Shark attacks increased 23% globally within the past 20 years on a multifactorial scale through climate change and human impacts, yet healthcare lacks treatment guidelines for these victims. This systematic review proposed a shark attack treatment protocol that will potentially reduce the morbidity and mortality rates by assessing prehospital management with transfusions, hospital management with prophylactic antibiotics, and mental health evaluations to prevent and/or treat psychological impacts. This study screened 463 sources and eliminated 432 sources due to repetition or irrelevance to this study. The protocol initiates with prehospital management by implementing emergency medical service (EMS) to follow the SHARC protocol (systolic blood pressure (SBP) < 90, hemorrhage, appearance, radius of the bite over 15 cm, and coagulopathy) to administer whole blood transfusions in route to a hospital to prevent hypovolemic shock. The next step is the antibiotic protocol to administer ciprofloxacin or moxifloxacin, and a third-generation cephalosporin with doxycycline to prevent wound infections commonly caused by vibrio species. Assessing mental health before and three months after discharge can help prevent and/or treat anxiety, depression, and post-traumatic stress disorder (PTSD).
References
[1]
Somand, D.M. and Ward, K.R. (2020) Approach to Traumatic Shock. In: Tintinalli, J.E., Ma, O., Yealy, D.M., Meckler, G.D., Stapczynski, J., Cline, D.M. and Thomas, S.H., Eds., Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, McGraw-Hill Education. https://accessmedicine-mhmedical-com.canisius.idm.oclc.org/content.aspx?sectionid=211002580&bookid=2353&Resultclick=2
[2]
Cevik, J., Hunter-Smith, D.J. and Rozen, W.M. (2022) Infections Following Stingray Attacks: A Case Series and Literature Review of Antimicrobial Resistance and Treatment. Travel Medicine and Infectious Disease, 47, Article ID: 102312. https://doi.org/10.1016/j.tmaid.2022.102312
[3]
Coerdt, K.M. and Khachemoune, A. (2021) Vibrio vulnificus: Review of Mild to Life-Threatening Skin Infections. Cutis, 107, E12-E17. https://doi.org/10.12788/cutis.0183
[4]
NOAA (2018) Mean Temperature Percentiles: January-December 2017. NOAA. https://www.ncei.noaa.gov/access/monitoring/monthly-report/global/201801
[5]
NOAA (2008) Mean Temperature Percentiles: January-December 2007. NOAA. https://www.ncei.noaa.gov/access/monitoring/monthly-report/national/200713
[6]
NOAA (2023) International Shark Attack Data Set. https://www.floridamuseum.ufl.edu/shark-attacks/maps/
[7]
Riley, M., Meagher, P., Huveneers, C., Leto, J., Peddemors, V.M., Slip, D., et al. (2022) The Australian Shark-Incident Database for Quantifying Temporal and Spatial Patterns of Shark-Human Conflict. Scientific Data, 9, Article No. 378. https://doi.org/10.1038/s41597-022-01453-9
[8]
Oury, N., Jaquemet, S., Simon, G., Casalot, L., Vangrevelynghe, G., Landron, F., et al. (2021) Forensic Genetic Identification of Sharks Involved in Human Attacks. Forensic Science International: Genetics, 54, Article ID: 102558. https://doi.org/10.1016/j.fsigen.2021.102558
[9]
Maillaud, C., Fournier, J., Guittonneau, A., Tirard, P., Bowling, T. and Naylor, G. (2022) Tiger Shark Attack on a Scuba Diver in New Caledonia. Wilderness & Environmental Medicine, 33, 332-336. https://doi.org/10.1016/j.wem.2022.04.003
