Sea creature bites and stings

If you are bitten or stung by a sea creature, the best first aid treatment depends on the creature involved.

Sea creature bites and stings can cause a severe allergic reaction (anaphylaxis) in some people. Learn more about first aid treatment for severe allergic reactions in the ‘anaphylaxis’ section below.

Box jellyfish, Irukandji and other tropical stingers

Tropical stingers (jellyfish) live in tropical waters around Australia’s coastline north of Bundaberg in Queensland through to Geraldton in Western Australia. The most dangerous are the box jellyfish and Irukandji. The stinger season usually peaks from November to March.

The symptoms of a box jellyfish sting are severe pain and red or purple marks on the skin. It can cause increased heart rate, severe pain elsewhere in the body, sweating or anxiety, nausea or vomiting or cardiac arrest.

The symptoms of Irukandji sting are severe backache or headache, shooting pains in the muscles, chest and abdomen, nausea or vomiting, anxiety, restlessness and breathing difficulties.

To treat a sting, call triple zero (000) for an ambulance and pour vinegar liberally over the tentacles on the person’s skin for at least 30 seconds to deactivate the sting. Remove any remaining tentacles. If vinegar is not available wash the area with seawater. Do not use fresh water.

If the person is unconscious, you may need to start cardiopulmonary resuscitation (CPR) while you are waiting for an ambulance. Keep the person calm.

Never substitute vinegar with methylated spirits or alcohol because they will make the sting worse.

If you are in tropical waters and you cannot clearly identify the cause of the jellyfish sting, then treat the sting with vinegar and seek medical assistance just to be safe.

Stonefish

Stonefish live all around the Australian coastline. They look like rocks and live among rocks on coral reefs. They can also be found sleeping in the mud or sand.

The stonefish’s back is lined with spines that release a venomous toxin. This makes it very dangerous.

Symptoms of a stonefish sting are severe pain that quickly travels up the limb and swelling. The person may go into shock.

The person may need hospital treatment to further relieve their pain and to be given stonefish antivenom.

To protect yourself from stonefish stings, wear thick-soled shoes and shuffle your feet when you walk in the shallows. Also, do not pick up rocks on reefs — they could be stonefish.

Blue-ringed octopus, sea snake and coneshell bites and stings

Bites and stings from the blue-ringed octopus, sea snakes and coneshells are very dangerous.

The sting may not be painful and may leave small puncture marks. Some people may develop pins and needles, nausea, dizziness or feel very unwell.

 Provide emergency care including cardiopulmonary resuscitation (CPR) if needed.

Apply a pressure immobilisation bandage and keep the person calm and as still as possible until medical help arrives.

A guide to pressure immobilisation bandages can be found on the Australian Venom Research Unit website.

Non-tropical stingers (jellyfish)

Non-tropical stingers live in waters all around Australia’s coastline, but are more generally found south of Bundaberg in Queensland and south of Geraldton in Western Australia.

To treat a sting, wash any remaining tentacles off the skin with seawater or pick them off the skin. Soak the affected area in hot water (no hotter than can be easily tolerated) for 20 minutes to relieve the pain. Remove briefly before reimmersing and continue this cycle if pain persists. If immersion is not possible, a hot shower is an alternative. Seek further medical attention if the person’s condition gets worse.

Bluebottle stings

Bluebottle stings are the most common jellyfish stings in Australia. The sting can cause intense pain and sores, rash or redness on the skin. The pain usually fades in 1 to 2 hours.

If stung, wash any remaining tentacles off the skin with seawater, or carefully pick them off the skin (wearing gloves if possible).

Do not use vinegar. Immerse the person’s sting in hot water (no hotter than can be easily tolerated) for at least 20 minutes. You can even run a hot shower over the affected area if easier.

Do not use this method for suspected box jellyfish or Irukandji stings.

If you cannot access hot water, apply an ice pack or cold water to the affected area.

Seek medical attention if the person develops further symptoms such as abdominal pain, nausea and vomiting, or if there is continuing pain, itchiness or blistering at the site.

Never rub sand or pour soft drink over any jellyfish sting, or urinate on the stung area.

Fish stings injuries

There are numerous venomous or spiny fish, such as red rock cod in New South Wales, and soldier fish and cobblers in southern Australia. Most of these cause injuries when they are handled, for example by fishermen.

They cause immediate severe pain that lasts for up to an hour with minimal other effects. There are a number of things you can do to help manage pain from fish sting injuries:

• Remove any pieces of spine
• for pain relief immerse affected area in water (or shower) as hot as patient can tolerate (45°C) until the pain goes away, or a maximum of 90 minutes. The temperature must be tested with an unaffected limb first
• painkillers can be used to treat the pain

Sea urchin injuries

Most sea urchin injuries are from non-venomous spines and the main problem is removal of broken-off spines. Venomous spines are less common but cause more intensely painful puncture wounds.

There are a number of things you can do to help manage pain from sea urchin injuries:

• remove spines close to the surface
• for pain relief, immerse affected area in water (or shower) as hot as patient can tolerate (45°C) until the pain goes away, or for a maximum of 90 minutes. The temperature must be tested with an unaffected limb first
• painkillers can be used to treat the pain

Sponge injuries

Sponge contact reactions are uncommon and may be difficult to diagnose if they are delayed.

Initially there may only be a mild sensation with itchiness and stinging in the area developing after minutes to hours. In some cases, this sensation increases and can cause intense symptoms for 2 to 3 days.

No specific treatment has been recommended except washing the sting site. The symptoms will disappear over days to weeks. Pain relief medication can be used to manage the pain.

Cardiopulmonary resuscitation (CPR)

Read these articles for an overview of:

• cardiopulmonary resuscitation (CPR)
• how to perform CPR

For printable charts, see St John Ambulance Australia’s first aid resuscitation procedures (DRSABCD) poster, as well as their quick guide to first aid management of bites and stings.

Pressure immobilisation bandage

A pressure immobilisation bandage is recommended for anyone stung by a sea creature.

This involves firmly bandaging the area of the body involved, such as the arm or leg, and keeping the person calm and still until medical help arrives. If possible, mark the site of the bite on the bandage with a pen.

A guide to pressure immobilisation bandages can be found on the Australian Venom Research Unit website.

Anaphylactic shock

Occasionally some people have a severe allergic reaction to being stung.

In cases of severe allergic reaction, the whole body can react within minutes to the bite or sting which can lead to anaphylactic shock. Anaphylactic shock is very serious and can be fatal.

Symptoms of anaphylactic shock may include:

• difficult or noisy breathing
• difficulty talking and/or hoarse voice
• a swollen tongue
• persistent dizziness or collapse
• swelling or tightness in the throat
• pale and floppy (young children)
• wheeze or persistent cough
• abdominal pain or vomiting

If someone is having an anaphylaxis, call triple zero (000) for an ambulance.

The Australasian Society of Clinical Immunology and Allergy recommends that for a severe allergic reaction adrenaline is the initial treatment. This may include administering adrenaline to the person via an autoinjector (such as an Epipen®) if one is available.

The St John Ambulance Australia first aid fact sheet for bites and stings .

For further information, visit the Choosing Wisely Australia website.

How to prevent bites and stings

To protect you from marine stingers:

• swim at patrolled beaches between the red and yellow flags and inside stinger nets if they’re available
• do not enter the water when the beaches are closed
• wear a full-body lycra suit for extra protection (particularly from tropical stingers during stinger season)
• do not touch marine stingers if they are on the beach — they can still sting you
• enter the water slowly to give marine stingers time to swim away
• ask a lifeguard for help or advice if needed