Once Bitten, Twice Shy

18 August 2011 By Patricia M. Campbell, RN, MSN, CCRN, ANP, BC,

The seven seas are brimming with brilliant creatures: jellyfish, sea urchins, fire coral, lion fish, sea snakes, blue-ringed octopus, cone shells, certain starfish (crown of thorns), stonefish and stingrays. But these ocean inhabitants can turn a day out swimming, diving or jet skiing in the ocean into a nuisance — or even a life threatening disaster — if or a guest or crewmember has an up-close and personal encounter with a venomous marine animal. One sting from a poisonous jellyfish or small puncture from a stingray requires immediate medical treatment.

Know the Signs and Symptoms
All crew should know the basic signs and symptoms of an interaction with dangerous marine life and be ready to react to a sting, bite, etc. accordingly, especially if professional shore-side medical care is a day or more away.

Symptoms of a poisonous bite or wound can range in severity from a burning sensation or a skin rash to excruciating pain, severe blistering and generalized illness. However, depending on the type of sea creature, the first responder may witness more life-threatening symptoms: signs of an allergic reaction or shock, shortness of breath, paralysis, coma or death.

While there is not a one-size-fits-all approach to treating a victim injected with the venom of a sea creature, below are basic rules when managing medical ailments. Be sure to check with your remote medical provider and identify the sea creature (e.g., sea snake) because treatment varies.

1.    Be sure it’s safe to assist the victim, then carefully remove the person out of the water or away from danger.
2.    Locate your first responder medical kit, oxygen kit and telemedicine vital sign monitor to take to the scene. Immediately put on protective eyeglasses and gloves to reduce your exposure to toxins.
3.    Delegate someone to call the remote medical provider and describe the sting or wound and victim’s symptoms. Use the telemedicine monitor to transmit a video or photo of the wound area to the doctor.
4.    Conduct a primary assessment and treat for life threatening conditions (e.g., Do they need CPR? Is it a severe allergic reaction? Do you need to administer oxygen?)
5.    For a jellyfish sting, stop the reaction by rinsing the skin with seawater. For stingray and lionfish wounds, immerse the site in hot water to inactivate the release of venom.
6.    If bleeding, apply direct pressure with a clean town to stop the bleeding.
7.    Remove the stinger, spines, sand or foreign objects carefully with a multipurpose tool or tweezers.
8.    Clean the wound gently with soap and water followed with irrigation solution.
9.    For a sea snake bite, elevate extremity to avoid swelling and apply a compression immobilization dressing if needed.
10.    Contact your medical provider if symptoms, such as faintness or sweating occur; these may indicate that venom has been absorbed. Likewise, seek assistance if the victim has redness, swelling, infection or delayed healing. Your medical provider can provide a medical referral to a credentialed shore-side medical facility and/or assist with a medical evacuation if immediate treatment is recommended. Check your contract for details.

Exposure to poisonous sea creatures can result in mild- to life-threatening injuries. Early recognition and initial treatment of these conditions are important to prevent further injury. Additionally, it’s paramount that crew maintain first aid skills and have access to the onboard medical kits and medications and to remote medical help.

Patricia M. Campbell, RN, MSN, CCRN, ANP, BC, is the author of the Maritime First Responder Guide published by MedAire Inc. When she’s not consulting for MedAire’s maritime and aviation clients, she is treating patients at a Phoenix, AZ-based emergency department where MedAire’s 24/7 MedLink Global Response Center manages 41,000 remote medical events a year.