We have added some links covering rescue and PTSD at the bottom of the article. The goal is to save lives. Surfers are usually the front line of rescue and you can play a huge role.

When we least expect it, life gives us a challenge, testing our courage and willingness to change; at such a moment, it is meaningless to pretend that nothing happened or that we are not ready yet. The challenge will not wait. Life does not look back. Paulo Coelho

My mother passed away in 2011 when I was nineteen years old. A family and friend comforted me and said, "There are some things in life that you can never overcome. You just need to learn to sit with them." I have never seen death or CPR before. This is just an introduction. I swear to surf more. His words have always been with me. As a doctor, bad things happened, and since then I have had to appeal for this wisdom of aging many times. I kept my promise, I surfed more and more. Waves took me to the emergency room in Cornwall, Eastern Cape, South Africa, which is now the intensive care unit in the South Island of New Zealand.

Since I signed up for the 2021 South Island Surfing Championships on the impulse a week ago, April 3, 2021 has been a defining moment. My girlfriend Michaela and I were exploring the warm waters of the North Island and luckily swelled in Taranaki before returning to Dunedin. The event will be held in St. Clair, and I check the place from my bedroom window every day. By 2 pm on the day of the game, I was already far away from the beach. I was in the emergency room of the hospital and was still wearing a diving suit. I flew by helicopter with medical staff. A two-year-old child was fighting for her life. I grabbed a few paper towels and wiped the floor under the wetsuit. At that moment, both of my hamstrings cramped uncontrollably. The nurse on the other side of the recovery room rushed to help. "I see, don't worry about Will, give yourself a shower. You look like a fart." Without taking a double shot of taking care of passers-by, I went to the fifth floor and took a shower with the ICU staff. I turned the knob to full heat and waited for the steam to surround the cubicle. A minute later, I walked in, took off my wetsuit, and cried.

The sun gleams on the Otago Peninsula a few kilometers away from the beach. My third hottest of the day is the next one. I handed the tea to Michaela and put a blue rash vest over my head. The tide was full, and the fifteen seconds of the earth's tide violently hit the square. The waves jumped on the promenade, making a few little surfers happy. My goal quickly changed from winning the Heat to not completing the Kook Slams Instagram account, which was the victim of my greasy steps before. Going to the beach in a minute or so, Tannoy jumped up, "Blue surfer, you need a quarter to move forward." Waves appeared, it was time for my own buzzer moment. A dark green warbler stumbled during the backwash. Something rose, and the morning sun engulfed his lips. I turned around, paddled, and stood up based on the familiar energy. I promised and made a drop-just-then set my route. I felt the wave and straightened it, pointing the nose of my board towards the beach. With a slight hesitation-a quick nod to the gods-I dug my toenails into the wax and moved the corners towards my lips. Time arranges everything, perfect and impeccable. Dog walkers along St Kilda Beach a few kilometers away must have felt the shore shaking there. A rimmed ruler slammed me directly into the sand, and I surfaced, approaching the greasy steps. When the buzzer signaled the end of the high temperature, I held the same warm teacup in my hand. Michaela mentioned something about participation. More than 15 minutes after the start of my professional surfing career. We went back for breakfast and exchanged some laughs when I failed in the first round. Dunedin is a city with almost as many surf spots as sea lions, and it is located at a latitude of -46°N. Some surfing activities are sure to make your chest hairy. It faces the southeast and extends from the southwest (the roaring forties) to the northeast (the direction in which I pray every day). The high tide that day came from the roar of the 1940s. The old sailor said: "Below 40 degrees south latitude, there is no law; below 50 degrees, there is no God." Considering our upcoming afternoon, I must have underestimated the expansion angle. Evie is a longboard surfer from Raglan and a medical student in the last year. She and her dog Elfie (yes, confusing) shook to our home before noon. Together with our 6-foot-7 male roommate James, who is also a doctor, the four of us traveled south in two vans, which is a familiar route. Taieri Mouth is a charming little fishing village located along the river of the same name about 30 kilometers south of Dunedin. In front of the mouth of the river, about a kilometer from the shore, there is Taizhili Island, a large uninhabited rock from a distance. For thousands of years, this rock has quietly sucked silt north or south according to its mood. Sediments are currently depositing northward, and long and changeable right-handers are present on a special kind of swell. The white pointer should adjust the lineup here to facilitate some local rumors. Our two vans drove into the gravel road overlooking the sandbank. We weave between several utes, their fishing rods sticking out from behind like bayonets. I jumped off the driver of the van and felt a breeze blowing across my right cheek, staring at the oncoming waves hundreds of meters offshore. No one goes out. Since the waves break far away from the shore, it is difficult to determine the size from the shelvingers, but it must be up. "What's that?" Evie pointed to the beach to the north. We all reconfigured our eyes. I can't even figure it out.