[10]
Scala, V.A., Hayashi, M.S., Kaneshige, J., Haut, E.R., Ng, K. and Furuta, S. (2020) Shark-Related Injuries in Hawai’i Treated at a Level 1 Trauma Center. Trauma Surgery&AcuteCareOpen, 5, e000567. https://doi.org/10.1136/tsaco-2020-000567
[11]
Adegunsoye, A., Naureckas, E.T. and O’Connor, M. (2023) The Pathophysiology of the Circulation in Critical Illness. In: Schmidt, G.A., Kress, J.P. and Douglas, I.S., Eds., Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition, McGraw-Hill. https://accessmedicine-mhmedical-com.canisius.idm.oclc.org/content.aspx?bookid=3350§ionid=279556808
[12]
Harper, K.D., Quinn, C., Eccles, J., Ramsey, F. and Rehman, S. (2018) Administration of Intravenous Antibiotics in Patients with Open Fractures Is Dependent on Emergency Room Triaging. PLOS ONE, 13, e0202013. https://doi.org/10.1371/journal.pone.0202013
[13]
Cameron, P., Knapp, B. and Teeter, W. (2020) Trauma in Adults. In: Tintinalli, J.E., Ma, O., Yealy, D.M., Meckler, G.D., Stapczynski, J., Cline, D.M. and Thomas, S.H., Eds., Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, McGraw-Hill Education. https://accessmedicine-mhmedical-com.canisius.idm.oclc.org/content.aspx?sectionid=221180871&bookid=2353&Resultclick=2
[14]
Chin-Hong, P., Joyce, E.A., Karandikar, M., Matloubian, M., Rubio, L., Schwartz, B.S. and Levinson, W., Eds. (2024) Laboratory Diagnosis. In: Chin-Hong, P., Joyce, E.A., Karandikar, M., Matloubian, M., Rubio, L., Schwartz, B.S. and Levinson, W., Eds., Levinson’s Review of Medical Microbiology & Immunology, A Guide to Clinical Infectious Diseases, 18th Edition, McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?sectionid=284618414&bookid=3428
[15]
Saavedra, A.P., Roh, E.K. and Mikailov, A., Eds. (2023) Bacterial Colonizations and Infections of Skin and Soft Tissues. In: Saavedra, A.P., Roh, E.K. and Mikailov, A., Eds., Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, McGraw-Hill Education. https://accessmedicine.mhmedical.com/content.aspx?bookid=3309§ionid=275944706
[16]
Coil, C.J. and Santen, S.A. (2020) Transfusion Therapy. In: Tintinalli, J.E., Ma, O., Yealy, D.M., Meckler, G.D., Stapczynski, J., Cline, D.M. and Thomas, S.H., Eds., Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, McGraw-Hill Education. https://accessmedicine.mhmedical.com/content.aspx?sectionid=221179053&bookid=2353&Resultclick=2
[17]
Khan, F., Singh, K. and Friedman, M.T. (2020) Artificial Blood: The History and Current Perspectives of Blood Substitutes. Discoveries, 8, e104. https://doi.org/10.15190/d.2020.1
[18]
More, A., Sayeed, S., Morankar, P., Churi, S., Gawli, S., Karandi, R. and Gorade, R. (2022) A Comprehensive Insight into Artificial Blood. International Journal of Pharmaceutical Sciences and Researchx, 14, 1000-1012. https://www.researchgate.net/profile/Sohail-Sayyed-2/publication/379654769_A_COMPREHENSIVE_INSIGHT_INTO_ARTIFICIAL_BLOOD/links/661395557476d47e4447bf50/A-COMPREHENSIVE-INSIGHT-INTO-ARTIFICIAL-BLOOD.pdf
[19]
Azuma, H., Amano, T., Kamiyama, N., Takehara, N., Jingu, M., Takagi, H., et al. (2022) First-in-Human Phase 1 Trial of Hemoglobin Vesicles as Artificial Red Blood Cells Developed for Use as a Transfusion Alternative. Blood Advances, 6, 5711-5715. https://doi.org/10.1182/bloodadvances.2022007977
[20]
