Wednesday, March 13, 2013

The importance of stretcher, mattress and necropsy for stranding cases

The Indonesia team in Subic Bay. L to R: Efin Muttaqin, myself, Yanti Purnomo, Danielle Kreb and Sekar Mira

I’ve been meaning to write a post about the lessons I received after attending a stranding symposium and workshop in the Philippines last February. However, February has been crazily busy for me (happy busy, not sad busy), so I never got to it. Some comments from Philippe Borsa on the Sabu stranding event today sent me to my working desk now (In fact, I woke up this morning with a mind to write a post about necropsy; Philippe beat me to it with his/her constructive feedback). So, here’s thanks to Philippe.

This post should be subtitled: ‘Or, why you better attend a stranding workshop before claiming you know about stranding’. Mostly, it refers to myself rather than others. For that was really what I felt when I attended the 1st Southeast Asian Stranding Network Symposium and Workshop in Subic Bay (3 hours north of Manila), Philippines from 4-9 February 2013. I felt like hiding under the table during some country presentations. Thank God for the Whale Stranding Indonesia website, otherwise I – as a delegate from Indonesia – would feel so hopeless due to the lack of success story from my country.  Actually, the WSI website was such a hit that people tend to disregard that Indonesia is still very new with this stranding business. We are still writing up our stranding protocol (looking specifically at a friend of mine who have to finish her round-robin part...), and we are still figuring out how to structure our national stranding network. But still, better late than never.

Now, the title of this post refers to the three most important things I should have realised, but did not, about stranding management (those are not the only important things, trust me). The stretcher and necropsy things I know – kinda, but never realised the full importance of the two aspects. The mattress is a new thing to me, such that I realised that I really have to understand more about the biology of cetaceans and dugongs. And I call myself a cetologist. Sigh.

I usually compare a stranding event with a traffic accident (knock knock on the wood). Rescue effort is kindly meant. However, inexperienced rescuers might actually give more injuries to the victim. It’s not that we shouldn’t help a traffic accident victim; I think we should. But it’s much better if we know first aid. By the same token, a better understanding of the medical aspects of stranding will help us to better assist the stranded marine mammals.

I write this post based on my memory, which I hope serves me well. I have to also make an advance disclaimer that I have not consulted any veterinarians before writing the necropsy part. However, I write it based on the understanding that I gained during the veterinarian workshop in Subic Bay. But since this post should be elementary, I hope I manage to avoid some elementary mistakes.

Stretcher and mattress: your two most basic needs for live stranding

Basic rescue tools: Mattress, stretcher (and its metal rods), water sprayer and/or bucket

Stretcher (or anything to reduce rescuer-animal contact)

Yes, stretcher. Why do we need it? Because (and this is IMU – in my understanding) rope hurts the animal more than helping them. Ropes will create narrow pressures on their skin and will add more pain to their already dire situation. Stranded marine mammals (read: whales, dolphins and dugongs) are usually compromised already, even before they strand. The roping, dragging and pushing will do more harm to these fine creatures. Oh, and stretchers don’t usually work with large whales. It works more with small cetaceans, up to around 6 meters, I’d say.

There will be some situations where the animals need to be moved on the beach (e.g., rough swells or surfs that will put the animals and the rescuers at risk). Maybe the animals need to be transported to another beach nearby with less wave exposures and more chance for successful release. This case happened when eight pygmy killer whales (Feresa attenuata) stranded in Padanggalak, Sanur Bali in April 2006. Now, in such situations, these animals should be moved into a vehicle (most likely land-based vehicle like a small truck). The animals will be transported for 20-30 min if lucky.

In such a case, stretchers are needed so that the rescuers can lift the cetaceans from the water/beach, put them inside the vehicle and transport them to a safer location. If the transport is more than 20 min, you will need a stretcher to: 1) reduce the risk of rescuers getting hurt (the cetaceans, when panic, can really hurt you with their flippers or tails); and 2) giving extra comfort to the animals by not having them touched by so many people. If possible, make holes on the stretchers to fit the pectoral fins (‘flippers’) into the opening and reduce the stresses on their limbs. Flippers are one of the main weak spots on cetaceans, so make sure you let them dangling safely in the stretcher opening. If you cannot make holes, tuck the flippers gently next to the animal’s body to prevent twisting or fractures. This trick is also to be used if the transport is less than 20 min. See this site for better explanation on this matter.

