Slammed by waves: Hundreds in Delaware hurt each summer

Hundreds of people will head to the emergency room this summer after being slammed by a wave on one of Delaware's beaches.

For some, this journey represents an unfortunate blip during summer vacation, a few scrapes and sore muscles. For others it's a life-changing experience – a broken neck, a cracked vertebrae, in some cases paralysis. And every year one or two people die from injuries sustained on a Delaware beach.

Dr. Paul Cowan of Beebe Healthcare in Lewes and a team of researchers from the University of Delaware's Sea Grant College Program and the National Weather Service are trying to determine when injuries are most likely to occur, what wave and weather conditions are most problematic and what role the ever-changing shape of the beach and wave patterns might play.

Ultimately, they hope to establish a warning system to alert beachgoers when risk of injury is greatest.

"We want to minimize those injuries," said Wendy Carey of the university's Sea Grant program. "We see the way to get there is increased awareness."

It's too late for Josh Basile, who had just finished his freshman year at Skidmore College when a wave on North Bethany Beach forever changed his life.

He was in waist-high water, holding his boogie board in his hand, when he turned his back on the ocean to watch his friends tossing a football on the beach.

"All of a sudden a wave picked me up," he said. "I landed straight on my head."

He fell face down in the water. He couldn't move. He couldn't scream for help. He held his breath and waited. His friends pulled him from the water, covered him and ran to get Basile's father, a physician. It was a private beach. There were no lifeguards on duty.

"The wave was so strong, it knocked off my shorts," he recalled.

Basile said his father immediately knew the injury was serious because of the bulge from the displaced vertebrae in his neck. Josh was airlifted to the University of Maryland Shock Trauma. He was one of four people there injured in the Delaware surf that week in 2004.

One moment, the Basile family was enjoying a spectacular day on its annual vacation at Bethany; seconds later a rogue wave changed Basile from a strong young man in his prime to a quadriplegic.

Basile finished college at the University of Maryland, graduated cum laude and then went on to the David A. Clark School of Law, where he graduated magna cum laude in 2013. He is now a practicing lawyer in Maryland and the District of Columbia, where he specializes in catastrophic injury cases. He also is the creator of Determined2Heal, a foundation to help people with spinal injuries.

Through this journey, Basile, 29, has studied beaches and wave action. He is convinced that Delaware's renourishment of beaches – dredging sand off the coast and pumping it on shore to mitigate constant erosion from rising seas – is a factor in surf injuries because large earthmovers smoothing sand on the beach also make the slope of the shoreline steeper, causing waves to break closer to the water's edge.

"I've been going to the beach my entire life," he said. With renourishment "the way the natural erosion took place was no longer natural."

Geologists, many in the surfing community and some lifeguards along Delaware's coast also believe beach renourishment plays a role in surf injuries. Waves break further in the ocean on natural beaches – rather than expending all their energy into shallow water on renourished beaches.

"Beach nourishment often involves obtaining coarser sand from offshore shoals," said Stephen P. Leatherman, a coastal geologist and professor at Florida International University, known as "Dr. Beach" for his annual best beaches rankings.

"Coarser beaches are steeper beaches," Leatherman said, and on moderately steep beaches with sufficient wave energy, such as along the Delaware coast, waves do break closer to shore.

Leatherman said people often ask him if there is a correlation between beach renourishment and increased potential for injuries. While he would like to tackle the research, he said, funding has not been available.

Ron Phillips has life experience to tell him renourishment is causing problems.

"I see some people just get slammed," said Phillips, who has served as a lifeguard at Bethany Beach the past 32 years. "It happens more often."

Phillips works as a full-time attorney in Dover now, but he's still a part-time lifeguard and is working a shift this holiday weekend. He believes beach renourishment projects have changed the way waves break and even cause rip currents, which can pull swimmers out into deep water.

Anthony P. Pratt, state shoreline and waterway manager for Delaware, said safety is paramount for beachgoers. The state will explore the impact of renourishment, he said, to determine if the slope of Delaware's shores have been shaped too steeply.

Beach renourishment was not explored as a possible cause of increased injuries by the surf injury researchers because the team does not have the detailed data on injuries, weather, the number of people on the beach each day or surf conditions before renourishment projects started, Cowan said.

