American Survival Guide

WHEN BEASTS AT­TACK

EX­PERT AD­VICE FOR TREAT­ING AN­I­MAL BITES

- By Joe Al­ton, MD United States of America · Saskatchewan · Canada · Alaska · Oregon · Washington State · North America

Ex­pert Ad­vice for Treat­ing An­i­mal Bites

The Great Out­doors is, well, great, but there’s al­ways a risk of com­ing face to face with one of its res­i­dents. Most of these en­coun­ters will be be­nign, but in some cir­cum­stances, you may not be so lucky. Let’s face it; if it’s got a mouth, it can prob­a­bly bite you, whether it’s a fire ant, a polar bear, or your se­nile old Un­cle Fred. In this ar­ti­cle, we’ll talk about bites from the crit­ters you might con­sider cute: the ones with the nice soft fur. They may live in the woods or right in your own home. The av­er­age per­son’s life is spent in close prox­im­ity to dogs, cats, and other mam­mals, so it pays to know about an­i­mal bites as well as their treat­ment and pre­ven­tion.

AN­I­MAL BITES AREN’T RARE

Half of all Amer­i­cans will ex­pe­ri­ence an an­i­mal bite in their life­time. Bites from mam­mals num­ber in the mil­lions an­nu­ally and ac­count for 1 per­cent of all emer­gency room vis­its. About 90 per­cent of these wounds are in­flicted (of­ten upon chil­dren) by dogs and cats. Deaths from an­i­mal bites are rare, but bleed­ing, nerve and tis­sue dam­age, crush in­juries, in­fec­tion, and pain are com­mon, not to men­tion psy­cho­log­i­cal trauma. Ev­ery year, tens of thou­sands re­quire sur­gi­cal re­pairs in the U.S.

CANINES

Dog Bites

Dog bites ac­count for 80 to 90 per­cent of all in­juries caused by an­i­mals. Al­though an at­tack from a wolf or coy­ote will make the news, most in­ci­dents oc­cur from con­tact with some­one’s pet on or near the vic­tim’s prop­erty. About 30 dog at­tacks, mostly from non-neutered male dogs, turn fa­tal yearly. Pit bulls, rot­tweil­ers, Dober­mans, Ger­man shep­herds, and huskies are some of the breeds most likely to cause sig­nif­i­cant bite in­juries. Their vic­tims are com­monly young chil­dren.

Dogs and other canines have 42 teeth as adults. These are de­signed to rip, shred, and tear flesh. As a re­sult, some of the more se­vere ca­nine bite wounds may have gap­ing lac­er­a­tions, some­times with flesh torn off. Swelling from the pres­sure of the bite or in­fec­tion is also com­mon.

Wolf and Coy­ote Bites

The wolf and the coy­ote may ap­pear sim­i­lar, but the size and strength of the coy­ote can’t com­pare to that of a gray wolf, and the same can be said of their bite. Wolf bites ex­ert about twice the pres­sure of a Ger­man shep­herd bite. Their bite is so pow­er­ful that they can chew through the fe­murs of elk and moose. Coy­otes, on the other hand, have a bite sim­i­lar to that of a medium-size dog.

For var­i­ous rea­sons, wolves haven’t adapted as well to en­croach­ing civ­i­liza­tion as the coy­ote, which has ac­tu­ally in­creased its range over the decades. You’re much more likely to run afoul of a coy­ote in your sub­ur­ban neighborho­od.

Con­trary to the opin­ions of some, wolves and coy­otes will at­tack hu­mans if the op­por­tu­nity arises. The most re­cent fa­tal at­tacks oc­curred this cen­tury. A young man in Saskatchew­an, Canada ,was killed in 2005 by healthy wolves that had be­come ac­cus­tomed to peo­ple. In 2009, a young woman was killed by coy­otes, in Canada and in 2010, a young woman died while jog­ging in Alaska.

CATS

Cat bites rep­re­sent be­tween 5 and 15 per­cent of all an­i­mal bites sus­tained by hu­mans, al­though many cases aren’t re­ported due to the small size of the in­jury. The most ag­gres­sive breeds are usu­ally hy­brids with ge­net­ics that come from wild cats, such as ben­gals.