"It looks like a big piece of white plastic, like a table or something?" I said. People much better than my eyes recognized this as an upturned fishing boat, like a small fish or something like that. Observe carefully, there are also some black spots beating there. A few saltwater fishing people watched us put on our clothes and ran to the beach with our wooden boards. Evie entered the water and first went to the lonely dark spot a few hundred meters away from the ship, while Michaela and I let the ship drift slowly north, but were still punished in the impact area. The waves are merciless. James followed us for thirty seconds. The water is cold. After the first few waves rushed through, I had a headache for ice cream. I remember thinking about whether they are wearing diving suits. they are not. We arrived at the scene of the panic. The mother was still alive, wearing a life jacket floating ten meters away from the ship, while the father used a clam shell to throw cannonballs at the inverted hull. He slid down. We handed them the board and they caught it. Dad looked back at the ship in horror, and in the distance I saw her, a girl less than twelve years old. After dunking from the shoulder-high wave again, she just surfaced with the boat. The waves rolled up along the sandbar at low tide. She let out a scream. I can only see the white of her eyes and the yellow of her life jacket. She was half under the boat and half outside. Her face was beaten intermittently by the waves. She was trapped. When James escorted mom and dad ashore, I swam over. The girl's life jacket was stuck on the railing of the ship and couldn't escape. She is in hell. At the mercy of the sea, her mouth barely surfaced, and the poor boat kept dragging her into the water. Her screams were drowned out by the water pouring into her mouth. "Close your mouth. You'll be fine. I promise. Take it easy." I held her head with one hand and started to pull the buttons of her life jacket. She was tied tightly. "The waves!" Michaela shouted about ten meters away. I grabbed the girl and the railing, and we were ready for the impact. The waves pushed us down. We surfaced and I tried to release her. "The waves!" I continued to fight with the life jacket. "The waves!" The girl's scream stopped, and she slumped down. She was unconscious and did not breathe. Her face floated under the water. I lifted her head up, opened her mouth, and let her breathe quickly. Changing direction, I sank under the boat and tried to unbutton her life jacket. When her legs were shaking, I didn't think about some things. The life jacket gave way, and I drew her towards me. Her head and arms slid out of the lifejacket vise like grasping. "The waves!" I lost her. I found her under the water after the bubble. Michaela is already there with my board. She has been watching, ready to save me when I get stuck or hit my head. She is a doctor and former lifeguard herself, and she supports me. We put our bodies on the board. Michaela took over. "Kick Will and I can breathe." I paddled from behind the surfboard while Michaela blew air into the damp lungs of the girl lying on her back. "The waves!" I threw on her, hugging tightly. Michaela closed her mouth. "Okay, kick" Michaela continued to perform artificial respiration and cleared the white foam that overflowed from the girl's mouth. "The waves!" We rode for a while. We have passed through the worst impact zone, and now there is a seemingly endless lagoon where we can fight by spinning dark chopping waves. My legs are starting to get tired. Tears began to run across Michaela's cheeks. "Look at Will, she's moving. She's still alive!" The girl groaned, her eyes kept closed.