One of the first of the major beach renourishments along Delaware's Atlantic Ocean started in Dewey Beach in 1994 and in Rehoboth Beach in 1998. Large, state-federal projects started in 2006 on Dewey Beach and Rehoboth Beach.

Tourists new to the region and locals familiar with Delaware shores often get hurt while wading in the water – especially when turning their backs on the ocean. Experts say few beachgoers understand the power of waves and that too many swim when there is no lifeguard on duty. Unsuspecting swimmers, waders, surfers or body boarders are slammed against the hard-packed sand, which feels like concrete to a body hitting it.

The majority of injuries occur in children under 16. But about 16 percent of injuries occur in people between the ages of 26 and 45 and another 16 percent between 46 and 60, "an unusual demographic for trauma," said Cowan, chief of emergency medicine at Beebe Healthcare.

Men are still more likely to be injured than women, accounting for 982 of the 1,519 injuries surveyed between 2010 and 2014.

"This study is all about correlating environmental factors with occurrence," Carey said.

Nicholas Bollinger, 27, of Ocean View, Maryland, and Ray Celikay, 50, of Norwood, Pennsylvania, became statistics on Delaware beaches in recent days.

Bollinger was paddle surfing recently on the north side of Indian River Inlet when he was hurt while trying to power through a set of three waves as he pushed into deeper water to catch another ride.

He managed to get through the first two waves and jumped over the third, but the wave snatched away his board and shot it into his chest.

"I definitely punched my lung and cracked a few ribs," Bollinger said.

His fiancée and several surfers helped retrieve the paddleboard and get Bollinger to shore. He was raced to Beebe Healthcare, where he learned he had four broken ribs and a punctured lung.

"They took it way seriously" at the hospital, Bollinger said. In the days leading up to his accident, staff at Beebe had already seen one surf-injury-related death and a second accident where the patient had paralysis, he said.

"I'm lucky," said Bollinger, who was released from the hospital on Wednesday. He plans to get back on the water as soon as his recovery allows.

Celikay tells a similar story. And he, too, has no intention of allowing a beach injury to keep him out of the ocean.

On Wednesday afternoon the wind kicked up the surf, and Celikay waded into the water to convince his two boys, Teddy, 6, and Ben, 4, to make one last pass with the body board they were riding and come ashore.

"A wave caught us," Celikay recalled. He was able to push his boys to safety before the wall of water slammed him into the sand and gravel at Cape Henlopen State Park.

As the family packed up to head west on Thursday afternoon, the cut on Celikay's knee was still fresh but he was no longer sore. The family had a wonderful vacation on the beach, said the boys' mother, Amy Celikay, noting that she and Ray sometimes have to literally drag their kids out of the surf.

The thrill of the ocean is "worth the risk," Amy Celikay said.

That's precisely the point Carey and Cowan want to underscore: Enjoy the water, but respect the power of the sea.

Jack Puleo, an associate professor in the civil and environmental engineering department at the University of Delaware, understands the strength of waves. An expert on how ocean forces suspend and mobilize sediment, he is one of the newer partners in the Delaware Surf Zone Injury Study.

Consider that a cubic foot of water weighs about 62.4 pounds, Puleo said. "Now, imagine taking many of those and having them moving toward you. A typical wave along the coast is almost like having somebody throwing eight or 10 of those cubes at you."

Plenty of power to knock down an adult.

Puleo said there are three forces at play – drag, inertia and slamming.

But it's the slamming that translates to the body when the wall of water hits you. If you are in shallow water, you may be driven into the sand.

"Either you supply the same force or you fall over," Puleo said. "It's like you are falling out of a tree. The ground doesn't give."

Beyond the physics of waves, there is the social aspect of the ocean with new visitors arriving each week, all summer long. Many have no understanding of how powerful the ocean can be. But even year-round residents get complacent about the life-changing consequences of waves, Carey said.

Last weekend, a 50-year-old California man died in the surf at Dewey – hours after the beach was cleared because of an impending thunderstorm. The official cause of death has yet to be determined.

In 2002, Cowan arrived at the emergency department at Beebe Medical Center in Lewes.

"The one thing that's unique here, we see all of these surf injuries," he said. "We could see these clusters."

