by Sue Endicott, MSN, RN:

Nothing can ruin a great dive or a day at the beach more quickly than a marine related injury. Whether it’s a lion fish sting, coral scrape or anything in between, being prepared can lessen the impact of these injuries.

Here are some basic guidelines for treating stings and marine related injuries. These injuries can range from localized skin wounds, to full allergic reactions, which in some cases can lead to difficulty breathing and Can Be Life Threatening. Remember it is not the initial injury itself that can cause the greatest amount of harm, but how the body reacts to it.

DO:

• Be familiar with marine life you may encounter where you are diving
• Be prepared and carry a Dive 1st Aid Sting Relief +, or similar 1st aid kit
• Your kit should include:
  • Alcohol prep pads
  • Tweezers
  • Gloves
  • Hydrocortisone cream
  • Disposable razor
  • Vinegar
  • Sterile saline wash
    (Use in place of salt water
    to decrease exposure to
    contaminants in sea water)
  • Instant hot pack
  • Sterile gauze pads
  • Rolled gauze
  • Adhesive tape
  • Antibiotic ointment
  • Scissors
  • Pain Relievers
• Use common household items if no first aid kit is available
  • Wine and Coke have a similar acidity to vinegar and may be substituted in cases where vinegar is recommended but not available
  • Honey can be used in place of antibiotic ointment as it has antibacterial properties
  • Eye wash can be substituted for sterile saline wash
  • Rubbing alcohol or whiskey can be substituted for alcohol prep pads
  • Any clean cloth material can be used in place of gauze pads to stop or control bleeding
• Be aware of your surroundings while entering and exiting the water
• Be careful what you come in contact with in the water
• Consider your personal safety before you offer aid
• If someone is having difficulty breathing, call 911 to seek immediate aid. Provide O2 and rescue breathing as needed until help arrives

DON’T

• Offer aid if it will jeopardize your personal safety
• Touch anything that has stung or injured someone, you may be next
• Urinate on a sting wound. The urine ph is not correct for neutralizing these wounds and could lead to infection.
• Panic! With preparation you can handle ANY situation until help arrives

Below is a summary for caring for the most common marine injuries. These are treatment guidelines and should be used for first aid care only. Always follow up with a medical professional for further care.

These injuries can be painful, so administer pain relieving medications if available. If the patient begins to show signs and symptoms of allergic reaction, such as itching, hives or swelling, give the patient Benadryl and if signs and symptoms of severe allergic reaction are noted such as wheezing or difficulty breathing, administer oxygen if available, call 911 and seek immediate medical attention. If a patient has a known allergy, and carries an epi pen, encourage them to administer the pen at the first signs of severe allergic reaction.

In many situations the treatment calls for hot water. If hot water is not available utilize the hot pack in the Dive 1st Aid Sting Relief + to apply heat to the area.

Fire Coral
Swimmers who accidently come into contact with fire coral can easily be stung.

• Clean and irrigate the wound with seawater or saline (eye wash) and some sort of wound decontaminate (alcohol prep pads)
• Apply vinegar to the area
• Remove any visible debris with tweezers
• Reapply vinegar for 15 minutes
• Apply hydrocortisone ointment to the wound

Lion Fish, Tiger Fish, Stone Fish, Scorpion Fish
Lion Fish continue to be a growing problem and are overrunning many dive sites as they have no natural predators. These stings are extremely painful

• Clean, disinfect and irrigate wound with fresh water
• Soak in hot water 30 – 60 minutes
• Remove pieces of spines with tweezers
• Clean with soap and water and irrigate the wound with saline (eye wash)
• Apply antibiotic ointment to the wound
• Administer pain medications if available

Sea Urchins
Sea urchin spine punctures are highly venomous and may cause difficulty breathing or weakness

• Clean and irrigate wound with fresh water
• Soak in fresh hot water 30-90 minutes
• Repeat if pain persists after first soaking
• Carefully remove visible spines with forceps
• Do not scrub area
• Seek medical attention for spines deeply embedded in the skin or in joints

Sting Rays
When sting rays are startled they whip their tail towards whatever intruder they feel threatened by. When they strike, pieces of skin and bone may be left behind in the wound. These injuries can be severe, and in some cases Life Threatening

• Clean and irrigate wound with fresh water
• Soak in hot water 30 – 90 minutes
• Remove visible pieces of stinger with forceps
• Scrub with soap and water
• Thoroughly irrigate wound with hot water
• Do not close the wound
• Apply antibiotic ointment to wound
• Seek medical attention

Jelly Fish, Sea Anemone
These creatures cause painful sting injuries when the skin comes into contact with the tentacles of the jellyfish.

• Immediately apply vinegar for 30 minutes
• If no vinegar is available use normal saline eye wash
• Remove any visible particles
• Apply shaving cream, soap or baking soda paste and shave area
• Meat tenderizer has shown to have pain relieving effects as well
• Reapply vinegar for 15 minutes
• Apply hydrocortisone to the wound

Portuguese Man-of War
Injury occurs when someone comes into direct contact with the tentacles

• Vinegar is not recommend in cases of Man-of War stings as the acidity may trigger the release of venom
• Rinse thoroughly with sea water or sterile saline (eye wash)
• Remove pieces of spines with forceps
• Apply shaving cream or soap and shave area
• Apply hydrocortisone to the wound

In summary, be prepared, be aware and get the proper training and supplies necessary to care for these common marine injuries before you are faced with one. The outcome will be much better if you do.

Happy Diving!

Sue Endicott, MSN, RN
Director of Education
Dive 1st Aid