While surfing would not be considered a contact sport, it still remains one of the most dangerous sports out there. From lacerations to drowning, there’s shortage of ways your session can quickly take a turn for the worse. If you’ve never been hurt surfing, you probably haven’t been surfing hard enough, and many surfers have adopted the motto: “You’ve got to pay to play.” I sat down with a surgeon who sees a constant flow of surf related injuries in both the Emergency Room and the Operating Room. We interviewed Dr. DeSantis about all of the injuries he sees, as well as their causes and prevention.
Dr. Steven DeSantis, a native of Southern California, obtained his Bachelor of Arts degree in Zoology and Master’s in Biology at the University of California Los Angeles. He earned his MD in 1978 at UCLA where he also completed his General Surgery internship and residency in 1983. He is board certified by the American Board of Surgery, and a Fellow of the American College of Surgeons. Previously, he held a faculty position in the Department of Surgery, Harbor-UCLA Medical Center and has served as Chief of Surgery at Mission Hospital. He is Advanced Trauma Life Support certified and a trauma surgeon at Mission. He is a surfer himself, as are some of his family members, and he’s had his share of getting roughed up in the water.
Mission Hospital, where Dr. DeSantis practices is a level II trauma center in south Orange County, California and is the receiving hospital for many surf related traumas, especially from Salt Creek, Strands, Trestles, Riviera, and Laguna Beach.
What are the most common surf injuries you see?
“Most common injuries are lacerations (cuts), facial fractures, and joint dislocations.” Dr. DeSantis himself suffered a facial fracture related to surfing some years ago. “Lacerations and fractures may be a result of getting hit with your own board, especially the fin, either on a solo wipe-out or a collision with another surfer or rocks. Never underestimate the force of two 180 lb people on boards moving around 20 mph colliding with each other. Joint dislocations are a likely injury in this scenario. Most lacerations can be sutured, but are prone to infection, especially when one has been surfing after a storm where storm run-off water feeds out into the ocean. Jetties are also known for having water with increased infection potential due to the fact that storm drains empty into the jetties. To be frank, dogs poop on lawns, people water their lawns, the bacteria in the irrigation water heads into the storm drains, and empties right where you’re surfing that jetty. The main bacteria villain here is coliform. Many times when suturing a laceration where there are concerns about infection, I will place a drainage tube into the wound. This allows any potential infectious material to drain out of the wound as it heals. Those people who have sutures need to stay out of any ocean water until sutures are removed and wound completely healed over. You’ll probably be given a course of antibiotics and it is crucial that you finish the entire prescription to prevent a re-occurrence of the infection.”
When you get cut on a reef, especially in remote areas, the common practice is to pour lime juice onto the open wound. How effective is this in treating infection?
While this will be beneficial (it creates an acidic environment in the wound which inhibits bacterial growth), an even better strategy when you’re surfing remote places where coconut trees can be found, is to pour the water from a green coconut onto the wound and irrigate it well. The water in green coconuts is sterile and is a good way of cleaning out the wound. The brown coconuts found on the ground are not to be used. Only the green “on the tree” coconuts are proper for this.
What do you see as far as eye injuries? I myself suffered from pterygium (known as “Surfer’s eye”) and had to get it surgically removed.
“Blunt force trauma to the face can break orbital bones and injure the actual eye itself. Bacterial infections are common in water with high bacterial counts. Long exposure to bright sun while surfing can often lead to a pterygium. Pterygiums can increase in size and eventually encroach upon the iris and disrupt vision. Treatment is surgical removal.”
Authors note: The pterygium graft surgery is about as fun as getting dragged across dry reef for an hour. I had the surgery on my right eye, and learned the hard way that while they do give you pain medication before the surgery they don’t knock you out. I was conscious for the entire time with some creepy device pulling my eyelids open, and watched as they jabbed needles and scalpels into my eye. As for recovery, you spend about 4 weeks with the overwhelming sensation that you have something in your eye but are not allowed to rub it.
What about the ears?
“Blunt force trauma to the ears can rupture the eardrum. Many surfers know the pain of having ice cold water rush into your middle ear when this happens. Usually a ruptured eardrum will heal, but it needs medical attention and medicine. A common ear problem suffered by surfers is called exostosis. Chronic exposure to cold water can cause the growth of bony lumps in the ear canal, which can affect hearing. Treatment involves this bone being ground down by an Ear, Nose, and Throat physician who must then also re-cover these ground areas with skin. This condition is also known as Surfer’s ear (not to be confused with Swimmer’s ear).”
