To your health: Pay attention to wounds at sea

Wounds, like fish and lobsters, come in all shapes and sizes. When you get a big wound, much like getting a huge fish on the line, you know you’re going to need some help to get it under control. Little wounds, like a small fish tossed back to sea, can be quickly forgotten and are usually self-treatable. But what about all the wounds in between? How do you know when you can handle that cut safely on your own or when you should seek medical care?
While there are many potential hazards that you face every time you go to fish, we’re going to focus here on typical soft-tissue lacerations and puncture wounds, a.k.a. cuts and hook bites. You may be asking yourself, “Seriously? How big of a problem is this?”

The most obvious medical advice is, “Don’t get hurt. Don’t cut yourself.” But we know that’s easier said than done.

Scott Fulmer, a researcher well-known to the lobstermen in Maine, reported in 2016 that over a quarter of lobstermen in the northeast United States had been returned to shore at some point in their career for a medical emergency. Most of these emergencies were acute injuries, including serious cuts on the hand. In 2019, Fulmer and his colleagues reported that the right hand and wrist were the most likely sites of injury and concluded that preventing sprains and cuts would help most lobstermen. Analysis of the 2019 Coast Guard District 1 casualty data (see Commercial Fisheries News, March 2020) further supports their findings, as five of the 23 medical evacuations involved hand or wrist injuries. These injuries are a problem not only on the East Coast. A study by V. E. Bovbjerg et al. published in late 2019 found that a quarter of Dungeness crabbers on the West Coast had had a cut or puncture wound in the previous 12 months.
The most obvious medical advice is, “Don’t get hurt. Don’t cut yourself.” But we know that’s easier said than done. Prevention is key. We recommend using durable gloves and eye protection when handling hooks and lines and following established vessel protocols to improve crew coordination and avoid injury whenever possible. Proper technique should always be used when handling knives, such as slicing away from you rather than toward you. Glove use is particularly important when handling rope, especially wire rope, which may have broken strands that stick out and could cause cuts or punctures. When encountering malfunctioning gear, having the right tools at hand such as bolt/wire cutters can be useful in avoiding injury to the hands.
Knowing that not all injuries can be predicted or prevented, here’s a quick guide to help you know what to do with small to midsize cuts and how to decide on next steps.

Wound care:

  • Apply pressure to stop the bleeding. Move to a safe spot away from the action and take care of your wound.
  • Wash the wound with clean, fresh water. If you have enough fresh water, flushing the wound for a few minutes will go a long way toward preventing infection. Be sure to remove any slivers, hooks, rope fibers, etc. from the wound, as these can introduce bacteria deep into the wound and make an infection more likely. You can use soap to help clean the wound and the surrounding skin, but don’t scrub the actual wound, as this will do more damage than good.
  • The wound will likely start bleeding again after you’ve cleaned it out. Apply pressure again, using a clean cloth, paper towel, or gauze for several minutes until the bleeding stops. Then apply antibiotic ointment to the wound. Try to keep the edges of the skin together—if you have “butterfly strips” or “steri-strips,” these can work well. Then cover it with gauze from the first-aid kit. You may need several pieces of gauze and medical tape to keep some pressure on the wound.
  • For puncture or stab wounds, you have to have an added level of vigilance to make sure that nothing remains in the wound. These types of deeper injuries have a higher risk of retaining dirt and bacteria. Wash the wound thoroughly with soap, apply pressure to stop the bleeding, put a small amount of antibiotic ointment on the opening, and bandage it.

When to seek further medical care

  • If you’re concerned about the wound, you’re never wrong to have a doctor or other medical professional take a look at it. But you should definitely be seen by a health professional if any of these apply to you:
  • You can’t get the bleeding to stop, even with firm pressure and a bandage.
  • You have any numbness, weakness, or difficulty moving the surrounding joints (such as finger joints).
  • You can’t keep the wound edges together or the wound keeps splitting open. This is a sign that the cut is too big and likely needs stitches. For reference, if a cut is larger than 2 cm (about 1 inch), it likely needs to be sutured closed. Size isn’t everything either. Areas that are under pressure (especially hands and fingers) are also more likely to need stitches to stay closed. If this is the case, don’t delay seeing the doctor. If you think you need stitches, try to get to the doctor within 6 to 12 hours, if at all possible, to improve your chances of a decent repair without increasing your risk of infection.
  • You develop a fever (100.4 °F or higher) within the first few days after the injury.
  • The wound becomes more painful over the next day or two. You’ll likely have an endorphin rush that dulls the pain when you first get injured. After this wears off, your pain will return, but it shouldn’t continue to get worse or spread over time.
  • You notice the wound getting hot or pus comes from the wound. These are key indicators of a festering infection.
  • You notice any redness or streaks spreading out from the wound. It is normal to have some redness immediately around the wound edges but it shouldn’t spread beyond that. Don’t delay seeing a doctor, as you’ll need to get on the right antibiotics as soon as possible.
  • For puncture wounds, the area around the puncture site will likely be sore, but if the affected area becomes increasingly red, hot, or painful, seek medical attention (especially if a fingertip is involved).
  • If you’ve lost a finger, find the missing part if possible and place it in a small clean plastic bag without ice. Clean and bandage the wound, then seek medical attention as soon as possible.

Commercial fishing and lobstering are unique lines of work, with hazards and highs that others may not understand. The highs from a big catch can sustain you for days, while a serious injury can keep you out of work for weeks. Before you leave the dock, check that your vessel has a well-stocked, Coast Guard-approved first-aid kit and consider packing your own small plastic bag with a few extra bandages, gauze, medical/athletic tape, and a tube of antibiotic ointment. If you ever find yourself or a deckhand injured at sea, we hope that you can remember the information in this article and take the right steps to care for yourself and others.

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