DROWNING – what to do

How many of us would know where to begin if we were suddenly confronted with a drowned surfer?
Surely we all should?
The aim of this article is to give you a sound starting point from which to make a positive difference. Not to replace official training which is something all surfers should be considering.

Most surfers, in their repertoire, have a story about the time they almost drowned, about the lessons they learnt and how their behaviour has changed. We regale our listeners with the sequence of events that led to the moment when everything got weird. Vision started to darken, thoughts started to wander, and how lady luck eventually gave us a helping hand.
If you’ve drowned, clearly, you’re of absolutely no use to yourself. Your future now lies in the hands of those around you. Surfers, lifeguards and passers by. If you’re lucky.
What they do in the seconds and minutes after you’ve drowned is crucial. The difference between life and death.

Let me be clear. Drowning is the impairment of breathing (respiration) due to immersion or submersion in liquid. If you die from this impairment it is ‘fatal drowning’. If this impairment is interrupted it is called ‘non-fatal drowning’. Phrases like ‘near drowning’, ‘dry drowning’ and ‘secondary drowning’ are vague and I will avoid them.

Be clear in the knowledge that technically, as the rescuer, the pressure should be off. If you do nothing with an unconscious non-breathing surfer they will certainly die. All you can do is help. Yes, be aware about neck injuries for example, but they are rare in drowning, and if they’re not breathing you can deal with the neck issue later if needs be.


A pro surfer said recently about his two wave hold down that ‘it is hard to drown’. He was correct. We are generally quite resilient. For all the scrapes we get ourselves into whilst surfing, the vast majority of us live to tell the tale. Surfers, you would imagine, are experienced in water and in reasonably good shape. Two factors that will reduce your level of risk.
Drowning, however, is the sixth leading cause of unintentional death for people of all ages. What does that mean? The risk of fatal drowning when in water (not specifically surfing) is estimated (exposure adjusted time) to be 200 times greater than the risk of death from driving a car in the United States. Or there is 800 times more risk of death than when a fit and well person has a (non-emergency) general anaesthetic.
Identified risk factors for drowning include male gender, risky behaviour and lack of supervision. Sound familiar?!


If you can’t paddle out then you shouldn’t be out. I’ve always liked that rule. Jumping off rocks usually is more likely to get me into trouble. I still occasionally do it.
When you come up for air, breath out first rather than breathing in. Your first breath in, after your breath out, will result in more oxygen being in your lungs.
Kicking uses up loads of oxygen. Use your legs wisely.
Panic increases adrenaline release. This increases blood flow to your body and your oxygen demand. Relax and go with it (if appropriate!). Time your efforts with the surf. Currents can flow faster than you can jog, let alone swim. Consider allowing yourself to drift and save vital energy for staying afloat, rather than exhausting yourself in the current


General torment. If you’re conscious, that is. Holding your breath is a conscious act. You have a desire to breath that increases in intensity. This desire is increasingly driven by the carbon dioxide levels that are accumulating in your blood. Eventually this desire is literally irresistible and you breath in water allowing it to pass into your airway and lungs. This water causes coughing and in some cases laryngospam (vocal cords involuntarily spasming closed). Laryngospasm, if it occurs, will eventually break due to the falling level of oxygen in your blood. This falling oxygen level, if no rescue occurs, rapidly leads to you losing consciousness. Eventually and rapidly your heart starts to struggle, ceasing to effectively pump blood around your body until it stops.


Call for help. This is crucial and obvious but often delayed. If you’re remote, send someone to go and call for help. If you’re in a remote location abroad hopefully you’ve planned your emergency numbers and where your help is coming from.

In water, carrying out a rescue requires fitness, training and skill. As a rescuer you should prioritise avoiding drowning yourself! Sounds obvious but it’s often overlooked. If you are going to put yourself at significant risk by getting close to the person drowning, and they’re conscious, try throwing them a buoyant object to hold on to.
In water, carrying out resuscitation with rescue breaths on a person who is unconscious is very difficult. It requires a high degree of training and carries its own risks of drowning for the rescuer. It is, however, extremely effective if done correctly and increases survival chances three fold.
Apply common sense. If you’re in the surf and don’t know what you’re doing, consider hauling them onto land. If land is way off and you don’t feel you’re at risk of drowning yourself, have a go at rescue breaths in the water but don’t delay getting them to land with failed attempts. Land is where this person needs to get quickly.
Chest compressions in the water are ineffective and shouldn’t be attempted.


Studies have shown that the only people to survive drowning where they have stopped breathing and don’t have a pulse (cardiorespiratory arrest) are the ones who received IMMEDIATE rescue breaths and chest compressions (cardiopulmonary resuscitation).
To learn how to do this properly you need to be trained by a professional instructor with a manikin. Bad cardiopulmonary resuscitation (CPR) doesn’t work. There’s only so much you can pick up from reading a chatty, but well meaning, article on drowning (or ER for that matter!).

If you don’t have training, try anyway.
The only reason I know how to do this is because I have experience of doing it, but more importantly because I have had official training on it. It’s available to everyone outside of medicine too. It’s a nice thing to know how to do.
If you come across someone unconscious in the water, you haven’t had training yet and you don’t have a clue, here’s my basic guide how..

Don’t panic. Give yourself a pep talk as you approach. Make sure you keep your witts about you and keep yourself safe

Best done on a flat surface.

Are they breathing?
This is such an important question. If you’re ever unfortunate enough to find yourself in this stressful rescue situation, try and clear your mind to focus on this question. Are they breathing? Remember that chest movement doesn’t always mean they are getting air in and out of their chest so be mindful of the patient’s airway. Lift their chin and extend their neck. Listen by their mouth for breathing. If you can’t hear any, is the chest moving or Adam’s apple ‘tugging’? Signs that their airway may be obstructed.
Regurgitation of stomach contents is common when resuscitating someone who’s drowned. It’s just food, stomach juices and sea water. Get on with it. Don’t stop CPR to try and empty out the fluid. Delays in CPR are bad and reduce their chances of survival. If you’re trained with airway skills then experience and judgement may lead you to clearing the airway. But if you don’t know what you’re doing, clearing the airway is confusing, time consuming and distracting from the important steps below.

They’re breathing! – Put them in the recovery position and keep checking that they continue to breath. Keep them warm. If you’ve never heard of the recovery position before, google it now.

They’re not breathing!!!! Then breath for them.
Just have a go. Don’t waste precious time checking and rechecking that they’re definitely not breathing.
At this point you don’t need to think about anything else other than getting air in and out of their chest. When someone drowns the problem is lack of oxygen. Giving 5 rescue breaths (mouth to mouth) to someone who isn’t breathing immediately addresses this problem. This is new (official) guidance and is different to all other CPR that starts with chest 30 compressions followed by 2 rescue breaths. The initial rescue breaths can be difficult to achieve because of the sea water in the lungs. This, and the problem of low oxygen, is why you start with rescue breaths and why there are 5 of them not 2.

You’ve put oxygen in their blood, but is it being pumped around their body?
Check their pulse.
Put you finger on their Adam’s Apple and slide off it to the side into their neck to feel their pulse. Practice on yourself now!

I can’t feel a pulse!! Then start chest compressions.
If you can’t feel a pulse on them it’s likely that there isn’t one, not that you just can’t feel it. Give 30 chest compressions. Google how to do this now. Feeling a pulse can be difficult. If there’s any doubt, you should get on their chest and start compressions without delay.
Keep putting oxygen in their blood (2 rescue breaths) and pumping it around their body (30 chest compressions) until signs of life return. Don’t underestimate how exhausting CPR is. If you tire, swap with someone else. Don’t stop this cycle of 2:30:2:30 until professionals arrive and they take over. By all means check for a return of pulse, but don’t do this at the expense of continued CPR. If you feel ribs breaking, don’t stop or lessen the force of your CPR. Ribs will mend. Clearly if they regain consciousness and they ask you to stop you should politely do so..

Keep doing CPR until emergency services arrive or exhaustion prevails.
Remember, if you can’t feel a pulse it’s because they aren’t able to pump blood themselves effectively. Your chest compressions, if done properly (google!), should be pumping their blood for them.


A non-medical general term to describe what can happen after lungs are exposed to fluid.
To talk about the physiological effects of drowning and the advanced detail of its management is clearly beyond the scope of this article.
That said,water in the lungs makes the lungs harder to inflate afterwards (breathing is tiring) and can make the lung membranes inflamed (wheezy) and leaky (fluid leaks into lungs from tissue). What does that mean? Be extremely vigilant of someone who has inhaled water. If there are any concerns, call emergency services and get them straight to a hospital.


Talk to people. Even professionals if need be. Don’t underestimate the stress that this sort of experience can put on you afterwards, regardless of the outcome. Understand that self criticism is normal and inevitable. Doctors and nurses deal with these situations at work frequently. We often will naturally, through repeated exposure in the workplace, get used to them and the emotions we subsequently can experience after. It’s completely different in a situation where you are someone that just happens to be there. If you lose composure and think you did things wrong, don’t punish yourself. Anything is better than nothing.

Basically, if I ever get washed up at your feet, just have a go!


Szpilman D et al. Drowning. New England Journal of Medicine. 2012;366:2102-10.

Carter E & Sinclair R. Drowning. Continuing Education in Anaesthesia, Critical Care & Pain. 2011. Vol.11 No.6:210-213.





There are only two truly distinguishable types of surfers.

Those who wear earplugs and those who don’t.


Those of us who don’t wear ear plugs view them with feelings of curiosity, suspicion and occasionally guilt. Guilt that perhaps we should be wearing them.

Most of us don’t give earplugs any further consideration after that.

Until the next time we’re confronted by seeing someone with blue-tac in their ears.


There must surely be surfers amongst us who are plug-curious. In an ideal world they see themselves wearing ear plugs whilst surfing, but something holds them back. Is it a lack of confidence to go public? Or perhaps there’s something else that’s stopping them taking the plunge towards ear utopia. Are ear plugs really that much of a hassle?

Some of us who don’t wear earplugs have experimented with them in the past..

It wasn’t for them. Claims of them being too uncomfortable, poorly fitting, expensive, deafening and generally ruining the overall surf experience.

The poor earplug it seems, suffers from a large amount of negative stigmatism and general resistance.

Why is that? Is it just that earplugs aren’t cool?

Or perhaps we feel that they would blunt our senses and detract from our overall performance and experience?


Some surfers, however, have taken the plunge. They won’t go near water without first protecting their ears.

These wise salty-dogs who do wear earplugs despite the reasons the rest of us don’t. These are surfers that have spent so much time in the sea pursuing their passion, that their bones in their ear have begun to grow again. Chances are that they’ve suffered the consequences of this new growth. If they haven’t suffered, it’s likely that they know someone who has and they don’t fancy one bit of it.

What is it then that this plugged minority amongst us suffer or fear? What do they know that we don’t?


You’d have to go a long way to come across a medical condition that is more poorly understood and neglected within a sporting community as Surfer’s Ear. It’s not a badge of surfing honour. It’s rubbish. It can keep you out of the surf, and make your life miserable with illness and pain. Pain in your head is hard to ignore and is miserable as a result.


In fairness, the main reason why Surfers Ear is poorly understood in the surfing community is that it’s also relatively (to other conditions) poorly understood by most in the medical community. Unless you live in a cold water surfing area, it’s unlikely your GP will know much about the condition. To a land locked surgeon it can remain a rare condition of seemingly little consequence. To those surgeons that live and operate in cold water surfing communities the condition is common, and they fully appreciate the impact it can have on people’s quality of life.







What is Surfer’s Ear?


The ear canal is made from the joins of a few bones of the skull. For some reason exposure to cold water makes these bones grow. It is thought that the greater the exposure the greater the growth, but this is only a theory and not proven. When these bones in your ear canal grow they form exostosis. Exostosis comes from Greek language and means ‘new bone’. This bone grows into the ear canal making it narrower.

 surfers ear

Photo of a surfer’s right ear showing significant narrowing caused by new bone growth (exostosis). They had been suffering from recurrent ear infections in this ear. A year previously they had their left ear exostosis successfully removed. 


These bone growths aren’t dangerous and most people who have Surfer’s Ear (exostosis) are completely symptom free. They may remain symptom free too. This is because a lot of people reduce the amount of time they spend in the sea before problem’s start. Getting a job or having children can be useful for that.

Some surfers who develop exostosis aren’t so lucky. They are plagued by constant pain, recurrent infections and rarely in some of the worst cases suffer with a constant ringing in their ear. Surfing to them, once perhaps irreplaceable as a pastime, now rapidly becoming something relegated to their past.

Unless they wear ear plugs..


Wearing plugs stops cold water constantly flushing the ear canal. There seems to be a relationship between exposure of the ear canal to cold water and the progression of surfers ear. They exact nature of this relationship isn’t well understood by medical professionals.


Once your ears have narrowed for the worse, you are essentially risking getting an infection every time you get them wet.

As the ear canal narrows with these bony growths, the ears become worse at draining water and drying out after every surf. You may notice this as your ear being blocked with water for longer after being in the sea.

Sea water is dirty. It’s teeming with bacteria, algae & zooplankton. The longer the ear canal has water within it, the more likely it is to get irritated and develop an infection.

Ear infections hurt, make you feel unwell and can make you deaf while you have them. Going in the sea with an ear infection will make the infection worse and it will subsequently take a lot longer to heal.

If left untreated ear infections can smell and look horrible. If severe they can leak pus out of your ear. Not to mention spread infection to the surrounding skin on your head.


It’s not really known why repeated exposure to cold water makes these bones grow. It’s not an area of medicine or surgery that has attracted a huge amount of funding for research. The wide acceptance for exposure to the cold to be the trigger has come from personal observations from surgeons operating to surgically remove exostosis. On the Australian East Coast for example Ear Nose & Throat (ENT) surgeons have noticed much higher incidences of Surfers Ear in surfers that live in Melbourne where the waters are cooler than in Brisbane and the Gold Coast where the waters are considerably warmer.

It’s not just humans either. Other mammals such as seals get exostosis too.


Wetsuit technology has come on leaps and bounds in the last 10-20 years. In fact we’re now actually able to make leaps and bounds whilst wearing them! Even summer wetsuits of yesteryear would have made such athleticism tricky. As a result of these developments we’re able to spend more time in cold water and are able to push surfing boundaries North and South into frigid seas. Can we then expect to see Surfer’s ear incidence on the rise? It seems reasonable that we will.



How Can I Tell If I Have Surfer’s Ear?


Unless a doctor looks in your ear you can’t. As the ear canal narrows you’ll start to notice it takes longer for your ears to empty during or after a surf. That sideways shaking of the head in the car park to clear them may be taking a bit longer. Or perhaps your ears clear hours later at work?

Some people notice their ears feel full for a while after a surf and can even begin to ache. Aching can be a sign of irritation. Irritation is a stepping stone to infection. Bacteria and fungi absolutely love skin irritation. Especially in a nice damp and warm ear canal. You’ll know if you have an ear infection. Your ear will start to really ache. Ear ache is really unpleasant, especially if you have it with a ( temporary) loss of hearing in the same ear.


A large number of surfers will have these boney growths in their ear canals (of varying size) and be completely symptom free.



How can I prevent it?


Wear earplugs. Newer designs can look cool and don’t come out during that horrific low tide winter flogging. Ear utopia can actually exist! Ear plugs really do work to prevent you getting Surfers Ear. It’s not essential they keep your ear completely dry either. They only need to reduce cold water flushing in your ear canal enough to allow the water in there to stay at body temperature. Much like how a wetsuit works on your skin.

Don’t stick things in your ear like cotton buds to try and clean or clear them. This irritates the skin further.

If your ears are feeling full and taking a while to drain then there’s ‘Surfactant’ drops that you can use. You can ask your GP about them but there’s a good chance they won’t know much about surfactant ear drops. Their knowledge can depend on how many surfers they have on their books and therefore how often they see Surfers Ear. You could ask in your local (surfing community) pharmacist or surf shop as they are often well versed on keeping on top of problem ears. Surfactant drops work by reducing the surface tension of the water in your ear and help it drain. A bit like washing up liquid’s effect on oily water.


Don’t stop surfing over winter.


The overwhelming message has to be to for us to go out and buy decent ear plugs and actually start wearing them..

All year round.



What is the management of Surfer’s Ear?


If you start getting recurrent ear infections, you’ve already lost the first battle.

Your GP may give you courses of anti-biotic drops to help your ear infections to clear. For your infection to clear effectively however, the pus in the ear canal needs to be able to drain out. The exostosis in your ear canal can make this difficult. Your GP may refer you to an ENT surgeon to have ‘micro-suction’  of the ear canal to have the pus and infected debris physically removed. The debris is usually dead skin, wax and potatoes (if my Grandad is to be believed..). Micro-suction is then followed by a course of antibiotic ear drops. The exostosis, due to their obstruction of the ear canal, can block the insertion of the suction equipment and make removal of the pus tricky and less effective.


The good news is that these bone growths can be removed. The principle of surgery is to widen the ear canal to improve water drainage.

To understand the technique of surgery will help dispel hearsay and misinformation.




This piece of bone is an exostosis and was chiseled off an ear canal. The exostosis grow in particular layered way that enable them to be effectively removed using a  chisel (shown next to the bone).

ENT surgeons are a highly skilled group of surgeons. They’ve been removing these boney growths from ear canals for years. They’re extremely skilled at it.

There are two techniques surgeons use for removing the bone: drilling and/or chiseling. You are put to sleep with a general anaesthetic for the operation.

A cut is made just in front or behind the ear. The skin of the ear canal that’s overlying the bony growths is then lifted up as a skin flap. This skin flap is kept intact so that it can be replaced at the end of the operation to reline the ear canal.

surfers ear

A drill being used to remove the bone at the base of the exostosis. The drill provides fine control and precision in areas of the ear canal where the surgeon requires.

