Shark Trauma (Shark Attack Injury)

What is Shark Trauma (Shark Attack Injury)?

There are more than 470 different species of sharks in the world. They live in both salt and fresh water, but they mostly prefer the shallow waters in warm, tropical areas. This is usually where surfers and divers may encounter them, leading to possible shark injuries. Although shark attacks are indeed a genuine danger, the likelihood of them happening is statistically quite low. However, when such attacks do happen, they often leave horrific injuries due to the power of a single shark bite. The injuries from a shark bite don’t typically follow any particular pattern of disease progression or bacterial growth. Non-lethal shark attacks can still cause severe blood loss, loss of a limb, or injuries to vital organs. Sharks haven’t become more aggressive over time, but the number of shark attacks is on the rise. This increase is believed to be due to more people engaging in water activities within the sharks’ territories.

What Causes Shark Trauma (Shark Attack Injury)?

Sharks might mistake humans as food and attack them; but this is quite rare. It usually happens when sharks get confused by the movement of limbs or the reflection from diving equipment, thinking they are small fish. Human behavior can also provoke an attack if a shark sees them as a competitor for food or even a mating rival. As a rule of thumb, touching a shark is not a good idea. A lot of bites happen when people try to handle sharks after catching them in nets or on fishing lines. Also, Sharks may attack to guard their territory.

The assumption that menstrual blood in the water could attract sharks and increase attacks has been around, but there’s no proof to support this. Still, some groups advise women to avoid swimming in waters where a shark might be present during menstruation.

Risk Factors and Frequency for Shark Trauma (Shark Attack Injury)

Between 1990 and 1999, the International Shark Attack File recorded 38 shark attacks on divers globally. This was a slight increase from the previous decade, where there were 34 attacks, 20% of which resulted in fatalities. Out of the 470 shark species known to us, only 30 have ever been recorded attacking a human. Of these 30, the majority of attacks are caused by 4 species: the Great White shark, the Tiger shark, the Bull shark, and the oceanic whitetip shark.

The oceanic whitetip shark is actually believed to have the most attacks, but many of them are not documented because they usually happen far from shore, near ship and airplane accidents where it’s difficult to accurately record data.

Shark attacks may seem common due to their coverage in the media, but the odds of being bitten by a shark in the United States in 2023 are less than 1 in 3.6 million. To give these numbers some context, an average of 3,300 people drown in the US every year, compared to just 91 who are attacked by sharks. Usually, only one of these attacks is fatal. The information about shark attacks can help us identify which areas and species to avoid. For example, almost 50% of all shark attacks happen to surfers.

• From 1990 to 1999, there were 38 recorded shark attacks on divers internationally.
• Only 30 out of the 470 known shark species have been noted to attack humans.
• Most attacks are made by the Great White, Tiger, Bull and oceanic whitetip sharks.
• The actual number of attacks by oceanic whitetip sharks is likely higher than reported due to their location in open seas.
• Despite media attention, the chance of a shark attack in the US in 2023 is less than 1 in 3.6 million.
• On average, 3,300 people drown each year in the US compared to 91 shark attacks, with typically only 1 being fatal.
• Nearly half of all shark attacks happen to surfers.

Signs and Symptoms of Shark Trauma (Shark Attack Injury)

Once a patient who has been involved in a shark encounter is stable, or if they are already stable upon arrival at the medical facility, a detailed record of the event and the lead-up to it should be taken. It’s also essential to note any existing health issues. Some health conditions can weaken the immune system such as diabetes, liver cirrhosis, alcohol use, or taking medications that suppress the immune system. Any pre-existing neurological conditions should also be documented. Additionally, the individual’s current immunization status for tetanus should be included in the record. The healthcare provider should carefully examine the injuries to assess their severity, to determine the amount of tissue damage, to check for intact nerves and vasculature, to identify potential bone injury, and to look for any foreign objects.

Testing for Shark Trauma (Shark Attack Injury)

If someone has been injured by a shark, it’s crucial to check for any leftover pieces of shark teeth in their wounds, broken bones, or damaged bone surfaces. This can be done with an X-ray, ultrasound, or CT scan, which are all tools that can help spot these objects. Sometimes, there might be a fear that blood vessels have been injured. In this case, even if the person seems stable and there are no immediate signs of blood vessel damage (like spurting blood or rapidly swelling bruises), a CT angiography might be done. This is a type of CT scan that provides images of blood vessels.

Treatment Options for Shark Trauma (Shark Attack Injury)

The initial care for someone who has been attacked by a shark often starts before reaching the hospital. The first step is ensuring the safety of the individual and the medical team, which can mean moving the person away from the water. As with all traumatic injuries, the first medical treatment should focus on keeping the patient’s airway open, helping them breathe, and maintaining circulation, usually done following the Advanced Trauma Life Support protocol. Controlling any bleeding is vital. If the person’s arms or legs are injured and bleeding isn’t stopping, tourniquets should be used until further medical intervention can take place. These tourniquets should stay on until a surgeon can examine and repair any blood vessel damage.

Intravenous lines should be set up as soon as possible to give fluids and/or blood transfusions. If the attack has resulted in extensive tissue loss, a surgeon should clean these areas in an operating room. Being cold is often a problem due to spending time in the water, shock, and blood loss. The person’s skin should be dried to stop more heat loss, and steps should be taken to warm them up as soon as possible, without delaying other life-saving interventions.

If there are isolated wounds, these can be treated in the emergency department or an outpatient clinic. These wounds need to be cleaned thoroughly to prevent infection. As with any animal bite, there might be foreign objects left in the tissue that need to be identified and removed.

