Marine First Aid

Many sea creatures are venomous, and the best way to avoid envenomation is to avoid the creatures. As an example, don’t pick up or handle creatures washed up on the beach or in rock pools, and don’t swim where Box Jellyfish or the Portuguese Man-of-War are prevalent.

The first aid treatments listed below are recommendations only. If in doubt, please seek medical attention immediately.

Cone Shell

The Cone Shell is a variegated shell, usually brown and white, which is common on tropical beaches. The shell contains a dagger-like spine, which can inject toxin into any unwary person who handles the creature.

Signs and Symptoms:

  • A spot of blood
  • Numb feeling of the face and tongue
  • Progressive weakness in the legs and body
  • Eventual collapse
  • Respiratory arrest

Care and Treatment

  • Examine the wound for the presence of a radular tooth and cleanse.
  • Determine the patient’s tetanus status and update as appropriate.
  • Place the affected limb in hot (not scalding) water to tolerance, with pain relief as the goal.
  • Immediate medical attention may be required.

Fire Coral

Fire Corals, also known as Millepora are common on reefs. Unlike others, Fire Coral are lined with inconspicuous hair-liked structures protruding from its skeleton. These fine hairs contain stinging cells called nematocysts which inflict stings on exposed human skin when touched.

Signs and Symptoms:

  • Faint feeling
  • Rashes on affected area
  • Paralysis

Care and Treatment:

  • Immerse affected area in or spray with vinegar  (or stingose)


Like its relative the scorpion fish, Lionfish also lie camouflaged on the reef. If disturbed, they flare their colorful venomous fins and will inject anything that approaches.

Signs and Symptoms:

  • Throbbing pain, itching, bleeding and numbness.

Care and Treatment:

  • Stop bleeding with pressure,
  • Clean thoroughly with soap and water.
  • Seek medical treatment for deep cuts and embedded spine pieces.
  • Do not try to remove pieces yourself.

Moray Eels

By nature Moray Eels are non aggressive however, if molested they will inflict nasty bites. They typically hide in dark places during the day and feed at night. There have been cases where Moray Eels have drifted away from their hiding places to attack approaching divers. This usually happens in areas where fish feeding occurs.

Signs and Symptoms:

  • Bleeding, severe muscle damage, but more commonly tendon and nerve damage.

Care and Treatment:

  • Stop bleeding with pressure, clean thoroughly.
  • Seek medical attention (guard against infection).

Portuguese Man-Of-War (‘Bluebottle’)

The Portuguese Man-of-War, or ‘Bluebottle’, is really a colony of small creatures living as one. The creatures have small stinging cells which, when encountered as a group, impart a venomous sting. People who are susceptible to bee sting are usually sensitive to Bluebottle venom.

Signs and Symptoms:

  • ‘Trails’ of blue ‘tentacles’ adhering to the body or limbs
  • Stinging sensation associated with the contact
  • Reddening of the skin
  • Pain for some hours
  • May cause severe allergic reaction (rare)

Care and Treatment:

  • Reassure
  • Remove the ’tentacles’’with a copious amount of sea water
  • Dry cold compress to relieve pain (or ice cubes)


The Stonefish is virtually invisible among rocks. The creature has venomous spines on its back that it erects when threatened or stepped on.

Signs and Symptoms:

  • Severe pain at the site of envenomation
  • Swelling
  • Open wound and/or bleeding
  • Irrational behaviour
  • Rapid pulse
  • Breathing difficulties
  • Collapse

Care and Treatment:

  • Reassure
  • Hot water immersion of the area to relieve pain—ensure that the water will not scald the casualty
  • Get medical attention

Sea Snakes

Sea snakes may grow to be several metres in length, and are found mainly in warmer waters. They appear similar to land snakes, but have flatter tails.

