First aid: Laypeople

• First-aid treatment is carried out immediately or very soon after poisonous fish has been eaten before the patient reaches a health centre or hospital. 
• If ingestion of poisonous fish has been the likely reason for the emergency, asking the patient or the bystanders nearly always provides this important information.
• There are, however, may other causes for the emergency which can be associated with the meal.
• The patient may be allergice to seafood, it may be an infectious gastroenterits causing the symptoms, etc.
• If other people had the same meal they must also be taken under observation since the intiation of symtoms can vary widely between people.
• Poisoning caused by poisonous animals can affect many people and can occur widespread. If this type of poisoning is suspected in a patient, it is necessary to locate other persons who might also be affected and to trace the source of the poisoning in order to prevent further consumption of the contaminated food.

Initiation of symptoms: May develop within minutes but may be delayed for many hours.

(Ranges which ahve been sites in clinical studies; references in the respective 'clinical entries')

• Ciguatera:  A few minutes to up to 30 h
• Scombroid fish poisoning: 10 min–2 h 
• Tetrodotoxin poisoning ("puffer fish" poisoning): usually within 10–45 min, but also longer. 
• Paralytic shellfish poisoning: on average 2 h 
• Neurotoxic shellfish poisoning: 15 min–many hours 
• Gastrointestinal form of shellfish poisoning: 30 min–several hours, rarely >12 h 
• Central nervous form of shellfish poisoning (Amnesic shellfish poisoning = ASP),: 15 min–38 h)
• Allergy to fish, shellfish and crab: minutes.

• the urgency of the problem.
• the expectation of signs & symptoms still to develop – very important to move quickly to a health post or hospital for assessment and observation (move preferentially to a health post or hospital that have antivenom available!).

Stay calm

Reassurance will reduce fear and excitement, slow the victim’s heart rate, and reduce the spread of venom.

Immobilize the patient

Place the victim in a comfortable and safe position, ideally in the recovery position.

• Locate and call the nearest hospital available.
• Get their advice on how to tranfer the patient (they may have an ambulance or connect you to the ambulance service of the region)
• If you have to tranport the victim on your own and the vital parameter of the victim deteriorate you may need to stop at a health facility on the way to the hospital  to get support.

Transport the victim on a stretcher, "fire-man's lift" method, bicycle, motorbike, chart, horse, etc.

• A stretcher can be made with materials that are available in villages or at work.
• Transporting the patient with a stretcher avoids any movement that increases systemic absorption of venom.
• The recovery position will allow for vomit and other secretions to drain from the mouth with less risk of airway obstruction. This is particularly important when the patient is unconscious or semiconscious.
• Fix the patient to the stretcher with straps.
• Let somebody walk alongside the patient to continuously observe him/her.

Two-wheeler transport

• Support the victim between the driver and a pillion passenger
• Protected the victim’s legs from exhaust burns
• Drive safely
• All passengers should wear helmets!!

If a service is available, call the ambulance

• Inform the responder about
• Number of mobile phone
• Name of the caller (victim, first responder)
• Nature of scorpion envenoming (Unconscious? Difficulties breathing? Cannot lift head whilct lying on the ground? Bleeding)
• Name of the incident location
• Nearest place where the ambilance can get to the victim
• Never put down the phone/mobile, wait for the call agent for any medical information/pre-arrival iinstructions