The air temperature and sea temperature on the day of the rescue were about 12°C. Before the fall, the family's body temperature should be around 37°C. When they were exposed to water, they probably all experienced a cold shock reaction-a series of cardiopulmonary reactions caused by the stimulation of cold receptors in the skin. An initial gasp and a period of rapid uncontrolled breathing followed. The amount of this panting depends on the water temperature. The colder, the deeper the breath. At these temperatures, the victim will inhale approximately 3 liters of air. If this initial gasp meets water, drowning will occur. The lethal dose of seawater to the lungs of adult males is about 1.5 liters. Interestingly, repeated exposure and training in a short period of time can weaken the cold shock response, which seems to last at least a year. Although weak, another contradictory physiological process occurred within the first few seconds-mammalian diving reflex, which is an oxygen-saving response that allows mammals to stay in the water for long periods of time. When immersion apnea is triggered, the heart rate slows down. After immersing in cold water for a few minutes, the nerves and muscles begin to cool down, reducing flexibility, strength and swimming ability. The deep muscles of the forearm can cool down to 27°C in 10 minutes, which affects both strong and weak swimmers. Dad clutched the hull tightly and left the water surface. This is a good insulation measure. His cooling rate will be four to five times slower. Thirty minutes later, the core body temperature really started to drop. Below 35°C, consciousness may be impaired, and the victim may become confused, aggressive, and even forgetful. Below 30°C, you may lose consciousness. The trembling reaction will stop at some point, which is a bad sign.

After hundreds of meters of desperate swimming, I felt sand on my feet. We threw away the planks and led the girl through the waist-deep water. An off-duty policeman met us and helped us to the beach. He has dialed the emergency service number and activated the vital chain of survival. The severely unwell patients lying in the sand in front of us did not allow Hollywood to recover on the spot. For many patients, determining the time of treatment-going to the hospital-is the most important factor affecting the outcome, and nothing should be delayed. For important physiological reasons, we removed the girl from lying down in the water to avoid a drop in blood pressure and subsequent loss of consciousness. Water is denser than air, so when we are immersed in water, there will be a pressure difference, which basically squeezes us. The blood is concentratedly transferred from our periphery, which helps to maintain the flow to our vital organs during survival. During extraction, this pressure gradient will be lost, which will cause a rapid drop in blood pressure. Keeping the victim level can at least offset some of the effects of gravity, and it will work if you move in an upright position.

The citizens scrambled for blankets and warm clothes. It is almost impossible to reheat patients with hypothermia at the scene, but if possible, rescue workers should not be prevented from taking off their wet clothes, covering and isolating the victim from the ground. The purpose here is to prevent further heat loss. The police officer handed me a phone that could still be connected to emergency services. "We have an 11- or 12-year-old girl who drowned. She stopped breathing for about three to five minutes. She is currently breathing for herself; it is cold and her level of consciousness has decreased." "How many other casualties do you know?" "Mom , Dad, brother." I said. I can see a little boy Evie rescued further on the beach. As far as I know, he is fine. "Anyone else?" "I don't think so." I turned to Michaela and went out to sea. What's wrong. "Wait." I returned the phone to the police. Michaela took care of the girl who was regaining her posture, wrapped her in a blanket to make sure she would not inhale her vomit by mistake. I ran back to the shallows along the beach. Dad was still in the waist-high water, with Michael's board in his arms, and his eyes fixed on the boat. When I reached him, he was wavering and unable to understand. "Go in now!" I said I took the board from him. "Go!" "Now." I led him to the shore. It is now clear that at least one child is outside. I scratched it back.

Between the waves, I can see James and Evie are ready to board the boat. they know. The hull is clearly visible about fifty meters away. I saw Evie sitting on her longboard, and James's board was placed next to her. He is nowhere to be seen. James surfaced beside the boat. Ten seconds later, his feet hit the water and sank again. The waves continued to break. I don't know there is another victim. I paddle harder. I saw a yellow life jacket emerge, with James' arm following. "Fuck." That was the bravest thing I have ever seen. Evie picked up the yellow life jacket and placed it on the board. She unbuttoned her, revealing black hair and a petite body, a little girl about two years old. Evie shaved his hair back and started CPR with the heel of his right hand. Due to the size of the child, only one hand is needed. Evie stopped-James took two deep breaths-Evie started again. I have arrived. The child is cold and lifeless. We go for the shore. In the rough sea, the engine screamed, and a jet ski flew past us. The driver relaxed the accelerator next to us, and Evie climbed up. We passed by the little girl, and I followed. Just before another wave broke out, we accelerated and James was left to swim. When we were sliding on the wet sand, a helicopter flew overhead. We ran along the beach towards the flashing lights, holding the toddler in my arms. The paramedics rushed to greet us. Soon, James and the helicopter team joined us. I recognized these people, and we worked together to transport patients between hospitals in the South Island. Between heavy breaths, I told this story. "She must have been down for twenty minutes." We continued the CPR, and I inserted an inflatable airway device to better control her airway. The paramedics handed James a small drill, and a small hypodermic needle made a drill. There is no point in finding veins, this toddler is very cold. In an emergency, you can enter the intraosseous (IO) blood stream through your bones instead of intravenous (IV). His hand was firmly placed under her right knee, and the small electric motor started. One of the paramedics sticks to the electrode pads of the AED (automated external defibrillator). We stopped CPR and analyzed the heart rhythm. there is nothing. "Shocks are not recommended," the crackling machine said. We continue cardiopulmonary resuscitation. Every time I grabbed the bag attached to her breathing tube, there was a high flow of oxygen flowing in. Each chest compression will squeeze her heart, and now a ball of adrenaline is expected to stimulate the muscle fibers of her heart.