Signs and Symptoms:

  • Relatively painless
  • Drowsiness
  • Weakness
  • Nausea and vomiting
  • Breathing difficulties
  • Visual disturbances

Care and Treatment:

  • Ensure safety
  • Reassure and rest the casualty
  • Apply direct pressure over the bitten area
  • Obtain a history
  • Apply a pressure immobilisation bandage (PIB) starting from over the bite area, and then wind as far up the limb as possible to the armpit or groin
  • Apply a second PIB commencing at the fingers or toes of the bitten limb and wind as far up the limb as possible to the armpit or groin
  • Immobilise the limb with a splint
  • Send any evidence of the snake to the hospital only if safe to do so.
  • Avoid washing the bitten area, as a venom sample may be obtained
  • Immediate medical attention may be required. Evacuate to a medical facility as quickly as possible
  • Avoid elevating the limb
  • Do not use an arterial tourniquet
  • Do not remove the bandage and splint once it has been applied
  • Do not try to capture the snake
  • Do not cut the bitten area
  • Do not suck the bitten area

The main treatment for a snake bite is the application of a ‘pressure immobilisation bandage’. This bandage is applied as firmly as bandaging a sprained ankle, and is designed to slow the movement of venom through the lymphatic system which helps to slow or prevent the venom from leaving the bite site.

Sea Urchins

“spiky balls” of varying sizes having numerous long spines. As they are often present in cracks of rocks they are usually not seen until the spines puncture the feet of surfers or fishermen clambering on the rocks.

Signs and Symptoms:

  • The puncture wounds are painful and the spines may break off in the wound.

Care and Treatment:

  • Place affected limb in hot (but not scalding) water
  • Seek medical attention.

Starfish, Crown of Thorns, and Sea Star

If medical attention is not readily available, the following guidelines are recommended in treating a puncture wound:

  • Immerse the affected area in water as hot as the person can tolerate for 30-90 minutes. Repeat as necessary to control pain.
  • Use tweezers to remove any spines in the wound because symptoms may not go away until all spines have been removed.
  • Scrub the wound with soap and water followed by extensive rinsing with fresh water.
  • Do not cover the wound with tape.
  • Apply hydrocortisone cream 2-3 times daily as needed for itching. Discontinue immediately if any signs of infection appear.
  • Apply topical antibiotic ointment (Bacitracin) 3 times per day if signs of infection, such as pus, redness, or heat, are present.

Pain may be relieved with 1-2 acetaminophen (Tylenol) tablets every 4 hours or 1-2 ibuprofen (Advil, Motrin) tablets every 6-8 hours.

Stinging Hydroid

Hydroids are actually colonies of animals equipped with strong stinging cells (nematocysts) used to capture prey and for defense, which can inflict painful and venomous stings if touched. In the water they look like tiny ferns and are usually white in colour.

Signs and Symptoms:

  • Some species can give quite severe stings causing inflammation, swelling and pain lasting up to a week. Effects may sometimes be more severe.

Care and Treatment:

  • Douse or spray liberally with vinegar.
  • Pluck off any visible tentacles carefully—try not to use your fingers, use your fins, a towel, etc. instead to brush them away.
  • For severe pain, try applying a hot pack. If heat makes the sting feel worse, try applying a cold pack or ice to the sting.
  • Seek medical help for severe reactions.


Stingrays often burrow under the sand in shallow water. The usual method of injury is a reflex forward whip of the tail when the ‘wings’ are trodden on. The tail contains one or more sharp barbs, which may embed in the skin of the victim and break off, or glance across the skin causing a laceration that may be quite deep and extensive.

Signs and Symptoms:

  • The wound is usually (though not always) acutely painful.
  • Most occur on the lower limbs but there have now been two deaths in Australia after the barb penetrated the heart.
  • Other serious injuries have also occurred after the barb penetrated the chest or abdomen.

Care and Treatment:

  • Immerse the wounded area in hot water (remember to test yourself first!).
  • Seek immediate medical attention, as the wound must be thoroughly cleaned to prevent infection, and tetanus immunization given.
  • Any wound to the chest or abdomen must be referred to a doctor.

Titan Triggerfish

A Titan triggerfish is capable of locking its tough dorsal fin into its predator, sometimes pinning them to the reef. Nesting females are found to be more aggressive and will nip divers approaching their nesting areas. Trigger fishes usually gazette their territories as the area directly above and below them so when approaching, do not swim over but around them.

Hot Water Treatment Instructions

  • First, test the temperature of the water Colour with your own limb. Because of the pain of envenomation, the victim’s may be unable to feel the heat of the water with the affected limb; a severe or painful burn could result!
  • After the water has been tested, the affected limb is immersed in hot water until the pain is reduced, or relieved. It may be necessary to change the water, or ‘top it up’ several times—don’t forget to test each time!