Volunteer lifesavers on jet skis and in IRBs (inflatable rescue boats) carried out 40 rescues at Cronulla beaches on Sunday.
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Council lifeguards were also kept busy when sunny skies and high temperatures drew large numbers to the beach.
While the surf was not particularly big, rips created dangerous conditions around Bate Bay.
The most serious incident occurred between Elouera and Wanda beaches just before 4pm when a man in his 40s and a woman in her 20s had to be rescued.
Board riders, lifesavers and lifeguards were involved in the rescue.
A NSW Ambulance spokeswoman said the woman was unconscious when she was brought to shore, but regained consciousness before being taken to St George Hospital.
Her male companion was treated for shock and also taken to St George Hospital.
Paramedics also responded to two medical incidents at Cronulla and Wanda beaches during the late afternoon. A man in his 80s suffered abdominal pain and a man in his 40s had a heart issue.
Lifesavers and lifeguards stayed at their posts beyond scheduled finish times because of the number of people remaining in the surf.
Surf Life Saving Sydney reported "an exceptionally busy day" with "a significant amount of major incidents" on the beaches patrolled by clubs in the branch, which extends from Bondi to Royal National Park.
"All in all, there were at least 14 serious incidents across the branch, with some clubs completing many rescues," Surf Life Saving Sydney said.
"Our support operations team were kept busy, with our RWCs (rescue water craft) in Bate Bay completing 40 rescues.
"Clubs extended hours beyond the usual sign off with 2 incidents requiring ambulances occurring post 6pm.
"Great work by our clubs and services today."
Facebook comments included: "I was sitting on Cronulla beach this evening well past the last patrols finish time. Both the beach and water were packed. It was really impressive to see both our volunteer lifesavers and council lifeguards stay back until everyone was out of the water. There were a lot of non swimmers there today and a couple of nasty rips running. Many rescues were performed throughout the day as it was. Well done to both teams."