Marine Life

Coastal areas are rich in animal, plant, and insect life. They are also rich in human life. It is commonly known that coastal areas have a larger human population than other regions of civilization. What is it about this area that draws people to it? I love it all except for the Hurricanes; yet those are semi-predictable. Bountiful food? Delicious cuisine? If one is fortunate enough to live in the coastal area, you already know about the benefits of the water activities like fishing, boating, sailing, scuba diving, and snorkeling. Or beach activities like shell combing, playing in the sand, and surfing. Maybe your job requires you to live there. Whatever the reason, you may be at risk for some nasty illnesses common to the coastal area and not aware of them. Some unforeseen dangers lurk beneath the surface of those waters; for that matter, above the surface as well. The risks are real. The environment dictates its own special chest of maladies.

The area is known to harbor more insect, aquatic, and animal life than other areas. This also brings more unique illnesses associated with living in coastal areas. It harbors some dangerous marine organisms and has unique zoonotic diseases. In the field of medicine, we see an overlap of these illnesses in internal medicine, surgery, hyperbaric medicine, operational medicine, occupational medicine, and the public health sectors. Centers specifically designated for marine medicine are few and far between. Specialty programs in this field are highly specialized and uncommon. Notable institutions include the Center for Marine Biotechnology and Biomedicine at Scripps Institute for Oceanography (UCSD, California), Hollings Marine Laboratory (HML) (Charleston, South Carolina), the Naval Branch Oceanographic Institute (Florida Atlantic University), or The Glassell Family Center for Marine Biomedicine at the University of Miami Rosenstiel School. UTMB could be the premier institution located along the Gulf coast.

Zoonotic diseases are diseases that humans contract from insects, fish, arthropods, or animals that arise from infectious living microbes like bacteria, viruses, or parasites. They can be transmitted to humans by direct contact (e.g., rabies). They can be transmitted indirectly to humans through ingestion, inhalation, or contact with infected animal products, soil, water, or other environmental surfaces that have been contaminated with animal waste or a dead animal (e.g., anthrax, leptospirosis). Diseases can be transmitted from an animal reservoir but require a mosquito or other arthropod to transmit the disease to humans (e.g., malaria).

Dangerous marine life can produce some devastating diseases or injuries from direct physical harm as well. These should put us on guard whenever we put ourselves in harm’s way. Any marine organism that produces human illness or injury may be identified as a dangerous organism. These organisms may be encountered in numerous ways through a wide variety of marine activities. Examples of an activity and a potential dangerous marine species injury are as follows. Wading and stepping on a stingray. Swimming and being stung by a Portuguese man-of-war. Snorkeling and sustaining coral cuts. Scuba diving and being bitten by a Moray eel.

I vividly recall when a group of friends and I were doing a full moon night dive and I was head butted by a turtle. Normally, sea turtles are docile creatures. I think it was frightened from the bright light I was using or possibly a territorial dispute. No physical harm was done to either of us that I could tell. But, sea turtles can deliver a nasty bite.

Other possible scenarios are boating and suffering from a red-tide-induced asthma attack. Fishing and suffering fish fin wounds. Board surfing and getting shark bitten. Body-surfing and coming down with Lyngbya dermatitis. Beach-combing and being stung by dried-out jellyfish. Marine specimen collecting and getting Palythoa intoxication. Shellfish harvesting and having sea urchin stings. Sponge harvesting and having sponge poisoning.  These examples are some of the direct or indirect encounters by contact. Diet also plays a role in illness by ingesting seafood in the absence of spoilage. Examples of this are as follows. Ciguatera fish poisoning, paralytic shellfish poisoning (PSP), sardine poisoning, pufferfish poisoning, scombroid poisoning (tuna, mahi mahi, bonito, sardine, and saury), and food allergies.

