Whitewater canoes and kayaks come in different shapes and sizes, depending on the purpose of the craft and expected water conditions. Craft designed with an emphasis on linear speed are long and sleek to reduce drag, e.g., wildwater, touring, or marathon kayaks (3.5–5.2m). Slalom, freestyle, and surf craft are typically shorter for increased maneuverability (3 m and <2 m, respectively) and flat bottomed for greater stability. For higher grade whitewater (III+), decked craft are the norm. Those designed for “heavy” (highly aerated) whitewater are higher volume compared to those intended for smaller whitewater, with an extreme being squirt boats – a form of freestyle kayak that can perform subsurface maneuvers even on flatwater. Competition canoes and kayaks are constructed from composite materials to minimize weight and maximize performance. Modern recreational canoes and kayaks are constructed from polyethylene plastic in order to maximize durability, although this comes at the cost of increased weight. These stronger plastic boats have led to the exploration of smaller steeper creeks, the running of waterfalls, and the evolution of the modern playboat that is shorter than more traditional canoes and kayaks. Playboats have also evolved to have highly rounded ends in order to reduce the risk of pinning the craft in a dangerous manner. Inflatable and sit-on-top canoes and kayaks have also become increasingly popular, particularly with novice paddlers and for grade I–II water. Modern rafts are constructed from inflatable rubber with multiple chambers aiding buoyancy (even if one chamber is punctured). Raft paddlers sit perched on the outer tube with both legs in the raft and use a longer paddle to reach the water (Fig. 6.4).

In the event of capsize, sufficient boat buoyancy is an important safety feature as upturned canoes or kayaks filled with water are extremely heavy and difficult to extract from a fast flowing river. In contrast a buoyant capsized boat can provide an excellent flotation aid to a swimmer struggling to stay on the surface of turbulent water. For this reason, removable air bags placed inside the craft are a standard requirement for Whitewater competitions and strongly recommended for recreational paddling.

Paddle design is largely dependent on the craft and canoeing discipline plus the physique and ability of the paddler (Fig. 6.7). Craft with greater linear speed tend to be propelled with longer paddles that have a larger blade area. For these faster craft, kayak paddles with a greater feather angle (45–85°) and winged blades (“spoon” shaped with a distinct upper lip) are commonly used. Cranked shaft paddles are popular among slalom kayakers and have been suggested to improve performance and reduce injury risk.

Personal flotation devices (PFD) or buoyancy aids are essential personal equipment for all Whitewater paddle sports. This is reinforced by statistics from two surveys where a high proportion of fatalities (68 and 92 %) were not wearing a PFD [9, 11]. The minimum competition standard is 60 N of buoyancy (EN/ISO 12402-5), but for more severe conditions/river grades, higher levels of buoyancy are recommended and may be crucial in helping to keep a swimmer on the surface. A helmet is also essential personal equipment. Approved helmets (e.g., CE EN 1985) are recommended for all Whitewater activities. For more extreme Whitewater helmets incorporating jaw and/or face protection may also be appropriate. Face guards are more relevant for rafters due to the higher incidence of reported facial injuries.

The water temperature of alpine or mountain rivers is often just a few degrees above freezing; therefore, even in warm/hot air temperatures, wet or dry suits can be an important safety precaution, mitigating the risk of hypothermia during a prolonged capsize and swim. Wet suits also provide other advantages, increasing ­personal buoyancy and reducing abrasion/impact injuries if a paddler should be separated from their craft. Watertight clothing and equipment, including a spraydeck, help to maintain body temperature and prevent craft becoming water logged, which causes a rapid loss of paddler control.

Throw bags are an important piece of equipment when there is a significant chance of capsize. A throw bag thrown from a stable position into swift water or rapids enables a swimmer to grab the rope and be pulled to safety.

Many paddle sport organizations (clubs, federations, etc.) offer courses, tuition, and extensive information on safe Whitewater paddling. Table 6.3 contains a summary of important safety advice for all Whitewater paddlers issued by American Whitewater.

