First Aid for Victims of Paralytic Shellfish PoisoningWhat Is Paralytic Shellfish Poisoning?Paralytic Shellfish Poisoning (PSP) is caused by a poison produced by small organisms called dinoflagellates. Clams, mussels, oysters, snails, scallops, and barnacles ingest these organisms while feeding, and the poison is stored in their bodies. This toxin has been found in these seafoods every month of the year, and butter clams have been known to store the toxin for up to two years. One of the highest concentrations of PSP in the world is reported to be in the shellfish in southeast Alaska.Some people have died after eating just one clam or mussel, others after eating many--each with a small amount of poison. You cannot tell whether the dinoflagellates are present by looking at the water with your naked eye. No simple, reliable test for PSP exists, and most beaches in Alaska are not tested. If you are not sure the seafood is toxin-free, avoid eating it if it is from an area with a high incidence of PSP. Signs and symptoms of PSP most often occur within 10 to 30 minutes after eating affected seafood. Problems can include nausea, vomiting, diarrhea, abdominal pain, and tingling or burning lips, gums, tongue, face, neck, arms, legs, and toes. Later problems may include shortness of breath, dry mouth, a choking feeling, confused or slurred speech, and lack of coordination.
Emergency Treatment for PSP VictimsIf you think someone has PSP, follow the four steps outlined here.
1. Is the person alert?If the person is conscious and alert, and can speak clearly, have him drink at least 2 glasses of water, each mixed with 3 tablespoons of activated charcoal.Contact the Coast Guard or a physician for further advice.
2. Does the person respond to you?If the person isn't making any noise, try to get a response by gently tapping him and asking, "Are you okay?" If he doesn't respond, he needs help!Yell for help if people are nearby. Contact help on the radio. Encourage the person by being positive in your speech and actions. Unconscious people can often hear what you are saying.
3. Does the person have an airway, and is he breathing?If he is talking or screaming, he has an airway and is breathing.If you are not sure if he is breathing, look, listen, and feel for 3 to 5 seconds. You can usually do this without moving him. If he is breathing, find out if he has a pulse as in step 4. If he is not breathing, you must breathe for him as follows: If he isn't on his back, carefully turn him over, keeping his neck and back in line.
![[image]](images/PSPfig1.gif) Turn the PSP victim over so he is on his back.
Kneel beside his head. Use the head-tilt/chin-lift maneuver to open his airway. Check for 3 to 5 seconds to see if he is breathing. If he has started breathing, find out if he has a pulse as in step 4. If he is not yet breathing, breathe for him. Keep his head tipped, pinch his nose shut, take a deep breath, and breathe into his mouth until his chest rises, then immediately give him a second breath. If his chest does not rise, reposition his airway, and check to make sure his nose is pinched closed and you have a tight seal around his mouth. Try to give the two breaths again until his chest rises.
![[image]](images/PSPfig2.gif) Use the head-tilt/chin-lift method to open the airway.
4. Does he have a pulse?Check for a carotid pulse for 5 to 10 seconds. This pulse is in the neck, in the hollow between the windpipe and the large neck muscles.
![[image]](images/PSPfig3.gif) Locate and check the carotid pulse.
If he has a pulse and is breathing, loosen any restrictive clothing. If he has a pulse, but is not breathing, breathe for him once every 5 seconds until he breathes on his own, someone else takes over, or a doctor tells you to stop. Recheck his pulse every minute or so. If he does not have a pulse, do CPR (Cardiopulmonary Resuscitation).
CPRTo find the proper hand position for CPR, trace along the bottom of his ribs until you feel his breastbone, place the heel of your other hand two finger-widths up from the tip of his breastbone, then lay your first hand on top. Make sure your hands are not on his ribs.
![[image]](images/PSPfig4.gif) Locate the proper hand position for CPR.
Compress his chest 1 1/2 to 2 inches, then release the pressure. Do 15 of these compressions in 10 to 12 seconds. Open his airway and give him 2 full breaths. Repeat the set of 15 compressions and 2 breaths until you have done a total of 4 sets. (Four sets should take about one minute.) Check his pulse for 3 to 5 seconds. If he has a pulse, make sure he is breathing. If he is, place him on his right side (recovery position). If you have not contacted the Coast Guard or a physician, do so now. If he does not have a pulse, continue your cycle of 15 compressions and 2 breaths, rechecking his pulse every few minutes. Continue CPR until the person breathes on his own and has a pulse, someone else takes over, you are too tired to continue, or a doctor tells you to stop. CPR is very tiring. You may become so exhausted that you have to stop. Taking a CPR course is the best way to learn, but try to do CPR in an emergency even if you've never done it before. One-Rescuer CPR Standards
First Aid and CPR TrainingFor information on training in your area, inquire at your local fire department or ambulance service or contact:
Emergency Medical Services Section
U.S. Coast Guard Phone Numbers:
 The U.S. Coast Guard performs rescues. If someone has PSP symptoms and needs to be transported by helicopter or boat, call the Rescue Coordination Centers at the numbers above. (Most of this information is taken from Beating the Odds on the North Pacific: A Guide to Fishing Safety, edited by S.C. Jensen, University of Alaska Sea Grant MAB-41, 244 pp., 1994.)
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