Even if the amount of trauma is small, punc­ture wounds by cat teeth can be deep and are more likely to cause in­fec­tion than dog bites. In­fec­tion oc­curs in 10 to 15 per­cent of dog bites but close to 50 per­cent of cat bites. One rea­son may be the depth of the wound. Not only is it dif­fi­cult to clean the site, but the nee­dle-like teeth push bac­te­ria deep into flesh, ten­dons and joints. The or­gan­isms find the en­vi­ron­ment fa­vor­able and mul­ti­ply, caus­ing swelling, red­ness and pain.

In ad­di­tion to their 30 teeth, do­mes­tic cats also use their claws in at­tack or de­fense, caus­ing scratches that can lead to in­fec­tion with bar­tonella, aka cat scratch fever.

Bob­cat, Lynx and Cougar Bites

At­tacks by large cats such as moun­tain lions are rare, but fa­tal­i­ties oc­curred in 2018 in Ore­gon

and Wash­ing­ton. In­juries in­clude lac­er­a­tions, bro­ken bones and crush dam­age. Smaller wild­cats such as bob­cats and lynxes, if healthy, are shy and avoid con­tact with hu­mans, but they can in­flict deep bites and, un­like do­mes­tic cats, deep claw wounds as well.

BEARS

Some of the largest mam­mals on the con­ti­nent, bears cause claw as well as bite wounds. There are three dis­tinct species in North Amer­ica to worry about: black bears, brown bears (in­clud­ing the griz­zly) and polar bears. Of the three, the polar bear is the largest and has the strong­est bite. The dam­age caused by bear bites in­cludes bro­ken bones, loss of soft tis­sue and se­vere hem­or­rhage.

Along with wolves and moun­tain lions, bears are some of the few North Amer­i­can an­i­mals that may show preda­tory be­hav­ior to­ward hu­mans. As wounds can be large and ragged, dif­fi­cult sur­gi­cal re­pairs may be re­quired to re­con­struct dam­aged ten­dons, mus­cles and joints.

RO­DENT BITES

The Ro­den­tia fam­ily is char­ac­ter­ized by a pair of con­tin­u­ously grow­ing in­cisors in the up­per and lower jaws. Mem­bers in­clude rats, mice, squir­rels, beavers, por­cu­pines and many other an­i­mals. In­deed, they com­prise about 40 per­cent of all mam­mal species. Rab­bits were once con­sid­ered ro­dents, but are now cat­e­go­rized as a re­lated group called lago­morphs. The teeth of all these an­i­mals can be quite long and sharp and, thus, in­flict smaller but very pain­ful bites.

Rat bites are the most com­mon ro­dent type to gen­er­ate a visit to an emer­gency room. The wounds may be shal­low or deep. The main con­cern with ro­dent bites is the dis­eases the an­i­mals trans­mit, such as rat bite fever and tu­laremia, com­monly spread by rab­bits.

OTHER SMALL MAM­MALS

Other small mam­mals ca­pa­ble of de­liv­er­ing a nasty bite in­clude rac­coons, opos­sums, skunks and foxes (foxes can be in­cluded un­der canines, but be­long to the genus Vulpes, not Ca­nis like dogs, wolves, and coy­otes). Al­though pain­ful, most trau­matic in­jury is mi­nor. Some of these an­i­mals, how­ever, are known car­ri­ers of the ra­bies virus. Rac­coons, skunks and foxes can

all carry the dis­ease. Ra­bies seems to be very rare in opos­sums, pos­si­bly due to lower body tem­per­a­tures than the av­er­age mam­mal.

BATS

They may look like fly­ing mice, but bats be­long to the Chi­roptera fam­ily, not Ro­den­tia. Like any wild an­i­mals, they may bite if dis­turbed or han­dled. The trauma from a bat bite is usu­ally min­i­mal and is some­times not even no­ticed by the vic­tim. De­spite this, the in­fec­tions that bats can trans­mit in­clude some deadly dis­eases such as ra­bies and Ebola.