Drilling is the traditional method used for ear canal bone removal. The drill-bits are very small and it is an accurate and precise way of removing the bone. This can mean that bone growing next to or against the fragile eardrum can be removed with fine control. The downside of using the drill is that it is more often associated with damage to the skin overlying the bone growths. This would delay your post-op recovery time (time till you can surf again). It has also been noted that on very rare occasions some patients have had post-operative tinnitus or nerve hearing loss – which has been assumed to be due to the noise created by the drill during the operation. Tinnitus is hearing a sound when there actually is none. Like the ringing you can get in your ears after listening to loud music.


Using a chisel to remove the bone has become more popular particularly in the UK and US over the last decade. Chiseling takes advantage of the way these exostosis grow. They consist of horizontal flat layers of bone cells. The chisel is used to gently fracture along these natural planes of cleavage (weak points in the bone). A bit like how you would use an axe to split wood. But with a lot more finesse! This technique makes it much easier to preserve the ear canal skin in a healthy state and the ear canal heals quickly after the operation. Surgeons who prefer the drill would however argue that the chisel is unsafe as it could create a fracture into the delicate structures in the middle ear.


Microscopes allow ENT surgeons to view such detail they are able to operate in the small confines of the ear canal.



Due to the surf culture in Cornwall UK, The Royal Cornwall Hospital in Truro undertake many of these operations each year. They have had 10 years experience of using both techniques alone and in combination, reserving the drill for exostoses close to the ear drum as it offers a greater degree of accuracy. When they looked at their results they found that chisel techniques were safe, with less risk of tinnitus and hearing loss. They also observed that patients healed faster after their surgery and seemed to have less pain post-operatively.


How Long Until I Can Safely Surf Again After Surgery?


After surgery it is important to allow time for the replaced skin flap to heal. This usually means 6-8 weeks out of the sea. The actual length of time will depend on the state of your ears and the extent of surgery you had. To go surfing too early means a skin infection. That leads to a nasty painful ear infection, and ultimately longer out of the surf.


Can Surfer’s Ear re-occur after Surgery?



Yes if you surf without earplugs! The data on how long it takes for the bones to grow back and whether drilling or chiseling makes a difference hasn’t been collected and analysed. It has been suggested though that once you’ve had Surfers Ear, the bone in your ear is more ‘sensitive’ to cold water than an ear that has no history of exposure.



My GP says I have Surfers Ear & I’m getting ear problems. What now?



If you’re getting recurrent infections you should discuss with your GP the possibility of a referral to meet ENT surgeons.

A discussion about the risks and benefits of surgery is very important.

We’re all unique, and the way our Surfers Ear presents itself and effects us is specific to us. A plan that works for one Surfer may not be the best plan for you.

Meeting ENT surgeons initially is about forming a plan together.

Surgery doesn’t have to be performed. Surfers Ear can be managed with just earplugs and surfactant drops.

Perhaps you don’t mind getting the odd ear infection. Your discussion will focus on the benefits of surgery Vs the risks of not having it.

This discussion is really important as the surgeon is able to give you a balanced view of surgery in terms of relative risk to you.

Don’t seek management advice from people who aren’t in a position to give it. Listening to friends who have Surfers Ear and their experience can be very useful to help inform you, but shouldn’t substitute professional consultation. Surgeons aren’t robots who want to operate on every person that they get referred. Unlike friends or bloggers with their personal accounts, surgeons have a huge amount of experience dealing with Surfers Ear. They have seen all the risks and all the benefits from following up patients over decades of treating Surfers Ear. They have your best interests as heart.



Reaching Ear Plug Utopia


Not everyone reading this article will be convinced of the merits of ear plugs. Good luck to them.


Most that do believe in the merits, will probably only go so far as to make a mental step closer towards being an ear-plugged-surfer. Understandable human behaviour and still a worthy outcome for this article.


Some will try ear plugs for a while, and then give up. Not seeing results challenges motivation.


Hopefully a small percentage will join me by taking the plunge and embracing plugs for good. And surf happily ever after.


And who knows what will happen in the future.. one day ear plugs may be cool.




There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.

A large proportion of the photos on this site are not our own. We have tried to reference all that aren’t ours in good faith. Please contact us if you feel any of your pictures could be referenced better.

Mickey Smith Interview

“The lip landed on my back. I have never been so violated by a wave before or since. It was wild and so very humbling.”

mickey smith interview

Mickey Smith’s CV is long and distinguished. Cornish waterman, journeyman, big wave surfer, professional musician, filmer and photographer. Mickey shares his unique story of when he smashed his arm surfing alone in Ireland, his experience of Surfer’s ear, his thoughts on taking risks and how he keeps himself in shape.

What’s your favourite wave in Cornwall?

MS: Porthleven.

What’s your favourite wave in the UK?

MS: Bagpipes in Scotland.

What’s your favourite wave abroad?

MS: Riley’s in Ireland.

Mick’s incredible movie dedicated to his sister.



Do you wear ear plugs?

MS: I have tried lots of ear plugs over the years and lost them all, so I just use blue tack now in winter. The Earplugs I tried were great until I lost them all, mostly after a decent rumbling at sea. The blue tack never seems to come fully unstuck so that’s why I’ve ended up with that.

When did you start having problems with your ears?

MS: I first had problems with ear infections when I started travelling to tropical locations like Indonesia and Tahiti. That’s when I realised how closed over they were inside already as water would get stuck ,I couldn’t clear my ears and the heat would turn the water in there into infections, and I was still pretty young. I’ve had some pretty bad ear infections, one turned into staph in Tahiti and I was hospitalised for two days. That was the first doctor to tell me I had 50 percent closure in my right ear, and that was 10 years ago now. That’s when I started wearing blue tack more often and when I blew my right eardrum last winter the specialist said I still have 50 percent closure in that ear so I’m stoked it hasn’t worsened.

If you’d known more about surfer’s ear would you have worn ear plugs?

MS: I knew about surfers ear but being young and dumb I thought weathering the cold was tough so I wouldn’t wear plugs,  hoods or boots or gloves, now I’m half deaf and waitin on arthritis to kick into my hands and feet, awesome! Since wearing blue tack and realising I don’t want arthritis I have tried to help my body out more in the elements.

Have you had surgery on you ears?

MS: I have so far never had ear surgery thankfully, fingers crossed.

How do your ears effect you now?

MS: I just have to not be slack, I’ve definitely lost hearing sensitivity and am probe to blocked ears and infections if I’m not on the case.

Mick combining doing what he loves on an Irish emerald  gem.
Mick combining doing what he loves on an emerald Irish gem.


You’re able to handle yourself in challenging conditions in the sea..

Do you do any training other than surfing and filming in the sea? 

MS: I used to train a lot when I was building my confidence and pushing myself. Now I just stretch little and often, and focus on slowing down my breathing more on bigger days.

I don’t smoke.

Do you reduce how much alcohol you drink before a big surf?

MS: I don’t really drink much these days unless Im on tour with the band, and I definitely wouldn’t have ever consciously aimed to be getting leathered before a big swell, its not really conducive to your preparation! Saying that there have also been times that sacrifices have been made and the bottle has been hit in the name of an elusive swells arrival,and also times where hot whisky’s have been drunk on long cold search missions out to sea.

Do you avoid any foods or eat anything in particular to keep in shape?

MS: I am now vegan and try to eat a lot of raw foods and I am realising more and more how much fitter and healthier that makes me feel without actually doing anything but merrily stuffing my face all day long. I am more energised and alert than I ever was before, it’s been the best thing I’ve ever done for myself without a doubt.

That moment when you know you’re about to get drilled by a wave, (apart from get drilled) what do you do?

MS: Depends on the situation, deep water waves I dive deep, shallow water or heavy explosions just wait for the first big bounce of the whitewater and pin dive or crouch under that. Trying to guess where the bottom is and where you are orientated while getting smashed helps and staying flat while keeping your hands ready to take impacts before your head does helps, but really, sooner or later its your time to take a hit and there’s nothing you can do about it.

How do you get yourself into shape mentally for big surf? 

MS: I think about what I want to do, check my motivations are coming from the right place in my heart, what kind of waves I want to ride, how i might do that, or what positions I might want to get into to shoot waves of consequence. Every winter I try and achieve little personal baby steps, I’m 33 now and I’m still learning every swell, staying open to that and watching how the young guns and the other old pards like me deal with it each winter helps so much. Mostly though I like to make it fun, so theres never too much pressure, if its not fun then why are you out there? There’s inevitably times where it gets serious but a grin or a chuckle always helps calm the mind in most situations, however full on they might be.

For someone who doesn’t surf such heavy waves it can look almost like you have a disregard for your own safety. How do you see it? 

MS: Depends on your personal approach, everyone is different and has different styles and motivations. When I was younger I was very up for getting smashed out there and pushing myself as hard as possible. Now I’ve hurt myself so much as a result I’m a lot mellower in my approach, you always have to maintain a little edge of wildness to be able to switch off the body and head going ‘nooo’ and just be able to commit to certain situations, but up to that point I try and be very calm and calculated, no pressure, if it happens it happens,just flow and be present with a grin.

Has becoming a dad (I hear she’s now surfing!) made you change how you are in the water?

MS: I definitely have changed my approach a lot to many things since being blessed with my little girl Eiva. She’s 20 months old now and caught her first waves the other day, such an amazing day man! I think of my missus, my daughter, and my family always, they are number one for me and I’ve mellowed so much as a result of having suffered heavy tragedies in my own life. I know how hard it is for those left behind now and I didn’t before. We all have our time and who knows how long that’ll be, so that’s why I try to keep my motivations real and from the heart, and if it doesn’t feel right – when before I might have pushed on and gone against my instincts anyway – now I’m not feeling living like that. I love my family too much to consciously put them through losing me if I wasn’t-and they weren’t 100% sure why I was out there doing that in the first place. Accidents happen and if I went out of this world doing something joyful that fulfilled me as a person and helped me be the best man I can be for them, my family could hopefully be proud of the way I lived my life no matter what. Fingers crossed and reaper willing, I’m aiming to be around to live life with them til I’m a merry old lunatic anyways.


What’s your view on buoyancy jackets?

MS: The billabong V1 parachute vests seem awesome for hectic situations. Ferg has had one a while and when he’s committing hard in conditions that are beyond human control and I want nothing to do with, I feel alot safer for him. Anything that helps preserve life at sea is a bonus,but ultimately you shouldn’t be heading out there unless you feel solid in your own human ability to get yourself out of there I guess,despite the fear of the unknown.

What’s the closest you’ve come to drowning?

MS: A two wave hold down at a place called the Womb in Western Australia,took off in an 8ft wave, lipped in the back, beaten, shoved into an underwater cave, panicked, and was thankfully ripped out again by the second wave. Also my first big wave at aileens in 2005 nearly killed me, still the biggest wave I’ve paddled into, the lip landed on my back and I have never been so violated by a wave before or since, it was wild and so very humbling.

Have you ever been taught how to resuscitate someone who’s drowned?

MS: I did a first aid course a long time ago with that in mind but every year we tell ourselves we need reminding as the techniques change so often. I know basic methods and that’s helped us deal with various situations over the years. Could and should get myself a refresh on the latest training though,we all should.

What’s the story behind you breaking your arm whilst surfing?

MS: I was surfing a shallow ledge in Ireland,the swell was pulsing 6ft and the tide was dropping and I was alone. I kept seeing bombs but kept feeling too scared to push myself into them,I had a few fun ones and was about to get a wave in to shore when a set came through like the others and I just put my head down and went on the first one despite my instincts clearly telling me a straight up no. Pulled in, the shocky exploded me up and over, I was cruising shoulder first coming round the tube and down in the lip ready to try to land flat underwater,and then craaaack, my whole body weight landed shoulder first on my upper arm across a dry ledge of angled rock with the force of the wave on top. Instantly almost blacked out, I have never hit the bottom that hard before or since,a full white flash impact scene it was wild. Came up seeing stars trying not to pass out and trying to grab my board before the next wave explodes when I realised my arm was not where it usually would have been and was instead hitting me in the back of the head. Grabbed my arm and realised I was in kind of in the shit. Got washed into the channel and tried to get the attention of my mate who was surfing the next slab across the bay. My missus was also on the rocks. Made it out eventually and realised I was in a lot of pain. Had a half hour walk back to the car and a three hour drive to the nearest hospital ahead of us. Foolishly we decided to head to the nearest doctors first for pain relief and hope they could call an ambulance to hospital. Had a ridiculous scenario at various local doctors and clinics as a result,all the while getting sent on to the next still in my wetsuit not knowing what had happened to my arm but in a lot of pain. To cut a long story short, 8 hours later I had my first shot of morphine in a hospital three hours away from the waves, after the final local clinic we visited actually believed that I needed serious help when I cut off my wetsuit with my good hand in a fit of rage to reveal my upper humerus snapped in two. They said they would get me an ambulance,but instead that turned out to be an old couple who run a taxi service for the clinic,with live chickens in cages in the back seat and who drove 40 miles an hour on motorways. The whole story would take too long to write down, but It was an interesting experience that’s for sure!

Mick is as versatile a character as he is an artist. He’s comfortable and accomplished with using different types of mediums for expression. Ben Howard is a good friend. Mick also tours in his band and shoots his music videos.

Keep up to date with Mick’s latest projects and work on his website.


Surfer’s eyes get a battering from the sun, wind, sea, salt and sand. Its small wonder then that some surfers suffer from a condition known as ‘Surfer’s eye’. Its not exclusive to surfers however, and is actually the oldest known eye conditions known as Pterygium.

What Is it?

The eye has a layer of tissue covering it called the conjunctiva. Surfing exposes eyes to the correct conditions for the conjunctiva to get repeatedly irritated and inflamamed. This regular irritation and inflammation causes the conjunctiva to lose control of its ability to repair and it starts to develop an extra layer of tissue which is essentially scar tissue. This new layer of tissue has the catchy name Pterygium with a silent P. In Greek Pterygium means wing. This is because the new tissue that grows on the surface of the eye is shaped like a wing. Apparently.

The normal eye

What causes it?

Irritation to the conjunctiva comes in many forms:

  • Exposure to changing atmospheric humidity. Moving from dry air conditioning to high humidity outside doesn’t help.
  • Sunlight. This is often incorrectly described as the biggest risk factor for developing surfers eye. It’s the biggest acquired risk factor. Having a genetic predisposition is now thought to be the biggest risk factor. Clearly the reflection of the sunlight of the water increases the intensity of ultra-violet exposure by the conjunctiva. Interestingly it’s a lot more common on the side of the eye nearest the nose. This has been thought to be due to reflection of sunlight by the nose. More recently its been thought that it’s due to the ability of sunlight to shine through the cornea ‘sideways on’ from the side of the head and cause irritation to the conjunctiva as its travels through the cornea and is refracted towards the conjunctiva.
  • Being male. Men are twice as likely to develop surfers eye as women.
  • Sea water.
  • Sea spray
  • Dust/dirt
  • Sand exposure
Surfer’s eye.
The ‘Wing’ of abnormal conjunctiva growing towards the pupil. The brown stain is often iron deposits.

What are the symptoms?

  • Often well tolerated. If you don’t mind looking like a Salty dog. Cosmetic is sometimes the only complaint.
  • Some people complain of having the feeling of having tired eyes.
  • The feeling of having something in your eye.
  • More frequent episodes of eye irritation
  • More frequent episodes of conjunctivitis
  • Very rarely effects vision. It has to grow a long way to start bothering the pupil.

Is it dangerous?


What can I do to stop it?

  • Don’t go in the sun and sea..
  • Wear sunglasses or goggles in the sea.
  • Wear decent glasses on land.
  • Perhaps now there’s another good excuse to avoid the shore dumps!

What is its treatment?

  • Surgery is the only treatment. It can grow back in 20% of cases.
  • Fake tears such as ‘lacrilube’ may help.
  • There have been trials using preparations of ‘anti-growthfactor’ with variable results.

For those who want to know more about the different types of surgery available, and don’t mind seeing pictures of eyes being operated on, watch the video below;


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.

A large proportion of the photos on this site are not our own. We have tried to reference all that aren’t ours in good faith. Please contact us if you feel any of your pictures could be referenced better.

Lewy Finnegan Interview

” I tried to pull through the back of a big closeout. The backwash off the rocks surged me into the sand head first. I heard a pretty scary crunch in the back of my neck.”


Lewy Finnegan, one of Australia’s hottest groms and tipped as a future World Champion, answers a few questions about his neck injury surfing his local WA wave, the Box.

What’s your favourite wave at home?

LF: The Box, it’s got heavy barrels, big bowls and is relatively easy to get waves out there.

What’s your favourite wave abroad?

LF: The best wave I’ve ever seen with my own eyes is Pipeline, but the most fun i’ve had surfing abroad is probably a wave in Samoa. It’s an isolated left reef break with a wedge takeoff that never gets crowded.

What’s the worst bodyboarding/surfing injury you’ve seen?

LF: At box I once  saw a stand up pull into a closeout and come up screaming for help, so I looked closer at him and saw his whole face was almost peeled off. He got rushed to hospital. He ended up breaking his foot as well.

Where were you when you had your injury?

LF: I was at Mandurah wedge on an ordinary day with just my friends out. Nothing was different that day at all to the past few weeks that I had been surfing it.

People often injure themselves in surf that they’re not expecting to. Were you feeling comfortable about being out there?

LF: Yeah I felt fine, my injury was on my first wave, so I wasn’t really used to the surf that day, but I was completely relaxed and comfortable out there.

What happened?

LF: I tried to pull through the back of a big closeout. Just as I dove off my board, the backwash that had rebounded off the rocks just surged me into the sand head first. My head went forward until my chin hit my chest and I heard a pretty scary crunch in the back of my neck. I wasn’t underwater for long at all, the backwash just pushed me off the back of the wave. I actually had a pretty bad sand graze on the top of my head too haha!

How did you know it was serious?

LF: Instantly! The pain was unbearable and i found it extremely hard to move anything without it hurting my neck.

Did you have any problems moving your limbs?

LF: No, I could move my limbs fine. I couldn’t really tell if I had numbness because once I got out of the water I was freezing so I could have just been numb from that.

Was it hard to swim?

LF: Yeh so hard, every paddle just killed my neck and back.