What if you don’t have a stretcher like shown on the photograph above? Improvise with large beach towels, blankets, or any other soft materials you can find. Avoid using plastic tarpaulins because those are abrasive and might hurt the animals further.

The metal rods/handles on the photograph above are meant to assist in carrying the stretcher with the small cetacean in it. However, if you are lucky enough to have such a stretcher, know this: you can leave out the metal rods. You and your friends can just carry the stretcher by hand, which may be easier if the terrain is uneven.

Mattress (or anything to add buoyancy)

This is something new to me, mattress. Here’s what I learned from the Subic Bay workshop (again, I haven’t checked this part with a vet; but I hope I’m right). Cetaceans and the dugongs are usually on buoyant position in the water column. They are used to having water supporting their body weight (and they do weight quite a lot, with those muscles!). Now, when these animals strand, they lose the support of the ocean (or river) water column they usually have. Their bodyweight will likely crush some of their internal organs, or at least exacerbate the breathing difficulty. That’s why inserting a mattress, foam or any soft, air-filled item between the animal and the beach will help the animals. The use of mattress will also help during the land transportation (see the section above) or on a boat (see the 19 February stranding case in Sanur). See also the first picture of this post.

In the absence of fancy mattress like the above, we can use the mattresses of deck chairs on the beach or any floatation device. Inexpensive life jackets often found inside the boats can also be used for this purpose, I gather. 

Subic Bay Participants saving a wannabe-dolphin (a snorkeler, really) with stretcher and mattress

I also just learned that the cetaceans can experience shock during stranding. Due to the shock, they might ‘forget’ that they actually CAN breath on land, off-water. Is it possible that this stress also killed many of our stranded marine mammals in Indonesia? Is it just due to shock, or also because their bodyweight crush their breathing organs?

I do not know. I do know that we can help by creating a hole under the animal’s body cavity and half-fill it with seawater. That way, they will feel a bit of water underneath them. If not creating some buoyancy, the bit of water can also reduce their panic and possible shock. 
Don’t forget to always keep their skin wet. Put wet clothes or towel over the animal’s back, and also around the fluke (those are where dehydration usually happens). Avoid covering the blowhole with towel (and please, do not fill the blowhole with water; it is not a radiator!). Protect the eyes from the sand. 

The ultra-importance of necropsy

Before I joined the Subic Bay workshop, I kinda knew already how important necropsy was for stranding events. I have read some papers about it. But knowing isn’t the same as understanding. Understanding came later as I joined the vet workshop in Subic. 

Disclaimer here: I’m so not a vet, hence I’m just going to give an impression of what I learned during the lectures and practice of medical aspects of stranding and necropsy. What I do know is this: Necropsy is done to understand the possible cause of death. Necropsy is like autopsy for humans. Only, we do necropsy to animals, instead of to human (what do we call an autopsy on aliens, by the way? Extra-terrestrial necropsy?).

The next thing that I learned is: you cannot assume to know the cause of death until you do a proper examination of the carcass. There are exemptions, of course. Like, if you find a dead dugong with large clear cut slices on its back (possibly due to boat strike), it’s very likely that the boat strike was the cause of death. Another ‘easy’ examination for my non-vet background would be to check for any foreign object(s) inside the animal’s stomach. Danielle Kreb and her team in East Kalimantan had found some Orcaella brevirostris with lots of plastics inside the animals’ stomach. It doesn’t take a rocket scientist to guess why the dolphins died...

But again, I’m certain a vet would argue against jumping to conclusion. They might still want to open up the animal to see its lungs etc, see if the animal drowned before dying, or having a heart attack before dying etc.

About two weeks ago, I had dinner with a colleague of mine who had joined a necropsy class beforehand. It was on a harbour porpoise, I think, that got entangled in fishing net. I thought that the animal died due to drowning. However, upon detailed necropsy examination, my friend and her team found out that the poor darling actually died due to heart attack! The poor porpoise was so scared that it got entangled in fishing net that its little heart stopped and its system failed. 

OMG, where’s the tissue? I feel like I want to cry!