Cooper, C., Silkstone, G., Simons, G., Gretton, S., Rajagopal, B., Allen-Baume, V., Syrette, N., Shaik, T., Popa, G., Shen, X., Bird, M., Choi, J.W., Piano, R., Ronda, L., Bettati, S., Peredi, G., Mozzarelli, A. and Reeder, B. (2024) Engineering Hemoglobin to Enable Homogenous PEGylation without Modifying Protein Functionality. Biomaterials Science, 8, 3896-3906. https://pubs.rsc.org/en/content/articlelanding/2020/bm/c9bm01773a
[21]
Chen, L., Yang, Z. and Liu, H. (2023) Hemoglobin-Based Oxygen Carriers: Where Are We Now in 2023? Medicina, 59, Article 396. https://doi.org/10.3390/medicina59020396
[22]
West Virginia Office of Emergency Medical Services (2024) State CCT Guidelines 1903/2903 Blood Transfusion. https://www.wvoems.org/media/241707/1903_2903%20blood%20administration.pdf
[23]
National EMS Advisory Council (2023) Prehospital Blood Transfusion Initiative Coalition. https://www.ems.gov/assets/Prehospital-Blood-Transfusion-Initiative-Coalition-Presentation---NEMSAC-August-2023.pdf
[24]
Taylor, J., McLean, L., Korner, A. and Glozier, N. (2018) Direct and Indirect Psychological Impacts of Shark-Bite Events. Australian & New Zealand Journal of Psychiatry, 53, 27-36. https://doi.org/10.1177/0004867418808899
[25]
DeSelm, T.M. (2020) Mood and Anxiety Disorders. In: Tintinalli, J.E., Ma, O., Yealy, D.M., Meckler, G.D., Stapczynski, J., Cline, D.M. and Thomas, S.H., Eds., Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, McGraw-Hill Education. https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=2353§ionid=226635666
[26]
Woolgar, J.D., Cliff, G., Nair, R., Hafez, H. and Robbs, J.V. (2001) Shark Attack: Review of 86 Consecutive Cases. The Journal of Trauma: Injury, Infection, and Critical Care, 50, 887-891. https://doi.org/10.1097/00005373-200105000-00019
[27]
Reus, V.I. (2022) Psychiatric Disorders. In: Loscalzo, J., Fauci, A., Kasper, D., Hauser, S., Longo, D. and Jameson, J., Eds., Harrison’s Principles of Internal Medicine, McGraw-Hill Education. https://accessmedicine.mhmedical.com/content.aspx?bookId=3095§ionId=265468363
[28]
Aliva, J. (2017) Shock. In: Stone, C. and Humphries, R.L., Eds., CURRENT Diagnosis & Treatment: Emergency Medicine, McGraw-Hill Education. https://accessmedicine-mhmedical-com.canisius.idm.oclc.org/content.aspx?sectionid=165058750&bookid=2172#165058767
[29]
Hanna, M., Knittel, J. and Gillihan, J. (2022) The Use of Whole Blood Transfusion in Trauma. Current Anesthesiology Reports, 12, 234-239. https://doi.org/10.1007/s40140-021-00514-w
[30]
Devlin, J.J. and Knoop, K.J. (2020) Marine Trauma and Envenomation. In: Tintinalli, J.E., Ma, O., Yealy, D.M., Meckler, G.D., Stapczynski, J., Cline, D.M. and Thomas, S.H., Eds., Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, McGraw-Hill Education. https://accessmedicine-mhmedical-com.canisius.idm.oclc.org/content.aspx?sectionid=220746848&bookid=2353#226628233
[31]
Mayersak, R.J. (2020) Initial Evaluation and Management of Orthopedic Injuries. In: Tintinalli, J.E., Ma, O., Yealy, D.M., Meckler, G.D., Stapczynski, J., Cline, D.M. and Thomas, S.H., Eds., Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, McGraw-Hill Education. https://login.canisius.idm.oclc.org/login?qurl= https://accessmedicine.mhmedical.com%2fcontent.aspx%3fsectionid%3d222324221%26bookid%3d2353%26Resultclick%3d2
