Sometimes contact with harmful flora or fauna underwater is either unexpected or unavoidable, and in these cases, it’s important to know how to react.

Marine life injuries are incredibly rare, considering how many organisms in the marine environment can cause harm to humans. Usually, divers can prevent marine life injuries by adhering to the general diving rule, “no touching, teasing or taking.” Sometimes, however, contact with harmful flora or fauna underwater is either unexpected or unavoidable. In these cases, it’s important to know how to react. In minor cases, delivering effective first aid provides pain relief. In more serious cases it can vastly improve a victim’s chances of survival. Here we’ll take a look at four potential marine life injuries and the first-aid procedures required to treat each one.

Jellyfish stings

Of the myriad jellyfish species, some are stingless and some can be fatal. When stung by a jellyfish, the seriousness of the situation depends on several factors. These include the species, the anatomical location of the sting, the size of the affected area, and whether or not the victim is allergic to the animal’s toxins. Many jellyfish stings do not require professional medical attention. But if the victim experiences severe symptoms, including chest pains and difficulty breathing, contact emergency medical services immediately.

Similarly, if the species is potentially lethal (like Australia’s infamous box jellyfish), professional medical care is imperative. If the victim is particularly old or young, or the sting covers a large area, call emergency services immediately. In general, however, first aid for all jellyfish stings follows the same guidelines. The victim should be treated out of the water, and kept as still as possible. This prevents more toxins from being released and spreading around the body.

If there are any visible tentacles on the victim’s body, remove them using tweezers, forceps, or gloves to avoid further stings. After you have removed the tentacles, clear any remaining stinging cells, or nematocysts, by applying shaving cream. Use a razor or credit card to carefully scrape them from the skin. If you do not have these tools on hand, use salt water to flush the affected area. Never use fresh water, as it can cause unfired nematocysts to release their poison.

Contrary to popular urban myth, you should avoid urine for the same reason, as well as alcohol. Some sources (including DAN) recommend using household vinegar for sting relief. Others, such as the British National Health Service, advise not to for fear that the vinegar may also trigger remaining nematocysts. Instead, they recommend either applying an ice pack to the affected area or soaking it in hot water. This offers the victim pain relief after all tentacles and stinging cells have been removed.

Lionfish, scorpionfish and stonefish injuries

All three of these fish species are highly venomous. They all have spines on their dorsal, anal and pectoral fins, capable of injecting venom into a diver’s skin. Typically, injuries from any one of these fish require emergency care. If you are stung by a stonefish, seek professional medical attention immediately. Of the three, the venom of this fish is the most potent and can be fatal. Victims will require anti-venom injections as part of their treatment. First-aid care is the same for both lionfish and scorpionfish injuries.

Once the diver is safely out of the water and in a stable environment, use tweezers to gently remove any spine fragments embedded in the wound. Then, soak the wound in hot water. It should be as hot as the victim can tolerate without burning the skin. These species’ venom is protein-based, and begins to break down and deactivate with the application of heat. Soaking the wound in hot water will not only relieve pain but also reduce the venom’s effects.

If possible, immerse the affected area for at least 30 minutes. If the wound is located somewhere that makes immersion difficult, use hot washcloths. Hot-water treatment may also help in the case of stonefish injuries. Apply hot washcloths or immerse the wound while waiting for medical care to arrive. After soaking, disinfect the wound, apply antiseptic ointment and take over-the-counter pain medication to help alleviate pain. Divers should seek immediate medical attention after exposure to the venom of any of these species, as some complications may take time to manifest. Serious complications include anaphylactic shock as a result of an allergic reaction, shock, infection, tissue death and paralysis. These wounds can take weeks, or even months, to heal.

Coral cuts and abrasions

These are perhaps the most common diver injuries. Coral scrapes can occur whenever a diver makes contact with the reef. Coral is often sharp, and those who get cut will find that they take a long time to heal, and often become infected. This happens because a thin film of living organisms cover the coral. They tear away from the main structure on contact and contaminate the victim’s wound. To treat coral cuts and abrasions, first stem any significant blood flow using direct pressure. Once the bleeding has stopped, make sure to remove any remaining coral fragments by flushing with clean fresh water. Use antibacterial soap or hydrogen peroxide mixed with water to disinfect the wound. Finally, rinse again with fresh water.

After you have cleaned the wound, apply antibiotic cream. Cover with a sterile, non-adhesive dressing. Clean and re-dress the affected area twice a day until the wound has healed. Although victims won’t usually require emergency medical care for coral injuries, watch closely for signs of shock or aggravated infection. Treat extreme redness, swelling, excess pus, swollen lymph glands or any other signs of fever or infection immediately.

Large animal bites

When it comes to marine life injuries, most people automatically imagine shark attacks. Truthfully, the likelihood of receiving a shark bite is infinitesimally small. But several marine species can inflict a nasty bite, including moray eels, barracuda and seals. Usually these species will only react aggressively in self-defense, or if they mistake a diver for prey. The severity of such injuries can range from the superficial to the fatal. In the case of more serious bites, first remove the victim from the water.

Contact emergency services immediately, and then focus on providing basic life support until the professionals can take over. Apply pressure to the wound to stem blood flow, remembering to wear protective barriers if possible. Do not release pressure to change bandages or cloths even if they become saturated. Instead, simply apply more bandages directly on top of the original ones. If the bleeding is excessive and you cannot stanch it, apply a tourniquet as close to the injury as possible between the wound and the heart. If not used properly a tourniquet can cause other complications. Tourniquets are an absolute last resort, and ideally someone with prior medical training will apply them.

If the bite is located on an extremity, raise it above heart level to help reduce blood flow. If the bite broke a bone, use a splint to support and protect the injured limb. If you don’t have a purpose-made splint on hand, you should be able to improvise one quite easily. Often, the shock and trauma of a severe bite can cause a victim to have difficulty breathing; in this case, administer oxygen and monitor continued respiration until emergency services arrive. In the event of minor bites, the victim may not require emergency services. Simply use direct pressure until the bleeding stops, and then rinse gently with fresh water, clean with antiseptic and apply a non-adhesive, sterile dressing. Should any infection occur, or other symptoms arise, make sure to seek medical advice immediately.

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