by Marty McCafferty
Any break in the skin, especially deep enough to cause bleeding, can cause an infection. The marine environment can cause even simple wounds to become infected from relatively uncommon types of pathogens (ie viruses, microorganisms and other disease-causing substances) and, depending on the region of the cut and where in the world you incurred the injury, many wounds can become infected quickly.
Clean it up:
Proper initial cleaning of any wound is essential. As a general rule to prevent cross-contamination, experts encourage medical staff to wash their hands for a full 15 seconds between contacts with patients.
For initial first aid for divers with skin break injuries, thatâs a reasonable amount of time. Larger wounds need longer cleaning time. Sometimes having the injured persons clean the wound themselves can yield better results. Remember the thoroughness of the initial care greatly influences the likelihood of infection and final outcome of the injury.
Or Splint It and get to medical care – ASAP:
In spite of the importance of a good initial cleaning, some wound care is best left to professionals. Someone well intentioned but inexperienced in cleaning the wound may aggravate more serious injuries. The more difficult injuries to handle in the field include open fractures and vascular, tendon or nerve injuries. Plus, it requires sound judgment to decide when it is simply better to splint and transport rather than risk uncontrolled bleeding or a permanent neurological damage from a not so skilful cleaning.
Check for Shock:
With any marine life injury, monitor the injured person for any signs of shock, allergic reaction (hives, itching, swelling) or anaphylaxis (a serious and potentially life-threatening allergic reaction). In the event of anaphylactic shock, provide supplemental oxygen and get immediate advanced life support and emergency medical services transport to the nearest medical facility.
Individuals who experience itching, burning and redness of the skin after a marine encounter of unknown origin: Usually the symptoms disappear after one to two days, but sometimes they abruptly return. This occurs anytime from two to five days after the initial encounter, and the recurring symptoms may be worse than they were initially.
According to DAN consultant Dr Bruce Miller, this is a âdelayed hypersensitivity reaction,â or reaction to a toxin. Unlike a systemic (whole body) allergic reaction, which may affect larger skin areas or other organs, the delayed reaction tends to remain confined to the injury site. âOnce this delayed reaction occurs,â Miller said, âtopical hydrocortisone cream (often part of the usual initial treatment) may have little or no benefit. The recommendation is to be evaluated by a physician, because oral steroids may be required to treat the reaction.â Itâs important to seek evaluation by a physician to ensure no secondary infection exists from the skin breaks that can occur when the skin is scratched too vigorously.â
Practise Avoidance Where Possible:
Avoiding contact constitutes the best cure for marine life injuries. This is not always easy. Heavy surge, clumsy dive buddies, less-than-neutral buoyancy and other factors can cause inadvertent contact. Whatever the circumstance, the results are the same. Certifying agencies offer courses or workshops for buoyancy skills as well as marine life identification. Buoyancy problems easily lead to contact with marine life or other injury. A few reminders:
- Practise good buoyancy
- Secure loose gear â¢ In heavy surge, allow greater distance from marine life
- Avoid grabbing mooring lines with an ungloved hand, and
- Know where you are in relation to the dive site.
Coral Cuts, Abrasions and Sponges:
Coral injuries can be painful and sometimes difficult to heal. Controlling bleeding is the first consideration – ie use direct pressure and elevate the injured part of the body. If the wound is significant, bleeding is difficult to control or the affected part is deformed (ie anything that might indicate a dislocation or fracture), then get professional medical care.
Clean the Area:
With coral cuts and abrasions, if there are no complications and bleeding is controlled, make sure that a thorough cleaning is the next priority. Proper cleaning is essential. Here are some recommended steps:
- Clean the wound of fragments. Small fragments of coral can remain in the wound, prolonging the healing process and increasing the risk of infection. To remove any fragments of coral irrigate the wound with sterile water or a saline solution. If none is available, clean drinking water will do. A 20cc. Syringe (without the needle) is an excellent way to flush the wound with enough pressure to remove particles.
- Clean the wound with antibacterial soap. This can be the same antibacterial soap you buy from the store and use at home. Mixing hydrogen peroxide with the water will further help disinfect the wound and aid the removal of fragments. Use gauze pads, fresh paper towels or a clean cloth for this next cleansing.
Use antibiotic cream. After a thorough cleaning, apply a topical antibiotic cream (eg neomycin, bacitracin, polymyxin, etc.), then cover the wound with a sterile dressing and bandage. Pre-sized bandages out of the box are absolutely acceptable if you have an appropriate size. Change dressings daily or as soon as they become wet or soiled.
An itching rash may develop within a few hours after contact with a sponge and is similar to the rash from contact with other mildly toxic marine animals. Itâs assumed that a diver who has handled a sponge and develops a rash on the hands has been exposed to a toxic species. The reactions are usually mild and subside in a few days with little or no treatment. However, reactions can become quite severe, with pain and blistering.
- Clean the wound. The best treatment is to clean the area quickly by removing the pointed spicules of sponges. These are the hard, pointed calcareous or siliceous bodies that support the tissues of sponges and become embedded in a diverâs skin. To remove use wide tape to lift the particles from the site. This is an alternative to shaving. Or carefully scrape the area with a credit card, tongue depressor or similar.
- Use antibiotic cream. Once you are confident that any remaining fragments are removed, apply a topical application of hydrocortisone cream. Monitor the injured person for any signs of shock, allergic reaction or anaphylaxis. Anyone assisting the injured person should use simple latex gloves as they will suffice in protecting against stings.
Stinging Creatures, Fire Coral and Hydroids
These marine creatures have nematocysts, or stinging cells, that inject venom when they come in contact with a body. The intensity of the sting varies with each species that administers the sting as well as the diverâs sensitivity to the venom. More and more divers have reported stinging injuries as a result of grasping mooring lines with ungloved hands. Rope fibres themselves can cause injury as well. From the reports DAN receives, however, most mooring line injuries appear consistent with a marine life envenomation. Colonies of organisms eventually inhabit all man-made objects in the ocean, including mooring lines. It is not known with certainty exactly what organism inhabits the lines. Many authorities maintain that the most likely suspect is a member of the hydroid family, a class of coelenterates that also includes jellyfish.
- Flush the injury site with vinegar. The initial treatment for fire coral and hydroid stings is the same: to neutralize the venom, use white vinegar. Do not use fresh water to flush the area: the change in salinity will cause any untriggered nematocysts to âfireâ, causing more envenomation. Continuously flushing the area with vinegar is ideal. Since most of us do not carry a litre of vinegar in our dive bags, however, soaking gauze pads, paper towels or clean cloths with vinegar and applying them to the injury site works well, too.
Remove pieces of the offending organism that remain. Use forceps or tweezers to remove any large pieces of the organism that might still be on the skin. To remove any imbedded or small particles, apply shaving cream and shave the area with a safety razor. For alternatives to shaving, use tape or scrape the area with a rigid object like a credit card.
Vinegar vs Alcohol.
The agent that neutralizes nematocyst venom appears to be species-specific. With differences among the venoms, thereâs not a universal treatment. Some species respond better to isopropyl (rubbing) alcohol, while others are neutralized by vinegar. Discuss with local authorities which solution works best with indigenous species, especially if youâre travelling to an unfamiliar area. Proper buoyancy control, respect for the territory of marine creatures and attention to detail, such as wearing gloves when using a mooring line, can help a diver avoid contact with marine life. Simply covering your skin can also help: less area exposed means less skin at risk. A thin Lycra diveskin is sufficient protection from these stinging organisms. Consider wearing a diveskin under your shortie to protect exposed arms and legs. This could mean the difference between an ideal vacation and one thatâs spoiled.