Accidents and injuries in Whitewater paddle sport are relatively rare, but due to the unpredictable nature of the Whitewater environment, the consequences can be severe. Most river fatalities are thought to occur in inexperienced paddlers attempting rivers beyond their skill, in adverse weather or high water conditions, and without appropriate safety gear [8]. Submersion accidents are the primary life-threatening hazard, possibly accounting for ∼1/3 of all Whitewater injuries [27] that include drowning, near drowning, and impact-related trauma while submerged. Fortunately fatalities are relatively rare, occurring at a rate of 8.7 per 1,000,000 user days for rafters, canoeists, and kayakers [50], which is similar to trekking [42]. The primary causes of drowning in whitewater are entrapment, blunt head trauma, or hypothermia leading to disorientation or loss of consciousness. Sudden immersion in cold water can cause hyperventilation, bronchospasm, and even cardiac arrest [4]. Therefore, all participants should be prepared for a capsize (as it is an integral part of the sport) and advised to wear appropriate watertight clothing with sufficient insulation (e.g., spray deck, waterproof jacket/cagoule, wet/dry suit). Submersion accidents and injuries primarily occur during a capsize or when a paddler is swimming downriver separated from their craft. Capsized paddlers and swimmers are also susceptible to hematomas, contusions, abrasions, and lacerations from contact with rocks and other objects, as they are carried downstream.

The incidence of Whitewater injuries has been estimated as 4.5 and 5.2 injuries per 1,000 paddler days among recreational [41] and competitive slalom [28] canoeists and kayakers. This is a similar injury incidence to alpine skiing, but higher than cross-country skiing or windsurfing [22, 34]. The injury incidence in commercial rafters appears to be lower at 0.26–0.44 injuries per 1,000 paddler days [49]. As with most sports, the incidence of Whitewater injuries rises with increased exposure [41] and is substantially greater during competition than training (ten times higher in competitive slalom paddlers [28]). The etiology of injuries/illnesses sustained by paddlers can be divided into acute trauma, chronic overuse, and environmental (Table 6.4). There are relatively few detailed reports in the scientific and medical literature regarding specific Whitewater injuries. Previous studies have typically been retrospective surveys relying on self-reporting, rather than any professional diagnoses.

Unsurprisingly for a predominantly upper body sport, the majority of injuries in canoeists and kayakers involve the wrist, forearm, elbow, and shoulder. Rafters have a different pattern of injury with more face (33 %) and knee injuries (15 %) and fewer shoulder injuries (6 %) [7].

The only evidence on severity of Whitewater injuries is from the surveys observing that 42–51 % of all injuries reported required medical attention [16, 41]; one survey showed that the severe injuries were similar in nature to milder injuries, i.e., 47 % acute versus 36 % chronic [41]. The shoulder was the most common site for severe injury in canoe/kayak paddlers, with 15 % of respondents in one survey reporting at least one dislocation [28] and more than half a cohort of elite slalom paddlers reporting a history of shoulder injury [15].

More than 50 % of all rafting injuries occur on the raft and include collisions with other rafters, impacts from paddles or other equipment, and entanglement of extremities within the raft. 40 % of rafting injuries occur when paddlers are ejected from the raft [49]. In Whitewater kayakers, 87 % of injuries occurred while in the boat, 8 % when in the water having abandoned their craft, and 5 % while walking or portaging [16].

The majority of Whitewater injuries are of an acute traumatic nature, accounting for 57–61 % of all injuries [28, 41]. The most common acute injuries in canoe/kayak paddlers were sprains (35 % of acute injuries) and tendonitis (20 %) in one survey [28] and sprain/strain (26 %), lacerations (17 %), and contusions (17 %) in another [41]. In rafters the most common acute injuries are similar: lacerations (33 %), strains and sprains (23 %), fractures (23 %), and contusions/bruises (10 %) [49].