Shark attacks increased 23% globally within the past 20 years on a multifactorial scale through climate change and human impacts, yet healthcare lacks treatment guidelines for these victims. This systematic review proposed a shark attack treatment protocol that will potentially reduce the morbidity and mortality rates by assessing prehospital management with transfusions, hospital management with prophylactic antibiotics, and mental health evaluations to prevent and/or treat psychological impacts. This study screened 463 sources and eliminated 432 sources due to repetition or irrelevance to this study. The protocol initiates with prehospital management by implementing emergency medical service (EMS) to follow the SHARC protocol (systolic blood pressure (SBP) < 90, hemorrhage, appearance, radius of the bite over 15 cm, and coagulopathy) to administer whole blood transfusions in route to a hospital to prevent hypovolemic shock. The next step is the antibiotic protocol to administer ciprofloxacin or moxifloxacin, and a third-generation cephalosporin with doxycycline to prevent wound infections commonly caused by vibrio species. Assessing mental health before and three months after discharge can help prevent and/or treat anxiety, depression, and post-traumatic stress disorder (PTSD).
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