First aid: Laypeople

First-aid treatment is carried out immediately or very soon after the sting before the patient reaches a health centre or hospital. It can be performed by the snakebite victim himself/herself or by anyone else who is present and knowledgeable.

Non-severe scorpion stings

• Sting site: (Severe) pain, redness, oedema, numbness.

Severe scorpion envenoming

• Sting site: Severe pain, oedema, numbness.
• Transient: Vomiting, sweating, diarrhoea, abdominal pain, spittle running from the mouth.
  Slow pulse, low blood pressure, collapse.  

• Longer lasting: Fast pulse, high blood pressure, tachycardia, irregular pulse, diffuculty breathing, collapse. 
• Hanging eylidis, wandering eye movements, difficulties to speak and swollow, convulsions, paralysis.
• Bleeding (Nebo hierochonticus - Near and Middle East)

• 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, and immobilize the bitten limb with a splint. Movement or muscular contraction, even undressing or walking, will increase absorption and spread of venom.

 CAUTION: Delay the release of tight bands, bandages, and ligatures.

If these, unfortunately still very popular methods of first aid were applied, they should not be released until the patient is under medical care, resuscitation facilities in place and antivenom antivenom applied (if for the species which caused the envenoming avaialbe and of proven value).

There is no evidence for the use of pressure bandage immobilisation (Wilkins et al 2025).

• Locate and call the nearest hospital that has antivenom* available.
• Make sure that you ask specifically about antivenom availability and get confirmation.
• 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 victim cannot move limbs, has "heavy" drooping eyelids or difficulties breathing you may need to stop at a health facility on the way to the hospital (with antivenom) to get support.

*Antivenom

• Early antivenom treatment is recommended, however, supportive evidence is poor.
• Indication and selection of antivenom needs to be based on the evidence available in the respective region where the envenoming occurs.
• New developments need to be followed-up.
• see 'Antivenom'in 'Clinical entries: Scorpions' 

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