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Chapter 29 — 3
!
Stop the blood loss.
This must be done by rescuers
at the site
of the attack. Bleeding which is oozing or welling
up from a wound can be stopped by applying a cloth pad (preferably but not necessarily
clean) to the wound and pressing firmly with the hand or applying a tight bandage. Spurting
arterial bleeders up to about 3 mm in size can also be stopped by a pressure bandage and pad.
Larger arterial bleeders can be stopped by the application of pressure by a finger or thumb.
Bleeding from major blood vessels (the size of a finger) can be stopped by pinching the end
of the vessel between finger and thumb, or a tourniquet if a limb is involved. Tourniquets
have to be released every 10–20 minutes to let blood return to normal tissues.
It is important that pads, used to stop bleeding, have pressure applied to them to force the
blood vessels closed. It can be disastrous when rescuers merely cover bleeding areas with a
dressing, without any pressure application. This soaks up and conceals the blood loss, without
stopping it. Any clean material such as toweling, clothing or handkerchiefs are satisfactory in
the first-aid situation.
!
Resuscitate the victim at the site of the attack
.
If the patient is unconscious the basic life support (
BSL
) priciples take precedence and should
be followed (see Chapter 42).
I
mmobilisation
is advised. Once the victim is in a place of safety, (boat or shore) it is vital
that he not be moved further. Bundling a victim into the back of vehicle for a bumpy ride to
hospital has resulted in death of the victim on many occasions.
The victim should be kept lying horizontal at the rescue site and resuscitation equipment and
personnel brought to him.
Resuscitation involves replacing the patient's blood loss by the
intravenous infusion
of
blood or blood substitutes such as plasma, saline or other intravenous fluids. It is not safe to
move the victim until a satisfactory circulating volume has been established. Evidence for this
is a relatively normal pulse (rate less than 100) and blood pressure.
This management principle is sometimes difficult to accept by rescuers who understandably
wish to dispatch the victim to hospital (anywhere!) as soon as possible. However, once the
victim reaches there, exactly the same management as should have taken place at the shark
attack site will be needed. i.e. arrest of the blood loss accompanied by the administration of
intravenous fluids.
Major hospitals in shark attack prone areas have a shark attack protocol along the lines
mentioned above. Equipment may be available for immediate transportation to a shark attack
site. Shark attack is so rare, however, that practice at implementing this protocol is sometimes
neglected.
In spite of the severity of the injuries, it is common for the patient not to experience
significant pain for some time after the attack. This phenomenon is frequently seen in other
forms of severe injury such as motor vehicle and war injuries. If the patient is suffering
significant pain or shock, the rescuing medical team will administer morphine in an
appropriate dose.
Nothing should be given by mouth to the victim, as an anaesthetic may be required.