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Original research
Shark-related injuries in Hawai’i treated at a level 1 trauma center
  1. Victoria A Scala1,
  2. Michael S Hayashi2,3,
  3. Jason Kaneshige1,4,
  4. Elliott R Haut5,
  5. Karen Ng3,
  6. Sho Furuta2,3
  1. 1Orthopaedic Surgery, University of Hawai’i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA
  2. 2Surgery, University of Hawai’i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA
  3. 3Trauma, The Queen’s Medical Center, Honolulu, Hawaii, USA
  4. 4Orthopedic Surgery, The Queen’s Medical Center, Honolulu, Hawaii, USA
  5. 5Surgery, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Sho Furuta; sfuruta{at}queens.org

Abstract

Background Although rare, human–shark interactions can result in a wide spectrum of injuries. This is the first study to characterize shark-related injuries (SRIs) in Hawai’i.

Methods This is a retrospective review of the State of Hawai’i Division of Aquatic Resources Shark Incidents List between January 1, 2009 and December 31, 2019. Trauma registry data and medical records of patients treated for SRIs at the only level 1 trauma center in Hawai’i were reviewed.

Results Sixty-one patients sustained SRIs in the Hawaiian Islands: 25 in Maui, 16 in O’ahu, 12 in Hawai’i, and 8 in Kaua’i. In cases where the shark species could be identified, tiger sharks were the most frequent (25, 41%). Four cases were fatal—all died on scene in Maui with the shark species unknown. Forty-five survivors (79%) received definitive care at regional facilities. Twelve (21%) were treated at the level 1 trauma center, of which two were transferred in for higher level of care. Of the 12 patients, 11 (92%) had extremity injuries, with 3 lower extremity amputations (25%), 2 with vascular injuries (17%), and 5 with nerve injuries (42%). One had an injury to the abdomen. All patients had local bleeding control in the prehospital setting, with 9 (75%) tourniquets and 3 (25%) hemostatic/pressure dressings applied for truncal or proximal extremity injuries. The mean time from injury to emergency department arrival was 63 minutes.

Discussion Most SRIs are managed at regional facilities, rather than at a level 1 trauma center. Prehospital hemorrhage control is an important survival skill as time to definitive care may be prolonged. For cases treated at the level 1 trauma center, nerve injuries were common and should be suspected even in the absence of major vascular injury. Correlating shark behavior with observed injury patterns may help improve public awareness and ocean safety.

Level of evidence Level V, epidemiological.

  • bites and stings
  • hemorrhage
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2020-000567

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    Footnotes

    • Presented at This paper was presented as a poster presentation at the 79th Annual Meeting of AAST and Clinical Congress of Acute Care Surgery.

    • Contributors Drafting of the article: VAS. Study conception and design: all authors. Acquisition of data: VAS, KN. Regulatory support: KN. Analysis and interpretation of data: all authors. Critical revision: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests ERH reports research funding from the Patient-Centered Outcomes Research Institute (PCORI), the Agency for Healthcare Research and Quality (AHRQ), the NIH/NHLBI, the DOD/Army Medical Research Acquisition Activity, and the Henry M Jackson Foundation for the Advancement of Military Medicine (HJF). ERH receives royalties from Lippincott Williams & Wilkins for a book, Avoiding Common ICU Errors. ERH was a paid speaker for the Vizient Hospital Improvement Innovation Network (HIIN) VTE Prevention Acceleration Network. The other authors (VAS, MSH, JK, KN, SF) have no conflicts of interest.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Research and Institutional Review Committee of The Queen’s Medical Center (approval ID# RA-2020-001). This retrospective study was approved with a waiver of informed consent as all medical care had already been provided and subjects were not impacted.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.