With all of this being said, the main danger is not simply “marine life”—it is that ordinary problems can become lethal when definitive care, surgery, blood products, imaging, and evacuation are days away. Planning must emphasize prevention, early recognition, stabilization, communication, and realistic evacuation thresholds.[journals.sagepub][pubmed.ncbi.nlm.nih]

Medical risks amplified by distance

• Trauma and bleeding: Falls, crush injuries, fractures, head injury, amputations, and deep lacerations can exceed onboard capability quickly; uncontrolled bleeding and airway compromise are immediate threats. Marine bites also combine tissue damage, bleeding, and contamination.[pmc.ncbi.nlm.nih][journals.asm]
• Acute illness: Heart attack, stroke, severe asthma, anaphylaxis, diabetic emergencies, seizures, appendicitis, kidney stones, dental abscesses, and severe dehydration may require diagnostics or treatment unavailable in an austere setting.
• Infection: A small cut can become a serious soft-tissue infection when exposed to seawater, especially warm or brackish water. Vibrio can enter through open wounds or be acquired through contaminated seafood; people with liver disease, diabetes, cancer, or immune suppression face higher risk of severe illness.[journals.asm][vdh.virginia]
• Environmental injury: Hypothermia, heat illness, sun injury, immersion injury, motion sickness, fatigue, and sleep deprivation degrade judgment and can trigger accidents.
• Behavioral health and fatigue: Isolation, conflict, fear, insomnia, alcohol or substance issues, and fatigue can impair decision-making precisely when disciplined procedures matter most.

Marine-life hazards

Do not assume every sting is minor: breathing difficulty, fainting, widespread hives, rapidly worsening pain or swelling, paralysis/weakness, confusion, or shock means a medical emergency and should trigger emergency communications and evacuation planning.

What “austere medicine” requires

Before departure, assess each person’s medical fitness, refill essential prescriptions with contingency supply, document allergies and conditions, and identify who is qualified to provide care. Extended-remote-expedition planning identifies optimizing personnel fitness as a core component of a workable healthcare system.[pubmed.ncbi.nlm.nih]

A serious offshore plan should include:

• A trained medical lead with defined authority to stop operations and order diversion or evacuation.
• 24/7 communications, telemedical support, current position reporting, and preidentified diversion ports, aircraft options, and rescue coordination contacts.
• Written protocols for major bleeding, airway emergencies, chest pain, stroke symptoms, severe allergic reactions, sepsis, fractures, burns, hypothermia/heat illness, and marine envenomation.
• A properly maintained medical kit tailored to crew size, voyage length, skill level, medications, sterile wound-care supplies, splints, bleeding-control equipment, oxygen/airway equipment where trained and permitted, and diagnostic basics.
• Infection-control capability: clean water, soap, irrigation, sterile dressings, temperature monitoring, isolation capacity, and safe food/water practices.
• Redundant essentials: power, navigation, communications, water-making or water reserves, medications, and evacuation fuel/range assumptions.

Wilderness guidance also recommends identifying evacuation routes and considering higher-level capabilities such as IV access when delayed rescue is anticipated—provided the team is trained, equipped, and operating under appropriate medical oversight.[wms]

Practical evacuation triggers

At extended distances, with no medical center, critical access center, etc. the threshold for calling for expert help should be low. Arrange telemedical consultation immediately for:

• Any chest pain, stroke-like signs, severe shortness of breath, altered mental status, seizure, or persistent severe abdominal pain.
• Uncontrolled bleeding, deep bite or puncture wound, open fracture, head injury with concerning symptoms, or suspected spinal injury.
• Anaphylaxis, repeated vomiting with inability to hydrate, significant dehydration, high fever, or rapidly progressive skin/wound infection.
• Any injury or illness likely to need surgery, advanced imaging, blood products, intensive monitoring, or IV antibiotics beyond a short bridge period.

The operational principle is simple: the farther you are from care, the earlier you evacuate or divert—not after the patient has clearly deteriorated.

Evert Randall Bentley, DO, MS, FACOI