Healthy at the Jersey Shore

"Every summer I get the same text messages from patients at the shore. Heat exhaustion in the parking lot at LBI. Severe sunburn after a Cape May beach day. A swimmer's ear flare from Ocean City. None of these are emergencies if you catch them early. All of them are easier to triage by text than to navigate at an unfamiliar urgent care after a long drive home."

A patient called from Stone Harbor last August. Her 7-year-old had been throwing up since the second night, and the family was 90 miles from their usual pediatrician. We sorted it out by text in 20 minutes (mild norovirus-pattern stomach bug, oral rehydration plan, anti-nausea pill called in to the local Acme), they avoided an urgent care visit, and the kid was back to playing the next morning. This article walks through the same shore-trip framework I use with patients heading down.

Heat and Hydration at the Shore

Heat illness is the most common shore-trip medical issue and the most preventable. It happens on a spectrum: heat cramps, heat exhaustion, then heat stroke (the medical emergency). Knowing where on the spectrum you sit changes the response.

The CDC framework:

• Heat cramps: painful muscle spasms in the legs, abdomen, or arms during or after activity in the heat. The body has lost a lot of salt through sweat. Treatment is shade, fluid with electrolytes, and rest.
• Heat exhaustion: heavy sweating, headache, dizziness, nausea, fast heart rate, weakness, cool clammy skin. The body is losing the fight against the heat but can still cool itself. Treatment is shade, fluids, removing extra clothing, cool cloth, and rest. Most heat exhaustion clears in 30 to 60 minutes if treated.
• Heat stroke: body temperature 103°F or higher, confusion or altered mental status, hot dry skin (sweating may stop), fast strong pulse, seizures. This is a 911 call. Body temperature can rise to 106°F or higher within 10 to 15 minutes once heat stroke begins. Move to shade, cool with cold water or ice (particularly on neck, armpits, groin), and get emergency care.

The hydration target for typical shore activity:

• About 1 cup of water every 15 to 20 minutes during heat exposure or physical activity, per NIOSH for occupational heat exposure.
• Electrolytes matter once sweat losses are significant. For a day at the beach, add a sodium-and-potassium electrolyte source: Liquid IV, LMNT, DripDrop, Pedialyte, or a salty snack with water. Plain water alone over many hours can dilute serum sodium.
• Pre-hydration: start hydrated the morning before. Trying to catch up at 3 PM in 92°F sun is much harder than starting at 8 AM with breakfast.
• Cool the gut: an iced electrolyte drink absorbs faster and helps body temperature.

Special groups to watch closely: kids under 5, adults over 65, anyone on diuretics or blood pressure medications, and anyone with diabetes or kidney disease.

Sun Protection

A sunburn raises your lifetime risk of skin cancer in a measurable way, and childhood burns carry the most weight. The CDC recommendation and the supporting dermatology consensus:

• Broad-spectrum SPF 30 or higher. Broad-spectrum means protection against both UVA (penetrates deeper, drives photoaging and some cancer pathways) and UVB (the burning ray).
• Apply 15 minutes before going outside. Sunscreen needs time to bind to skin.
• Reapply every 2 hours, and after swimming, sweating heavily, or toweling off.
• Use enough. Adult full-body application is about 1 ounce (a shot glass). Most people use a third of that.
• Mineral (zinc oxide, titanium dioxide) or chemical formulations both work. Mineral is the default for sensitive skin, infants over 6 months, and the face. Chemical often feels lighter and leaves less white residue on the skin. Pick the one you will keep using.
• "Reef-safe" typically means a sunscreen without oxybenzone and octinoxate. The evidence that these chemicals harm coral is well documented, so if you are paddling, snorkeling, or in protected waters, choose a reef-safe option.

Other layers that beat sunscreen for primary protection:

• UPF clothing (long-sleeve sun shirts, rash guards) for kids and adults during peak hours.
• Wide-brim hats that shade ears and the back of the neck.
• Beach umbrellas and shade during the 10 AM to 4 PM peak.
• Sunglasses with UV400. UV damage to the eyes builds up over the years.

A severe sunburn (large blistering area, fever, chills, confusion) is a sun-induced injury that may need clinical care. Call or text the same day.

For the full playbook on covering up, using enough sunscreen, and treating a burn, see our guide to sun protection for Philly and Jersey Shore summers.

Ocean and Sand Hazards

Most Jersey shore "water" issues fall into a small number of categories.