Any bite or scratch from a bat should be con­sid­ered a risk. Un­like other an­i­mals, bats with ra­bies may not look ill, so the dan­ger sign is un­usual be­hav­ior. Any bat out and about by day, un­able to fly, or not con­cerned by prox­im­ity to hu­mans may have ra­bies.

TREAT­ING AN­I­MAL BITES

Most small an­i­mal bites don’t cause sig­nif­i­cant trauma. Larger mam­mals, how­ever, are an­other matter. There are de­fen­sive or warn­ing an­i­mal bites and then there are an­i­mal at­tacks, where the vic­tim is knocked down by a sub­stan­tial ad­ver­sary, bit­ten re­peat­edly, and in some cases in­jured by claws. Thank­fully, these are few and far be­tween, but those in­jured may have mul­ti­ple bleed­ing lac­er­a­tions with sig­nif­i­cant soft tis­sue dam­age.

Ma­jor in­juries should be treated as you would any trauma. Abol­ish the threat to the vic­tim (and your­self). Large mam­mals such as bears may re­turn for round two, so leave the area if pos­si­ble.

If a bite wound is se­vere and ac­tively bleed­ing, place a dress­ing or cloth bar­rier on it im­me­di­ately and ap­ply firm di­rect pres­sure (prefer­ably with gloved hands). If the first bar­rier be­comes sat­u­rated, pack fresh ones right on top of the first.

If the bleed­ing is bright red and spurt­ing from the site, a bet­ter first step is to ap­ply a tourni­quet. Some of the most pop­u­lar mod­els in­clude the C-A-T, SOFTT and SWAT-T. Hav­ing a good sup­ply of ster­ile ban­dages, as well as hemo­static dress­ings (Quik­clot, CELOX, or Chi­tosam), would also be help­ful for hem­or­rhage con­trol and to pro­tect the wound. If you use one of these spe­cial blood-clot­ting prod­ucts, re­move sat­u­rated ban­dages first and pack the hemo­static dress­ing at the point of bleed­ing. Cover with a pres­sure dress­ing.

In most small mam­mal bites, the marks left may seem in­signif­i­cant. Any punc­ture of the skin, how­ever, is some­thing to worry about. Skin is the body’s ar­mor; any breach leaves the vic­tim open to in­fec­tion. Any per­son who has been bit­ten by an an­i­mal should:

• Seek med­i­cal care by qual­i­fied pro­fes­sion­als if at all pos­si­ble, es­pe­cially if the skin is bro­ken • Con­trol bleed­ing as men­tioned above

• Clean the wound thor­oughly with soap and water for sev­eral min­utes. Flush­ing the wound ag­gres­sively with a 60-100 cc ir­ri­ga­tion sy­ringe filled with clean water will help re­move em­bed­ded dirt and bac­te­ria-con­tain­ing saliva. This should be done even if the skin is in­tact; it’s im­por­tant to wash off any oral bac­te­ria de­posited there by the an­i­mal.

“HALF OF ALL AMER­I­CANS WILL EX­PE­RI­ENCE AN AN­I­MAL BITE IN THEIR LIFE­TIME. BITES FROM MAM­MALS NUM­BER IN THE MIL­LIONS AN­NU­ALLY AND AC­COUNT FOR 1 PER­CENT OF ALL EMER­GENCY ROOM VIS­ITS.

• Use an an­ti­sep­tic to de­crease the chance of in­fec­tion. Be­ta­dine (2 per­cent povi­done-io­dine so­lu­tion) or ben­za­lko­nium chlo­ride (BZK) are rea­son­able choices.

• Re­move any rings or bracelets in a bite wound to the hand. If swelling oc­curs, they may be very dif­fi­cult to re­move af­ter­ward.

• Use an ice pack to de­crease swelling, bruis­ing and pain.

• Ap­ply an­tibi­otic oint­ment to the area and watch for signs of wound in­fec­tion. These may in­clude red­ness, swelling or ooz­ing. In many in­stances, the site might feel un­usu­ally warm to the touch. Warm moist com­presses to the area will help an in­fected wound pro­duc­ing pus to drain.

• Fre­quently clean and cover a re­cov­er­ing bite wound.

