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MARINE TRAUMA

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Human contact with the marine environment is becoming more frequent as recreational and commercial use of the world's oceans increases. In addition to the hazards of drowning and cold exposure, the marine environment provides the habitat for dangerous marine fauna. Many marine animals have evolved sharp teeth and spines or venom glands for defense and predation. Encounters with marine life may result in traumatic injury or envenomation, requiring emergency medical management. Providing care for these conditions may be further complicated by the marine environment's geographic isolation from locations with definitive health care.

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EPIDEMIOLOGY

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Epidemiologic information typically is organized by geographic region. The most common reported U.S exposures are to jellyfish (31%), stingrays (16%), venomous fish (including lionfish, catfish, and others) (28%), and gastropods (6%).1 However, data likely favor the reporting of more severe injuries and the exclusion of common minor injuries. Human impact may be altering the geographic distribution of marine fauna as climate change affects migration patterns and artificial waterways connect previously separated bodies of water and their ecosystems.2,3

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The International Shark Attack File recorded 2074 unprovoked shark attacks between 1960 and 2013, with the United States reporting the most attacks of any country and Florida reporting the most attacks of any state.4 Despite the public perception, the risk of shark attack is extremely small compared with almost any other injury. There are probably between 70 and 100 shark attacks worldwide each year, with between 5 and 15 deaths.4,5 Although the incidence of shark attacks has steadily risen since 1900, the mortality has fallen from 40% in the 30 years following World War II to current rates of approximately 10% to 20%.6 Death is usually a result of a lack of prehospital resuscitation, hemorrhagic shock, or drowning.

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Other marine creatures have been reported to attack humans, typically in defense of territory rather than for feeding. The great barracuda (Sphyraena barracuda) is the only barracuda species implicated in human attacks.6 Moray eels, found in tropical to temperate waters, can inflict severe puncture wounds or lacerations, commonly to the hands of inquisitive divers. Other marine vertebrates known to cause traumatic injuries to humans include giant groupers, sea lions, seals, crocodiles, alligators, and piranhas. Some fish with sharp spines and fins (needlefish, wahoo, and triggerfish) can inadvertently injure humans. Wounds resulting from interactions with such creatures are a combination of crush injury, abrasion, puncture, and/or laceration.

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BACTERIOLOGY OF MARINE SOFT TISSUE INFECTIONS

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Marine soft tissue infections are often polymicrobial, halophilic gram-negative infections that may be resistant to first- and second-generation penicillins and cephalosporins.7 Infecting bacteria are numerous and can vary with the environment, type of injury, and marine organism. Bacteria include staphylococci, streptococci, Aeromonas hydrophilia, Escherichia coli, Pseudomonas species, Erysipelothrix species, Chromobacterium, Edwardsiella, Shewanella, Mycobacterium...

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