Jellyfish stings. The most common stinger on the New Jersey coast is the lion's mane jellyfish and seasonal sea nettle. For an uncomplicated sting:

1. Rinse with sea water, not fresh water. Fresh water can trigger remaining nematocysts to fire.
2. Pluck visible tentacles with the edge of a credit card or tweezers (not bare fingers).
3. Soak in hot water (around 110 to 113°F, as hot as you can stand without burning) for 20 to 45 minutes. The heat breaks down the venom. Vinegar is the right treatment for box jellyfish in tropical waters, but for the stings you get in New Jersey, skip it and stick with heat.
4. Topical hydrocortisone and oral antihistamine for itch and inflammation.
5. Call for help if the sting covers a large area, involves face or eyes, or if there is wheezing, throat tightness, or full-body rash (anaphylaxis).

Swimmer's ear (otitis externa). Saltwater plus warm humid air is the classic recipe. Symptoms are ear pain, fullness, drainage, and pain on pulling the outer ear. The fix is usually prescription antibiotic ear drops (ofloxacin or ciprofloxacin) and keeping the ear dry. Over-the-counter Swim-Ear drops (95% isopropyl alcohol + glycerin) used after swimming can prevent recurrences.

Surf cuts and shell injuries. Cuts on the foot or shin from shells, broken bottles, or rocks are common. Rinse the wound well with tap or bottled water, apply pressure to stop the bleeding, and cover it with a sterile bandage. Tetanus status matters; if your last shot was more than 10 years ago, plan to update it after you get home. See the Cut at Home guide for the 3-question triage if a cut looks deeper than expected.

Rip currents. Drowning is the worst-case scenario at the shore. The NOAA guidance is clear: never swim against a rip current. Swim parallel to the shore until you are out of the current, then swim diagonally back to the beach. Swim where lifeguards are present and on duty. Most New Jersey beaches have lifeguards from about 10 AM to 5 PM Memorial Day through Labor Day; off-hours and shoulder-season swimming is meaningfully more dangerous.

Stingrays and crabs. Less common. Shuffle your feet when wading in shallow water to give stingrays a chance to move. Crab pinches are usually minor; wash and bandage.

The bays sting differently from the ocean. Sea nettles are a back-bay problem more than a beachfront one, and Barnegat Bay in particular can carry a lot of them in a warm summer. The clinging jellyfish is a smaller and less familiar one that lives on eelgrass in the bays and tidal rivers, including the Shrewsbury and the Manasquan, and its sting tends to be more painful than its size suggests. Both respond to the hot water immersion described above, and both are the reason a kid crabbing off a dock can come back stung on a day when the surf was clear.

Cuts plus warm bay water deserve more respect than they usually get. Vibrio bacteria live naturally in warm coastal and brackish water and become more abundant as water temperature climbs through late summer, which is when most shore trips happen. The large majority of exposures come to nothing. The concern is an open wound going into bay water, or raw shellfish, in someone with liver disease, diabetes, an iron-overload condition, or a suppressed immune system, where infection can move quickly and become serious. Keep fresh cuts out of the bay until they have closed, wash any wound that goes in, and treat a wound that becomes rapidly more painful, swollen, or discolored over a few hours as something to be seen the same day rather than the next morning.

Water quality after heavy rain. New Jersey monitors bathing water at public beaches through the season and posts advisories when bacterial counts run high, which most often follows heavy rain washing runoff into the water. If it poured overnight, checking the local advisory before a morning swim is a reasonable habit, and it matters most for anyone with an open wound or a suppressed immune system.

Hot sand and hot boards. On a 90°F day, dry sand and boardwalk planks reach temperatures that cause contact burns on bare feet within seconds. Young children and anyone with diabetic neuropathy are at the most risk, because they notice it late. Sandals from the car to the blanket are the whole fix.

Food, Boardwalk, and Stomach Bugs

A common reason for a shore-trip clinic call is sudden GI illness in 1 or more family members. Two patterns:

• Foodborne (food poisoning) typically hits 2 to 12 hours after a suspect meal, often with intense early vomiting, then diarrhea, and resolves within 12 to 24 hours. Common culprits: undercooked shellfish, mayonnaise-based salads that were left out, and shared platters at large gatherings.
• Viral gastroenteritis (norovirus, "stomach bug") builds over a day, comes with body aches and low fever, and lasts 24 to 72 hours. Highly contagious among households and tight social groups (think shore houses with multiple families).

The home plan for either (detailed in the Nausea Clinical Guide):

1. Small frequent sips of an oral rehydration solution. 1 to 2 teaspoons every 5 to 10 minutes for the first hour.
2. Rest the stomach for at least 6 hours after the last vomiting episode before eating again.
3. BRAT diet (bananas, rice, applesauce, toast) for the first 24 hours of recovery.
4. Watch for dehydration signs: no urine for 8 hours, dizziness on standing, dry mouth, sunken eyes, rapid heart rate. Any of these in a child or older adult is a call to a clinician.

