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The Honolulu Advertiser
Posted on: Wednesday, March 8, 2006

Outdoor hazards you should know about

By Catherine E. Toth
Advertiser Staff Writer

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You know the stories: A swimmer goes into anaphylactic shock after being stung by box jellyfish. An ill-prepared hiker ventures off the trail and gets lost. A surfer emerges from a river-mouth break covered with boils.

Most of us shake our all-knowing heads and wonder, "What was that person thinking?" Yet these emergencies aren't uncommon in Hawai'i, where year-round pleasant weather begs residents and visitors to head outdoors.

Couldn't common sense help prevent these mishaps?

"There is no such thing as common sense," said Jim Howe, operations chief with the city Ocean Safety Division. "It's not common because everyone is different, and everyone has different life experiences. ... Many people just don't have any frame of reference or experience when it comes to understanding the Islands and our environment."

So we've put together a list of common hazards that experts say we should know about before heading outdoors.

HYPOTHERMIA

Most people associate hypothermia with cold climates. But hypothermia is possible in Hawai'i, despite our warm waters and weather.

"People don't realize you can get hypothermia in our waters," Howe said. "It's not as severe as in cold climates, but it happens all the time."

For example, spending an extended time in the ocean or getting caught in a torrential downpour while hiking can lead to hypothermia.

It doesn't take freezing temperatures to get hypothermia. Any temperature lower than 98.6 degrees can be linked to it.

According to the U.S. Centers for Disease Control and Prevention, water conducts heat away from the body 25 times faster than air because it has a greater density.

"That's why in the ocean," said Dr. Libby Char, director of the city's emergency services, "you can (get) hypothermia so fast, just being wet."

Hypothermia occurs when your body's control mechanisms fail to maintain a normal body temperature. Signs and symptoms include uncontrollable shivering and the gradual loss of mental and physical abilities.

In severe cases, muscle rigidity develops, skin pales, pupils dilate and pulse rate decreases. Severe hypothermia can lead to death.

Prevention tips:

  • Stay hydrated, especially in the water. When immersed, you lose fluids, causing a drop in core body temperature. Over time, even in "warm" water, hypothermia can occur.

  • Wear a wetsuit or protective clothing.

  • Hike with rain gear or Mylar blankets.

  • Avoid extended exposure. Get out of the water or move indoors to get warm and dry.

    BOX JELLYFISH

    Biochemist Angel Yanagihara has firsthand experience with the potentially fatal effects of box jellyfish stings.

    Nine years ago, on her usual pre-dawn swim at Kaimana Beach, Yanagihara swam directly into a swarm of box jellyfish, their tentacles striking her neck. She dove deeper to get away from them only to surface amid more tentacles, this time stinging her arms. She submerged a third time and was engulfed again on her way back up.

    "I was so exhausted and in so much pain," Yanagihara recalled. "I kept swimming toward the beach, but I wasn't getting any closer."

    By the time she reached the empty beach, Yanagihara made two big mistakes: taking off her wet suit and showering in fresh water (which aggravates the stinging cells embedded in your skin, causing them to discharge more toxin).

    Having trouble breathing as her body reacted to the stings, she headed for a pay phone to call for help. Then she fell unconscious.

    She woke up in an ambulance, drenched in meat tenderizer and vinegar and wrapped in plastic. She was suffering from anaphylactoid respiratory distress.

    Yanagihara was bedridden in pain for three days. The rash and welts lasted for 14 weeks.

    "It was your worst kind of nightmare," she said.

    Hawaiian box jellyfish live at 10 to 60 feet below the surface off O'ahu's leeward coast, where most of their food supply plankton exist.

    Alive, no part of the box jellyfish is safe to touch. The bell and tentacles contain stinging cells. Each cell has a nematocyst, which is composed of a capsule, tubule, spines and venom.

    It takes a few microseconds for the nematocyst to fire. And the skin rash people get from the sting can last up to 10 months.

    Prevention and treatment tips:

  • Avoid swimming in the ocean seven to 10 days after the full moon, when the influx of box jellyfish occurs.

  • If you have to be in the ocean, go out in the middle of the day. Box jellyfish don't like the sun they're photophobic and will sink to the ocean floor.

  • Rinse the sting with vinegar or saltwater. Use cold or heat to relieve pain.

  • Submerge affected area in very hot water 113 degrees Fahrenheit (43 degrees Celsius if you're from a metric country) for about 10 minutes.

  • Watch for signs of severe reaction to the stings. If severe pain, nausea, dizziness, irregular heartbeat or shortness of breath develop, get medical attention immediately.

    STAPH INFECTIONS

    Twelve years ago, Natalie Au went kayaking with friends in the Ala Wai Canal, ignoring the minor rash she had developed on her knees from paddling.

    But a few days later, she noticed blistering where the rash had been.

    "I thought they were just blisters, so I would pop them," said Au, now 31. "But then more appeared."

    She went to the doctor, who told her that she had a major staph infection and that popping the blisters had only spread it. He prescribed oral and topical antibiotics. It took a couple of weeks for the area to heal.

