﬁng as moderate or high, and only 1.9% (95% CI 1.0–3.3) or 12 individuals reported using protective headgear routinely, believing that there was a greater risk of head injury in sports other than surfing (P<0.001). Most surfers (73.8%, 95% CI 70.2–77.1) did however hold the belief that the wearing of headgear was likely to reduce the risk of injury. Four hundred (62.1%, 95% CI 58.2–65.9) reported that they would rather surf without headgear on the basis that it restricted performance. The main reasons given for not using headgear were ‘no need’, discomfort, claustrophobia, and adverse effect on sensation and balance.
So, where does that leave us?
Taylor et al. (15) suggest ambivalence surrounding surfers’ relationship to protective headgear use, noting that one third of surfers surveyed in their research responded vaguely or gave ill-defined reasons for not using it. They speculate that such impediment to use may be perceived rather than actual in nature and that there is considerable potential for education and other strategies to affect opinion and behavioural change within the surfing world.
Further research is required to clarify head injury risk and the protective efficacy of headgear in surfing populations. Pending the emergence of such evidence, numerous authors (1,4,5,9,14–16) of the existing knowledge database advocate educational initiatives, increased wearing profile within surfing, and improved equipment design as a means to increase protective headgear use rates amongst surfers.
How can I find out more on this topic?
Dr. Terry Farrell will lecture on head trauma and traumatic brain injury seen in surfing with a review of the incidence, causes, classification, and consequences. Evaluation and management considerations in remote settings, clinical signs, and indications for immediate evacuations will be discussed. Furthermore, concussion management, and ‘return-to-play’ guidelines, as well as prevention in surfing will be explored.
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- Barucq G. 5 Reasons Why Surfers Should Wear a Helmet. The Inertia. [Posted Online Nov 19, 2013; Accessed Aug 22, 2014]