Impact of a surfer rescue training program in Australia and New Zealand: a mixed methods evaluation

Drowning is a significant global health problem, with coastal environments presenting particularly complex risks. While professional lifeguards are crucial, bystander rescues, particularly by untrained individuals, contribute substantially to drowning incidents. Surfers, due to their frequent presence in the water, are conservatively estimated to perform as many rescues as lifeguards annually. This necessitates training programs to equip them with safe rescue techniques. The SR24/7 program, a coastal safety intervention in Australia and New Zealand, aims to provide surfers with such training. This study evaluates the effectiveness and implementation of SR24/7 to inform program improvements and contribute to reducing drowning rates. The specific objectives were to evaluate the program's impact on participant confidence, knowledge, attitudes, and behaviors; characterize surfers' roles as community responders; and establish best practices for enhancing surfer rescue training.

Existing literature highlights the global burden of drowning and the importance of rescue and resuscitation in mitigating its impact. The challenges of coastal rescue, particularly the risks to rescuers, are emphasized. While professional lifeguards and surf lifesavers are the typical focus, bystander rescues are increasingly recognized, with untrained bystanders unfortunately causing multiple deaths annually. Experts generally advise bystanders to help without entering the water unless possessing adequate aquatic competence, physical fitness, experience, and equipment – criteria often met by recreational surfers. Previous research indicates surfers conduct a significant number of rescues, prompting the World Health Organization to identify them as a target population for rescue training. Despite the existence of surfer rescue training programs, their methods and impact remained unevaluated until this study.

This study employed a modified type II hybrid mixed methods design, integrating quantitative and qualitative data to assess both the effectiveness and implementation of the SR24/7 program. The study comprised three parts: Part 1: A retrospective cross-sectional survey of past SR24/7 participants (n=241) from NSW, Victoria, and New Zealand assessed attitudes, beliefs, and skill application. Data analysis included descriptive statistics, composite scores for attitude domains, and thematic analysis of open-ended responses. Part 2: Semi-structured interviews (n=14) with participants who had conducted rescues after completing the course explored their experiences, motivations, and the program's influence. Thematic analysis was used to identify key themes. Part 3: A pre-post analysis of self-reported confidence scores (rescue and CPR) from Surfing Victoria's routine data (n=235) assessed the program's impact on confidence levels. Paired t-tests compared pre- and post-course scores.

Part 1 (Survey): Participants reported high satisfaction (mean 6.59/7) and would recommend the course. Motivations for participation included work-related needs, upskilling, improving safety and confidence, and a desire to help others, including previous rescue experiences. Many reported using learned skills to identify hazards, increase awareness, and warn others. A substantial proportion (32%) reported warning others more frequently post-course, and 16.2% had conducted rescues, estimating that 40.6% of those rescued would have drowned without intervention. Participants demonstrated high levels of understanding of key safety concepts like prioritizing personal safety and board placement during rescues. Those with less experience and lower self-reported ability had more positive attitudes toward their learning and the role of surfers in coastal safety, though these differences were minimal. Part 2 (Interviews): Interviews reinforced the survey findings, highlighting surfers' self-identified role as "custodians of the ocean." Participants emphasized their presence in areas lacking lifeguard services or during times when services are unavailable. A key takeaway was the course's strong emphasis on personal safety, with participants recounting risky rescue situations and acknowledging a shift in their approach due to the training. The interviews highlighted the importance of taught rescue techniques, particularly the methods of using surfboards during rescues, and the value of practice and debrief sessions. Participants recommended additions to the course, including improved catering to varying skill levels and strengths, CPR/first aid training, advanced techniques and instruction for more challenging scenarios, and tips for communicating with others about safety concerns. Part 3 (Pre-Post Test): Statistically significant improvements were found in both rescue and CPR confidence scores across all demographics except for the 60+ age group in rescue confidence. This demonstrated the positive effect of the program on participants' self-efficacy in these areas.

This study provides crucial evidence of the SR24/7 program's effectiveness in improving surfer knowledge, awareness, and confidence regarding water rescues and personal safety while contributing to drowning prevention. The findings demonstrate that surfers are actively involved in both rescue and preventative actions. While lifeguards remain essential, the study highlights the potential of empowering surfers as community-based safety ambassadors, expanding coastal safety beyond traditional lifeguard coverage, especially in unpatrolled areas. The program's success in integrating personal safety into rescue techniques addresses a critical concern in water rescues.

The SR24/7 program is an effective intervention that improves surfer skills and attitudes concerning ocean safety. Expanding this type of training to a larger surfer population offers a promising strategy for enhancing community-level capacity in preventing and responding to ocean emergencies. Future research should investigate broader surfer populations to evaluate program scalability and investigate the discrepancy between interest in advanced training and willingness to become professional lifeguards/lifesavers.

The study is subject to selection bias as it focuses on self-selected participants who completed the course and volunteered for research. Recall bias might also influence the survey and interview data, though the two-year timeframe limitation was implemented to mitigate this. The study also faced logistical challenges due to COVID-19 lockdowns and inconsistent pre-course data collection methods across locations. Furthermore, the lack of a control group limits the ability to definitively attribute the observed changes solely to the SR24/7 program. The use of solely self-reported confidence scores in Part 3 might also overestimate the true impact.