How did you get to shore?

LF: One of my friends helped me paddle around the rocks. The beachie on the other side was about 6 foot and heavy but as soon as I got near there it went dead flat. I quickly paddled in, got changed slowly out of my wetty and laid on the shore until the ambulance came.

What was it like being put on the board and head support?

LF: It was a pretty big relief to know that all the damage had been done and that I wasn’t going to screw it up anymore.

surf neck injury
Lewy riding Supine

What happened when you got to hospital?

LF: I was tripping pretty hard on the green whistle (Entonox) and had some morphine injections.. I waited for hours to get an x-ray. My parents actually drove down to the hospital to see me so I just chilled with them until I got my results.

What was going through your mind at the hospital?

LF: I was 100% sure at the time that I had broken my neck. 1 year previous to this injury I broke my back surfing and my neck injury was 5 times as painful, so until I got the results I was sure that I had broken it.

How are you doing now?

LF: Two and a half months on it’s still pretty stiff and a little bit sore, but it’s slowly getting better. I’ve been getting a lot of physio which is helping a lot as well.

How long were you out of the water?

LF: It took about a month until I started surfing again and then another month after that until I started trying to do bigger airs. I’m still not completely comfortable with doing anything massive yet.

What are you plans for the future?

LF: Im in Hawaii at the moment which is good. This year I just want to travel as much as I can and try to improve my surfing. But short term, I just want to get this injury behind me.

Any special mentions?

LF: Yeh, cheers to Davis Blackwell who helped a lot when i injured my neck. Cheers wingazz!

Cheers Lewy. We hope you’re back to 100% soon.

Find out more about neck and head injuries from our articles.

Lewy mixing it up a couple of years ago.


The shoulder is the most commonly injured joint in surfing with dislocations and tears. You can understand why. With all that arm paddling and being bundled when we inevitably stack it, this ‘ball and socket’ joint is seriously working hard.

Shoulder dislocations and injuries can, at best, keep you out of the water for weeks. Its not until you dislocate your shoulder you appreciate how much you need it to swim. And how its possible to vomit from pain!

Basic Anatomy of the Shoulder

In order to get all that movement (unlike your knee which only moves in one plane, or at least it’s meant to – see Stokesy’s interview here!), its naturally pretty loose and inherently susceptible to being injured. There are a few clever tricks your body does to improve the shoulder’s stability through all those wipeouts, like enlarging the ‘cup’ (glenoid) with a fibrous lip (labrum) to hold the ‘ball’ of the upper arm bone better. Around that is strung tight ligament bands and then muscles – these are mainly the internal rotator cuff muscles whose job it is to keep that ball in the cup, but more about that in a bit. Finally, you’ve got the true movers of the shoulder, the deltoid, pectorals, trapezius and latissmus. Or for Ron Burgundy, the ‘ubulus muscle’ that connects to the ‘upper dorsinus’. There’s no point curling that 1012th rep if you’ve got an unstable (extra loose) shoulder, you may look ripped but it won’t help the stabilising structures: the lip, the ligaments, or the rotator cuff.

surfing shoulder dislocation
A complex joint. Image from http://healthpages.org

How do you know if you’ve got an unstable, or worse a dislocated, shoulder?

For a mildly loose shoulder its pretty difficult – you might hear cracking coming from the joint when you move it, but simple cracks with no pain are pretty common, especially as we get older, and are not usually associated with underlying problems (in fact, there’s an ongoing argument about where exactly these sounds are coming from, like the phantom trump in the van when you’re scoping out breaks). However, if you feel pain – there’s something wrong. Watch this session out and go get your shoulder looked at.

‘Clunking’ is feeling like the joint is just slipping out of the cup before popping back or feeling like it’s about to slip out but never quite does. This is a sign of actual or imminent ‘subluxation’, where the ball is riding up on the lip of the cup and getting close to popping out completely. This implies those big 3 stabilisers, the lip, the lig and the cuff are loose. Scroll down to ‘What now?’ to see what to do.

Then there’s the biggy, the ball is completely out the cup. Because of the strength of the big mover muscles, mainly the pectoral muscles behind your nips, the ball of the arm bone typically ends up forward, kind of sat in front of where your armpit used to be. This is a dislocation. If it’s the first time its happened, its gonna hurt. Really hurt. A friend descriped it as feeling like your shoulder is slowing being torn off.

In order for the ball to get out of the cup, its torn those stabilising structures, and if you’re really unlucky, it’s broken some small bits of bone with it too. Any movement of the upper arm hurts like hell because the joint isn’t intact anymore. If you compare the look of the dislocated shoulder to the other side, the ‘squareness’ of the shoulder will have gone, replaced by a one-sided rounded, shortened look.

So that’s: pain, dramatically reduced movement, and finding the ball out the cup, normally forwards.

Shoulder dislocation surfing
Obvious asymmetry. Not that ‘humerus’ if it happens to you.

When is it likely to happen?

Your shoulder has most of the stablisers around the top, back and sides, meaning angles of the arm that push the ball down towards your feet are the most likely to cause dislocation. This means that where your upper arm is at the top of a paddle stroke is the weakest, if you have a cracking or clunking you’ll most likely feel it here. However, in reality it can happen at any angle, and if you add in the leverage force that your arm produces, being bundled by a heavy sunblocker wave or dropping over the falls onto your board, the shoulder can pop out like Pringles. Interestingly, there’s an increase in the summer months in shoulder dislocations in the UK with carrying longboards in classic Cornish crosswinds – presumably worse with foamies as they’re lighter, massive and likely to be still going out when there’s all that wind about.

Shoulder dislocation surfing
Jon Jon kindly showing the position of weakness for the shoulder joint.

I’ve Popped it! – What now?

If you’re in the water, GET OUT. Keep the affected arm tucked in to your side, hugging you or even tucking your fingers in to your boardies’ waistband or wettie’s neck to keep that upper arm against your body and reduce movement in the shoulder. Getting out might mean bodyboarding a straight line to the beach through the breakers or a slow one-arm paddle back to the boat, but GET HELP. Raise awareness your in trouble by waving your good arm or slapping the water. If you can’t get on your board, just grab it with your good arm and use it as a flotation device and shout to get help – treading water with one good arm is sketchy, even if you’re Laird you’ll tire.


If you LOSE SENSATION in you hand, or your hand/lower arm go COLD and BLUE – this is an emergency. You need to see a doctor ASAP.

The dislocated ball has impaired blood flow or nerves to your arm and it needs sorting quick.


You might have seen or heard of people putting their shoulder back in, Mel Gibson in Lethal Weapon-style, called reducing the dislocation. If this isn’t the first time a shoulder dislocation has happened to you, the stabilising structures will be loose from the last time, and you may have enough laxity to bring the ball back round the edge of the cup and back in, increasing your chances of reducing it. This doesn’t come without its own risks though – if it didn’t damage blood vessels, nerves or bone on its way out, it might on the way back. Therefore we still recommend you see a doctor even if you don’t have the ‘emergency signs’ above. However, if there are no emergency signs and you are truly surfing out in the middle of nowhere and there’s literally no-one about – email us immediately with your good arm where the feck you’re surfing, we want in!! Joking (kinda) aside, if you’re willing to take the risk here’s how it might be done:

Pain is the enemy of muscle relaxation. As bruising and blood establish themselves, the area and any movement of the dislocated ball is going to get more painful and any muscles that are still intact, like those powerful movers, are going to go into tight spasm. Therefore you have a window of a few minutes after sustaining a dislocation when it’s most likely a reduction will be successful without muscle relaxants and uber strong pain killers. While it’s true there is no agreed best technique to get the ball back in, there are some general best principles:

Go slow – Gibsonian slamming it back is likely to cause further injury and pain, and worsening resistant muscle tightening, whereas gently easing the ball back will give the best chances of success with least risk of further injury.

Get the position correct – get the arm (gently) out in front of your body (where it’d be if you were pointing at something dead in front of you – this is called a flexed shoulder position).

Gentle pulling – this is the key. Gentle traction of the outstretched arm aims to lift the ball back forward and around what remains of the lip of the cup. However, your muscles will fight this, all they know is its painful and injured so their natural response is to clamp down. That’s why jerking the arm with your other intact arm is unlikely to work – instead with your good arm grab the wrist of your affected arm and apply constant firm traction (as if you’re trying to pull your hand off in the direction of the horizon). Stay patient, it can take several minutes. A way of doing the same force is to lie on the bonnet/hood of your car (or any surface with a vertical drop beside it) face down hanging your affected arm down over the side, and holding anything you can in your hand to weight the affected arm. Try and relax. And wait.

You should feel a ‘clunk’ as the ball sits in back in the cup. There will still be pain (remember those structures are still damaged) but it’s likely to ease off a bit and some degree of shoulder movement return. Again, if you look at the squareness of the shoulder silhouette in a reflection or you ask a mate, it should look even with the other unaffected shoulder. BUT remember, structures can be damaged as it goes back in! Recheck for the emergency signs above, if you know how to feel your pulse in the wrist beyond the affected shoulder, do it.

Remember – only try and reduce it if that’s the only way for you to get help (ie to drive yourself back to civilisation). If you’ve got it successfully back, go get it checked out. Don’t get back in for another surf! It’ll be loose, injured (bruised, ligament and muscle sprain/strain, torn lip cartilage, with or without bony injury) and is likely to stiffen up over the next few days because of what its been through.

So you’ve had it checked out/reduced, what know?

Typically, the beautiful spots surfing takes you have less than stellar rehab facilities or advice. Again, there are basic agreed principles to post dislocation care, and some recent research that’s changing our management.

First off – rest it. Immediately after the injury, an inflammatory storm is happening in there. There is no advantage to busting through pain at this stage for the future of your shoulder. And definitely, definitely, don’t surf with it.

We used to rest the shoulder with the arm held across the chest in a sling that supports the elbow, which if you haven’t got anything else is definitely better than nothing. However, it’s been proven that keeping the upper arm next to the body, flexing the elbow to 90-degrees and bringing the hand out away from the body (as if you’re hitting a backhand tennis stroke) brings those commonly injured stabilising structures back into the perfect healing position. This improves the likely future function of the shoulder and reduces the potential need for surgery.

How to do this in practice though, without complicated medical slings and with stuff you can find in your location, is difficult and open to Macgyver-like ingenuity. One way (video explanation coming soon!) is a bandage-type strap (strap 1) in a figure-of-8, with one loop around the lower chest/body and the other smaller loop around the arm just above the elbow, tied tight enough to keep the elbow/upper arm against the body. Another similar strap (strap 2) can then be looped around once around the wrist, and then around the lower-chest/body and tied onto strap 1 in a way that keeps the arm out in that tennis backhand position. (If the hand keeps dropping over time, a third strap can be looped around the wrist and diagonally up over the opposite shoulder to keep you in primo ‘teapot’ position). As well as being tied up in some crazed cats cradle, your arm will be exposed to getting bashed about as you go from boat to car to that Garuda flight. Not ideal. As always, the best option lies as a compromise somewhere between theoretical and practical ideals.

When you can, get it checked out by a doctor. It’s likely you’ll need x-rays to look for bony injury and may even need surgery, despite doing all the above. After this, it’s time start the long-haul of rehab, slowly regaining range of movement, strengthening and tightening those rotator cuff muscles and regaining function. Finding a good physio can make the world of difference and get you back to the surf.

Rehabilitation exercises are important. The video below demonstrates the important first steps,

Sounds grim – how can I stop this from happening?

Strengthening the important muscles and ligamnets is the key. It works!

We think this site is pretty good for basic body strengthening exercises for surfing. We’re planning to make our own videos/instructions at some point.

Author: Dr Chris Ireland


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.

A large proportion of the photos on this site are not our own. We have tried to reference all that aren’t ours in good faith. Please contact us if you feel any of your pictures could be referenced better.


HYPOTHERMIA from surfing in cold water should not be dismissed as something that kills the weak and niave. Hypothermia has the potential to catch us all off guard at some point, no matter how experienced we think we are.

It kills. How it kills depends on the situation.

Most of us can hopefully spot when we’re starting to ‘slow down’ from the effects of hypothermia, and ‘catch the next one in’. But then what? The risk isn’t necessarily over. There was a tragedy in Cornwall not so long ago of a few lads dying on their way home from a surf. They stayed in their wetties in their van, presumably to try and keep warm (only works for very short distances), and came off the road with horrific consequences. The accident was thought to be caused by hypothermia.

Wetsuits are so much better these days. No one is probably putting their lives at risk quite as much as we used to paddling out on a -20 wind chill winters day. Most of the people that pitch up to hospital with severe problems from hypothermia in the sea have usually not intended to be in the sea in the first place, or had been kept in it for a lot longer than they wanted (rip current etc).

Early Morning Stuff

Understanding the signs and symptoms of hypothermia is important if you’re a cold water (and warm for long sessions) surfer and value the safety of yourself and those around you. Taming your ego & arrogance that you know what you’re doing, and that it won’t happen to you, should be your first step to achieving this.

Everyone’s different right? I was amazed last year in the Maldives watching an American pulled on a long sleeve neoprene rashie on a cloudy day to ‘keep warm’. I thought he was on glue. I was basking! But then I live in the UK where we live in neoprene all year round. An Ode to Winter..

The diagram below shows how people are affected by the cold differently. It seems that people are born different, but can also aclimatise (to warm or hot) to some extent. Clearly age and the amount of fat (insulating) you carry makes a big difference.

Surfing hypothermia
Everyone ‘feels’ the cold differently. The better the wetsuit and it’s fit, the longer you have.


I’ve always tried to buy the best wetsuit I’ve been able to save up for. Apart from being super stretchy, & lined with organic cinnamon charcoal or whatever, a good one could save your life. It’s worth the investment. The warmer they keep you the longer you avoid getting hypothermia. I’m not going to go into what to look for in a good wetsuit. Others are more qualified to tell you that. Just make sure they fit.

Pissing into them used to keep you going for longer. Now they don’t flush water through them anywhere near as much this as the charming effect of making you, and your towel, and your suit, and your car stinking of piss. Not cool. Excuse the pun.

Frigid & Fun.


Think of it as a scale, not an endpoint. As your body cools the number of side-effects and their severity increases. Most cold water surfers put them selves on this scale each session.

If you read the books they will give you core body temperatures at which it occurs, but I find that pointless in practice. Who surfs with a thermometer?

The key is to be aware of the points on the ‘hypothermia scale’ and try and recognise when you (or others) are moving along it, so you can act to warm yourself.

This really is the key to surviving hypothermia.

Your feet feeling like ice blocks, your hands not responding and ice cream headaches aren’t signs of hypothermia. They’re just signs that your environment is cold, and perhaps you’re not as well covered in neoprene as you could be. These signs could be occuring however alongside more subtle signs of the killer.

Your body relies on a complex & dynamic array of chemical (metabolic) reactions that need to be constantly occuring to survive and function normally. Cooling slows these reactions and prevents the body from functioning normally. For every degree celsius drop of your core temperature your metabolic rate drops by 4%. Heart arrhythmias caused by hypothermia (and severely impaired chemical reactions) allegedly was responsible for more deaths than drownings during the Titanic disaster.

Basically with a body temperature drop of 1-2 degrees celsius you’ll shiver, have reduced dexterity (zips & keys), numb extremeties and find it a bit harder to concentrate & think about stuff. Temperatures lower than this mean that your decision making and endurance is seriously impaired & you’re at significant risk of drowning. Temperatures still lower and you’re at risk of death regardless of drowning prevention.

Effect on Breathing

Being suddenly immersed in cold water, after the initial gasp, usually leads to a significantly increased breathing rate. This isn’t a voluntary response and can be hard to control. The effect of this increased inbuilt drive to breath is that it can be harder to hold your breath for as long as you’re used to in warmer water. Increased breathing rates also make you more susceptible to developing a wheeze if you’re asthmatic. Cold air inhaled rapidly is a common trigger for asthma.

Effect on Paddling/swimming

A number of studies have been done looking at the performance of swimmers in different temperature water. It’s been shown that as the water gets colder (even in the most experienced swimmers) that a decrease in stroke length and a resultant increase in energy expenditure to travel the same distance was experienced. Combine that with the thicker neoprene that you’re used to and you realise why we’re not aquatic mammals.

Cold water surf
Winter Stoke. Eileens.


Ice (s)cream headache. The nemesis of all cold water surfers. Often the reason given by the older gents of the line up as to why they won’t surf through the coldest months of winter. It hurts. Makes you feel sick, see stars and can ruin an otherwise epic surf.

Have you ever noticed why the headache is worse (and gets worse) as you’re paddling out after a wave? Rather than being under water getting nailed. Wind chill on a freshly submerged skull is agony. Why? This is my ice cream theory..

Everyone know that you’re tissues contain blood vessels, and that these vessels expand and collapse in response to your bodies temperature ASWELL as the environmental temperature. You’re head may be exposed to the elements, but if your body is wrapped up in state of the art neoprene, and you’re busting a gut to get through the winter groundswell peeling off your local sand bank, the you’re getting HOT. Your head will be used as a way of helping prevent your body getting too hot. The vessels under your scalp will be nice and expanded helping your body lose heat.

Then comes the duck dive. It’s cold water. Say 14 degrees. But the pains not there. It’s just really cold. Then as your head breaks back to the surface and the wind hits you the pain begins. Evaporation is a really efficient source of heat loss. All of a sudden your head (tissue) thinks been thrown into a sub-artic environment and quickly tries to constrict all your blood vessels. This causes ‘vasospasm’ which is painful.

Cold water suddenly entering your ear canal can cause a reflex called the calorific reflex. This can stimulate the vomit centre in your brain and make you want to throw.

Just a theory.

cold water bodyboarding
Seriously cold.


Apply common sense to this! If you jump in the North Atlantic in February naked, the signs are going to come on thick and fast (dead in 10-15 minutes). They would be less rapid if you’re wearing a well-fitting good quality wetsuit and accessories.

Having said that, your body will try and keep your body at normal temperature (normothermic) for as long as possible (by shivering and burning off easily accessible energy stores). It can’t do this indefinately (everyone is different), and the decline after this initial compensation can be rapid, even in a decent wetsuit.

