First aid: Laypeople
This is relevant for all animals belonging to Venomous Fish.
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 fish 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 fish can cause clinically significant systemic envenoming or severe injuries. 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 fish are dangerous?
| Stingrays |
| Stonefishes (Synanceiidae) |
| Lionfishes (Pteroinae) |
| Other Mail-cheeked fishes (Scorpaeniformes) |
| Weeverfishes (Trachinus sp.) |
| Catfishes (Siluriformes) |
| All other stinging fish (see Biomedical database) |
How can the species that caused the acutely dangerous accident be identified?
- Morphologically,
- indirectly from the circumstances of the accident,
- indirectly from the consequences of the accident: see Comments below.
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.
Painful stings
Hot water immersion
Immersion or showering of the affected extremity in water as hot as can be tolerated, especially if it is not possible to get immediate medical assistance (water temperature just below 45°C, temperature should be checked by a companion or with a healthy extremity in order to avoid burns, duration of treatment variable (30 - 90 min); if necessary repeatedly (Atkinson et al 2006).
Skin damage is a very serious drawback of the hot water immersion if the temperature is not carefully controlled (Abdul Jalil and Quaayum 2020; Lewis et al 2020).
The venom, which, in addition to the physical injury, is responsible for pain and tissue destruction, is heat-labile. Controversy exists if temperatures which can be safely applied to human skin suffice to inactivate venom injected at various depth into the tissues by venomous fishes. Alternative hypotheses are modulation of pain receptors in the nervous system. The debate is ongoing, e.g., Atkinson et al 2006; Barnett et al 2017; Harris (2024) and Harris et al (2025).
Painful, extensive puncture wounds
- Deep injuries: seek medical care as quickly as possible;
- Heavily bleeding wound / penetrating injuries: if a large vessel has been damaged, stanch the bleeding with the help of a tourniquet or by compression proximal to the injury or in the region of the injury.
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 extensive injuries, for wound care,
- patients with deep injuries, for exploration of the wound and wound care,
- patients with systemic signs of envenoming, for investigations, monitoring and possibly antivenom treatment (stonefishes).
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
- Wear helmets, also the victim
- 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