Emergency Airways After Himalayan Black Bear Attacks in Bhutan

Abstract

IntroductiondAlthough bear attacks on humans are uncommon, the incidence has slowly risen as human populations increasingly encroach on wilderness habitat. In the Kingdom of Bhutan, Himalayan black bear attacks occur regularly. Bears preferentially attack the face, often causing injuries that require surgical airway management. We sought to determine how often patients injured by Himalayan black bears required airway management during initial resuscitation.MethodsdWe conducted a retrospective review of emergency department and admission records of the 3 referral hospitals in Bhutan. We identified all victims of bear attacks in Bhutan who received emergency airway management, including surgical airway management during the period from August 2013 to December 2017.ResultsdThere were 21 patients who were treated for injuries from bear attacks during the study period. Of these, 12 required emergency airway management. Three patients who required emergency airways (2 intubations, 1 surgical airway) were attacked near a regional referral hospital and received care at that hospital. The remaining 9 patients received care from the helicopter emergency medical services (HEMS) retrieval team (1 intubation, 8 surgical airways).ConclusionsdThe use of highly trained HEMS critical care retrieval teams may improve outcomes in critically injured patients who require time-critical airway management in remote areas. Countries such as Bhutan with populations far from emergency and critical care might benefit from the establishment of HEMS critical care retrieval services. HEMS teams providing care while retrieving patients from austere environments should be expert in emergency airway management.

Mechanisms and patterns of animal-related injuries in patients admitted to a major trauma center in central India

“…[ 1 ] Similarly, bears typically attacked head, face, and neck region with the help of their claws causing severe lacerations and decollement, which is comparable to the mechanism of injury recorded in other studies. [ 2 3 ] In this study, bull attack was typically associated with penetrating injury to the abdomen, with multiple perforations of the bowel, a similar association has been found in other studies. [ 4 ]…”

Circumstances of human conflicts with bears and patterns of bear maul injuries in Bhutan: Review of records 2015–2019

“…The majority of the incidents have occurred during day time as reported from other studies in Scandinavia and India [ 19 , 20 ]. Males (26, 76%) were the common victims as they are more involved in outdoor activities such as hunting in Scandinavia or collection of forest products in the Himalayas and India [ 10 , 17 , 19 – 21 ] In Bhutan, the highest number was reported from Zhemgang district (7, 21%), one of the districts heavily dependent on agriculture and forests for livelihood [ 4 ].…”

“…The patients are then referred to the nearest higher centre, district or general hospitals, where general doctors are available for basic surgical and wound management. Cases requiring specialist surgical, Ear, Nose and Throat (ENT), oro-maxillofacial, orthopaedic or intensive care are referred to the referral hospitals or the JDWNR Hospital by road or air [ 15 – 17 ]. For those cases that require further management such as plastic and reconstructive surgery, patients are referred to hospitals outside the country.…”

A Case of Animal Mauling From Nepal

“…Males weigh an average of 135 kg. [1][2][3] Himalayan black bears, also known as Asiatic black bears, are found in the middle hills of Nepal from 1500 to 3500 m. 3 The incident occurred in the Palpa district, in the middle hills southwest of Pokhara. Although, bear maulings are common, mortality from bear attacks is rare compared to attacks from other predators.…”