Drowning is the third leading cause of accidental death in the world, causing 360,000 deaths every year. The number of people under five and between fifteen and twenty-five has surged. The number of child deaths from drowning exceeds many high-profile diseases. First is panic and struggling on the water, then irregular breathing and air hunger. Finally, the inhalation reflexes effort-the body must breathe. Low oxygen levels are the result of two physiological mechanisms. Either the vocal cords are clamped, a kind of reflex laryngospasm, because the water is in contact with the airway. Or, water rushes into the lungs, washing away the surfactant layer-the soap film that covers our air sacs. The balloon collapses and it is almost impossible to transfer oxygen to the blood. Either way, there is no delivery of oxygen to vital organs, and the spiral of cardiac arrest and death begins. Most of us can hold our breath while resting, for example, for one minute, but when wearing ordinary clothes and jumping into water at 10°C, this drops to about 5 seconds, but it can even be as low as 1 second. This explains to some extent the inhibitory effect of those lung bursts when surfing on cold winter mornings. In the case of drowning, the victim will first stop breathing, stop breathing, and then develop a cardiac arrest. Since oxygen-rich blood no longer circulates, the heart will stop beating. Unlike other causes of cardiac arrest, oxygen is the main problem and needs to be addressed. Once safe and on a stable surface, if the patient is unresponsive and breathing abnormally, rescuers should begin uninterrupted chest compressions at a rate of 100-120 beats per minute. Thirty compressions, then two breaths, and then repeat until rescue arrives. According to ANZCOR and the Australian and New Zealand Resuscitation Commission, this is true for all age groups. Compression should be about 1/3 of the depth of the victim's chest above the breastbone, with two hands for adults, one or two hands for people under eight, and two fingers for babies. Underwater artificial respiration is an advanced rescue technology, and the first task is always to let the patient go ashore safely. Studies have shown that the earlier basic life support is started, the better the results.

Pete, the helicopter paramedic, came over and squatted beside me like a brick garbage room. "Should we consider going to the helicopter?" Five minutes later, Pete, Shane and I were at the back door of the helicopter. I leaned firmly against the stretcher with the breathing tube and sat down. We put on the headphones and continued CPR. The rotor blades were spinning faster and faster, and soon we floated a few feet off the beach, and then we set off. I glanced out the window and found my surfboard floating there, a brand new fish beard, still not surfing. Things didn't look good; we didn't see any electrical activity of the heart on the monitor. The line is stubbornly flat. She has been sinking for a long time. I couldn't help but wonder, maybe she was trapped in an air bag in the bow, breathing smoothly. We don't know how long she was really disappointed. The waves are small when viewed from above. The light in the afternoon was flat, and the sky and the sea mixed into gray on the horizon. Whenever I fly in a helicopter, I am always thinking about the peaceful earth under my feet. Foresighted peace and order, the car was slow, and the waves shattered gently. From there I cannot quantify the panic and death vortex that defeated me a few minutes ago. I retracted my thoughts and continued to hold the bag. Shane continued her chest compressions. Our recovery attempt has been close to 25 minutes.