• Give med­i­ca­tions such as ibupro­fen or ac­etaminophe­n to treat pain at the wound site. Avoid as­pirin for pain in chil­dren un­der the age of 16 due to the risk of Reye’s syn­drome, a po­ten­tially fa­tal ill­ness.

• If the bite has sev­ered a body part, wash it with clean water, wrap it in a ster­ile dress­ing and store it in ice to trans­port with the vic­tim to ad­vanced med­i­cal care. If mod­ern med­i­cal fa­cil­i­ties can be ac­cessed, a sev­ered fin­ger or ear might be sur­gi­cally reat­tached.

Chil­dren who suf­fer an­i­mal bites may be­come trau­ma­tized by the ex­pe­ri­ence and ben­e­fit from coun­sel­ing. Young­sters should be in­formed about the risks of an­i­mal bites and taught to avoid stray dogs, cats and wild an­i­mals. Never leave a small child unat­tended around an­i­mals: Without an able-bod­ied per­son to in­ter­vene, the out­come may be tragic.

Nor­mally, tetanus booster shots are given to adults ev­ery 10 years. In the case of bite wounds, an ex­tra in­jec­tion is of­ten rec­om­mended.

It is im­por­tant to re­mem­ber that hu­mans are an­i­mals, too. In rare cases, you might see bites from this source as well. Ap­prox­i­mately 10 to 15 per­cent of hu­man bites be­come in­fected, due to the fact that there are over 100 mil­lion bac­te­ria per mil­li­liter in hu­man saliva.

Treat as you would any con­tam­i­nated wound.

MORE ABOUT IN­FEC­TION

The risk of in­fec­tion ex­ists when­ever a vi­o­lent en­counter oc­curs be­tween an­i­mal and hu­man. Dis­eases such as ra­bies and tetanus are still oc­ca­sion­ally seen in the U.S., and cer­tain types of an

imals can trans­mit other dis­eases as well. These may cause them to be sick and ir­ri­ta­ble, lead­ing them to bite. Other dis­ease-caus­ing or­gan­isms, also known as pathogens, use the an­i­mal as a vec­tor, that is, a car­rier that re­mains healthy but can pass the mi­crobe to hu­mans.

Bite wounds are no­to­ri­ous for caus­ing in­fec­tions. Bac­te­ria ex­ist in the mouths of an­i­mals; they might be na­tive to the an­i­mal or come from prey that has been re­cently eaten. Oc­ca­sion­ally, bac­te­ria from soil, fe­ces or the vic­tim’s own skin may be in­volved.

In sur­vival set­tings, oral an­tibi­otics are valu­able tools in the med­i­cal tool­box to pre­vent and treat in­fec­tion in bite wounds. You won’t usu­ally know ex­actly what bac­te­ria you’re try­ing to kill, but com­mon med­i­ca­tions used for bites in­clude seven days of amox­i­cillin with clavu­lanic acid 500 mg ev­ery 8 hours as a first line choice, with ad­di­tional op­tions such as clin­damycin (vet­eri­nary equiv­a­lent: Fish-cin) 300 mg orally ev­ery 6 hours and ciprofloxa­cin (Fish Flox) 500 mg ev­ery 12 hours in com­bi­na­tion; azithromyc­in; metron­ida­zole; and ampi­cillin-sul­bac­tam as pos­si­bil­i­ties. Side ef­fects of and al­ler­gies to the dif­fer­ent med­i­ca­tions must be taken into ac­count.

Should a bite wound be sur­gi­cally closed?

Many an­i­mal bite wounds are closed if a mod­ern med­i­cal fa­cil­ity is ac­ces­si­ble, but this may be in­ad­vis­able in a sur­vival set­ting. Any an­i­mal bite should be con­sid­ered a dirty wound; clos­ing the wound may lock in dan­ger­ous bac­te­ria. Fre­quent clean­ing and dress­ing changes may be a safer choice with pos­si­bly con­tam­i­nated in­juries. A de­layed clo­sure may be per­formed in some cases if no signs of in­fec­tion ap­pear af­ter three days of close ob­ser­va­tion.