The following are signs that you are starting to develop mild hypothermia and should be looking to catch a wave in:

  • Shivering. Your body is trying to generate more heat to keep your core (not your toes) warm. A good test is to see if you can stop yourself shivering. If you can you only have mild hypothermia. Having said that, if your hypothermia is getting severe, your body gives up on trying to shiver.
  • Purple extremities. Your body is no longer wanting blood to go to the cold bits
  • Pissing loads. As you get colder your blood vessels to your extremities close, your heart rate increases and your blood pressure rises. This can cause you to urinate more than usual and get dehydrated. This can make you feel horrible and be at risk of fainting when you re-warm.

The following are signs that you need to urgently get out, get dry and get warm:

  • Tiredness. This is subtle at first and gets more and more severe. Don’t just put it down to the pumping surf and the fact you got up at 5am.
  • Delayed thoughts. You know what I mean. When you are maybe aware that you’re slowing down, maybe, but the very act of thinking about your thoughts slowing down isn’t that easy, maybe. This is called dazed consciousness. Don’t be an idiot. Paddle in, get dry & get warm.
  • Slurred speech. Don’t think your mouth isn’t working because it’s cold. Your brain is not working properly (not an insult) and it can’t give your mouth clear instructions.
  • Bad surfing! You start to loose your fine motor control. Don’t just think you’re having a bad day or that your wettie is too thick. Get out, get dry & get warm.
  • Irrational behavior. If your mate starts doing more weird things than usual, be suspicious!
  • When the shivers begin to get more severe, then start having pauses between them things are getting serious.

Have a look at the following table to see the different signs of hypothermia. You can read it better if you click on it.

hypothermia symptoms
Know the signs. Click to enlarge.

Surf Canada
Surfing Lake Ontario in Canada. As core as it gets.



  • Make sure you’ve eaten (at least an hour before) and are well hydrated
  • Some of my mates swear by driving to the surf in a dry wetsuit to save losing heat by changing outside. Don’t drive home in a wet one.
  • Have plenty of dry layers to put on when you get out.
  • Thermos of a hot sweet drink or soup for when you get in.
  • There is no role for a ‘warming spirit’ or tot of whiskey before a surf. This is actually really dangerous for added reasons than perhaps surfing smashed!
  • Piss in your suit. I can’t find any evidence that this actually makes any difference in keeping you warm in the long run. That’s not going to stop me doing it! There is evidence that too much caffine makes you loose lots of heat through your urine!
  • Never surf after drinking booze. Alcohol makes you lose heat quicker. Beware the morning after.
  • Read these top ten tips by the editor of UK Carve magazine.
Wax or de-icer?


  • Get emergency medical help
  • As a general rule, if the hypothermia came on slowly (not sudden emersion) then it should be reversed slowly. No dunking surfers that have had a 5 hour session and are struggling from hypothermia in a hot bath.
  • keep them horizontal during and following removal from water. This prevents a sudden fall in blood pressure.

I’ll never complain of being cold again (maybe) after watching this movie. Its a different gravy!


Inhaling & swallowing cold water drops your body temperature. This can cause your heart to have problems beating properly. Having said that, the cold could be a blessing in disguise in the longterm, so don’t be put off attempts at resuscitation.

We are planning to write a detailed article on drowning and basic life support soon.

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.


A random splash or a darting shadow. The slightest of triggers can turn a fun surf into one that’s at risk of being ruined by a background level of anxiety and fear. Shark attacks are horrible, there’s no getting away from it. They’re terrifying in their intensity, merciless, bloody and a horrific emotional experience for all that are unfortunate enough to witness.

They are however really rare and are no more horrific than the experiences thousands of unlucky people suffer on the roads world-wide every day. Car crashes, like shark attacks, are also horrible and equally terrifying in their brutality and mutilation. Unfortunately the countries with warm barrels that surfers often like to travel to, also have significantly more road accidents. You’ll never hear a British surfer question going on a particular surf trip abroad because they’re concerned about the high rate of deaths on the road in that region. Obviously sharks, and the risk of being munched by one, does get a mention.. It’s the ultimate surfing paranoia. Shark biscuits- stand up and be counted!

On walking into the foyer of an Indonesean hospital recently, I noticed a graph on the wall showing the biggest causes of death in that area. Over 70% were caused by trauma on the road. A sobering thought when I considered the van and the journey that had just brought me to the hospital..

Why is it then, when I book a trip to a remote location like that, one of the first things I think of is ‘is it Sharky?’

It’s because I’m an idiot and a wimp. I’ve tortured myself over the years reading endless harrowing accounts of shark attacks. I hate the thought of being eaten alive, and like most of us on the road, I’m arrogant enough to think ‘I’ll be alright’. And that is exactly why I got in that van with bald tyres that pulled heavily to the left when it breaked, and travelled over a volcano at night, fast, on a pot-holed dirt track, driven by a local who seemed to be more focused on apparently texting the complete works of JK Rowling to his wife. A one & a half tonne Great White on wheels.

I AM a wimp and an idiot. But its not my fault though right? A dorsal fin is a lot easier to recognise that a dodgy motor.

Shark attack
The deadliest thing with a fin. Time to paddle in?
Shark attacks
Diving & snorkelling is one of the best things to do when it’s flat in my opinion. Gives you food for thought though when the swell returns.
Big Boy in the Maldives.

How to avoid road accidents is common sense. This article is about the more interesting, but less relevant,  topic of shark attacks. Trauma and major blood loss, whether from a shark attack or a car crash, has a similar theme for its management. Car crashes obviously also have the added issues of things like head and spinal injuries that must be considered.

This article is going to discuss what basic medical (and little) stuff there is to consider when dealing with a shark attack victim.


It’s often said that sharks (especially great whites) generally bite surfers out of curiosity. That the act of biting gives the shark’s senses enough information to work out what we are. It’s a comforting thought. It’s just a shame that a taste can rip off limbs and cause massive haemorrhage.

There are, however, other theories about the bite. Sharks species have survived since the dinosaurs for a reason. They’re built well, but they behave well too. Attacking an animal that can cause you harm puts you at risk yourself.  Sharks are also cannibals. Even a small bleeding wound inflicted on them by their prey during feeding can signal other sharks to dine on them too. The ‘bite and spit’ that surfers have been described as suffering can also be seen demonstrated by sharks on bigger, more dangerous prey, such as Sea Lions. Allowing your prey to bleed to death, to then consume it at your leisure is a much safer option.

This is perhaps why there are comparatively very few reports of people that bravely try to rescue victims of shark attacks, also being attacked themselves. Sharks seem to stay focused on their original victim and wait (with variable patience) to eat. This is an encouraging thing to bear in mind if paddling furiously towards a stricken friend. Surfing with others incidentally is shown to significantly reduce your risk of being attacked. There are theories about how this influences the hunting behaviour of the shark. Sadistically  you should draw comfort from the fact that if there are two of you in the water, no matter how unlikely the chances of an attack, they have also been reduced by 50%!

Another theory for the munch and run behaviour is that the jaws of juvenile Great White Sharks are actually too weak to sustain an attack and kill marine mammals. It’s believed that they let go of their prey to prevent damage to their jaws caused by sustained pressure & forces generated by their bite. Click here for a detailed article on this theory that was published in the Journal of Biomechanics.

Fear. Not always particularly rational.


There’s a theory that if someone suffers a heart attack out of hospital, and survives long enough to make it into hospital alive, that they are part of a self selecting group of survivors/patients. If your genetics have dealt you a bad hand, and given you a weak cardiovascular kit, then you probably wouldn’t have made it in to hospital.

The same grave theory can be applied to shark attacks. If the poor victim manages to make it to the safety of shore alive (not killed immediately), then the severity of their injuries are likely to be moderate enough to mean that they have an encouraging chance of survival.

You don’t have to have any medical experience to recognise that the major problem is of massive haemorrhage and shock.


Probably important to point out that haemorrhage and shock, no matter how severe puts the victim at serious risk of drowning.

All attention after should be placed upon preventing further blood loss:

  • Keep the victim immobile (to reduce desire of heart to pump more)
  • Try and keep damaged limbs above the heart.
  • Keep the victim warm with blankets. Blood loss/shock causes hypothermia even in warm climates. Hypothermia stops your blood clotting well.
  • Any material used for applying direct pressure to wounds is better than nothing.
  • Apply (constant) pressure to the wounds. Small grazes may be encouraged to clot by this and larger ones will experience less blood loss due to the increased pressure you create around the wound (you reduce the perfusion of the wound).
  • Use tourniquets. Leashes are everywhere, as are strong leash straps. Use more than one on effected limbs if you can.
  • If you know your anatomy try putting pressure on the pulses of the effected limb on the heart side of the wound.
  • The risk of death is so high that it removes any concern about damage caused by tourniquets or wound infection.
  • Give oxygen early if you have access to it.
  • Don’t be tempted to give the victim food or drink. Chances are they’re about to need an operation under general anaesthetic.

When emergency services arrive it’s ideal to be able to start giving replacement fluids ASAP. This has the effect of increasing the circulating volume of blood in the victim and their ability to keep oxygen going to their heart and brain. It is argued that victims of massive haemorrhage that die in transit to hospitals can sometimes die because they are transported. Where possible stabilisation should be attempted on the scene. Having said that often definitive surgical intervention is often required. The judgement of medical professionals at the scene should be followed. It’s certainly worth waiting for an ambulance if one is on the way rather than bundling the victim in the back of a car.

shark attack
major haemorrhage
The business end of a major haemorrhage



The Florida Museum of Natural History has the following instructions if you should ever find yourself face to face with evolution;

‘If one is actually under attack by a shark, we advise a proactive response. Hitting a shark on the nose, ideally with an inanimate object, usually results in the shark temporarily curtailing its attack. One should try to get out of the water at this time. If this is not possible, repeat bangs to the snout may offer temporary restraint, but the result likely become increasingly less effective. If a shark actually bites, we suggest clawing at its eyes and gills, two sensitive areas. One should not act passively if under attack – sharks respect size and power.’

Quite clear instructions really. If the shark literally wants a piece of you, unleash the fury. Like there’s no tomorrow..

Mike Coots in his interview below demonstrates impressive strength of character by cooly describing his savage experience when a Tiger Shark tried to kill him. He describes how showing aggression himself, he saved his life..


Free diving with a White Pointer:



Shark attack timing
What time is low tide again?
Taken from http://www.flmnh.ufl.edu/
Shark attack temperature
Do I need to pack a neoprene rashie?
Taken from http://www.flmnh.ufl.edu/
Shark attack water depth
Deep blue Vs dry reef
Taken from http://www.flmnh.ufl.edu/
Grow up!

Have a read of this BBC article exploring the cause and the possible solutions for the high number of fatal shark attacks in Recife, Brazil.


The purpose of this article is to get people thinking about their safety whilst abroad, specifically when travelling on motorbikes and in dodgy vehicles. The risk that these motors put you at may not be more horrific than a shark attack, but they are far more likely to cause you harm. Looking after someone that has just been in a major traffic accident can leave you haunted for life. In order to save help save their life (as with shark attack victims) there are a few simple things that can be done to help prevent catastrophic blood loss.

Remember. If you don’t want to be eaten by a shark. Stay on land. The further you are away from a major hospital, the less your chances will be if you get spat out after a major mauling.

Sharks are however really cool animals. They’re breathtaking to watch underwater. Go diving and see for yourself if you’re not sure!

I’d much rather be chewed to death doing the sport I love, no matter how unlikely or horrific, than be crushed to death behind the wheel and be another sad statistic on our roads. I’m going to make a conscious effort to put in out of my mind from now on. No more scary shark stories for me..

AUTHOR: Dr Dave Baglow


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.



painful breasts surfing
Girls in the barrel. Click on the photo for the video, it’s worth having a look at.

It seems that having breasts isn’t always as great as some guys imagine! Painful breasts & Nipples is something that plagues a surprising number of women after surfing.

It’s actually not that uncommon for women (and some men) to suffer from breast and nipple pain after surfing. It’s so common in fact that medical professionals are used to seeing women in their clinics.

Mr Iain Brown is an internationally recognised specialist Oncoplastic Breast Surgeon as well as a keen surfer. Being based in Cornwall in the UK he is familiar with the problems women encounter with their breasts from surfing, so much so that he is beginning to describe a condition called ‘Surfer’s Nipple’. “Some women can suffer so much with breast and nipple pain that it keeps them out of the water and significantly affects their enjoyment of surfing”. “Surfer’s nipple is very similar to the commonly known condition of ‘Jogger’s Nipple’.

Pain that keeps women out of the water? What is it that causes breasts to be such a handful?



What Causes Breast Pain in Surfers?

breast pain

There are more to breasts than you may think. The causes of breast pain are shown above & can be considered to be caused by pain from the breast/chest area or pain from the nipple.

Generalised breast pain from surfing can be either from;

  1. The breast glandular tissue itself or
  2. The chest wall and muscles that lie underneath the breast tissue.

Breast Tissue Origin

Breast tissue pain after surfing is generally due to trauma and bruising of  the delicate glandular tissue within the breast. This tissue is very sensitive to the hormones progesterone and oestrogen. Breast tissue becomes larger and more sensitive due to fluctuations in these hormone levels at certain times. Some women find that they are unable to surf comfortably just prior to their normal monthly menstruation. This discomfort may in fact be so severe that it keeps them out of the surf. Pregnancy is another cause of increased hormones and can also cause tender breast tissue.

The repetitive trauma of the board against the chest area even just when paddling out and resting can cause problems. You only need to look at the wetsuit below to see the trauma that can be experienced in the chest area.

painful breasts
Wetsuit Rub

“There’s no doubt that women benefit from additional breast support whilst surfing, whether that be a supportive bikini, sports bra under their wetsuit, or even a more supportive neoprene rash vest. Standard rash vests provide minimal support and the degree of support provided by a neoprene rash vest depends on the fit & thickness of the neoprene. Care must be taken to make sure the breasts are supported rather crushed” explains Iain Brown.  If these measures don’t help and the breast pain is effecting their surfing then they can consider dietary changes that have been shown to reduce breast sensitivity (reduced salt, chocolate, caffeine saturted fats) and take dietary supplements such as Evening Primrose Oil”. It’s obviously wise to speak to your doctor before you start drastically changing your diet or taking pills, especially if you have any pre-existing conditions or illnesses.

Chest Wall and Muscles

A significant number of women that seek medical advice for their breast pain are actually suffering from chest wall and/or muscle pain. Breasts sit on a complicated network of muscuature which is intrinsically involved in the biomechanics of surfing. Specifically paddling, duck diving and even strains from carrying large boards.

“ The Pec complex, the latissimus dorsi insertions (back muscle), serratus anterior (side of the chest wall)  and costrochondral (breast plate) junctions are all prone to strain and persistant inflammation” reports Mr Iain Brown. Its surprisingly common. I recommend that women suffering from musculo-skeletal breast pain re-consider their technique of paddling and diving and  may benefit from resting up for a week and applying gels such as Ibubrofen to the affected areas twice a day after bathing”.

Remember, It can often be as simple as adjusting how you carry your board and starting to do regular exercises that improve your core strength.


Nipple Pain

‘Surfer’s nipple’ is a common condition that is also suffered by some men. It is caused by repetitive rubbing & abrasions to the nipples by clothing or wax, and leads to soreness, irritation and in some cases bleeding. Out of the water the nipples can become dry and appear cracked. These cracks can develop into deeper fissures or splitting into the nipple tissue that can bleed and be prone to infection.

‘Surfer’s nipple’ as it will now be refered to is a common condition that is also suffered by some men. It is caused by repetitive rubbing & abrasions to the nipples by clothing or wax, and leads to soreness, irritation and in some cases bleeding. Out of the water the nipples can become dry and appear cracked. These cracks can develop into deeper fissures or splitting into the nipple tissue that can bleed and be prone to infection.

Tips to avoid surfers nipple (Nip Tips?) are as follows;

  • Avoid loose fitting material.
  • Apply a water proof emollient such as Vaseline.
  • Consider applying water proof plasters (carefully!) to the nipples.
  • If the nipples become inflammed and the skin is broken apply antispetic cream. It is probably best to avoid the water whilst the skin is broken.
  • Avoid sun burn.
What A Pain.


As with all things medical it’s very dificult to 100% rule  serious things out without checking with your doc. So if your worried and symptoms persist then take the plunge and go seek medical advice. Common sense and consideration of activities that casue the pain usually leads to the diagnosis, however it is important to be aware that breasts can develop other problems.

It is widely accepted that all women should perform regular routine breast self-examination and get used to knowing whats normal for them (Just like men should do with their balls!!) Breasts do feel  different at certain phases of the month and may be quite a lot more lumpy or sensitive in the run up to a period.  Changing your contraception (pill , implant, injection, coil) can also alter things. Regular self examination should be timed roughly to be a week or so after your period ends“.

There are lots of instructional videos available online such as the one below showing how to examine yourself effectively.

There are a number of Apps now availiable to help women to remember to examine their breasts and make it more of a usual routine. One of these is the iBreastCheck app for the iphone.





Most importantly please don’t worry if you have breast symptoms. Although it may be a  cause of stress and anxiety, (and must be taken seriously) reassuringly there is no medical evidence whatsoever that trauma to the breast can predispose or cause a cancer to develop.

GetSwellSoon would like to thank Mr Iain Brown for providing the impetus for this article, uncovering a so far under-reported yet important  problem in surfers and for his input in the writing of the Article.  Mr Brown is held in high regard internationally for his surgical skills in cancer , reconstructive and cosmetic breast surgery. He teaches breast and plastic surgeons in training and is committed to the science and art of all surgery for the breast

You can check out his website Cornwallbreastsurgeon.com  which is an  informative and reassuring  site that provides upto date information on the current treatment and management of  breast disease for women in Cornwall and beyond


Authors: Mr Iain Brown & Dr Dave Baglow

Due to the exposure this article has generated on surfers nipple a sister website has been created.