As doctors, we like to look for exceptions instead of rules and rarity, which is what makes it interesting. We introduced interesting cases, not common pneumonia. I couldn't help thinking of some factors in this little girl's corner. She is still young and the weather is very cold. The record of submerged survival dates back to 1988, when a two-and-a-half-year-old child named Michelle Funk from Salt Lake City survived after being immersed in 5°C water for 66 minutes. When she arrived at the hospital, her core body temperature was 19°C. Unfortunately, apart from strange cases, there is little evidence to support cold-water drowning associated with improved survival rates and good outcomes. In these cases, suppose that the cold water in the victim’s lungs cools the nearby heart, and importantly, it cools the blood flowing to the brain. When the brain cools down, the demand for energy and oxygen decreases. A 7°C drop in brain temperature can double the survival time. An ancient medical motto that is worth remembering in this field, patients will not die until they die with warm "n". We landed on the roof of the hospital and rushed to the emergency room. A large group of doctors are waiting for this 28 °C toddler. I handed the call to the anesthesiologist on call and felt my life was exhausted. When they started their resuscitation attempts, I stood there, wet and sandy staring. I swallowed the lump in my throat. Next door I heard another patient, an eleven-year-old girl. I heard some handovers. "Oxygen saturation 82%." "Temperature 32 °C." The normal parameters are 37 °C temperature and 98% oxygen saturation.

A few days later, we visited an 11-year-old child in the intensive care unit. When the four of us arrived, she was having lunch. I think that was the best moment of my life. I held Michaela's hand tightly. Unfortunately, the two-year-old child was not saved. A case that made many people in the hospital burst into tears. The recovery work continued for several hours. All other family members have fully recovered.

When I was a medical student, a retired general practitioner told me "Forget what they taught you in medical school, son, medicine is 90% art and 10% science." I resisted the temptation to call this stubborn old guy a paranoid, and reopened my textbook. However, his views have always troubled me. The longer I play in this game, the older this GP seems to be. After all, we practice medicine. As doctors, we have our own cemetery, and we wander through it from time to time. This two-year-old child is buried in front and in the middle. In all deaths, you can't help but... if only I was smarter, better trained, more supported, and even better resources. Although it feels different here, the wound stays open longer. It keeps me awake at night. If only I were brave. I should check the bottom of the boat. Maybe I'm just scared. James will get her out sooner. I didn't know there was another victim, I never asked. It was terrible, the waves rushed onto the boat and hit the two girls. I still can't believe James got her out. I fell asleep, imagining how close I was to her when I first arrived. She may have been breathing, screaming for her life. I want to thank James for his bravery, Evie's intuition, and Michaela's clarity, all of which are in front of death. We are connected by blood. I love them all. We met the family a few weeks later. It was a special moment to see my brother and sister running around, talking and laughing. They are a beautiful family. Every once in a while, I watched the teddy bears and the photo night watch they created on the sofa. There is a sense of loss in the air. However, the burden of guilt is indeed reduced. I feel much better. Science can only make us go further in life and medicine, and there are more things. This is what the old GP pursues, art. Not only the way we treat patients, but also the way we treat ourselves. It is here that we really found our medicine; accept, forgive, learn and move on.

A 2014 study by the University of New South Wales conservatively estimated that the number of rescues carried out by Australian surfers each year was equivalent to that carried out by volunteer surfing lifeguards. As surfers and water sports enthusiasts, we patrol crowded and remote beaches 365 days a year. We are the guardians of the sea. Part of the surfer’s pleasure lies in the close contact with wind, weather, and tides. When I ride my bike home from get off work, I feel windy on my face. It tells me what's going on outside. I know the state of tides and swelling. I know that Little Tung Chung will appear later that night. I know the condition of the local sandbar and what rip flow was used to save my arm. We continue to process these real-time data and make decisions. We see things that others can't. For us, a benign shore break is a freight train for others. Professional knowledge and timely extraction are irreplaceable, but the first few minutes may be the difference between life and death. A little knowledge can be of great help, whether as a rescuer or a victim. Remember, a quarter of the rescues in the NSW study were surfers saving other surfers. There are no heroes at sea; know your limits. Hide a blanket in your boots and ask for help.

After the incident, we are working hard to bring about positive changes. We will host Surf Survival Week in Dunedin in November this year. Everyone is welcome. In addition, please pay attention to our upcoming network series on marine safety. To contact me and stay up to date with the latest information, please visit New Zealand Surfing Magazine. To learn more about drowning and basic life support, please visit Surfing Medicine International and RNLI. Remember, always seek help and learn CPR. If in doubt, please do not go out.

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