RA­BIES

Bac­te­rial in­fec­tions that can be trans­mit­ted through an­i­mal bites in­clude cat scratch fever, rat bite fever, staph, strep, tetanus and tu­laremia. The is­sue that con­cerns most pub­lic health of­fi­cials, how­ever, is a virus: ra­bies.

Ra­bies is caused by mem­bers of the genus Lys­savirus. The dis­ease is trans­mit­ted when an in­fected an­i­mal scratches or bites an­other an­i­mal or hu­man. Splat­ter, es­pe­cially from saliva, can spread in­fec­tion if it gets into the eyes, mouth or nose of some­one nearby.

Glob­ally, dogs are the most com­mon do­mes­tic an­i­mal to have the dis­ease, ac­count­ing for more than 99 per­cent in many coun­tries. In the Amer­i­cas, how­ever, var­i­ous wildlife is more likely. Bat and rac­coon bites are the most com­mon source of ra­bies in­fec­tions in the U.S. (less than 5 per­cent of cases are from dogs). Ro­dents are of­ten blamed, but they’re very rarely in­fected with ra­bies. Rep­tiles and other non-mam­mals don’t con­tract the dis­ease; you won’t get ra­bies from a snake bite.

The pe­riod be­tween in­fec­tion and the first symp­toms (the in­cu­ba­tion pe­riod) is typ­i­cally 1 to 3 months in hu­mans, but can be much longer. This, along with a death rate of al­most 100 per cent if un­treated, is the rea­son hu­mans sus­pected of be­ing ex­posed are given a se­ries of vac­ci­na­tions and an­ti­bod­ies as soon as pos­si­ble.

Symp­toms usu­ally be­gin as fever and headache, but the ill­ness pro­gresses to af­fect the ner­vous sys­tem, caus­ing paral­y­sis in many cases. Ra­bies causes sig­nif­i­cant al­ter­ations in men­tal sta­tus, in­clud­ing con­fu­sion, ag­i­ta­tion, anx­i­ety, para­noia, hal­lu­ci­na­tions, and gen­eral delir­ium.

One un­usual sign of ra­bies is hy­dropho­bia, the fear of water. Be­cause of a vic­tim's dif­fi­culty swal­low­ing de­spite se­vere thirst, water seems to cause panic in those in­fected. It’s at this point that vic­tims pro­duce a large amount of saliva, mak­ing them ap­pear to foam at the mouth. There is no cu­ra­tive treat­ment; death usu­ally oc­curs within a few days af­ter symp­toms ap­pear.

PRE­VENT­ING AN­I­MAL BITES

This ar­ti­cle is not about an­i­mal en­counter safety, but the sim­plest way to pre­vent an­i­mal bites is to stay away from wildlife and un­fa­mil­iar do­mes­tic an­i­mals. With known do­mes­tic an­i­mals, try to dis­cour­age ag­gres­sive play, and closely mon­i­tor chil­dren at all times. If you han­dle an­i­mals of­ten, wear per­sonal pro­tec­tion gear.

Dif­fer­ent strate­gies ex­ist for bear, cougar and ca­nine en­coun­ters. For ex­am­ple, main­tain­ing eye con­tact is en­cour­aged with cougars and dis­cour­aged with dogs. All, how­ever, rec­om­mend not run­ning away; this is con­sid­ered prey be­hav­ior that can trig­ger a preda­tory re­sponse.

If you’re alone and en­counter a large car­ni­vore, try to ap­pear as large as pos­si­ble and, given the chance, back away slowly in the di­rec­tion you came. Carry bear spray in ar­eas where large car­ni­vores are present. You’re safest in the com­pany of others; even bears will hes­i­tate to at­tack groups of more than two peo­ple.

“SHOULD A BITE WOUND BE SURGIALLY CLOSED? ... ANY AN­I­MAL BITE SHOULD BE CON­SID­ERED A DIRTY WOUND; CLOS­ING THE WOUND MAY LOCK IN DAN­GER­OUS BAC­TE­RIA.”

