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  1. Cnidarians (Jellyfish, Corals and Anemones)
  2. First Aid: Laypeople

First aid: Laypeople

This is relevant for all animals belonging to Cnidarians (Jellyfish, Corals and Anemones).

General problems  

The patient is in the water (risk of drowning), pain, fear, loss of consciousness. 

  • Take the patient to land.
  • Pain management (see below).
  • Calm the patient.
  • Place the patient in a stable lateral position.

  • If critical, transport the patient as quickl as posible to a health centre / hospital.
    (Instructions see below)

Pain following injuries from venomous jellyfish as well as anxiety (fear of death) play an important role and have an additional negative influence on the clinical course after an accident. Loss of consciousness after an accident with a venomous animal can have many causes. It is important to place the patient in a stable lateral position to avoid aspiration. Only a few venomous jellyfish can cause clinically significant systemic envenoming. Respiratory or cardiovascular complications may also be caused by drowning or near-drowning.

If peripheral circulatory failure is present, the shock position may improve the patient's condition. If resuscitation is necessary, it is only in exceptional cases that lay people will be sufficiently well trained to be able to intervene.

Which venomous jellyfish are dangerous?

The jellyfish which are responsible for the majority of life threatening envenoming and fatal outcome are

A wide range of jellyfish is relatively harmless 

  • Stings are at the beginning very painful which can persist for several days with only symptomatic pain control for easing it off. 
  • Delayed and recurrent skin lesions to jellyfis stings are often misinterpreted. 
  • Under certain circumstances, thousands of bathers can be affected, e.g. each year by Pelagia noctiluca (Mauve blubbers) in the Mediterranean Sea.

Prevention

If worn correctly, ‘stinger suits’ including protection of hands, neck and face, are of great value.

How can the species that caused the acutely dangerous accident be identified?

The “marks” of the jellyfish tentacles or the bell (in the case of the Irukandji, Carukia barnesi) help distinguising the most dangerous venomous jellyfish.

Ecological, morphological and medical characteristics of dangerous jellyfish in the Indo-Australian region.
a Chironex fleckeri ('Box jellyfish') lives primarily in flat coastal regions. Stings leave typical marks with a ladder-like “cross-hatching” pattern.
b Physalia sp. (Portuguese Man-of-war) sail on the surface of the water and are drifted into waters near the coast. The tentacle marks are whip-like.
c Carukia barnesi (Irukanji) is a thumb-sized jellyfish that lives in open water. They may enter reefs after strong storms. Stings are caused by the bell and are barely visible. 

Because of the great variety of puncture wounds that can occur while bathing, diving or fishing, the layperson must decide whether or not this is a serious injury on the basis of his/her own knowledge and the extent of the symptoms. Usually the animal that caused the accident cannot be identified morphologically. The layperson must thus distinguish between:

  • stings that cause pain; all venomous fish can cause this type of injury, as well as sea urchins and starfish, among others;
  • stings that cause pain as well as systemic effects; this type of sting is mainly caused by stonefishes; however, other venomous fish stings may be so painful that the pain alone can lead to systemic reactions, such as sweating, tachycardia and collapse;
  • stings that cause pain as well as extensive soft tissue and penetrating injuries; stingrays belong to this group.

What can be done to stop the jellyfish venom from acting?

Due to the high regional diversity of jellyfish, the unpredictable dynamics caused by global warming and the uncertainty of the evidence base for the various recommendations, we refer to regional/national guidelines. We recommend to follow-up developments of the evidence carefully.

“For people with symptoms and signs of jellyfish stings, and their first responders or treating clinicians, treatment will depend on the species of jellyfish, as the stings from different species produce symptoms of varying severity. However, we cannot be certain which is the best treatment for any species of jellyfish. Although our evidence was very uncertain, the data from the included studies evaluating heat application after non-box jellyfish stings in Australia and Hawaii are consistent with the ARC 2010 guideline, which suggests starting treatment with heat after stings in non-tropical Australia. We have found no evidence to refute heat application for non-box jellyfish stings in non-tropical Australia. For box jellyfish envenomation, the evidence is more limited, but both the ARC 2010 and ILSF 2000 guidelines recommend the application of vinegar to inactivate the nematocyst. Our review did not find sufficient evidence to support these recommendations, but the recommendations are consistent with evidence from in vitro studies" (Cochrane review of 2023). 

The current uncertainty of recommendations is also reflected in the accompanying document ‘Research on Jellyfish Stings’ of the 2025 version of the ANZCOR Guidelines ‘Guideline 9.4.5 - First Aid Management of Marine Envenomation’

The ANZCOR Guidelines emphasize:
“The most important part of first aid for a potentially fatal jellyfish sting is to watch for cardiac arrest, treat with CPR (Refer to ANZCOR Guideline 8) if this occurs, and expedite transfer to definitive care including antivenom.”

Antivenom administration by trained ambulance personnel (Box jellyfish - Chironex fleckeri - antivenom)

The fact that antivenom works most likely best when given as soon as possible after the accident, led to considerations regarding how to administer antivenom as quickly as possible on the beach. Thus, ambulance personnel were trained to administer antivenom and have already used this knowledge a number of times. Reports on success are, however, only based on reports of few cases. 

Which patients need to be seen by a doctor or hospitalised?

  • All patients who have no tetanus vaccine protection, for a first vaccination or a booster shot,
  • patients with strong pain, for effective pain management,
  • patients with systemic signs of envenoming, for investigations, monitoring and possibly antivenom treatment (Chironex fleckeri).

Transport the victim on a stretcher, “fire-man's lift” method, bicycle, motorbike, chart, horse, boat, 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 positionwill 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 snakebite 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 instructions