‘Surfers Nipple’ is now an official medical term!
Published in Surfer Girl issue 40, UK surf magazine.


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.

A large proportion of the photos on this site are not our own. We have tried to reference all that aren’t ours in good faith. Please contact us if you feel any of your pictures could be referenced better.



Kissing the reef.

Lets be honest. Coral cuts can be really cool, but only when the pains gone and the cut’s heeled up. A badge of honor.

Reef cuts have the potential to ruin your trip, and if they’re not dealt with properly, can kill you. Not so cool.

Reefs include coral, all types of rocks and sand bags. This article is going to discuss the issues around coral cuts.

Basic knowledge and understanding of how to deal with cuts and wounds is important for the traveling surfer. Its worth reading our article on Wound Management first to understand the basic principles.


When I first started taking on reefs, a good mate of mine at the time used to constantly remind me ‘remember, if you mess up, its YOUR fault’! He was referring to the predictability of a set breaking over a reef compared to a sandbank. He had a point, but we all make mistakes right? I seem to make a habit of it.

Bouncing on the reef presents a number of hazards. head injuries, spinal injuries, broken bones, getting stuck underwater, not to mention reef cuts.

Know at what tide a reef breaks dry. Try and work out the different sections of the wave from watching people who know it surf it. Have a clear plan on how you’re getting in and out. Pushing yourself to improve provides massive rewards, but be aware of your limits.

There are things you can do when you’re getting worked that can help reduce your chances of kissing the reef.

I found this video really useful:


Corals are dirty. They have bacteria and spores on their surface, and because they’re so brittle they can slice through your flesh and break off leaving small chunks inside the wound.

Some corals contain toxins which add to the pain, and increase the chances of your whole body reacting to the injury, not just the damaged tissue. Septicaemia can be a serious complication of infected reef cuts.

coral cut

Bits of coral and spores act as a source of infection and prevent the cut/wound from healing.

I got back from a trip a few years ago feeling really lethargic with a small reef cut on my shin that wasn’t healing. I thought it wasn’t going away because I kept getting it wet.  It was only after a proper clean and antibiotics that I realized how much the cut had been affecting my general health. And that was just a scratch.

Coral cuts have the capability of spreading infection around your skin, and then onto your whole bidy making your really ill. Death from septicaemia (poisons from bacteria in your blood) is not unheard off from coral cuts.

surfing wounds
Its almost unbelievable to think someone could miss a foreign body this size!
This guy presented to hospital with a surf wound that wasn't healing after 'cleaning' and suturing.
This guy presented to hospital with a surf wound that wasn’t healing after ‘cleaning’ and suturing.


This is often the bit that is done worst, but is in the case of coral cuts it is the most important.

Take your time to carefully clean the wound. This is your best opportunity to make sure the cut behaves itself in the future.

  • Remove ALL the foreign bodies in the wound including any small chunks of flesh that you don’t think have a blood supply. Don’t get carried away removing flesh, if you think there’s more than a few small pieces it should be done by a surgeon! Having a pair of sterile (use boiling water) tweezers or a few new green needles are useful for this.
  • Wash the area really well. Drinking water is really useful. Sea water isn’t useful (contains small organisms & eggs) but is just about better than nothing. I really like putting betadine solution in with the water.
  • If the wound is stinging a lot consider pouring vinegar over the wound.
  • Using a clean syringe to blast the area with clean water can be useful to help dislodge debris and assess the depth of the wound and any underlying damage.
  • I use hydrogen peroxide on reef cuts once I’ve spent ages cleaning them. Manufacturers advice that you dilute neat hydrogen peroxide before you apply to flesh. I now use 50% clean water & 50% hydrogen peroxide on wounds as neat solutions can delay your healing time. It really hurts, but the acidic solution reacts with your alkaline flesh and causes a bubbling reaction. This acts to help work the microscopic spores out of your flesh and kills bacteria. Don’t use this as a substitution for thorough wound investigation and cleaning beforehand.
  • Antibiotic powder is recommended by some at this point to help prevent infection. If you have it then apply it evenly 3-4 times a day for a few days
  • If you think there is damage to any nerves, arteries or tendons or the wound contains things that aren’t foreign bodies that you don’t recognize (like bone splinters) DON’T CLOSE THE WOUND. You need to get to a hospital to have the wound dealt with properly.
  • Dress the wound with sterile cloth and bandage. Don’t use sticky materials on the wound. Change dressings if necessary.
  • Steri-strips are really useful for reef cuts. I avoid closing the wound with sutures if I’m concerned about the wound as they can close in any bits of coral you’ve missed.
  • Read our article on antibiotics. If its not improving consider taking antibiotics. Only take them if you know you’re safe to do so.
  • Don’t use lime juice or products you’re not familiar with.
  • Try and keep the wound elevated.
Indo. The home of barrels and reef cuts. Shows good wound management at the end..
Infected reef cut


  • It won’t be healing
  • It will be red, tense, weeping pus (or pus visible beneath skin)
  • It will hurt!
Cellulitis from a finger wound. This needs to be seen by a Dr.

Signs that it’s affecting your whole body are:

  • You may feel knackered all the time
  • You may be getting fevers
  • You may be getting night sweats
  • You may be feeling sick with a reduced appetite
  • There may be a red warm area spreading over your skin starting from the wound area.

Get to a doctor urgently if any of the above is happening.



  • If you hit the reef hard the pain may distract you from sprains and joint damage. Be suspicious of pain in the joints either side of the injury.
  • Remember its possible to damage nerves and arteries beneath wounds.
  • If the coral cut is deep and potentially entering a joint space you should go to a hospital for surgical cleaning.
  • A bleeding wound may distract you from thinking about other issues around head injuries.

coral cut
Sport Hurts


For the best chances of not having any issues from the reef cut, then wait until it’s healed.

If however you want to ignore that advice and try to make the most out of your surf trip by taking your chances, try doing the following:

  • Apply a waterproof plaster spray prior to going in (then cry like a baby!)
  • Methodically clean the wound after every surf
  • Use clean dressings after every cleaning session.
  • Antibiotic powder 4X a day
  • Watch for the danger signs mentioned above. In you and your mates..
  • Admit defeat if it starts to get nasty.

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.



weever fish

That’s Weever. Not Weaver. Some people really seem to care about this, but fair play, it’s the fish, not the bird.

Now the UK may not have bacterial infested coral, sea urchins, hospitalising jelly fish, Bull sharks, White Pointers or generalised tropical water badness, but European waters are home to one of the nine Weever fish species. I give you the Lesser Weever.

These little silver/brownish critters, maximum 15 cm long when adult, can be found under the sole of your non-boot wearing foot in shallow coastal waters. They have no swim bladder, so they can sink to the sea bed when not swimming and bury themselves in sand. All that’s on show are their eyes and a series of dorsal spines containing a pretty potent toxin (as do the small spines on their gills). Here they wait for the returning cold and tired surfer, with the specific intent (from personal experience) of making it really difficult to use your clutch foot when driving your van home.

Weever Fish
The business part of the Weever Fish

Contrary to popular cornish belief, they don’t migrate here in the summer (or ‘commute’ as one surfer said!). They are in our waters year round travelling in and out with the tide, feeding off crustaceans and other small fish down to about 50m, but the number of reported incidents increases significantly in the summer due to the increased numbers of people in the surf, and the fact that people stop wearing boots. In reality, stepping on a Weever fish is rarely a serious injury, but can be severely painful and will make you wish is wasn’t low tide with a long walk up the beach.

You are very unlikely to see ‘the bullet that hits you’, your first knowledge of the Weever fish will be a sharp scratch underfoot as you wade through shallow water. Over the next minute or two you’ll fast realise that the pain is worsening, and your foot may subsequently develop redness and swelling, or areas of numbness. If this is the case and there is no obvious abrasion to your skin, it will most likely be the Weever fish as few other injuries follow this pattern in tidal sandy East Atlantic waters. Ideally, you need to get out of the sea and submerse your foot in as-hot-as-bearable water as soon as possible, as this destroys the heat sensitive protein based toxins and helps alleviate symptoms. There is obvious risk of further injury here from burning, especially if you’ve already taken pain killers, so be warned and take care.

Time in the hot water varies according to who you ask, but the UK National Poisons Information Service (a site used by Doctors that advises on random poisons) recommends 30 – 90 minutes, or until the pain is easing, and that this heat treatment can be initiated to some effect up to 2 hours after the initial injury. Hot flannels are an alternative if immersing the site of the injury is impractical. If in peak season on a main beach, then the best option here is to head up to the lifeguard hut as they see more Weever fish injuries than anyone. They are very experienced, and chances are they will have already put the kettle on as they see you hobbling up the beach. Out of season or in remote areas, tried techniques include knocking on car doors for sweet old ladies with a thermos of coffee and a handy sandwich tupperware box, if it’s not too hot to drink it should be the perfect temperature! If no hot water is available, simple pain killers and anti-inflammatories are the way forward, safe in the knowledge that the worst of the pain should start to reside in a few hours, though pain can remain for 24 hours or longer depending on the sensitivity of the area stung. Rarely symptoms may be more severe, including headache, fever, chills, delirium, nausea, vomiting and dizziness.

Lesser Weever Fish

Photo Copyright, Richard “Tiny” Daw. With kind permission.

The spines usually stay with the Weever fish for its next malicious attack, but rarely they snap and remain imbedded in the skin. This can prolong inflammation and increasing the chances of subsequent infection, so it’s worth a visual inspection of the wound for foreign bodies. This is especially important if the site of the injury overlies a joint. See our Urchin Injuries article if  you see a spine fragment after inspection  for information on removal, as the same principles apply.

As always, if concerned then it is best to seek medical advice in person, especially if the pain is uncontrolled, the swelling is worsening, an area of redness is spreading up your leg over time or you are becoming unwell.

If the pain gets really bad, take solace from the fact that at least you didn’t have something several hundred times your body weight step on your head today. The Weever’s day was worse.

Author: Dr Doug Orr

Article published in UK Carve magazine June 2012

Carve Surf Magazine UK
UK surf mag CARVE showing support for getswellsoon


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.

Ben Player Interview

“I asked the Doctor in Australia what precautions I could take. She said ‘don’t go to tropical countries’. That’s a bit hard when all of my favourite waves are in tropical places.”

Ben Player
“I could barely move & felt extremely weak. My fever got worse & I started hallucinating & by the next morning I was almost blacking out from the fever”.

 Ben Player 2X World Champion Bodyboarder & all round nice guy talks of his brush with Dengue Fever.

Ben Player Dengue
Ben Playing at Padang

What’s Your Favourite Wave At Home?

BP: I love surfing Whale Beach wedge which is my local and Shark Island when it’s uncrowded, which is nearly never!

What’s Your Favourite Wave Abroad?

BP: I love Teahupoo, Padang Padang, Pipeline and Puerto Escondito. All places are warm and tropical which is good but can also be a hazard with viruses and infections

ben player dengue
The Beautiful Bali

Tell Us About Your Trip. Where Were You, Who Were You With & What Were Your Plans While You Were There?

BP: I was in Bali on the 2007 NMD trip where we were filming podcasts and shooting for a feature story, so I was surfing my arse off.

The day after the trip had ended I felt like I had a sore back when I woke up, but I went on a drive to Ubud anyway. By the time I got to Ubud I had a fever and a headache, so I lay down. That afternoon I could barely move and felt extremely weak. That night my fever got worse and I started hallucinating. The next morning I was almost blacking out from the fever (that might have been from almost overdosing on Paracetamol!). I decided to get my girl friend at the time to take me to hospital which was an hour away. By the time I got there I was falling in and out of delirium. I would wake from it in a crazy shivering fit, and then get too hot and sweat profusely, then pass out.

The next 4 days went on like this. My platelet count (the gauge for how close you are to dying from Dengue Fever) was down to 30/220 which was really low, and my fever got up to 41 degree which is 1 degree off causing brain damage.

Did You Take Precautions Against Mosquitos?

BP: I didn’t at the time. I didn’t know much about Dengue Fever, only really Malaria at that time. I’d heard of Dengue but thought it was mild like the flu or something.

ben player tropical fever

What Treatment If Any Did You Have?

BP: There is no treatment for Dengue fever, you have to wait for your body to form it’s own defence against it and make an anti-virus. The anti-virus is actually the biggest problem with dengue fever as every time you get it, the anti-virus from previous infections reverses, so you’re getting attacked from multiple Dengue Viruses at the same time. There is 4 different strains known, but apparently you only usually make it to 3 before you die, as your platelet count will get too low and you start haemorrhaging all over your body. You usually die from internal bleeding.

How Long Did It Take To Get Better? How Are You Now?

BP: It took about 6 months in total. I couldn’t surf for ages as all of my spacial awareness was out, and doing simple moves like El Rollos was impossible for me. I am fine now, but I can’t risk getting it again. If I get it again I will have to get a blood transfusion to help increase my white blood cells/platelets. I asked the Doctor in Australia what precautions I can take and she said ‘don’t got to troical countries’. That’s a bit hard when all of my favourite waves are in tropical places..

Do You Do Anything Differently On Trips Now As A Result? What Would You Advice To Someone Going On A Surf Trip To A Dengue Fever Area?

BP: I cover up at all times in long pants and shirt and put repellent with heaps of D.E.E.T in it. I don’t like doing this but it’s the only precaution I can take so I do it well. It’s ok in Indonesia though as you look like a local and fit in better, but in places like Mexico it’s kind of weird as everyone has their skin showing.

Thanks Ben.

Read our article for more information on Tropical Fevers.

ben player
Mozzies Don’t Surf

The images used for this interview have been taken from the following film by Edward Saltau featuring Ben on a recent holiday in Bali. Its an exceptional piece of filming & editing with a candid interview and inspiring surfing.


Injuries to your spine are serious. Paralysis & death is not uncommon after SPINAL INJURIES.

I’m sticking my own neck out writing this! The purpose of this article, & the information in it, is to get more people safely to a hospital. Apply common sense and don’t take chances.

Not all spine injuries are dangerous, but Its impossible to know that without a hospital and xrays. Damien Martin below is one of the lucky ones.


There is no rule to this. You should always be suspicious. Your mate who’s been slammed on the sand with a broken collar bone/nose/wrist/concussion, or any distracting injury, is at high risk. Breaking your spine isn’t always as painful as you may expect. Another injury that IS painful can distract you from a spinal injury. Its well documented that 10 % of head injuries have a spinal injury aswel.

broken back
This is the wave that broke Damian’s back.

A missed spinal injury can have much more severe consequences than one that’s picked up and managed carefully. Paramedics are taught to assume that every trauma patient has a spinal injury.

The vast majority of spinal injuries are painful to some degree. Your mate rubbing their thumb down the boney points of your spine shouldn’t be painful, and if it is you should suspect a spinal injury. Obviously finding a step or lump in the spine is a clear indication that things aren’t as they should be!

Any of the following is a good indication of a spinal injury:

  • pain anywhere along the spine
  • pain spreading from the spine around to the front of your body
  • weakness or paralysis
  • loss of sensation
  • An erection. Have you broken your back or are you just pleased to see me?! This is actually a really sensitive sign of a spinal cord injury.
Just because you don’t have any of these signs doesn’t mean you don’t have a spinal injury. In fact moving someone who does have a spine injury is dangerous and can cause the above.
 Don’t move.
As a general rule the higher up the spine the injury the more serious the consequences.
High injuries are associated with difficulties breathing/coughing and can dramatically drop your blood pressure.
 Injuries to the  neck (cervical spine) still need immobilisation of the whole spine.
Unless your life, or the person you’re ‘helping’ is at risk from where they are, then not moving and waiting for trained professionals is by far the best thing to do. Moving them could paralyse or even kill.
Keep them warm. This video is quick and quite useful. It’s really important to immobilise the neck in the way shown in this video.
If you think that they have a spinal injury and that their life is at direct risk from remaining where they are then moving them should be done with as many people as possible. The person should be lifted keeping their spine in line with their body and as straight as possible. This is called a log roll and should only be done by professionals. The following video shows two professionals performing a log roll.
If your attempt to align (get the straight) the injured persons spine in order to immobilise them causes pain, then its a good idea not to try and align them.
If you’re miles from help, or there is none, then consider using a surfboard, or some other hard flat object, as a spine board. Its important to consider that it only takes an hour to start to develop pressure sores, so use towels or clothes on the board to act as a bit of a cushion. Making sure obviously that the material doesn’t prevent the injured person from lying flat.
There’s nothing that gaffer tape isn’t useful for on a trip. Use the tape to secure the injured person to the board. Roll up clothes either side of thead to improve the heads stability.
Injured people can often be distress and confused and don’t like lying still. A spine board that keeps them immobile can be distressing for them. This doesn’t matter in the great scheme of things.
Don’t dop them!
No matter where you are or how good your trip is. Anyone who has a suspected spinal injury needs to get to a hospital urgently. If they have to be moved by non-professionals then every care MUST be taken to make sure their spine doesn’t twist, flex or move out of line with the rest of the body.
A sobering image. This person fell down two steps. An injury this high can have catastrophic consequences.


You’d be unlucky to get a neck wound from surfing, but its not that unusual from car & bike accidents.

Bear in mind that your neck contains lots of important stuff! Don’t go poking around inside a deep wound trying to have a good clean. This should be done by a surgeon in a hospital. Clean the outside carefully but don’t go inside! Wounds that are clearly just on the surface can be cleaned normally. Read our article on how to do this first if you’re not confident.

Dressings- NEVER bandage around the neck. Swelling can increase pressure and close the airway.. Suffocation isn’t always obvious.

Author: Dr Dave Baglow


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.

A large proportion of the photos on this site are not our own. We have tried to reference all that aren’t ours in good faith. Please contact us if you feel any of your pictures could be referenced better.



Imagine if sharks killed one million people every year.

You would seriously think twice about paddling out at any location where there were reports of regular fatalities, and if you did still go you’d be likely to change your behavior.