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 ?? © GETTY IMAGES ?? Right: An­i­mals, even those that seem calm and friendly, can bite without warn­ing.
© GETTY IMAGES Right: An­i­mals, even those that seem calm and friendly, can bite without warn­ing.
 ?? © GETTY IMAGES ?? Above: House cats have needle­sharp teeth that can pen­e­trate deep into mus­cle and ten­don.
Left: Cat bites make up 5 to 15 per­cent of all an­i­mal bites sus­tained by hu­mans.
© GETTY IMAGES Above: House cats have needle­sharp teeth that can pen­e­trate deep into mus­cle and ten­don. Left: Cat bites make up 5 to 15 per­cent of all an­i­mal bites sus­tained by hu­mans.
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 ?? © GETTY IMAGES ?? Near right: If you’re breath­ing, this preda­tor as­sumes you’re prob­a­bly food.
Left: Rac­coons with ra­bies might be un­aware of their sur­round­ings, make strange noises, and have wet-look­ing fur.
© GETTY IMAGES Near right: If you’re breath­ing, this preda­tor as­sumes you’re prob­a­bly food. Left: Rac­coons with ra­bies might be un­aware of their sur­round­ings, make strange noises, and have wet-look­ing fur.
 ?? © GETTY IMAGES ??
© GETTY IMAGES
 ?? © GETTY IMAGES ?? Right: Even small ro­dents can in­flict pain­ful bites.
Far right: Bats ac­count for more cases of ra­bies in the Western Hemi­sphere than any other mam­mal.
© GETTY IMAGES Right: Even small ro­dents can in­flict pain­ful bites. Far right: Bats ac­count for more cases of ra­bies in the Western Hemi­sphere than any other mam­mal.
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© GETTY IMAGES
 ?? © GETTY IMAGES ?? h Be­low, left: Even small an­i­mal bites must be thor­oughly cleaned and prop­erly treated.
© GETTY IMAGES h Be­low, left: Even small an­i­mal bites must be thor­oughly cleaned and prop­erly treated.
 ?? © GETTY IMAGES ?? h Be­low: Thou­sands of an­i­mal bite in­juries re­quire sur­gi­cal re­pair ev­ery year in the US.
© GETTY IMAGES h Be­low: Thou­sands of an­i­mal bite in­juries re­quire sur­gi­cal re­pair ev­ery year in the US.
 ?? © GETTY IMAGES ?? Near right: States and coun­ties reg­u­late the ad­min­is­tra­tion of ra­bies vac­cines to dogs and other do­mes­tic an­i­mals. Check with your vet­eri­nar­ian about the re­quired fre­quency of re­vac­ci­na­tions.
Left: Claw wounds, as well as bites, can cause a range of prob­lems, from trauma to in­fec­tion.
© GETTY IMAGES Near right: States and coun­ties reg­u­late the ad­min­is­tra­tion of ra­bies vac­cines to dogs and other do­mes­tic an­i­mals. Check with your vet­eri­nar­ian about the re­quired fre­quency of re­vac­ci­na­tions. Left: Claw wounds, as well as bites, can cause a range of prob­lems, from trauma to in­fec­tion.
 ?? © GETTY IMAGES ?? Above: Clostrid­ium tetani spores
(tetanus) pro­duce tetanospas­min, which causes mus­cles to in­vol­un­tar­ily con­tract.
© GETTY IMAGES Above: Clostrid­ium tetani spores (tetanus) pro­duce tetanospas­min, which causes mus­cles to in­vol­un­tar­ily con­tract.
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© GETTY IMAGES
 ?? © GETTY IMAGES ?? Above left: This is an ex­am­ple of a poorly ap­prox­i­mated and in­fected dog bite wound.
Above cen­ter: Due to con­tam­i­na­tion, clos­ing wounds in the wilder­ness may lock in­fec­tions in­side.
Above: Head and neck wounds from dog bites are more com­mon in chil­dren than in adults.
© GETTY IMAGES Above left: This is an ex­am­ple of a poorly ap­prox­i­mated and in­fected dog bite wound. Above cen­ter: Due to con­tam­i­na­tion, clos­ing wounds in the wilder­ness may lock in­fec­tions in­side. Above: Head and neck wounds from dog bites are more com­mon in chil­dren than in adults.
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© GETTY IMAGES
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© GETTY IMAGES

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