Cervical Spine Injuries and the Beach
Two Emergency Physicians go for a swim at Mooloolaba beach, QLD (Photo O. Thom)
This blog was submitted by Dr Ogilvie Thom. Dr. Thom is a Senior Staff Specialist at Sunshine Coast Hospital and Health Service in Queensland, and is a PhD Candidate at James Cook University in Townsville, QLD.
I work as an Emergency Physician on the Sunshine Coast in Queensland Australia. Most days of the week, you can find me swimming a couple of km’s before work along the Spit at Mooloolaba. It’s spiritual, it’s cleansing and when the wind is from the north-east it can even be a bit stingy. Most of the time though, it’s pretty flat, protected from the prevailing swell by Point Cartwright. I think that might be why it’s such a popular beach with visitors and locals alike.
Except the shore-break can be vicious (see picture!) At my work, it’s notorious for causing serious neck injuries. So much so, that there is little attempt at clearing the neck clinically when patients come from the beach with neck injuries. We send the vast majority to the CT scanner.
Five years ago I met Professor Richard Franklin at the World Conference on Drowning Prevention in Vancouver, Canada. We had a beer and a chat. Now I and my colleague Kym are doing PhDs with Richard, researching drowning. It very quickly became apparent to us how little evidence there actually is that informs the Emergency Department treatment of drowning patients. So we have set about trying to fix some of that.
I was immediately interested in the link between neck injuries and drowning. The available literature showed around five percent of drowning victims also had cervical spine injuries (1-3). Except all the literature came from the USA. The listed mechanisms of injury for these patients included diving into shallow water, falls, motor vehicle accidents, even plane crashes. But not one patient had been injured by a wave.
This didn’t gel with what I was seeing at work. So we took seven years of data from the hospital, and linked it with data from the Queensland Ambulance Service and Surf Life Saving Queensland. Then we linked it to wave data from the Wave Rider buoy and the time phase of the tide (many thanks to Mike @ BOM for his help with the data). Talking with Prof. Rob Brander from the UNSW Beach Safety Research Group opened my eyes to how complex and fluid beach morphology is, as well as the relationship the beach has with the waves and the tides. So I know how limited, even inadequate, this analysis might be but the data was the best we could get.
So what did we find(4, 5) ? You can read the full journal articles here and here on this topic, but I am a doctor and we love writing in point form so here we go!
· One in six of the cervical spine injuries seen in our hospital comes from the beach;
· Even in this high-risk population, less than 1% of drowning patients also had a cervical spine injury;
· The most common wave size associated with cervical spine injuries was 20 cm smaller than the average wave height;
· The last half of the outgoing tide resulted in the most injuries;
· An unacceptably large number of surfers (mostly female) are still getting injured diving (i.e. not getting wiped out) off their board onto sandbanks.
What does this all mean? At my work, we see an astonishing number of neck injuries from the beach. Despite this, very few people combine a neck injury and drowning (thank goodness!). I am worried by the number of surfers who dive off their boards rather than dismounting feet first. We need to get the message out. Being knocked off your board, ‘paying the tax‘ when you hit the ocean floor, is part and parcel of surfing. But getting injured diving off your board? We need to do something about that.
I understand why people hurt their necks in the last part of the outgoing tide. The water levels are dropping, where it might have been safer on the sandbank an hour ago, it’s not so safe now. I am not so sure as to why people are injured more frequently with the smaller waves. The power of a wave is proportional to the square of the height, so that a 2m wave is four times more powerful than a one metre wave. Hence more force to drive you into the ocean floor. Perhaps larger waves are more obviously dangerous to beach goers? So the inexperienced or lesser skilled swimmers only catch smaller waves. Perhaps it’s because smaller waves break in shallower water and there is less water between the swimmer and the ocean floor? More work needs to be done on this.
One last point to finish this blog. Almost every day I’m in the water at Mooloolaba, I see people catching the waves and putting both arms down their side and going ‘over the falls‘ head-first. It absolutely terrifies me every time I see it. If I say something to them, I am usually brushed off, sometimes politely. It’s sort of akin to driving a delivery van into a wall. Your neck becomes the crumple zone and necks don’t like that. So not only do we need to improve ocean swimming skills so people don’t drown at the beach, we also need to help people how to catch waves safely. So that they can come back and do it again and again.
A/Prof Ogilvie Thom with input from Kym Roberts & Prof Richard Franklin, James Cook University.
Contact: Ogilvie.Thom@my.jcu.edu.au
1. Chotai PN, Manning L, Eithun B, Ross JC, Eubanks JW, 3rd, Hamner C, et al. Pediatric near-drowning events: do they warrant trauma team activation? J Surg Res. 2017;217:246-.
2. Hwang V, Shofer FS, Durbin DR, Baren JM. Prevalence of traumatic injuries in drowning and near drowning in children and adolescents. Arch Pediatr Adolesc Med. 2003;157(1):50-3.
3. Watson RS, Cummings P, Quan L, Bratton S, Weiss NS. Cervical spine injuries among submersion victims. J Trauma. 2001;51(4):658-62.
4. Thom O, Roberts K, Leggat PA, Devine S, Peden AE, Franklin R. Cervical spine immobilisation is only required in drowning patients at high risk of axial loading of the spine. Emerg Med Australas. 2022.
5. Thom O, Roberts K, Leggat PA, Devine S, Peden AE, Franklin RC. Cervical spine injuries occurring at the beach: epidemiology, mechanism of injury and risk factors. BMC Public Health. 2022;22(1):1404.