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The liveaboard arrived in the harbor approximately
two hours later, just before 3 p.m., and the diver was
transported ashore in a waiting panga boat. The crew
had dressed and bandaged his wounds, and he was in
good condition overall. The patient, trip leader and crew
determined that waiting for an ambulance might delay
transport (unfortunately ambulances in that area cannot
always provide timely responses), and so the trip leader
chose to drive the diver in his private vehicle.
During the drive, the diver’s vital signs were normal,
and he did not show any signs of distress despite his
obvious wounds. Because he appeared stable and the
bleeding was controlled, they chose to go to a nearby
local clinic. Area hospitals are usually quite busy
with patients, possibly causing a delay in treatment
for this diver.
They arrived at the local clinic just before 4 p.m., and
the attending physician assumed care of the patient. The
wounds were two parallel lacerations approximately
2 inches long, a half-inch wide and more than an inch
deep with some smaller adjacent puncture wounds.
The doctor and his staff thoroughly cleaned the
wounds, injected a local anesthetic and sutured the
wounds closed. Two internal sutures were used first in
each wound as they required a multilayer closure. Before
he completed the closure, the doctor placed a sterile
wick to promote drainage. One of the small puncture
wounds required a single suture to close.
At the doctor’s direction, a nurse administered a
tetanus booster. The diver was discharged around 6 p.m.,
and his traveling companions escorted him to his hotel.
ANALYSIS
This incident is an excellent reminder of why dive
operators need to have a preexisting emergency action
plan and not hesitate to implement it. It also serves to
illustrate that any action plan needs to accommodate
emergencies beyond those involving decompression
illness. For dive crew, good first-aid skills for physical
trauma are a must.
The dive operator contacted local personnel who were
familiar with local resources and made a decision based
on their input and knowledge. The operator decided to
transport the injured patient with the assistance of an
EMT who was on the trip as well as a local lifeguard
who was also an EMT.
Medical evaluation and treatment are important with
any injury in which the skin is penetrated in the marine
environment. Seal and sea lion bites in particular have
a very high probability of infection. The importance of
proper cleaning and disinfection cannot be overstated,
even with apparently small wounds. All such wounds
should to be monitored for signs of infection for at least
seven to 10 days. Those signs can include increased
swelling, pain or tenderness at or around the wound,
increased redness, foul-smelling discharge from the
wound, red streaks extending away from the wound site,
fever and nausea.
Although it is not entirely clear why the sea lion
bit the diver, a witness saw two bull sea lions fighting
aggressively followed by one turning to flee from the
other. The diver was approximately 50 feet away from
them, but he was in the path of the fleeing animal and
was bitten. Regardless of how playful or docile a marine
animal may appear, we must not forget we are visitors
to their environment and should remain keenly aware
of their behavior. Be sure to learn how to observe
and approach animals, and always follow experts’
recommendations.
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SEAL AND SEA LION
INJURY MANAGEMENT
Contact with seals or sea lions can result in a serious infection
by the bacterium leptospirosis, commonly known as “seal
finger.” Avoid feeding seals, as this will significantly reduce the
likelihood of seal/human contact. Prevent contact between dogs
and seals; diseases can be transmitted between them.
Wash any wounds caused by seals or sea lions thoroughly with
disinfectant, and dry them. Seek medical care for any injuries
caused by these animals, as there is potential for serious long-
term health implications. Be sure to tell the doctor you were
bitten by a seal or sea lion. Watch carefully for unusual signs or
symptoms for seven to 10 days, and go to the hospital if you feel
unwell at any time.
ED STETSON