And there was something else: Patients were coming in covered in sand, and they all smelled like suntan lotion.

"As soon as a cluster started," Cowan said, "it would end."

Cowan had witnessed this phenomenon before when he was working on Ski Patrol at Shawnee in the Pocono Mountains of Pennsylvania. What he discovered was there were a lot more injuries when the resorts were making snow.

He wondered if there was something similar going on along the Delaware coast. And if there were clusters, what were the conditions that lead to them?

His goal: Create a model for when injuries were most likely to occur. But the answer has been elusive. There are many factors affecting how and why people get injured in the water – not just that waves are rougher or larger.

Usually when the waves are rough, beaches are closed, Cowan noted.

Over the last five summers, Beebe staff have surveyed patients injured on the beach, gathering data on their age, sex and what type of activity they had been doing before they got hurt.

Clusters of injuries during "swimming days" in the summer can be as many as 15 in one day, but the average is typically two, Cowan said.

"I think the majority of people just don't think of hopping in the water as any kind of risky activity," he said. "I'm sure they all wore their seat belt to the beach. But once you get in the water, you don't understand that you are doing something that's risky."

From 2010 to 2014 there have been 1,519 injuries, with the number varying from year to year — 432 in 2010, 427 in 2011, 262 in 2012, 118 in 2013 and 280 in 2014.

Cowan said the drop in injuries from 2011 onward could be attributed to the fact that Beebe closed its emergency department in Millville. People could have been transferred to a hospital in Maryland instead, or simply avoided seeing a physician.

Injuries can be as minor as cuts and scrapes or as serious as spinal cord injuries where the vertebrae are completely unaligned. Serious injuries can be devastating, potentially causing paralysis or yearslong recoveries.

The most common types of injuries are those to the upper extremity such as shoulder dislocations. The second most common is to the lower extremity, which includes anything from hip, foot and leg fractures or knee dislocations.

People also can be diagnosed with cervical strains and sprains. These are injuries to the soft tissue surrounding the cervical vertebrae. Symptoms include pain, swelling and difficulty moving.

The lower-extremity injuries are common for waders who bury their feet in the sand. The sand acts as freshly hardened cement surrounding their feet, so when they are walloped by a wave, they go down – hard.

"They are getting injured in 6 inches of water," Cowan said. "The closer you get to dry land, the more dangerous it is."

"You're going to feel beat up the next day or two," he said.

The majority of people treated in the emergency room for these types of injuries are well enough to go home, Cowan said, but those with serious spinal cord injuries are transferred to larger hospitals, where total bills can reach $10,000.

Cowan said the team is looking to reduce the number of injuries by studying the mechanics of the waves so people can make informed decisions about how they approach going out in the surf.

The most important safeguard is to never turn your back on a wave. Try to angle yourself to the side, Cowan said, so you can have better footing. If you are in water that is waist deep or higher and you see a wave coming, just sink under the wave.

"The message is not that it's unsafe," Cowan said. "It's that there is a risk there, and you have to be safe."

Staff are still gathering injury data for the 2015 season, and Cowan expects the type and number of injuries to be similar to previous years. Going forward, there's no set quota for injury reductions, he said, but they just know the number needs to be reduced.

"If one person doesn't break their neck, that's all I need," Cowan said.

Cowan and Carey began working together on the surf injury project in 2010.

She reached out to area beach patrols to learn about daily weather and surf conditions and to learn more about how many people were using the beach. Injuries were down in 2013, but rain fell almost every weekend that summer, and fewer people were on the beach. During summer 2011, there were 25 injuries serious enough to send people to the emergency room on one single day, she said.

The scientists already know that most injuries do not occur when waves are enormous, Carey said. Instead, it's the days where the surf doesn't look dangerous when people get knocked to the shore.

They hope to roll those facts and other indicators into the alert system.

"Ultimately, we can predict ahead of time ... beach patrols can increase their staffing and emergency departments can increase staff," Carey said. Access to the ocean could be restricted, with beachgoers staying close to shore in knee-high water.

Todd Fritchman, captain of the Dewey Beach Patrol who has 36 years' experience, said bad decisions also play a big role in beach accidents. Fritchman worked Rehoboth Beach 16 years, and his worst nightmare occurred one summer when a hurricane passed nearby, kicking up waves 10 to 12 feet high.