When to call (or text Fishtown Medicine for triage):

• No fluids in for 8 hours.
• Blood in vomit or stool.
• Severe abdominal pain or rock-hard belly.
• Fever over 101°F with vomiting.
• Confusion, severe weakness, or fainting on standing.

Ticks, Greenhead Flies, and Other Biting Things

The Jersey shore is also a tick environment, particularly in the wooded and marshy areas inland from the beach. Two pathogens to know:

• Lyme disease is endemic in southern New Jersey. Transmitted by the deer tick (black-legged tick). Removing an attached tick within 24 hours of bite dramatically reduces the risk. A bullseye rash 3 to 30 days after a tick bite, with or without fevers and aches, is the classic early sign and needs antibiotics same week.
• Babesiosis and anaplasmosis are less common but exist in NJ and can cause severe disease.

Practical tick prevention:

1. DEET 20 to 30% or picaridin 20% on exposed skin for adults and children over 2 months.
2. Permethrin-treated clothing (gaiters, socks, pants) for hikes and yard work.
3. Tick checks after every outdoor session. Focus on the scalp hairline, behind ears, armpits, waistband, groin, behind knees.
4. Shower within 2 hours of coming inside.
5. Save the tick in a sealed bag if you find one attached. Photo and date it. Mail-in identification services exist.

Mosquito-borne illness in southern NJ is mostly a nuisance; rare West Nile virus cases occur. The same DEET or picaridin protection applies.

Greenhead flies are the one nobody warns you about until it happens. They breed in the salt marsh, they are worst from roughly early July into August, and they bite hard enough to draw blood, because the female cuts the skin rather than piercing it. They are worst on windless days, they are drawn to dark colors and wet skin, and they largely ignore the repellents that work on mosquitoes. The answer is wind and cover rather than chemistry: a breezy stretch of beach, a light-colored long sleeve, and distance from the marsh side. Treat a bite by washing it, using a cold pack and an antihistamine for the welt, and watching it over the following days, because the wound they leave is open enough that a small number get infected. Spreading redness, warmth, or a streak moving up the limb needs to be looked at rather than waited out.

Guidance from the Clinic

"Most shore-trip medical problems are predictable, preventable, and texted-not-emergency. The two emergencies are heat stroke and severe allergic reactions. Everything else triages well from a chair on the porch with a phone and a pen. Save your urgent care visit for when it matters."

What to Pack: A Shore-House Health Kit

A small bin in the car covers 95% of what comes up:

1. Sunscreen (SPF 30+ broad spectrum), enough for the whole household for the week. Backup tube for the car.
2. Aloe vera gel for sunburn.
3. Electrolyte packets (Liquid IV, LMNT, DripDrop, or Pedialyte powder). 1 per day per adult, more on big sun days.
4. Oral rehydration solution ready-made (Pedialyte) for kids.
5. Anti-nausea: Dramamine for motion sickness; prescription Zofran on hand if a member is prone to GI illness.
6. Loperamide (Imodium) for adults with diarrhea (avoid in children under 6 unless directed).
7. Diphenhydramine (Benadryl) for stings and rashes. Cetirizine for non-drowsy itch control.
8. Hydrocortisone 1% cream for stings, rashes, plant exposure.
9. Topical antibiotic like plain petrolatum (Vaseline or Aquaphor) and adhesive bandages. See the Cut at Home guide for the case against routine Neosporin.
10. Acetaminophen and ibuprofen for fever and pain.
11. Saline ear drops or Swim-Ear for swimmer's ear prevention.
12. DEET or picaridin insect repellent.
13. Tweezers and a small first-aid kit with gauze, tape, and sterile bandages.
14. Thermometer.
15. A list of family medications, allergies, and your physician's contact info in case a local clinician needs it.

For Fishtown Medicine members, Dr. Ash's cell number replaces step 15.

Special Groups to Plan For

Kids under 5. Higher dehydration risk, higher sunburn risk, harder to assess. Lower threshold to call for vomiting, fever over 102°F, or any change in behavior.

Adults over 65 and patients on diuretics. Lower thirst sensation, higher heat illness risk. Pre-hydrate, take cool breaks, and watch for confusion as the first sign of heat stroke (rather than waiting for a clear collapse).