    Staph short for Staphylococcus is a bacterium that can live harmlessly on many skin surfaces. But when the skin is punctured or broken for any reason, staph bacteria can enter the wound and cause an infection.

    "One in five of us have staph on our skins right now, doing nothing," said Dr. Gary Ahn, an internal medicine and sports medicine specialist at Straub Hawai'i Kai. "There's nothing you can do about that. But it's when staph gets under that barrier of first defense your skin or in a hair follicle that you have problems."

    Most staph infections are caused by the species Staphylococcus aureus, which most commonly causes skin infections such as folliculitis, boils, impetigo and cellulitis.

    But once it enters the bloodstream through a break in the skin, S. aureus also can cause more serious infections in other parts of a person's body, such as the lungs, bones, joints, heart, blood and central nervous system. These infections are more common in people with certain chronic diseases, in people who are having surgery, and in those with a weakened immune system.

    Prevention tips:

  • Wash wounds with soap and water and keep the area clean.

  • Apply antibiotic ointment such as Neosporin if needed, but don't overdo it.

  • Don't pop blisters. That can spread infection.

  • Avoid walking with the open wound on sidewalks and even sand both are breeding grounds for bacteria.

    HEAVY RAINS

    Heavy rains like the ones we experienced last week signal a warning for anyone planning to go into the ocean.

    That's because rains bring runoff debris into the water twigs, rubbish, even dead animals that can become a breeding ground for bacteria (including staph) or attract other ocean animals (think sharks) to the area.

    Heavy and prolonged rain also can cause sewage spills.

    "Whenever it rains and it rains hard and the water turns brown, that means there's something in there," Howe said.

    Two weeks ago, spilled sewage entered a nearby storm drain that leads to Ka'elepulu Pond. Warning signs were posted at Kailua Beach. Last week, the heavy rains caused runoff in many locations around the Islands.

    "It's one of those common-sense things," said Ahn, the Straub doctor. "If there's a lot of runoff, it's probably not a good time to go swimming."

    Prevention tips:

  • Heed posted warning signs for waters that may be affected by sewage spills.

  • Avoid swimming in areas that are polluted or where there is poor water clarity.

  • Stay away from murky waters, harbor entrances and areas near steam mouths, especially after heavy rains. These types of waters are known shark hangouts.

  • Don't enter the water with open wounds.

    LEPTOSPIROSIS

    You've probably seen the signs along mountain streams and at swimming holes, warning about leptospirosis. Hawai'i averages 44 cases of the bacterial disease a year, according to the state Department of Health.

    It causes a wide range of symptoms including high fever, severe headache, chills, muscle aches and vomiting. Untreated, patients can develop kidney damage, meningitis, liver failure and respiratory distress. In rare cases, people die.

    Outbreaks are usually caused by exposure to water, food or soil contaminated with the urine of infected animals, according to the Centers for Disease Control and Prevention. The bacteria can enter the body through broken skin or the eyes, mouth or nose. Most cases are mild and may be confused with the flu.

    In Hawai'i, many of the outbreaks involve campers or those who entered contaminated streams and ponds.

    "The overall risk is probably not that high," Ahn said. "But if you have any open wounds, you should avoid mountain streams and pools."

    In 2004, there were 36 cases of leptospirosis, including four people who became ill as a result of the Oct. 30 flooding in Manoa.

    The last Hawai'i fatality from the disease occurred Jan. 26, 2004, when college student Simon Hultman, 22, of Pahoa, died on the Big Island, where he went hiking and swimming. His death was the seventh attributed to leptospirosis in the state in the past decade.

    "Life has risks," Ahn said. "But I wouldn't give up hiking and crossing rivers because of the potential for leptospirosis. ... Just be cautious."

    Prevention tips:

  • Avoid entering streams and swimming holes with open wounds.

  • Pack first-aid kits that include adhesive bandages and antibiotic ointment on your hikes.

  • Always hike with a buddy.

  • Know the area and how long the hike will take, and let people know where you are going.

    HIGH WINDS

    It's not uncommon for lifeguards to get a call about a kayaker or paddler in distress off Waikiki.

    And most of the blame can be attributed to the wind.

    Paddlers love flying downwind even better during a swell from Hawai'i Kai to Waikiki.

    And with more people picking up the sport, there are more incidents than ever of paddlers and kayakers getting into trouble in these windy conditions.

    "There are a lot of kayaks and one-man (canoes) out there when the winds are up and the swell is up," Howe said. "If they get tumbled or lose their paddle or their kayak blows away, how are they going to get back in?"

    The bigger the wind, the better for board sailors, kitesurfers, one-man canoe paddler and kayakers. But lifeguards caution that windier conditions are often more dangerous, particularly for novices.

    Prevention tips:

  • Know your limits. Don't venture into conditions you're not able to handle.

  • Check with lifeguards on wind and ocean conditions.

  • Always go out with and stay with a buddy.

  • Have a plan with your buddy in case of emergency. Agree on a rendezvous spot.

    Reach Catherine E. Toth at ctoth@honoluluadvertiser.com.