Main stomach of the necropsied spotted dolphin in PHL. Do you know that dolphins have three stomachs? I didn't.

Then again, the cause of death isn’t the same as the circumstances of death. In the case of the poor harbour porpoise (where’s the tissue?!), the animal died due to heart attack. However, without finding out that it got entangled in fishing net before it died, my friend may never find that the porpoise got its heart attack because of the entanglement. 
Here, we can also find the important links between proper examinations of stranding cases with environmental management options. In this case, reduction of unsustainable fishing practices, including by-catch and ghost nets/marine debris.

Just last week, my Canadian Taiwanese colleague John Wang also told me a story about how he examined the skeleton of a dolphin to find out that the jaws of the dolphins were rotting (infection? I forgot). IIRC, the animal might got the jaws physically wounded somehow, but then the muscles around the jaw grew again to cover the infected jaws. So, without John taking out all the flesh and examining the jaws, we would not know that the dolphin died a slow death of pain and hunger...

What would be the management recommendation of the dolphin that John Wang handled? Well, we know that dolphin might die a slow death of hunger. But we may never know how it got its injuries in the first place. Sadly, in this case, no management recommendation might be available...

But how do we do necropsy? How do I know that, by looking at the lungs, for instance, we will know that the animals actually drowned? Or that by looking at their hearing systems, kidney etc we know that they died due to sonar activities? 

At times, vets also need hardcore tools for necropsy... (Pic by Sekar Mira)

That comes with practice, and also reading a lot of references. My vet friend Nimal Fernando (you can read his advice re: the Sanur stranding here) warned me against putting a simple flowchart or analytical matrix/table to decide the possible cause of death. Instead, for post-mortem investigations, he recommended that we contact a local vet to do a gross necropsy (external and internal), paying attention to any abnormalities. Then we should write a good, thorough descriptive report (in plain English, avoid high-tech vet terms), take lots of good photographs (at good angles etc) and send them to trained vets for further analyses. That way, we can avoid jumping into conclusions and make wrong management recommendations. 

I can see his points. I was also painfully reminded of how Indonesia sorely needs first-responder trainings and vet trainings, pronto. By the way, first-responders are – well – people who first respond to a stranding event. Most likely than not, they are not vets. 

In closing: Now I see that a stranding event is like a canary in the mine. It is the harbinger of something wrong in our oceanic (or riverine) system. We must treat every stranding case seriously if we want to save other marine animals out there from suffering the same fate as their unfortunate, stranded companions. See the ref list below for some vet-related stranding cases. Many more are out there.

Optional reading list:

Jepson, P. D., ARbelo, M., Deaville, R., Patterson, I. A. P., Castro, P., Baker, J. R., Degollada, E., Ross, H. M., Herraez, P., Pocknell, A. M., Rodriguez, F., Howie, F. E., Espinosa, A., Reid, R. J., Jaber, J. R., Martin, V., Cunningham, A. A. & Fernandez, A. 2003, 'Gas-bubble lesions in stranded cetaceans', Nature, vol. 425, no. 575-576.
Jepson, P. D., Deaville, R., Patterson, I. A. P., Pocknell, A. M., Ross, H. M., Baker, J. R., Howie, F. E., Reid, R. J., Colloff, A. & Cunningham, A. A. 2005, 'Acute and Chronic Gas Bubble Lesions in Cetaceans Stranded in the United Kingdom', Veterinary Pathology Online, vol. 42, no. 3, pp. 291-305.
Morimitsu, T., Nagai, T., Ide, M., Kawano, H., Naichuu, A., Koono, M. & Ishii, A. 1987, 'Mass stranding of Odontoceti caused by parasitogenic eighth cranial neuropathy', Journal of Wildlife Diseases, vol. 23, no. 4, pp. 586-590.
Yang, W.-C., Chou, L.-S., Jepson, P. D., R.L. Brownell, J., Cowan, D., Chang, P.-H., Chiou, H.-I., Yao, C.-J., Yamada, T. K., Chiu, J.-T., Wang, P.-J. & Fernandez, A. 2008, 'Unusual cetacean mortality event in Taiwan, possibly linked to naval activities', Veterinary Record, vol. 162,  pp. 184-186.

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