Why is it then, that when Mozzies are responsible for tropical fevers that kill this many people every year that a lot of us don’t give it much thought?

tropical fever
A lesser known ‘Sharkmozzie’


Okay, so a shark bites may itch slightly more than a mosquito bite, and the overwhelming majority of deaths that occur are in local populations (kids under 5yrs), but the fact remains that if you go on a surf trip to a tropical country you’re far more likely to be killed by a tropical fever than from a shark attack.

I know four English people that have malaria. How many friends do you have that have been attacked by a shark?



Malaria is a parasite that has been killing us since humans first walked the planet. So it knows what its doing! There are 5 main species but the main two to watch for when you plan your trip are P. falciparum & P. vivax.  The parasite spreads via the female of a species of night biting mosquito. P. falciparum is responsible for almost all of malarial deaths and P. vivax is the one that can crop up whilst you’re checking the surf at your home break 6 months later. And then keep cropping up.. That might sound cool, like a Padang scar, but try it on when you’re in your 60’s. Not so cool.

Malaria is a grave threat to millions of peoples lives globally. There are huge initiatives internationally to try and remedy this by different means. If you are interested to find out more about Malaria and the issues surrounding it there are now traditional and online programs available from many accredited academic institutions and universities. Understanding an issue can often be the first major step to helping combat it.


Dengue fever is a virus that is also carried by mosquitoes. The virus wrongly received a lot of media in the surf industry recently due to it alleged responsibility for the sad death of Andy Irons. It’s known as ‘breaking bone disease’ because the people who get it can end up in so much pain they feel like all their bones are breaking! There are 4 different strains of the virus, and having ‘caught’ one of them before makes subsequent infection with another much more serious. In 2010 it is estimated that between 50-100 million people worldwide caught Dengue, with estimates of half a million dying. If you’re really unlucky (like Ben Player) you can go on to develop ‘Dengue Haemorrhagic Fever’. Fighting the illness basically knackers your liver & destroys your bloods ability to clot normally. This unfortunately can lead to you literally bleeding to death.

dengue fever
Dengue can unfortunately make you literally bleed from your eyes.

Unlike Malaria there is no cure. You’ve just got to try and sweat it out with fluids and paracetamol.


  • Tell EVERYONE who’ll listen that you’re going abroad to score sick warm barrels while they’re slogging out winter here. This is important.
  • Get medical insurance. You’re an idiot if you don’t.
  • If you’re in anyway like me you’ll spend hours on the internet creaming over pictures & videos of the surf planning your trip. Spend 10 minutes on http://www.who.int/malaria/travellers/en/ and read their annual update (click on ‘International travel and health’) on which type of malaria is where, and which drugs you should be taking. This is the website that the travel nurse at your GP surgery uses for reference.

As a general rule, If you can surf there without a wettie (excluding Oz) then they have malaria.

  • Go to your GP early armed with a list of all the vaccines/boosters (Hep A is a must) that the World Health Organisation (WHO) recommends for your destination at that point in time, and the name of the anti-malaria drug(s) you’ll need.
  • They’re likely to give you a private prescription, which generally cost more than a NHS prescription. As far as I know Superdrug is the cheapest place to pay for private prescriptions.
  • TAKE YOUR PILLS. All drugs have side effects and all people respond differently. Take them early as directed to check that you can tolerate them. Basically watch your mood, and look forward going to sleep because it’s like going to the cinema!!
  • Take long sleeve tops/light trousers. Pack a mosquito net and take repellent. Be aware that sun cream with anti-mosquito additives used in the sea is really bad for reef ecosystems. Just a thought.
  • A week of binging to say goodbye/rub noses in to everyone before you leave is not necessarily a great idea. Give your liver and body a chance to get match fit.
Causes vivid dreams. Probably best avoided if you’ve got a history of mental illness.


  • TAKE YOUR PILLS! If your gran can keep on top of her daily pills then so can you. That doesn’t mean taking them in between jungle-juice induced spews either! Taking them doesn’t guarantee not getting malaria because the virus mutates quickly. Not taking them regularly or not taking them at all however is proven to significantly increase your risk of contracting Malaria.
  • Don’t sleep next to a swamp, or any stagnant water. Rubbish holds a lot of water on it.
  • Sleep behind nets (impregnated ones are shown to be better). Beware passing out hammer drunk & exposed.
  • Use repellant. Use it as a second skin.
  • Cover up evenings/night and early morning.
  • Leave your net and left over repellant behind for the locals. You never know, it could be the best gift you ever give.
  • If you’re ‘making friends’, use condoms. Malaria isn’t a STD but Hepatitis and HIV are common in developing countries and Kill.


Things you’ve got in your favour are that you’re not malnourished. You’re a chubby Brit with medical insurance to help bail you out if you need, and importantly your mates feel great!

A publication to GPs in the US estimates that 37% of short-term travelers experience a health problem during a trip abroad, and of 11% of travellers suffer from an illness with fever. So be aware of your health and those you’re travelling with. Don’t panic at the first sign of illness, but be sensible. Make contingency plans early. A friend told me her account of ‘when she almost died from Malaria’ and her friends (medical students) forced her to go to the nearest doctor who was a couple of days away whilst she was in a persistent feverish state. They ended up eventually carrying her in to the doctors virtually unconscious. She was very lucky.


Basically you name any symptom (including those caused by liver failure, kidney failure, coma & death!) and Malaria can cause it. The symptoms you have depend on your bodies reaction to it. Chances are though that you’ll feel worse than you’ve ever felt before, and you’ll literally be shaking with fever. Malaria can kick in at any point after a couple of weeks.

Dengue is a bit quicker at kicking you into touch. Early signs apart from fever are severe muscle ache/pain, and pain behind your eyes made worse by moving them. It also quite commonly has a rash that looks like measles.


Being ill on a trip and having a fever doesn’t mean you have a Mosquito born virus. A lot get better on their own and never get diagnosed. Some are caused by less exciting illnesses we get here in the UK like chest infections and the flu.

Don’t forget that your illness could be a sign that the reef cut you’re been nursing, and watching with fascination getting bigger day by day, is getting funky!

Fever patterns (how long it lasts, when/if it returns) can help indicate the disease, but are not diagnostic. Any Fever returning after a day or so should be treated seriously.


If you’re worried then seek medical advice. A good general rule in medicine is that early diagnosis and treatment usually leads to a quicker and better outcome. Apart from the preventative measures, this really is the most important point.

The key to treatment is diagnosis. In the UK we are understandably crap at diagnosing foreign illnesses compared to our foreign colleagues. If you visit a Dr abroad that has spent their career diagnosing and treating tropical illnesses, then chances are you’ll get a quick and more accurate diagnosis. If you get ill when you’re back within 6 months or so (or longer if you’ve been ‘making friends’!) remember that it may not just be something you’ve picked up here in the UK.

Malaria treatment involves high doses of anti-Malarials in hospital, and Dengue Fever is bed-rest with fluids and Paracetamol.

Paracetamol is a great drug for reducing any fever and worth packing with antihistamine tablets for bites and stings, along with rehydration salts.

Remember that if you don’t take the anti-malarial tablets regularly and don’t protect yourself from Mozzies, then you’re playing roulette with your health. I know that anti-malarials can make you feel grim sometimes, but they do work most of the time. There is research going on to make better ones, but not enough.  At the moment there is more cash invested globally in developing new anti-baldness drugs than anti-malaria ones!

We can all probably think of times when not having put a leash on our board could of had us on a really sticky wicket. An action, which it’s easy to see the  benefit from. I’m 100% confident that there are people that will read this (scaremongering) article that would have been severely ill, if not dead, had they not been sensible and already followed the advice above.

It’s hard sometimes to appreciate the benefit without seeing it. Worldwide charities appreciate it and that’s why there’s an international drive to provide mosquito nets to people in affected areas worldwide.


So in conclusion, Mosquitos are evil and deserve to die!

Have an awesome trip.

Make sure you check with your GP before you take pills, especially if you have any kind of medical condition. This article should only be used as a guide.

Tropical Fever

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.

Alan Stokes Interview

“The bottom of the wave dropped out over a shallow ledge. I got compressed by the lip into my board and my knee just popped and gave way.”

Alan Stokes 2X UK Pro Surf Champion talks of his horrible knee injury that threatened his hobby, career and mental health.

Alan Stokes Surfer

What’s your favourite wave at home and why?

AS:  My favourite wave at home is a secret! I also really like surfing at a Fistral. Its where I grew up surfing, and its still the bench mark spot for progressive surfing in the UK.

What’s your favourite wave abroad and why?

AS:  My favourite wave abroad would have to be Snapper because it has all the sections, but its mental busy, more like slalom surfing.

Tell us about your Trip that you had your injury on? 

AS: I injured my knee on a film trip up north for the StRaNGeBeautiful LIFE series, surfing with mates Tom Butler and Lyndon Wake.

What happened when you had your knee injury?

AS:  Basically I got too cold. The sets were really inconsistent and I was thinking ‘im just going in on the next wave to run around on the reef and warm up’. Unfortunately the next wave i hurt my knee.
I tried to pull into the inside tube section backside without grabbing my rail. The bottom of the wave dropped out over a shallow ledge and i got compressed by the lip into my board. My knee just popped and gave way.

The Wave that claimed the knee

Did you know it was a serious injury?

AS:  While I was still under water from the wipeout  I knew what I’d done. I wasn’t even swimming back to the surface. I was just really gutted because I knew it would be along time before I could surf again.

Did you know how to treat the injury? What did you do?

AS: The first thing I did was get my weight off it and get it into the air with some ice to prevent further swelling. I called my phyiso guy and he basically diagnosed it over the phone. He’s really good and he just laid it all out, what I needed to do there and then, how long it would take etc. By the time I got to see him a few days later I had already started the healing process.

-MRI showing the damage that was done

What did your recovery involve?

AS: I stayed home for four months and rehabilitated the knee just using equipment I have at home, and then visits to my physio to see how it was getting on.
I’ve had a few injuries, mainly ligament or tendon, and I’ve learnt that time is the biggest healer. It takes months, and you have to make sure you keep flexibility in the joint.

Did you get depressed after your injury?

AS:  I started off really positive. I just took the time to rest and do some things that I didn’t have the time to do. After a few months however I did go through quite a bad depressive period. I’m a super active and motivated person, so it got tough, but my lovely girlfriend Celine and friends sensed something was up and they all really helped me. That was special, and it gave me energy to get better, so a big thank you to them.

How is your knee now? Do you approach things differently?

AS:  My knee feels really good now. My surfing is back to normal and I feel like im progressing again. I’m still trying to fight the demons in my head and not think about it altogether, but that takes time so im just trying to let that go, and not process it to much.

Back on his feet

What advice would you give someone that has an injury that is going to keep them out of the water for months?

AS:  My advice is if you suffer an injury that will keep you out of the surf, would be firstly be to think if you cant surf, can you body surf or body board? I’ve hurt my ankle  before, but I could body surf for four months, so when I got back out there on my board I was fitter than ever.

Also you have to keep positive, I know it sounds stupid, but a positive mental state will increase the healing process, it’s all energy connected.

What are your plans for the future?

AS:  To keep surfing bigger and better, compete and continue the StRaNGe Beautiful LIFE project.

Danni or Kylie?

AS: Neither. My girl Celine is the hottest thing this side of mars.

Thanks Alan.

Have a ganders at his website for more media on what Alan’s been up to.

The images for this interview are taken from Stoksies’ stunning film series StRaNGe Beautiful LIFE project. In Episode 5 he talkss of his injury and shows a pretty good account of his recovery back to full fitness!

Click here to go to StRaNGe Beautiful LIFE’s facebook page to see what they’ve been up to.

Alan Stokes Surf
Alan’s sponsors ‘Animal’ stuck with him during his injury period and recovery48158968


You never know when it may strike.

TOOTHACHE, gum disease and teeth damage are a pain on a surf trip. Literally.

Dental problems such as toothache are very unlikely to kill you, although the pain can be so severe, it may seem that way at the time.


  • Hurts all the time?
  • The toothache wakes you up at night?
  • Tooth tender to touch?
  • Possibly some swelling around the gum at the top of the tooth?

You have a dental abscess.

Antibiotics will sort this out in the short term (taking them for anything from a week to 6 months), but ultimately you’ll need to find a dentist for the offending tooth to be pulled, or have the root treated.

  • Sensitive to hot & cold?
  • Pain lasts for more than a few minutes?

It is likely you have some decay in a tooth.

You need to find a dentist to get it filled in or pulled out. There aren’t any serious problems beyond the toothache itself. So if you’re stuck somewhere with no access to a dentist it’s a case of taking some pain killers and just hardening up.

If you are sensitive to hot or cold (more so to cold), some ‘Sensodyne’ type tooth paste rubbed on the teeth should help in a day or 2.

tooth anatomy


Living it up, smoking and drinking excessively, and not brushing your teeth effectively can affect your gums. If your gums bleed or are sore when you brush, you do not have a weird tropical disease, you have boring gum disease! Brushing your teeth and gums twice daily can treat this. The bleeding and soreness will stop in a couple of days.

Wisdom teeth are the teeth that grow right at the back-top & bottom of your trap. The gum surrounding the teeth can become swollen, and you may even begin to have trouble opening your mouth. If this happens it is likely that you have an infection of the gum due to a partially erupted wisdom tooth. Antibiotics and cleaning around the gum with a good toothbrush will sort it out.


broken teeth
Mike’s winning smile after a post-surf skate

You fall and hit your teeth 0r get smacked by a board. Remember to think about the problems you can get from a head injury.

The teeth can break in a number of ways:

Broken Teeth

The crowns (the part of the tooth above the gum) can snap off. This will smart a ‘little’. Probably worth trying to find a dentist who will stabilise it by covering over the broken part. If there are no dentists available, chewing gum over the broken part will ease discomfort a little. Take pain killers.

Wonky Teeth

The tooth is wonky & looks like it has moved. It can catch in the bite. You have likely moved the tooth in its socket.

The treatment is to try to move the tooth back into position. Probably best done by a dentist. You can try moving it back yourself, but it will hurt. Take a firm hold of your tooth and push it back into position.

Loose Teeth

The root of the tooth breaks. If the tooth is very loose you’re probably going to lose it. To try to save it the idea is to stabilise it with some sort of splint. Or if you are in the middle of nowhere, you can try to remove it yourself by taking a firm grip and pulling. Again this will ‘smart’ a bit.


Bad teeth in a very few number of cases can cause life threatening problems.

If you notice that your eye is beginning to close from the swelling on the side of your face, you should make plans to go see someone medical. It is still treatable with oral antibiotics but sometimes doesn’t respond very well, and you may need antibiotics put in your blood (IV). Get to a hospital.

If the floor of your mouth (under the tongue) starts swelling this can cause problems. If you start to notice it is becoming difficult to swallow, and especially if you notice it is becoming difficult to breath, drop what you are doing and get to a hospital. You need antibiotics in the blood (IV).

If you are in the middle of nowhere keep, on taking the oral antibiotics, don’t panic, and aim for the nearest place that can get you I.V. antibiotics.

Hells Mouth
Hells Mouth, Wales, UK


Tooth abscess

Amoxicillin 500mg  x3 day for 7 days.

Clarithromycin 500mg x2 a day for 7 days

Metronidazole 400mg x3 day for 7 days

( only one of the above )

Gum swelling

Metronidazole 400mg x3 day for 7 days

Floor of mouth swelling / eye closing

Metronidazole 400mg x3 a day 7 days + Amoxicillin 500mg x3 a day for 7 days.



Author: Mr Chris Munn

Download this article here

This article has been written with the traveling surfer in mind.

We get contacted a lot from people with teeth related questions about every day care and management. It can be hard to find out about your teeth without the fear of paying vast sums of money. In our opinion the best website out there for information on everything to do with teeth & their care is www.toothloop.com. It’s a free site written by dentists with really clear, detailed information on everything to do with teeth. It’s the site we use as our main resource when we come across people with dental issues and it’s the one we’d tell you to look at if you ask us anything too complex about your tegs.


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.

A large proportion of the photos on this site are not our own. We have tried to reference all that aren’t ours in good faith. Please contact us if you feel any of your pictures could be referenced better.



It hurts, looks rubbish and is a burning reminder of the real risk of skin cancer all of us face from the sun.

Skin cancer kills more surfers than drowning. Maybe we should be worrying more about the UVA & UVB properties of our creams, than how long we can hold our breath..

Sun burn & sun stroke can ruin your trip, make you unwell and kill you in the long term. Over the last decade surfers are getting wise to the risks. Its common to see suncream in the car park in the summer, and long sleeve rashies with hats on the boat trips.

Some people claim that they ‘never burn’. Good for them. I burn. That doesn’t mean that they’re immune to skin cancer, and there’s a strong argument that fair skinned people who take good precautions are at less risk than a darker skinned person who doesn’t.

Two-fifths of people (40%) say they burn their skin in the sun on purpose to ‘deepen’ a tan, according to new research by Macmillan Cancer Support. This is despite the fact that getting a painful sunburn just once every two years can triple the risk of skin cancer. You can read more about their research here.

Painful Sunburn


If you’re British you’re probably more used to dealing with hypothermia than sun burn. According to Macmillan 25% of us think that we need to burn inorder to tan!!!

  • Some people argue that going on a sun bed a few times prior to a trip gets your skin warmed up (‘base tan’) and ready to deal with scorching sun all day for a couple of weeks. I haven’t been able to find any evidence that this works so I can’t recommend it.
  • UV rash vests. Think about the arm length, neck cut and how well it fits around the waist. I always forget to put cream on the base of my back before a surf.
  • Hats. They work really well to keep the sun off your face and neck. The designs have improved and its starting to be accepted that you don’t have to be a knob, or a ripper to wear them..
  • Sun Block. Everyone has their favourite products. Slap it on. Try and use UVA & UVB. Give it time to soak in before you go in. The stronger the better. Remember that spf declines as the product ages so check the use by dates.
  • Zinc cream. Highest spf available. Bright colours. Makes you feel like a kid putting on face paint. Put it all over the bits that stick out of your face!
  • Lip Balm. An often forgot about bit of skin. Commonly burnt and very prone to skin cancer. Apply lippy!
  • Some people try and avoid the midday sun. I don’t, I’m there to surf so I just make sure I’m covered up and lubed up with sun cream.
  • Surf in Scotland.
Ireland can offer some shade from the sun too.