Pregnant patients. Higher core body temperature already. More careful with heat exposure, particularly first trimester. DEET is safe at typical concentrations in pregnancy.

People on blood pressure or diabetes medications. Heat-induced vasodilation can drop blood pressure too far. Some diabetes medications (SGLT-2 inhibitors, GLP-1s) raise dehydration risk. Plan extra fluids and consider holding a diuretic dose on the highest-heat days, with your physician's approval.

Patients with skin conditions (psoriasis, eczema, rosacea, vitiligo, melasma). Sun can help or hurt depending on the condition. Get a personalized plan before the trip.

Which Shore Town Are You In?

Philadelphia families spread across the whole coast, and the drive determines the plan more than anything clinical does. What changes town to town is how far you are from a hospital and which hazards dominate.

The hospital systems covering the shore include AtlantiCare in the Atlantic City area, Shore Medical Center in Somers Point, Cape Regional in Cape May Court House, Southern Ocean Medical Center near Long Beach Island, and Jersey Shore University Medical Center further north. Look up the nearest one for your specific town when you arrive and save it in your phone rather than trusting a memory of this table, since the closest option depends on which block you are staying on. For anything that is truly an emergency, call 911 instead of driving, because an ambulance starts treatment on the way and knows which door to use.

Can Your Philadelphia Doctor Treat You in New Jersey?

This is the question that decides whether any of the above is useful to you, and the answer for us is yes.

A physician can only treat a patient in a state where they hold a license, and the state that matters is the one the patient is physically standing in rather than where the practice is. This is why a lot of Philadelphia patients discover that their doctor goes quiet the moment they cross the Walt Whitman. Dr. Ash holds licenses in 40 states, New Jersey among them, so a member on a beach in Wildwood is a patient he can treat rather than someone he has to refer to an urgent care.

In practice that means a member can text a photo of the sting, describe the timeline of a stomach bug, or ask whether a sunburn has crossed a line, and get an answer from the doctor who already knows their history. When a prescription is the right answer, it goes to a pharmacy near where you are staying rather than one back home.

Two limits belong here. Anything that needs hands, eyes, or equipment on the patient, meaning a wound that needs closing, an X-ray, or an examination, still needs somebody local, and the useful thing we can do is tell you which of those it is and where to go. And controlled medications follow their own stricter rules that are tied to where you physically are and to an in-person visit every 6 months, so a refill of that kind is worth handling before you drive down rather than from the beach.

How Fishtown Medicine Handles Shore Trips

At Fishtown Medicine, the shore-trip protocol is the same as the at-home protocol: a text gets a triage answer within minutes during waking hours.

The flow:

1. Pre-trip text if anyone in the family has a medical question. Confirms medication list and refills. Reviews any recent issues.
2. In-trip text triage. Photo of the sting, the cut, the rash. Description of the timeline. Response usually inside 20 minutes.
3. Prescription if needed called in to a local Acme, CVS, or Wawa pharmacy.
4. Coordination with a local urgent care or ED if escalation is required.
5. Follow-up the next day to make sure things resolved.

This is the kind of issue continuous-care DPC was built for. The infrastructure for routine same-day texting from out of town does not exist in most insurance-based primary care.

The Bottom Line

The Jersey shore is one of the best parts of being a Philly family in summer. Most of what goes wrong on a shore trip is predictable and preventable. Pre-hydrate, use enough sunscreen and reapply it, pack a small kit, and know the few red flags that need same-day care: heat stroke (confusion, body temp 103°F or higher, hot dry skin), severe allergic reactions (throat tightness, breathing trouble), uncontrolled bleeding, severe dehydration, and any sudden neurologic change. Everything else triages from the porch. Our August guide covers the peak-heat weeks and the hurricane remnants that can cut a shore weekend short.

Scientific References and Sources

1. Centers for Disease Control and Prevention. "Heat-related Illnesses (NIOSH)." Accessed 2026.
2. Centers for Disease Control and Prevention. "Sun Safety Facts." Skin Cancer Prevention, accessed 2026.
3. Centers for Disease Control and Prevention. "Reducing Risk for Skin Cancer." Accessed 2026.
4. NIOSH. "Keeping Workers Hydrated and Cool Despite the Heat." Hydration recommendations for occupational heat exposure.
5. National Weather Service. "Rip Current Safety." Drowning prevention guidance.
6. American Academy of Dermatology. "Sunscreen FAQs." Application and SPF guidance.

Dr. Ash is a board-certified internal medicine physician at Fishtown Medicine in Philadelphia. Practice members get direct text access for shore-trip triage; non-members can tell Dr. Ash what's going on before the season starts.