At breaks like “The Wedge” in Newport Beach, the biggest enemy is spinal injuries. Do you see these much?
“Wiping out on the board and coming down extremely hard (especially onto rock, reef, or sand) on your back, head, or your butt can cause areas of the spinal cord to actually burst. I’ve seen plenty of paralysis cases related to surfing, including higher neck injuries which can cause complete quadriplegia. There’s no getting better from this. Lesser degrees of trauma may cause transient symptoms. If you take a hard fall and later experience symptoms like numbness, tingling, headache, confusion, any alteration in the full use an extremity, dizziness, etc. head to the ER. Time is the enemy in these injuries.”
There are multiple known cases of surfers getting attacked by sharks, then using their leash as a tourniquet to control the bleeding. What are your thoughts on this?
“Some people suggest using their leash as a tourniquet, but this isn’t the best choice. Why? A tourniquet will stop the flow of blood to the entire extremity (arm or leg) beyond where the tourniquet is tied. After a short amount of time, acid will build up in the tissues below the tourniquet, and when the tourniquet is released, the body will receive a rush of acid which can make a person very sick. In addition, tissue death can occur in that extremity from lack of oxygenated blood for too long. The better solution is to apply direct pressure to where you see the blood coming out. I mean HARD pressure. Push hard enough to literally slam shut those blood vessels and keep it there until you have help. Putting direct pressure onto only the area that’s injured allows collateral vessels on the sides of the wound to get some amount of blood down to the lower extremity.”
What internal organ damage do you see?
“Visceral (soft tissue) injuries—damage to liver, kidneys, spleen from collisions with rocks, your board, etc. These organs are very vascular meaning they have a lot of blood supply and can bleed heavily internally. These types of injuries are very similar to injuries seen in snowboarding accidents.”
Now onto drowning. Can you elaborate on that process?
“Near drownings can occur when you’re thrown into the ‘washing machine’ of surf and pulled under for an extended period of time. You can only hold your breath so long before you will go unconscious. As soon as you go unconscious, your body will attempt to take a breath and if you’re still under, you’re going to suck in a lung full of salt water. If help is immediately available with CPR and advanced medical help, rescuers may be able to get that salt water to come up out of your lungs and restore your breathing. Interestingly enough, salt water near drownings are less lethal than fresh water near drownings. In a fresh water near drowning, the lungs will fill with fluid from your own body (called edema) and this is more difficult to surmount. Salt water inhaled into the lungs does not cause this edema.”
“Also, cold water near drownings are less lethal than warm water near drownings. Some surfers pulled unconscious from very cold water may not be breathing and have a barely detectable pulse. However, the cold body temperature can slow damage to the brain and heart and with intensive medical measures, some of these victims may survive. Their blood will be routed through a machine that will re-warm it and re-infuse it into the body. A man in the U.K. was rescued with a body core temperature of 19 degrees centigrade (that’s 66 degrees Fahrenheit) and with profound rescue measures recovered fully.”
We all know that melanoma can be a deadly culprit in the surfing community. What do you see as far as damage to the skin from surfing?
“I can’t emphasize sunscreen enough. A lot of surfers smear it on their face and shoulders and completely forget their back, the backs of their legs, and feet. Remember your back, backs of your legs, and soles of your feet are facing up at the sun a large part of the time you’re surfing. Also, all you guys with shaved heads need to sunscreen your heads. Melanoma is not particular about what body part it chooses.”
“Chapped skin is uncomfortable and can ultimately crack and bleed. A great product to put on before you get in the water is called ‘What’s Krack’n’. It comes in a tube like a lip balm and can be used on then face, hands, feet, wherever. It’s waterproof and will help keep the wind and salt water from taking its toll. Find it at Marbella, Whole Foods in Tustin, and the Malibu Market at Trancas.”
Is there anything we missed that you would like to sign off on?
“Remember what exhaustion can do. There’s no such thing as ‘taking a break’ when you’re out in sets of huge waves. The exhaustion from hard paddling and pushing through the waves can be overwhelming and lead to deadly accidents. If you’re getting tired, get out. I love the water, but have a healthy respect for her power. Surfing is the greatest sport ever, but be safe.”
See more from Tim at Sticksling.com.