Australians are largely descend from cooler climates, and are now living now under tropical strength sun. They have a high rate of skin cancer as a result. In response to this they are streets ahead the rest of the rest of us in getting the message across about being sensible in the sun. Its working and their incidence of skin cancer is falling.


Know what product to use, where and how often. This really is the key to reducing the risk of sun burn and problems associated with it. There’s a lot to learn. I really recommend reading two detailed articles published by Surfline about sun burn & sun cream. These articles are so comprehensive that we’re not going to elaborate on sun cream further.

We’ve also found a website that claims to have reviewed every sun screen product available. Worth a look if you’re deciding what to buy.

Just make sure you lube up!


  • UV radiation goes into wet skin better than dry.
  • Most (65%) of UV radiation in the day hits between 10am & 2pm.
  • Clouds & sea mist aren’t good at blocking UV radiation
  • If you’re brown and you don’t use cream you’re still at risk of premature skin aging and skin cancer.
  • You should be up to date with your tetanus boosters before you go anywhere.
  • Anti-mozzie properties in sun cream can really knacker reef ecosystems by killing of the small invertebrates. It only takes a couple of people wearing it to have an impact.
Different ways to get out of the sun. Some harder than others.


There can be a delay.

  • Red skin that’s warm to touch
  • Intolerance of warm water
  • Skin discolouration
  • Blisters. These can take a few days to develop.


From severe or prolonged exposure. This is worsened by dehydration and can be a medical emergency.

  • Fatigue
  • Fever with the sensation of chills
  • Nausea
  • Vomit
  • Rash
  • No sweating (due to severe dehydration)


A reasonably helpful video:

  • Once you’re burnt you’re screwed. You’d be a fool to keep going out in the sun. That means less waves so make sure you prevent it happening.
  • Keep in the shade
  • Keep hydrated with clean water. Try not to get smashed on the local booze.
  • Ibubrofen works well for reducing the discomfort. Putting ibubrofen gel onto burns is claimed to help the pain and reduce the reaction. These claims however are made by the companies that make the gel.


Most sort themselves out on their own. The following helps reduce the damage done:

  • Apply cool clean water. Do this for about 20minutes. Not too cold as you can burn the skin further (cold burns). Do this at least 4 times a day.
  • Ice packs (that are clean) have good evidence but again make sure you don’t burn the skin. Repeat 4 times a day.
  • Keep clean
  • Do not break blisters. They act as a barrier to infection.
  • Antibiotic cream should only be used on severe blisters.
  • Avoid oil based creams early. These can exacerbate the damage. Try keeping damp clean cloths on the area.
  • Moisturisers (non-perfumed) once the initial burn has died down help prevent the skin drying and cracking.
Moderate sunburn with blisters.


  • Keep hydrated
  • Good diet
  • Loose clothing over area
  • Avoid further sun exposure
  • Don’t smoke (reduces the blood supply to your skin)
  • Aloe Vera cream
  • Vitamin E cream


If you have any concerns about your health or the normal function of the area of body that is burnt.

  • The sun burn appears to be deep. Try pressing the area. The colour should disappear and then return. If this doesn’t happen (doesn’t disappear) then its deep. If its white its deep.
  • Deep burns aren’t to be messed with. They can kill.
  • If you have bad burns all the way around your neck you should consider going to hospital. Keep the burns moist to prevent constriction.
  • The area looks infected
Mick taking no chances.
Click to visit http://www.skincancer.org/ for useful information.


You’re more at risk if:

  • Loads of moles / freckles
  • Fair skin that does not tan
  • Suffered with bad sunburn in the past, particularly as a child
  • Family history of skin cancer
  • History of lots of time in the sun, even if sun cream was used.

Its really really common. Not having any of the above risk factors doesn’t mean you can’t have it.

I was going to write a bit about the different types of skin cancer, but I’ve decided not to. If you’re go any dodgy looking moles, freckles, skin discolourations or itches you should go to a doctor to have them looked at.

Early diagnosis and treatment is the key to make it a curable, not fatal illness.

Remember to cover up, keep hydrated and use loads of high SPF sun cream.

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.



That moment when you realize that you’re not invincible as you get smacked in the head, really hard, and the lights go out.

What do you do when you’ve hit your head? I almost decided not to write an article on head injuries because of how serious they are. It was the experience of a friend who knocked himself out and wasn’t sure how seriously to take it that made me realize that this article would be useful. He had brain contusions which are not cool. Hopefully this article will help people decide to go to hospital sooner.

Eye injuries, smashed noses, broken ear drums and other facial trauma will be discussed in other articles.

Porthleven UK on an early November swell. The only time I’ve hit my head hard in the sea.

We all think about it when see the water boiling in front of us, or set up to navigate a dry section, but serious head injuries in the surf are quite uncommon. You’re actually far more likely to have a head injury on the way back from the beach in the car (like my mate), or your way home from the pub, than you are in the water.

Everyone has a ‘sketchy-car-journey-abroad’ story. This article is aimed at advice on what you, or your mates, should look for if the lights go out and you see stars.


This isn’t a very lighthearted article. I’ve seen people who have died or been severely disabled from relatively unremarkable low impact head injuries. It really is very difficult to diagnose early without imaging machines. Head injury followed by a loss of consciousness is one of the injuries that I don’t advocate getting back in the sea straight after. Wait until you’re well. When you feel well do some exercises and see if you still feel well. A second impact is much more likely to be fatal. Get advice from a doctor.

Your brain is a box. If it bleeds the pressure in the box after a while can increase. The rising pressure gradually squeezes your brain and eventually pushes it out of the only opening in the box at the base of your skull. This kills you in the process. Before the pressure increases there may be a period of time when you may feel fine after an injury as your brain makes room for the extra blood in its box. You may then deteriorate rapidly.

Your brain may not bleed, but it may have little stress fractures (contusions) as well as swelling. This swelling creates mild pressure and basically causes the symptoms of concussion.


You Don’t.

head injury
sport hurts


Head injuries are really serious. Take them seriously. They’re an opportunity for your mates to prove their metal.

Bottom line is, if you’re in any way concerned about the behavior of a mate who’s hit their head you need to make plans to get them to a medical organization as soon as possible. This is why you have insurance. Throw all your money at it if you need to.

Remember head injuries can also mean spine injuries. Its thought that 10% of head injuries also have a spine injury. Be careful handling injured people. If help can come to them, don’t move them. Let professionals do their job. Read our article on spinal injuries.

If you’re concerned or just interested then the following link is a document that has the current UK guideline on Head Injuries. Skip to chapter 4.


Another useful resource:

The following then is a guide only, not the rule on when it may be okay for an adult not to go to a hospital after a head injury.


When all of the following are met:

(remember that if you have anyamount of concern you should go to hospital)

  • Normal level of alertness and ability to process information.
  • Low force injury
  • No loss of consciousness
  • No memory loss of what happened before injury
  • Maximum of one episode of vomit
  • No seizures.
  • No areas of numbness/tingling anywhere
  • No neck stiffness or discomfort from bright lights
  • No generalized irritability (this is important!)
  • No difficulties with vision
  • No bowel or bladder accidents
  • No severe or worsening headache
  • You weren’t hammer drunk or off your head before the injury!
Apart from the serious issue of the head injury, you may also have to navigate the problems associated with coral cuts, sea urchin stings/spines and general wound management.
Make sure you’re clued up on what to do.

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.



They can be your silver bullet! I always take travel medicine, particularly anti-biotics with me on surf trips. I know which I’ve had before however and that I’m not allergic to them. If you don’t, be careful. Some people can have nasty reactions to them so be careful.

Don’t buy drugs over the counter unless you know what they are and you know that you’re safe to take them.

Boring maybe, but it really is better to be safe than sorry.

Generally the antibiotic metronidazole is said to be the main antibiotic that you cannot drink alcohol with. If you’re worried enough about an infection though to be taking antibiotics, you should probably think about giving your immune system a break and not hitting the bottle.

travel medicine
Moroccan Medicine.
In some countries you can buy virtually any drugs you need over the counter. Especially if you offer generous payment.


travel medicine

This is what the World Health Organisation recommend:

Ciprofloxacin 750mg (over 18s only) & Loperamide (Imodium) 4mg

If no improvement in a day:

Azithromycin 500mg once a day for three days.


If no improvement AND blood in stools or fever continue to take Ciprofloxacin but at 500mg twice

a day for three days. If no improvement after this take Azithromycin 500mg

If after three days there is no improvement take azithromycin 500mg twice a day for three days.

If there are no signs of improvement after this you should be making plans to get to a doctor as you’re at much higher risk of the problems from having the shits for a week and you’ll probably need more fancy antibiotics and IV fluids.

Read our article on travellers diarrhoea.


Read our article on surfing injuries  ‘wound management.

Signs & Symptoms of Wound infection:

  • Pain
  • Swelling
  • Redness
  • Heat
  • Fever / feeling flushed
  • Formation of absecess

If the injury is prone to or displaying signs of infection consider a course (3 to five days) of:




Co-amoxiclav (Augmentin)

Antibiotics surf trip
IV Antibiotics. Should really only be mixed and given by those who know what they’re doing. Getting to those people if infections are poorly managed could be life saving.

DOXYCYCLINE can be used as a first line oral treatment for skin infections. 100mg a day is the dose people take for Malaria prophylaxis. If you have a wound that you’re concerned is going to get infected consider taking 200mg (two tablets) for one day, then continue with one tablet (100mg) a day. If you develop a skin infection whilst on doxycycline (for malaria prophylaxis) then you should consider using one of the antibiotics above as the bugs in your wound are likely to be resistant.


Most chest infections are viruses. Bacterial chest infections can sometimes take hold after the lungs have been inflamed by a viral infection.

The symptoms of a bacterial infection are:

  • Yellow or green sputum
  • Reduced exercise tolerance
  • SOB
  • Fever and night sweats

Chest infections aren’t really something you should be self diagnosing and giving yourself antibiotics for. If you think you have one, and you’re not about to fly home you should make your way to a hospital for treatment.

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.



Avoiding dirty local water by not having ice or salad while travelling. Taking daily ‘friendly bacteria’ tablets to try and out compete the nasty ones to prevent Bali belly. Avoiding local food (badly cooked chicken, reheated rice, food with raw eggs & ice-cream)  and washing my hands before eating anything..

I’ve tried it all.

Nothing worked.

Pissing out of your bum is an occupational hazard on surf trips just like jet lag, sun burn and spending over budget.

It got to the point where on a trip to the Philippines I ate dog meat from a mobile street stall early on, hoping that the diarrhoea that followed would toughen me up and be the only ‘episode’ I had on the trip. Fail!

Theoretically ‘Bali belly’ (travellers diarrhoea) should be avoidable though. The steps I’ve tried do help reduce your chances, but you’ll end up having your fingers (and legs) crossed.

Having the squits is one of the most common causes of illnesses on a trip. It can be caused by simply a change in diet or bacteria (85% of diagnosed), viruses and parasites.

Most of the nasty bacteria are E-coli or its evil side-kick Campylobacter and their fury is limited to 2-3 days of diarrhoea. Hopefully

Infections lasting for longer are likely to be something a bit more exotic like Salmonella, Cholera or Shigella.

‘Shit tickets’
Don’t leave home without them.


Better out than in. Not thought to be the case anymore. The high poo output level was thought to be due to your body wanting to get rid of the nasty bugs, but its now widely considered to be because of the irritation to your gut.

You should aim to keep yourself hydrated.

Traveller’s diarrhoea in a warm climate can make you dangerously dehydrated. That means keeping yourself topped up with clean water (with hydration salts if you have them) and loperamide (Imodium) to block yourself up.

A lot of people find that they vomit with gut infections. If this is the case then have lots of sips of water. You’ll still absorb something hopefully. Take a tablet after a vomit and hope it stays down.


Most infections sort themselves out on their own. Just keep hydrated.

The World Health Organisation (WHO) advise a one off dose of Ciprofloxacin followed if this doesn’t work a day later by 500mg twice a day for 3 days.

This should help. If it doesn’t WHO advise to take Azithromycin 500mg once a day for three days. This is because a lot of bugs are starting to get resistant to Cipro.

Have a look at the article on which anti-biotics it may be wise to take with you. Remember that people can have nasty reactions to anti-biotics so be careful taking new ones.

It’s possible that your infection is a virus that may just sort itself out in time.

sewage fish food


Eat well and keep hydrated on a trip. You never know what’s round the corner!

The main problem is caused by dehydration. Getting fluids into you is a priority and if days keep going by and you can’t, then you need a hospital to stick some in your blood.

Losing lots of poo and vomit means that your body loses lots of important ions that it needs to function normally. You have a good reserve of them, but after a while without replacement (hydration salts) you will start to struggle and the acidity of your blood may start to change. This will then make you feel even worse than you initially did. This is a life threatening situation.

It’s hard when your life revolves purely around sleeping, puking and shitting, but try and make sensible decisions while you still can. No one wants public displays of infection (put nicely), but if you really start to struggle, get to a hospital. The shits can kill.

Don’t forget it could be hepatitis or a presentation of malaria!

If you start to get blood in your poo or vomit getting to a hospital is a good rule. If the blood is only on the toilet paper it’s okay usually. That’s if you even have any toilet paper. It may just be a dark hole and a bucket of water.


  • Take precautions.
  • Try and keep hydrated.
  • Take hydration salts (read instructions).
  • Take ways to clean water if you’re remote.
  • Take Imodium.
  • Take antibiotics with you.
  • Get to a hospital if you don’t get better and you feel gradually worse.

Remember that you’re not alone, and that one day in the future your life will once again not revolve around stomach cramps and explosive shit. Hopefully..

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.



Sea Urchins are found in oceans all around the world. they sting and can be your nemesis.

Sea Urchins are the reason why a lot us wear reef boots to protect our feet. Floundering (insert trying to look like a pro here!) on the reef trying to get in or out of the water is when I’m most at risk of getting nailed. Put your hand down on the reef (be it coral or rock) and you’re asking for trouble.

There is a debate as to whether urchin spines are actually poisonous. It doesn’t matter. Many species have little claw like structures between their spines which are venomous and sting. This means that urchins can mess with you in three ways:

  • Poison
  • Wound/cuts
  • Foreign Bodies (spine tips)

The only way to deal with urchin injuries is to tackle the poison and foreign body issues before you can sort out the wound.

Before I go into treatment I need to explain the grave (as in they could put you in one!) points for these issues.


Poisons can really sting, paralyse and kill. Local dive shops are a good resource for info on dangerous marine life. There are about 10 sea urchins that have poison and there are a few deadly ones. You’ll know soon enough which one you’ve caught yourself on..

You can be allergic (anaphylaxis) to sea urchin poisons. Feeling unwell, looking blotchy, red, finding it hard to catch your breath (wheeze) and tongue swelling are signs of this. Don’t be a hero. If this happens getting to hospital fast is your only priority. You need oxygen, IV fluids, IV hydrocortisone, antihistamines and adrenaline injected into a muscle. This is not a cool way to die.

You’d be seriously unlucky to react like that. If you’re like most of us your reaction will just range from no pain to a ferocious sting!


Injuries to tissue from sea urchin spines can be quite severe. They can swell, become red and inflamed. They can become extremely painful and are prone to infection which if allowed to can spread in the blood around the body and make you pretty unwell. Uncontrolled infections can kill.

If you think there is a chance you’ve broken a bone underneath the wound, or a sea urchin spine could have worked its way into a joint space you need to get to a hospital as soon as possible to have the area surgically cleaned. It’s not a rapid emergency like anaphylaxis, but don’t hang about. This isn’t something you can take lightly as we’re talking about losing bone is you don’t. If you’re not sure, don’t be a hero. You should make plans to go to a medical center where they can have a look at you and sort you out.


Sea Urchin spines break off as they damage your skin. If they are allowed to stay in/under your skin they are a source of bacteria and are foreign. Your body will start to react against them. Locally this will make the area become tense, inflamed, hot and very painful. Pus is likely to collect around the spines and form an abscess. If you’re unlucky this can then make you really unwell as the infection spreads around your body. Checking lymph node tenderness or swelling (groins for legs, arm pits for arms) may indicated spread of infection but is not at all reliable.


It may be useful to also read our article on coral cuts and wound management & surf injury.

The following is what I consider minimal care of an sea urchin injury. I’m going to include the steps to help with alleviate problems with poisons.

Remember that this is to increase your ability of being able to be in the water for the rest of your trip, and to reduce your chances of becoming unwell.

The best management of any skin injury would be to keep out of the water until its healed and to seek medical expertise in its treatment. To do anything else is at your own risk.

With that in mind this is what I do:

  • Soak the area in hot drinking water for at least an hour. Soak in a bowl or use wet cloth. The water should be as close to boiling as can be tolerated without causing burns. Add salts to the boiling water if you can or a few drops of Betadine solution. The heat will break down the poison and help with the sting. It also makes the area swell and soften a bit and make spine removal easier. Repeat as much as needed to help with the pain. Acidic solutions such as vinegar can be used as a substitute for hot water in breaking down the poison, but isn’t as effective in cleaning and softening the area.
  • Use clean (Boiling water) tweezers, safety pin or needle to carefully work out ALL the spines you can see. Believe me. This can be really uncomfortable but is really important. Your mates will love it as they get to torture you with a needle. Make sure they’re being careful and not doing more damage than good. Try reminding them it could be them tomorrow!
  • Use shaving foam over the area and gently scrape with a clean razor. I haven’t done this myself but I’ve been told by a couple of people that this is a very effective way of removing the small claw like bits of the Urchin snagged on the skin that contain the poison. If your wound isn’t stinging the chances are you haven’t snagged on a poisonous Urchin and you can skip this step.
  • Scrub. This is a really important step and will be uncomfortable. Use soap and clean water. You can use hydrogen peroxide or betadine solutions instead of soap. Make sure you rinse the area really well with drinking water after.
  • Allow to dry. Don’t cover with bandage or tape and keep flies away.
  • Dry savlon spray with iodine for example is really good to treat the area with throughout the day and evening.
  • If despite this the area starts to become swollen hot and red you need to start applying antibiotic cream, and if that doesn’t sort it out you should considering tapping into your precious anti-biotic supply. Co-amoxiclav, flucloxacillin or Penicillin V should work fine. If it doesn’t you may need to go somewhere they can put antibiotics in your blood.
Not all urchin spine injuries end in horror! They can quite commonly pierce the skin, and after cleaning, not cause much of an issue (apart from marks). If you think that this is the case, you should apply common sense and not butcher yourself with a needle/knife trying to get them out. This may only serve to guarantee infection later down the line, and theres no guarantee either that you’ll get them all out.
sea urchin spines

Not all spines cause a problem.
Removing these 3 would have caused significant trauma to the skin & really increased the chance of infection.
Vigilance is the key, to watch for early signs of infection.


