Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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A Stingray Wound to the Heart

We are now certain from eyewitness reports that Steve Irwin pulled the stingray's detached jagged spine from his chest immediately after he was struck by the animal. I have been asked repeatedly whether he would have had a better chance for survival had he not removed the spine from his wound. It is quite possible that this might be the case. Although the instructions for management of a stingray injury (which usually occurs on the leg or arm) are to remove any visible portions of the spine (because they continue to release venom into the wound and thereby cause pain and increase the possibility of tissue damage), Steve's situation was different. This was a very unusual (for a stingray wound) situation. By having a spine lodged in his chest, Steve Irwin was as much a victim of a stab wound, akin to that from a knife or dagger, as of an envenomation.

The classic teaching for treatment of impalement (e.g., by a knife or arrow) is to leave the object in place undisturbed until the victim has been brought to a controlled medical (surgical) environment before attempting its removal. The reason for this is that the object may be a “finger in the dike” if it has punctured a large blood vessel or, in Steve’s case, the heart. When the dagger (spine) is removed, it is no longer occluding the hole that it created, and bleeding can be torrential through the now-unblocked opening. In addition, the removal process itself can worsen the internal damage, by cutting additional tissue on the way out. This might have been worsened by the rear-facing serrations on the rigid spine, which could easily catch and tear human tissue during a forceful extraction.

Had Steve been brought to a trauma center, the surgeons would have tried to wait until they were set up for surgery before removing the spine. Had the removal occurred where a surgeon(s) could rapidly expose the complete path of the wounding object and stop the bleeding caused by the primary injury and the effects of the object's removal, then Steve may have survived.

Steve was not a trained medical professional, and what he did was a normal response to what was in all likelihood an extremely painful predicament. He had a stingray spine sticking into his chest. This was undoubtedly a very painful and visually frightening situation. He reacted and did what he thought was the quickest maneuver to relieve his suffering and pulled out the spine. Anyone in this situation would have probably done the same thing, and absent someone underwater with him to manage his response and a trauma surgeon or an emergency physician on scene to guide the immediate rescue, what happened is understandable. So, might he have had a better chance if the spine was left in place? Perhaps, if his heart or a great vessel was penetrated and his body could tolerate the presence of a venom-bearing spine until he could be taken to an operating room.

Based on the reports I have read about the autopsy, it is not possible to tell whether the cause of death was blood loss, a heart attack, abnormal heart rhythm, compression of his heart within a blood-filled pericardium, or some combination of these. The venom itself causes toxicity to human tissue, but it is not certain to what degree the envenomation aspect of this wound contributed to Steve's demise. The trauma (hole in the heart) alone would certainly have been sufficient to account for the outcome.

It is important to once again emphasize that stingrays are wild animals, and therefore not completely predictable. Most rays will flee when disturbed by humans. However, it is impossible to know which ray will tolerate an approach and which ray will flee or strike out to thwart an agressor. I am unaware of any episode in which a ray pursued a human or struck out with its barbed tail unless in a provoked manner in self defense. I have been underwater with solo stingrays and rays in large schools, and except for places like Stingray City in the Cayman Islands (where they are regularly fed and handled by tourists) and certain popular diving locations like Cocos Island (Costa Rica) where they have similarly apparently become habituated to people in their underwater habitat, I have never witne

ssed one to closely approach a human. But, like many other divers, I have accidentally startled rays and witnessed how fast they can move with powerful flaps of their "wings." Like the caged tiger that tolerates its trainer for years before a seemingly inexplicable attack, stingrays should be respected for their feral nature. They are graceful and beautiful animals that should be admired from a distance - certainly out of range of a possible tail strike.

Steve's death has called attention to the need for divers and other ocean-goers to be aware and respectful of hazardous marine animals. As shall everyone else familiar with his good work and lust for life, I will miss him.

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Tags: Bites & Stings

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.