‘Cocaine bear’: When animals attack
Animal bites and envenomations pose some interesting challenges to EMS providers
There are few things in nature more capable of rendering your features into something resembling a Picasso painting than a mama bear with cubs. There is nothing quite so frightening.
Unless, of course, it’s a mama bear on cocaine. That’s scary.
Like most of us, I watched the trailers for Universal Pictures’ “Cocaine bear” with a mixture of eye-rolling and gentle amusement. After a career in EMS and watching the cinematic glory of “Snakes on a plane,” no movie premise can really surprise me.
“Cocaine bear” tells the wacky but true story of a black bear in the Chattahoochee National Forest who ingested millions of dollars of cocaine dropped from a plane in 1985. I shudder to think what havoc might be wreaked by a bear high on cocaine, and the movie plays it to maximum comedic effect, but it got me to thinking about what angry bears high on drugs might be like.
But high on drugs or not, animal bites and envenomations can pose some interesting challenges to EMS providers. First, consider the environmental challenges; a bear attack is not simply a matter of patching the wounds and loading the patient into an aeromedical helicopter for a quick flight to the nearest level one trauma center.
By their nature, wild animal attacks occur far from hospitals and roads. Just getting to the patient can be a challenge, and when you arrive at their side and stabilize their injuries, extrication back to civilization might well take days instead of minutes or hours. The unique skills and techniques to overcome such challenges is the foundation for the Wilderness Medicine course, but if you haven’t taken it, operate on the premise that help is not immediately available, resources are scarce, and everything you need you had better pack in with you. Even then, you may find yourself improvising splinting and wound care materials, and attempting to stabilize a critical patient for days instead of an hour.
Wound care itself is fairly straightforward; air goes in and out, blood goes round and round, and any variation on that theme must be addressed immediately. Arterial bleeds are the same in the Wyoming backcountry and the inner-city streets, and soft tissue injuries are treated the same way. Remember that arterial limb tourniquets are generally short-term solutions; if definitive surgical care is available within hours, there isn’t much worry. However, in a days-long extrication, nerve damage and limb ischemia becomes much more of a concern. If the time to surgical care is expected to be prolonged, carefully release arterial limb tourniquets and reassess every 2 hours.
On-Demand: When seconds count – Stop the bleed
EMS training in bleeding control must incorporate mass casualty incident plans and drills as well as the need to prioritize patient triage by injury severity, transport priority and the type of treatment – layperson or medical professional – that is required.
Animals are infamous for having detritus embedded in their teeth and claws, and their mouths are rife with harmful bacteria. The potential for infection is so great that surgeons commonly close animal bite wounds with Penrose drains in place to drain the expected infections. Wound cleansing and irrigation prior to bandaging may be beneficial, and in a prolonged extrication, administration of broad-spectrum antibiotics may be indicated. Interestingly enough, in austere environments where antibiotics are not available, topical application of honey has been demonstrated to be an effective antibacterial agent against both Gram-positive and Gram-negative bacteria.
Remember kids, if you bite a snake and get sick, it’s poisonous. If a snake bites you and you get sick, it’s venomous. If a snake bites you and the snake gets sick, it’s entirely possible that you’re in EMS and your body is colonized by a host of harmful bacteria.
Envenomation from a snake bite usually travels through the lymphatic system, but snake bite fatality is a rare occurrence in North America, with fewer than 10 deaths per year. A great many snake bites every year are non-envenomating, but even so, a snake bite is rarely a life-threatening condition.
Definitive treatment for snake bite is with crotalid antivenom, which is hideously expensive and may subject the patient to the risk of anaphylactic reaction, which may be more likely to kill the patient than the snake bite. Thus, antivenom is typically reserved for severe, systemic envenomation.
In emergency treatment for a snake bite, immobilizing the limb to limit movement and thus blood return through muscle contractions may be beneficial, and you should keep the limb lower than the heart. Thoroughly cleanse the wound site with an antibacterial solution, because infection is a serious concern. There is no need to use ice or cooling packs, and arterial tourniquets may cause more harmful side effects than the venom.
Spider bites – both black widows and brown recluse spiders – are not a life-threatening emergency unless there is an anaphylactic reaction to the venom.
Animal attack injuries
Remember that many large animal bites may have associated fractures and dislocations, the natural result of a large predator seizing a limb in his jaws and shaking his head vigorously. In south Louisiana – alligator country – the rare alligator attack often results in joint dislocations resulting from the well-known Saurian “death roll.” Alligator and crocodile teeth are not well-suited for ripping and tearing unless the meat is significantly softened from decay. Therefore, the cause of most deaths in alligator and crocodile attacks is actually drowning.
Lastly, remember that the first rule in treating an animal attack victim is not to become a victim yourself. If you happen to encounter an angry mama bear high on cocaine, back away slowly. If that doesn’t work, raise your arms and yell at the bear to make yourself look more intimidating. If the bear charges and reaches you, roll yourself into a ball to protect your vital organs and play dead.
Or, this being a cocaine bear, try to distract them with some glow sticks and techno music. That sometimes works.
Training Day: Chest seals, tourniquets and trauma dressings
Challenge EMS providers’ critical thinking and appropriate skill deployment with these 3 penetrating trauma scenarios, ranging from moderate hemorrhage to exsanguination