Accept that the healing will be delayed and you’re increasing your risk of infection and scarring considerably. This is what I do:

  • If its an area of likely friction or abrasion try and tape it to help reduce damage to the area.
  • When out of the water repeat the scrubbing step described above. Use your common sense as to how aggressive you should be.
  • I find that the new ‘second skin’ ‘breathable plaster’ sprays are great for these sort of injuries when you’re going in the water. Some contain antiseptic. Cake the area in the stuff before you go in the water, and after you’ve cleaned them. Oh, and they may sting a lot when they go on!

If your digit starts to look like this (below) you need to start taking antibiotics or get yourself to a doctor to get them. Even if you do have antibiotics, bear in mind that if the bone gets infected you still need to go to hospital for antibiotics in your blood. Its hard to diagnose bone infection clinically. The pain will be bad, and antibiotic tablets won’t help much, if at all. Its diagnosed with X ray.

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.



If you haven’t got anything you can’t do anything.

Only take what you’re happy using and be careful taking medications with you that you’ve never tried before. Dangerous reactions to antibiotics aren’t that uncommon.

An injury on a surf trip in Europe is a different kind of gravy to an injury in the depths of Indo. Kit lists to each destination will be listed separately.

The articles on this site will hopefully (first) aid you in managing the commonly encountered injuries and illnesses. This article is about what basic medical kit we think its wise to take with you.


Read our article on ‘wound management’ & ‘reef cuts’.

EUROPEAN DESTINATIONS (and other well developed countries)

  • E111 if you’re British. This makes getting health care a lot quicker and easier. Its basically a blank cheque from the NHS.
  • Tweezers
  • Green needles
  • Cotton buds/tips
  • Small sharp scissors
  • Small bandage and safety pin
  • Dressing pads that can be cut to shape
  • Zinc oxide tape (keep stuff on in the water)
  • Gaffer tape (best at keeping stuff on in the water)
  • Spray on plaster (waterproof and breathable) with disinfectant.
  • Waterproof plasters
  • Steristrips
  • Gloves
  • Iodine spray. I really like this:
  • Sun screen
  • Paracetamol
  • Ibubrofen (Gives about 25% of asthmatics an attack. Be aware)
  • Antihistamine cream

This is a really basic list.

If you think you may need more items, you should probably be going to your nearest hospital for treatment and supplies. Chances are its not far. This will make sure you get the best wound cleaning, dressings and drugs.




Remember that if you’re worried about the injury, or you feel out of your depth managing it, you should make your way to a hospital. Here’s what we recommend you take.

In addition to the list above:

  • Antimalarials (read ‘Fever Pitch’)
  • Mosquito net
  • Insect repellant / DEET spray (This isn’t great for the environment so I only use in high risk areas).
  • Long sleeve tops for evenings
  • Always make sure you have access to clean drinking water.
  • A couple of small plastic syringes to help clean wounds.
  • A few large bandages (for redressing wounds)
  • More dressing pads!
  • Loads of tape!
  • A sling. T-shirts can actually be turned into handy slings..
  • Betadine solution (watch for leaks)
  • Hydrogen peroxide (watch for leaks and contact with eyes)
  • Cyclizine anti-sickness tablets (try before you go)
  • Anti-biotics. Read the antibiotics article. Be cautious taking new drugs for the first time.
  • Re-hydration salts.
  • Aspirin
  • Sutures. Read the wound management article


  • Insurance details
  • Contact numbers. This should include embassy’s, medi-evac, next of kin and local emergency services.
  • Photocopy of passports (or actual passport)
  • American dollars or Travelers cheques. I stash a credit card in my medical kit.

Please don’t rob me now!

  • If you’re really remote you should have a list of the places you can bolt too in an emergency and a vague idea of how you’re going to get there.

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.



Chunda. Blow chunks. Spew. Sea soup. Chuck-up. Vomit. Barf. Wretch. Hurl. Technicolour yawn. Puke. Losing lunch. Tossing cookies. Yacking. Ralfing. Heave.

Doesn’t mater how you say it. Sea sickness is really grim once it gets going and you know that you’re miles from land.

It’s embarrassing too. Everyone knows that there’s a direct relationship between how much of a watermen you are and how easily you get sea sick!

Well maybe not..

It doesn’t matter who you are. Everyone gets sea sick. The fun bit is finding out how prone you are compared to your mates. The not so fun bit is waiting to improve. Or giving up and hoping it kills you and so ending your torture.

Vomiting over the side of a boat is a good opportunity to start thinking hard about your life and focus on getting back to basics. Like breathing.



It’s thought to be (few other clever theories) caused by a confused set of information about your environment going to your brain from your eyes and (middle) ears. To interpret these conflicting bits of information requires your brain to make adjustments to the information it’s getting. The reason why some people are more prone to others, is that some are worse at adjusting for misinformation than others. You can be naturally good at it, and also learn it. Get your sea legs. The adjustment made over time is the reason why you can feel like you’re at sea when on land after spending a week on a liveaboard. 


  • Feeling sleepy
  • Nausea (mild to severe)
  • Dizziness
  • Headache
  • Sweating
  • Sweeping feeling of hopelessness and a growing disregard for self-dignity


  • Avoid sitting near exhaust fumes
  • Avoid getting to hot. Putting on a wetsuit on a boat is a classic. Try soaking it in water first.
  • Try not to go below deck
  • Cabins right at the front of the boat are going to move a lot up and down when on the move through swell. There’s some evidence that suggests that up & down movement is the worst.. It may be a good idea to swap to try and get a cabin in the middle of the boat.
  • Look at the horizon. Don’t actually try and focus on it.
  • Don’t focus on objects on the boat as your body will think that they are stationary.  It will be confused as to why your inner ear is telling it that you are moving. Confusion = Puke time!
  • Keep well hydrated
  • Don’t binge on huge amounts of food.
  • Being hungover makes you more prone to travel sickness..
sea sickness cabin
A room with a view. A cabin on deck at the front. Not the ideal place to sleep if you’re prone to sea sickness.


Once you’re blowing chunks its too late to take a tablet. Get them down your neck early.

  • Keep well hydrated. Especially is you’ve been in the sun all day. Dehydration + vomiting = Bad times.
  • Antihistamines such as cyclizine. Most over the counter travel sickness tablets are antihistamines. They make you drowsy. Piriton which is used for allergies can be useful. Have a look at our article on medical travel kit.
  • There are a number of good anti-sickness tablets out there which would be useful if you get sea sick badly. To get your hands on these you need to go to your doctor and get a private prescription. I find Ondansetron works really well for me.
  • Pressure bands. Some people swear by them. Good for them. There is some evidence that having a positive mental attitude reduces the symptoms of sea sickness too.
It’s not always hard going. Plain sailing somewhere in there Southern Atols in the Maldives

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.



Licking your wounds is something we’ve all learned to do since we’ve been old enough to fall over.

coral cut

It seems the fun police are winning in the UK, with ‘Health and Safety’ being used as their motto. Having said that, getting on a late night bus that’s twice your age, being driven (fast!) by a rasta smoking a spliff who’s using a monkey wrench instead of a steering wheel helps you reflect that perhaps the fun police aren’t all bad.. Maybe.

Skin wounds are probably one of the most common injuries sustained on surfing trips.

They’re not all bad. I remember my mate happily picking at his ‘Padang Cut’ on his leg when we were in Indo so it would scar. 12 years later its probably the only memento he has from that trip. Better than any holiday tattoo.

These are basic principles on how to manage a wound. Don’t use stuff you’re not happy using (like sutres). The better you care for any wound the less likey it is to become a problem.

The most important thing you can do though is recognize when it is becoming a problem and act on it. That may be antibiotics, or a trip to a hospital.

People die from infected cuts.




If you think they’re acting funny or were knocked out get them to hospital. Make sure you’ve read the article on head injuries.




Any cut that goes all the way through the skin has the potential to damage things beneath the skin. You need to decide if arteries, nerves, veins or tendons are damaged too.

If you’re not sure you need to go to hospital.

Nerves: is there normal sensation on the skin to light touch away from the cut?

Tendons: is there full range of movement of the damaged part of the body?

Arteries: Feel for pulses if you know them. Press the skin hard for 5 seconds with your thumb away from the wound. The colour should return to the area you pressed before you can finish saying ‘sting in the shower’.

BITES             Twice shy.

Animal (including human) & fish mouths are dirty! Bites often result in nasty infections and need to be cared for and monitored carefully. It’s a good idea to start taking antibiotics if you’ve been bitten to prevent infection. Don’t forget than animals can leave teeth in the wound too. The best management of a dog bite would include a x-ray to check for teeth.

Don’t close the wound unless you are sure there is nothing left in it.

Don’t forget that bites can also cause significant crush injuries beneath the skin.


Not the sexy kind! Foreign bodies need to be removed before you can close a wound. This is covered quite well in the article on Urchin Injuries.


fin rub
Fib Rub

The plague of every bodyboarder.

Prevention is the best cure. If I knew how to do that I would be rich.

Once you start to get a rub the best thing you can do is keep it clean and stop flies feeding on it.

No one is going to stop getting in the surf because of a few rubs. The best thing I’ve found for this the second skin sprays that are now availiable. They stop flies and dirt getting in them, and they offer a bit of protection from rubbing.

This is product I find really useful for keeping on top of fin rubs. There are loads of other similar sprays out there so shop around. The Savlon iodine spray mention in the ‘Medical Kit List’ article in the BEFORE YOU GO section is also a must bring in our opinion.

fin rub


This common injury deserves a dedicated article, but the principles are the same. Read our article on coral cuts.

reef cut anyone?


This is often the bit that is done worst, but is probably the most important.

There is no rush, so take your time to carefully clean the wound.

  • Remove ALL the foreign bodies in the wound including any small chunks of flesh that you don’t think have a blood supply. Don’t get carried away removing flesh, if you think there’s more than a few small pieces it should be done by a surgeon! Having a pair of tweezers or a few new green needles are useful for this.
  • Wash the area really well. Drinking water is really useful. Sea water isn’t useful (contains small organisms & eggs) but is just about better than nothing.
  • Clean area with soap and use a disinfectant such as betadine. Cleaning products are discussed in a different article.
  • Using a clean syringe to blast the area with clean water can be useful to help dislodge debris and assess the depth of the wound and any underlying damage.
  • If you think there is damage to any nerves, arteries or tendons or the wound contains things that aren’t foreign bodies that you don’t recognize (like bone splinters) DON’T CLOSE THE WOUND. You need to get to a hospital to have the wound dealt with properly.

Dress the wound with sterile cloth and bandage. Change if necessary.




Bottom line is that if you don’t feel happy closing a wound then you shouldn’t.

If this is the case then regular cleaning, clean dressings and prophylactic antibiotics will reduce the chances of serious infection. A large wound should be dealt with in a hospital. Leaving a wound ‘open’ increases the risk of infection and worsens the scar.

Don’t close wounds that look infected, have resulted from bites or wounds that are over 12hrs old.

surfboard fin injury
Nasty cut from a surfboard fin.



Special superglue basically. Its great for small superficial cuts. The great thing about it is that it can be washed as normal after a couple of days.

Its easy to get your fingers stuck to the cut. Avoid contact with eyes.


These are basically small bits of tape. They last about 30 seconds in the sea.

If you think you can keep the wound dry they are great.


If you’re going in the sea taping a wound can work really well. Remember each time you get out of the sea that you’ll need to clean the wound again and apply antiseptic. I’ve found that using tape isn’t really that effective for closing wounds, more just keeping it clean and preventing it getting worse.

Taping around a joint works well to keep the wound closed and helps keep it in place when in the sea. Be carefull not to tape too tight so you don’t cut of the blood supply to the wound, or the arm!

Tape is best used to keep dressings in place.


These are really good for closing skin. They place the skin together nicely and they don’t put the skin under too much tension. A potential problem with sutures.

Take them out the same time you would take sutures out.



Sutures       Stich up

Only suture if you are happy to do so.

There are loads of videos out there to remind you of how to do it:

Most effective way of closing a wound.

Only suture wounds that are clean and fresh (less than 12 hours old)

Deep wounds should be closed by professionals.

Use non-absorbable sutures. Ethilon 5 for the face, neck, ear or hands. Ethilon 3 or 4 for cuts anywhere else.

The sutures need to be removed after time.

Foot: 10 – 14 days

Arm or Leg: 7-10 days

Scalp: 5 days

Face: 4 days

Torso: 1 week

Don’t pull the sutures too tight. This will cut off the blood supply to the tissue around the sutures and prevent healing.

Good luck!


You’d be unlucky to get a neck wound from surfing, but its not that unusual from car & bike accidents.

Bear in mind that your neck contains lots of important stuff! Don’t go poking around inside a deep wound trying to have a good clean. This should be done by a surgeon in a hospital. Clean the outside carefully but don’t go inside! Wounds that are clearly just on the surface can be cleaned normally.

Dressings– NEVER bandage around the neck. Swelling can increase pressure and close the airway.. Suffocation isn’t always obvious.

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.



Surfing makes you more likely than the next person to get an ear infection. Having surfers ear or perforating your ear drum whilst surfing makes it even more likely. Whilst very rarely dangerous, they can be very painful, disorientating and worse of all keep you out the water.

There are simple preventative measures you can take, and things to do if you’re getting pain.


Ear Infections
Basic Anatomy Of The Ear



Ear canal (Outer Ear) infections are a common problem encountered by surfers in both temperate and tropical climates, although it is more likely in warm humid climates.

Surfing increases your risk of getting an ear canal infection 5 fold.


  • Surfing in clean sea water is better than dirty sea water. Complicated stuff!
  • The longer your ears remain filled with water after a surf, the increased chance of getting an ear infection.
  • Trying to clean your ear with something like a cotton bud annoyingly causes abrasions in the ear. This makes you more likely to get an ear infection
  • Having ‘Surfers Ear’ (exotoses) means that you’re more likely to have crap retained in your ears like sea water, dead skin and ear wax. This is bacteria’s equivalent of G-land and they can’t wait to go camp there. This obviously makes your ear more prone to getting an infection.
  • There are a large number of different bacteria that like the ear but the common one in surfers and divers appears to be  a bug called Pseudomonas aeruginosa. This is the Kelly Slater of the ear infection bug community.


Going in the water a lot and for long periods gets rid of the bacteria that normally live in your ear canal and replaces them with one that that’s a bit more hostile. It’s this hostility that usually precedes the ear canal getting infected.

How Do I Know If I have an Ear Infection


  • Itchy ear.
  • Painful ear which may become worse when you move your jaw.
  • You may have reduced hearing on that side.
  • Rarely the ear can discharge dirty fluid.

For an accurate diagnosis a Dr needs to have a look in your ear. There is always the possibility that you have a perforated ear drum and/or a middle ear infection which has different consequences.

How Do I Treat it?

  • Pain killers. Drugs like Ibuprofen work really well because they help reduce the inflammation.
  • Gentle cleaning of the ear. There are special cotton wicks you can buy in pharmacies. You can use cotton buds but be sure not to ram it in and that the cotton isn’t going to come off in the ear. Be careful not to cause damage to the ear. Use clean water that can have a small amount of betadine or another anti-septic added. Never use hydrogen peroxide as it will irritate the already agitated skin in the ear.
Ear Drops
Antibiotic & Steroid Ear Drops
  • Anti-biotic/steroid drops.
    • These are easily bought over the counter in tropical countries. The best one to go for usually contains an anti-biotic called Neomycin and a steroid. Some contain a local anaesthetic agent too to help with the pain.
    • The drops shouldn’t be used for more than a week as this can lead to fungal infection of the ear.
    • Put the drops wit your head on one side bad ear facing up. The ear should feel full after.

Can I Help Prevent It?

Sea water that dries in the ear canal causes formation of salt crystals. These crystals can keep moist and keep the ear canal wet.

Rinsing the ear with fresh water prevents this from happening.

If you have problems in the past with ear canal infections then you could consider using olive oil drops to help clean the ear.


Much more common in kids than adults.

The ear becomes painful and you can become to feel unwell.

  • These are much less common than outer ear infections.
  • They can occasionally become a problem after an ear drum perforation that’s resulted from trauma to the ear. Water & blood in the ear provides good conditions for bacteria and they are able to get into the ear from the outside.
  • The chances of getting a middle ear infection after a perforated eardrum are increased if you’ve had a recent cold/sore throat.

ear infection

Middle ear infections without a perforation should not be treated with antibiotics as they are usually caused by viruses. Perforated ear drums are discussed in a separate article.

Its sensible that any perforated ear drum sustained whilst surfing is treated with anti-biotics. This is because blood and water in the middle ear are a great mix for bacteria to grow. Amoxicillin being the drug of choice. Remember to think about if you have any known allergies to anti-biotics.

Middle ear infections can only really be diagnosed by a Dr that looks at the ear drum. If you’ve got ear pain and hearing loss and/or start to feel generally unwell it’s best to seek out a Dr.

Author: Dr D Baglow


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.

A large proportion of the photos on this site are not our own. We have tried to reference all that aren’t ours in good faith. Please contact us if you feel any of your pictures could be referenced better.