The beach was closed, caution tape was placed across each of the access walkways and guards were posted at the street ends.

Fritchman and fellow lifeguard Tim Green were standing at Hickman Street when they "looked out and saw two men screaming for help."

It took 15 minutes or more to struggle through the raging surf where the desperate men were treading water. They spent another 30 minutes angling through the surf, towing the men back to shore.

Both men survived, and their families came back to thank the exhausted lifeguards.

But Fritchman said he and Green would "never know for sure what they were thinking."

When Cowan and Carey first began their research, they anticipated learning that "the higher the wave, the more people would get hurt." But clusters of injuries occur most often when waves are in the 1½-foot range, Cowan said.

Each day during the summer, Puleo sends out teams of students who count the number of people on the beach, take samples of sand to understand the size of granules, measure the slope and contour of the shore from the dune to the edge of the water and use a monitor off Bethany Beach to capture wave height and the time between each breaker.

"On the vast majority of days, there are very few injuries in the ocean," Cowan said. Figuring out the triggers of those worse-case days could help warn people of the dangers and guide them to take extra care.

"Sadly," Cowan said, "people who are injured in the surf have no idea they were doing anything risky."

Reach Molly Murray at (302) 463-3334 or mmurray@delawareonline.com. Follow @MollyMurraytnj on Twitter.

Reach Jen Rini (302) 324-2386 or mailto:jrini@delawareonline.com. Follow @JenRini on Twitter.

Number of injuries by sex

Females: 537 injured

Males: 982 injured

Most dangerous times

Because more people are on the beach, the most dangerous days of the week are Saturday, Sunday and Monday, and the most dangerous months are July and August.

Source: Dr. Paul Cowan, chief of emergency medicine at Beebe Healthcare

Serious beach hazards and some tips to avoid them

Rip currents: A concentrated flow of water that can rocket a swimmer offshore in a matter of seconds. The first reaction is typically panic. Don't. You can do three things: stay calm and wait for help from a lifeguard; swim parallel to the shoreline to swim out of the rip; or let the rip carry you out and then swim in. Rip currents are one of the most common causes of shoreline drowning.

Surf zone injuries: Unlike a rip current, a surf zone injury occurs when a beachgoer dives into shallow water or gets slammed by a wave onto the bottom. Always remember that wet sand is as hard as concrete and the power of the ocean is enormous. Talk to a lifeguard before swimming to assess the risks and hazards. Before diving, check the water depth. Always swim near a lifeguard and never turn your back on the ocean.

Sand collapse: Dozens of people are injured, and some die, every year by doing something as simple as digging a hole in the sand. Remember that sand is unstable and a deep hole can collapse and bury anyone who is sitting or standing inside. Time is critical in sand-collapse rescues, and sometimes the exact spot of the hole is difficult to locate once there is a collapse. Dig with your hands and don't use sharp objects in a rescue. Call for help immediately.

Lightning: A beach is not a good place to be during a thunderstorm. Typically beach patrols along the Delaware and Maryland coast, clear the beach when a storm is forecast.

Types of waves

Plunging (shorebreak): The most dangerous type of wave along the Delaware and Maryland coast for surf injuries because this type of wave crests and crashes in shallow water. It's the wave you can hear pounding on the sand from a block away. Shorebreak is worse on an incoming tide as water builds up along the shoreline.

Surging: Water rushes onto the beach and recedes quickly. Its force can pull people back into the surf or cause them to lose their balance.

Spilling: These waves slow gently, the crest falls and the white water rolls onto the shore. White, rolling water can knock people over.

What about undertow?

Your mom used to warn you about this, but what she was referring to was the current that carries you up or down the beach and away from her watchful eyes. That near-shore current is what makes you see the Candy Kitchen sign in Rehoboth Beach one minute and then look up see you're now in line with the Dolle's sign. Make Mom feel better by keeping track of where you are.

Why do waves pull sand from around my feet? It's really cool, right?

Not really. Lots of people can be injured in the surf standing in knee-deep water. In some cases, as the sand erodes from around their feet, they lose their footing and fall, hitting the hard, sand bottom.