Cleaning the wound well is key to preventing infection. This can start at the scene using tap water to clean the wound. Further cleaning should happen in the emergency department or outpatient clinic. It’s important to examine the wound carefully for foreign bodies. Tissue that has been damaged should be cut away and the area thoroughly irrigated. Although most injuries are minor or superficial, some can be more serious and may need surgical cleaning and repair.

For minor wounds, there’s no agreement on whether or not to close a wound. The decision on whether or not to stitch a shark bite wound should weigh the risk of infection against the potential for poor healing. It can be helpful to talk things through with a patient who is reliable and well-informed to help make this decision. One report in a scientific study described a shark bite wound that was loosely stitched together 24 hours after injury, and the person was given preventive oral antibiotics and scheduled for regular checks. The wound did not become infected following this treatment.

Preventive antibiotics should be given for all shark bites, even minor ones. The chosen antibiotics should be effective against a type of bacteria called Vibrio species. Drugs like fluoroquinolones, third-generation cephalosporins, and doxycycline are particularly effective against Vibrio vulnificus. Given the common occurrence of Staphylococcus and Streptococcus infections in wounds, these should also be considered in drug selection. A combination regimen of cephalexin, doxycycline, and ciprofloxacin would be suitable for prevention. For more serious Vibrio infections that require hospitalization, the Center for Disease Control and Prevention recommends a 7-14 day course of doxycycline and a third-generation cephalosporin like ceftazidime. Antibiotic treatment options should be adjusted based on wound or blood culture results.

What else can Shark Trauma (Shark Attack Injury) be?

Usually, when a person is bitten by a shark, it’s pretty clear what happened. The person, emergency medical workers, or someone who saw the incident can tell what caused the injury. In rare cases when no one saw what happened and the injured person can’t communicate about the event, it may be necessary to consider injuries from other sea animals.

Doctors also have to think about possible complications from severe injuries such as a shark bite. These might include:

• Severe lung problems from almost drowning (ARDS)
• Allergic reaction (Anaphylaxis)
• Injury to an artery
• Skin infection (Cellulitis)
• Compartment syndrome, a painful and potentially dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues
• Broken bones (Fracture)
• Infections caused by a range of bacteria, including Aeromonas (in freshwater), Chromobacterium, Edwardsiella, Erysipelothrix, Escherichia coli, Mycobacterium, Mycoplasma, Pseudomonas, Shewanella, Staphylococcus, Streptococcus, Vibrio (in saltwater), and Clostridium tetani (which can cause tetanus)
• Severe skin and muscle infections (Necrotizing fasciitis or myonecrosis)
• Injury to a nerve
• Infection of the bone (Osteomyelitis)
• Rhabdomyolysis, a serious syndrome due to a direct or indirect muscle injury

Other sea animals that could cause injuries might include:

• Barracuda
• Crocodile
• Giant Groupers
• Octopus
• Jellyfish
• Moray eels
• Skates
• Stingray

What to expect with Shark Trauma (Shark Attack Injury)

Most people survive shark attacks. In a review of 86 consecutive cases, the majority (81%) of patients had minor injuries which were treated with simple stitches. However, those with more severe injuries were more likely to have complications and were at a higher risk of losing a limb. In cases where the attacks were fatal, most deaths were due to severe bleeding caused by injuries to the blood vessels.

Possible Complications When Diagnosed with Shark Trauma (Shark Attack Injury)

Similar to other kinds of deep injuries, trauma to the nerve and blood vessels or sudden fractures can occur in the early stages. Improper cleaning or exploration of the wound might leave behind a foreign object or dead tissue, which can cause infection. This can then result in further tissue damage and health issues. Despite receiving appropriate care and antibiotics, some patients may still end up with serious wound infections. These infections can cause tissue death, severe systemic infection commonly known as sepsis, or even necessitate the amputation of a limb.

Preventing Shark Trauma (Shark Attack Injury)

Sharks might bite for various reasons like hunting for food, defending their territory, or out of surprise. However, shark attacks are quite rare. Here are some recommendations from the Global Shark Attack File to minimize the likelihood of shark attacks:

Before diving into water activities where shark attacks have happened before, it’s a good idea to seek advice from the locals. Always stay aware of your surroundings. If you start to feel uneasy while in the water, get out immediately. If a shark is in sight, do not bother or touch it, regardless of its size.

When you’re swimming or surfing, avoid going into the water when sharks are known to be present. If you spot a shark or are asked by an authority figure like a lifeguard to leave the water, do so quietly and calmly. Make sure you’re not alone when swimming, surfing or diving. Stay not too far from the shore and avoid swimming at night or in unclear waters, like when the water is murky.

Avoid swimming near the mouth of a river and be extra cautious when swimming in breaking waves. Don’t swim close to sandbanks and be careful when crossing channels between sandbars or on the edge of steep drops. Don’t swim or surf near jetties. Avoid areas where birds are diving into the water. If there are schools of fish nearby, don’t try to scare them off. If small fish are jumping above the water surface, get out of the water straight away.

If you’re spearfishing or collecting shellfish, don’t attach your catch to a belt around your waist, and always stay alert when removing a fish from your spear. If you’re wade-fishing, avoid carrying bait with you. Change your location frequently if you’re spearfishing. Avoid places where people are fishing or where fishing waste is discarded into the sea. The presence of porpoises and dolphins could mean sharks are hunting nearby.

Leave the water if you see a group of dolphins moving towards the shore. Avoid swimming, surfing, or diving near areas where seals and sea lions gather or breed. Avoid wearing swimsuits that have high-contrast colors. Try not to splash too much or make fast, sudden movements in the water. Don’t swim with dogs or horses. If a shark gets too close for comfort, try to keep it away with your speargun or a stick meant for deterring sharks. Only try to spear the shark if you believe a bite is imminent.