Confusion about best treatment for jellyfish stings

There continues to be confusion about the appropriate first aid for most jellyfish envenomings in Australia and the world, according to a paper published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine.

“Most people don’t know what type of jellyfish has stung them, so first aid needs to be simple, easily understood, and easily performed,” said Dr. Mark Little, Director of Emergency Medicine at Caboolture Hospital in Queensland.

Dr. Little, an emergency physician and clinical toxicologist, said a “stinger” season has passed since Dr Conrad Loten and his colleagues published a landmark study in the Medical Journal of Australia comparing ice packs with hot water immersion (at 45ºC) to treat patients stung by Physalia sp. (bluebottles or Portuguese man-of-war), finding hot water the preferable treatment.
 
The many hundreds of people stung by Physalia sp. on southeast Queensland beaches during the 2006/7 summer were still being treated with ice packs.

They were following guidelines from the Australian Resuscitation Council (ARC).

The ARC gives separate advice for tropical and non-tropical stings, and recommends vinegar for tropical jellyfish stings, and the application of cold packs or wrapped ice pain relief for all jellyfish stings.

Despite these recommendations, a prospective study of 107 patients stung by jellyfish contacting the Western Australian Poison Information Centre, found 12 different first aid treatments were used.

“This suggests that recommended first aid treatments may not be effective and there is confusion about the most appropriate one to use,” Dr. Little said. “Vinegar prevents nematocysts from firing but does nothing to affect the venom that has already been released. This is recommended for box jellyfish, but further work to confirm whether it is effective for all jellyfish stings is required.”

He added there is very little evidence to support the use of ice packs for jellyfish stings and there is increasing evidence that hot water immersion is more effective in reducing the pain of jellyfish stings. “It is time that bodies such as the ARC recommend the first aid treatment supported by the evidence.”

Dr. Little said because many beaches do not have a thermometer to accurately test the water temperature, any recommendations for jellyfish stings should be as for stings by fish, that the water is “no hotter than the victim can comfortably tolerate”.

Hopefully, the relatively cheap installation of thermostatic mixing valves will be undertaken in beach first aid stations around Australia to allow an accurate supply of water at 45ºC, he added.

(Source: Emergency Medicine Australasia: Alina Boey: Wiley-Blackwell: February 2008)