If a shark attack victim makes it through the night, why do they sometimes die within a few days? What goes wrong?
Why didn’t they survive if doctors were able to keep them alive for a few days?
A body that has been ravaged by a shark can be somewhat (not completely) compared to a body that has sustained a high-impact motor vehicle crash.
(There’s a big unique difference, though, which contributes to death several days later — and that will be explained shortly.)
If the trauma team can keep them alive through the next day, and even into a third or fourth day – then why can’t they keep them alive long enough to improve and eventually be discharged from the hospital, even if they’re minus a limb?
Trauma surgery
The Shark Attacks
Enormous blood loss from even a single bite can render the victim incapable of pulling through despite blood transfusions and fluid replacement.
“An adult has about 10 to 12 pints of blood, and if a major artery has been severed [such as the femoral artery, which supplies blood to the lower body], blood can be lost very quickly,” says David Beatty, MD, a retired general practitioner with 30+ years of experience and an instructor of general medicine for 20+ years.
“With rapid blood loss the victim’s blood pressure drops, leading to faintness, hypovolemic shock and loss of consciousness.”
The hemorrhagic shock from significant blood loss (exsanguination) disrupts the body’s organ systems. Rapid transfusions may not be enough to overcome this shock.
Complications that lead to death after a shark attack can take days to gain momentum.
Organs begin shutting down towards a point of no return, despite the scrambling efforts of top trauma teams.
When a shark attack results in a quick death, it’s due to such a rapid loss of blood that they die in the water or moments after being dragged to the beach. A fast death is easy for the layperson to understand.
Great white sharks attack seals from below. A surfer can easily be mistaken for a seal.
A Death Several Days in the Making
Why do the efforts that have kept the shark attack victim alive for a few days then eventually lose to the injuries?
It’s too simplistic to say, “He lost a lot of blood; his organs shut down despite transfusions.”
When someone is attacked by a shark, the body knows its under siege, triggering biochemical responses.
“Adrenaline and noradrenaline secretions are increased,” begins Dr. Beatty.
“This speeds up the heart rate and raises (or tries to maintain) blood pressure.
“Cortisol is released and this increases glucose manufacture and increases the breakdown of fats to provide energy.
“It also has an anti-inflammatory effect and tends to retain bodily fluid.
“Increased vasopressin levels work on the kidneys to retain sodium and water in an attempt to maintain blood pressure.
“As blood loss increases, the body will try to maintain blood supply to the most important organs, the heart and the brain, and will close down blood supply to the limbs.
“As the situation gets worse blood supply to the bowels, liver and kidney is reduced.
“This can result in an acute failure of these organs. If the blood supply is improved rapidly then the organ usually recovers fully.
“The longer the organ goes without blood, the more likely it is to be temporarily or permanently damaged.
“Sometimes dialysis is needed for renal failure, or a raft of other supportive measures may be needed if the liver isn’t functioning properly.”
But this begs the question: Being that an ambulance may arrive at the beach literally in minutes after the victim is pulled to shore, and the trauma center is only a short distance away, wouldn’t life-saving measures be in place “rapidly” enough to save the patient?
Dr. Beatty explains, “The management of the shark bite initially involves stopping the bleeding and replacing lost blood with fluid, blood or other blood replacement products.”
But there’s so much more involved.
Dr. Beatty continues, “Electrolyte imbalance needs to be carefully watched especially if kidney function is impaired.
“High levels of potassium occur with renal failure, and this can cause fatal cardiac arrhythmias.
“The breakdown of tissue from the shark bite can also cause a release of electrolytes.”
Furthermore, a blood transfusion comes with risks including death, says Dr. Beatty.
“When a large amount of blood and blood product has been given there’s a risk of blood coagulation disorders.
“These can manifest as the blood clotting too much or too little.
“Occasionally this can both happen at the same time: Blood clots form using up all the available clotting factors so that blood is then unable to clot when needed.”
At the beginning it was pointed out that the ravage of a shark attack differs in a unique way from the bodily damage that’s sustained in a high-impact motor vehicle collision. And that difference is infection.
Infection from a Shark Bite
An infectious process from a shark mauling, even a single bite, cannot be compared to the possible infection from a car accident.
- A shark’s mouth is full of bacteria. That bacteria will get passed onto the victim, getting deep into their tissue.
- Shark teeth may end up in the wounds, too, meaning an additional harbinger of infection.
- In addition, wounds will likely be contaminated with sand and miscellaneous debris.
“Infection can be a major cause for concern, especially if the bacteria present don’t respond to the commonly used antibiotics,” says Dr. Beatty.
Even the best efforts to prevent a systemic infection can fail, even if it appears that the bite wounds are cleaned out and sutured up.
A body-wide infection doesn’t kill the patient immediately. It takes a few days to become fatal, and this can happen despite the administration of broad spectrum antibiotics and the most meticulous cleansing and repairing of the wounds.
During the time that a massive infection is setting in, it may seem that the patient is stabilized because they’re breathing on their own and their blood pressure is normal.
If a limb must be amputated, though, this compounds everything.
“No one wants to remove healthy tissue, but If non-viable tissue is left, then further surgery may be needed,” says Dr. Beatty.
“The more dead tissue that remains, the more likely the patient is to get sepsis or infection spreading up the limb to previously healthy tissues.”
Other Factors that May Cause Delayed Death of a Shark Attack Victim
Many shark-human interactions occur in areas where a level 1 trauma center — which could provide the most expertise care possible including the high availability of numerous surgical specialists — is not nearby.
The patient thus ends up at a common regional treatment facility.
When the arrival time to a hospital is signficantly delayed (e.g., victim is pulled onto a pier; waits for a boat to take them to shore where an ambulance is waiting), this correlates to poorer outcome — especially when there wasn’t a tourniquet applied ahead of time.
Dr. Beatty has worked in primary medicine, surgery, accident and emergency, OBGYN, pediatrics and chronic disease management. He is the Doctor of Medicine for 
