Docs versus crocs

6 minute read

Patching up a patient after a croc attack is just one of the challenges facing the NT’s rural doctors.

Let’s talk crocodile medicine. Or #CrocMed, as I like to call it. In other words, the medical aspects of saltwater crocodile attacks in Australia. 

A few weeks ago, a man was bitten on the head while crabbing in the Kimberley, and to those fortunate enough to live in the spectacular country that is Northern Australia, stories of crocodile attacks never seem to be out of the news for long.

The saltwater crocodile (crocodylus porosus) is one of two crocodile species found in Australia, the other being the much more pleasant freshwater crocodile. There are more than 100,000 salties in the Northern Territory alone, making the largest number in the country. Males of this species can grow up to 6 metres, although larger specimens have been recorded. The salty has the strongest bite of any animal in the world.

Now let’s look at the numbers. In the Northern Territory, these have been cyclical, with 10 deaths between 1971 and 2004; 14 between 2005 and 2014(!); and two since then. Croc attacks are actually the third most common cause of environmental death in the NT after drowning and heat illness.

In Queensland, there have been 12 deaths since 1985, with the state averaging one fatal attack every three years. This may surprise those who could have sworn Bob Katter, in response to a question on same-sex marriage, once said that one person is torn to pieces by a crocodile in Queensland every three months. That was not a fever dream, but thankfully, it’s not the case.

Impressively, no one has been killed by a croc in Western Australia since 1987.

Why do crocs attack? The three big reasons are defence of territory, defence of their nest, and because they’re hungry and we’re delicious.

One Australian study concluded that most people probably die from a crocodile attack by drowning. However, another study disputed that, given the severity of the injuries the researchers found, which ranged from a crushed skull to decapitation. It can be difficult to ascertain the exact cause of death when a body is examined, and formulation of the diagnosis by the coroner necessitates integrating the autopsy findings and the death scene from eyewitness accounts etc).

The fact that some bodies are never recovered or they’re too decomposed makes it particularly challenging. Therefore, deaths may be a combination of blunt force injury, exsanguination and drowning, while the exact contribution of each may not be clear. As a small consolation, death appears to be relatively swift.

A study in 2016 which analysed deaths in the NT between 2005 and 2014 found five involved complete traumatic disruption of the body, leaving only incomplete and fragmented remains for examination. Four involved crushing of the head with fractures of the skull, four revealed avulsion of limbs, while two involved crushing of the chest with fractures of the ribs and sternum. One involved decapitation.

If you don’t die but are merely chomped at, the most common injuries that result from this are, unsurprisingly, serious soft tissue and bone injuries.

Antibiotic coverage is an interesting consideration and in 2017, a study of wounds sustained in crocodile attacks in Far North Queensland found a diversity of organisms in the wounds. Bacteria originated from the crocodile’s oral flora, the patient’s skin, or from the water or soil during the attack. The oral and cloacal flora of Australian crocodiles are known to contain numerous organisms, including aeromonas hydrophila, pseudomonas aeruginosa, and proteus and salmonella species.

Based on their findings, the authors concluded that the Australian therapeutic guidelines’ empirical regimen suggested for “animal bites”, of oral amoxycillin-clavulanate for high risk wounds and mild infections, and intravenous piperacillin-tazobactam for more severe infections, would appear appropriate.

So how are some people lucky enough to survive while others are not? Factors such as your size, weight, and position in the water influence your chances of survival, according to a study in 2018. The size of the croc, however, and the difference between its mass and the victim’s, is the most significant. If you are a 75kg person attacked by a 3-metre croc, your chances of survival are good: 4 in 5. If the croc is 4 metres, however, your chances have dropped a lot, to a mere 1 in 5. Once a croc hits 4.5 metres, your chances of survival, no matter your size, are negligible.

Another potentially important factor is the presence of a second person available to help the victim. In Australia, all attacks by crocodiles larger than 4 metres against unaided victims in the water have been fatal. But the presence of company was found in one study to increase the survival probability of a victim – in most cases by preventing them from being dragged into the water and by moving them away.

Being able to prevent an attack means being “CrocWise”, which is effectively just a lot of common sense. The NT government’s “CrocWise” approach can be found online.

What if, despite your best and most sensible efforts, you are attacked? Here’s what to do:

  1. Hope that it’s a small crocodile.
  2. Scream, obviously, though this will probably come naturally. You need the help of anyone nearby.
  3. This may sound ridiculous, but try to stay focused. The more targeted your defence, the better the position you are in.
  4. Poke it in the eyes – aggressively. Its eyes are its biggest weakness.
  5. If you can’t do that, strike its nostrils and, if a limb is already inside its open jaws, its throat. (You are aiming for the palatal valve behind the tongue, which is what stops it from drowning.)
  6. Conk it on the head, as many times as you can.
  7. Fight. Hard. Your life is depending on it, and you are up against a killing machine that outlived the dinosaurs.
  8. If you are lucky enough to escape, get out of the water as fast as you can. If it follows you onto land, just run. Ignore the ‘run in a zig-zag’ nonsense you may have heard in your youth – you are fastest running in a straight line, and it is insulting to the crocodile’s intelligence.
  9. Get medical attention right away!
  10. Contact Channel Nine to regale others with your story of tenacity and bravery.

Dr Brooke Ah Shay is a GP in Maningrida in Arnhem Land.

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