What is the correct first aid treatment for jellyfish stings? Finding this out can be a confusing experience. Just typing “first aid for jellyfish stings” into a web browser throws up a wealth of information, the majority of which is utter bull crap, or at least we thought it was. We were confident, you see, that we knew exactly how to treat a jellyfish sting and having added shaving cream and various condiments to our first aid kit, we were pretty certain that we had covered all the bases and were prepared for anything the gelatinous little buggers could throw at us. What we weren’t expecting however was for everything we thought was right, to be proved wrong, and vice versa. Yet that is exactly what has happened and it’s not just us who’ve got it all wrong. Thanks to the work of some white-coated brainiacs in Hawaii and Ireland, some very authoritative sites including the British National Health Service and Diver Alert Network are going to have to revise their advice too.
The problem is all to do with Portuguese man-of-war. Ah you might say, but a man-of-war is not technically a jellyfish so those brainiacs are barking up the wrong tree all ready. Technically you’d’ be right. A Portuguese man-of-war is a Siphonophore not a jellyfish. However in this instance it makes no difference as Portuguese man-of-war belong to a family called Cnidarians, which include Jellyfish, Hydrae, Anemones and Corals. The tentacles of these Cnidarians contain tiny capsules called Cnidae or nematocysts and it is these toxin-firing structures that cause all the pain and suffering to unwary humans.
The advice that the most authoritative websites give on treating Portuguese man-of-war stings was not to douse the stings with vinegar or alcohol as this made more nematocysts fire and consequently things got worse for the victim. On the other hand, if you knew that the critter that stung you was a notorious Box Jellyfish, then the advice was to drown the affected areas in so much vinegar that the whole place smelt like a Sarsons factory. Confused? Why wouldn’t you be? But things get worse. Some sites suggest that you use baking soda, alcohol, or lemon juice and the myth of urinating on the affected area still persists in places. The British National Health Service (an authoritative organisation, you’d all agree) suggested that the area should be treated with shaving foam and then remaining nematocysts/tentacles scrapped from the skin using a credit card. If shaving foam wasn’t at hand then rinsing with seawater was a good substitute before you got to work with your American Express Card.
Now however Dr Angel Yanagihara of the University of Hawaii and Dr Tom Doyle of the University of Galway, Ireland and their colleagues have put these treatments to the test. Their findings, published in the Journal Toxins, revealed that almost of all the suggested treatments were utter codswallop and the only effective treatment was in fact vinegar. And it doesn’t matter if it’s a sting from a Portuguese man-of-war, a Box Jelly or a Mauve stinger, the best first aid is to rinse with vinegar to remove any residual stingers or bits of tentacle left on the skin and then immerse in 45°C (113°F) hot water or apply a hot pack for 45 minutes.
As for the use of shaving foam, Yanagihara, Doyle et al, found that shaving cream didn’t inhibit the nematocysts from firing and the use of credit card “shaving” produced further firing due to pressure. Doyle himself explained that “this is Quite a u-turn for me” as he helped write the current Irish protocols almost ten years ago, which unfortunately recommend the worst possible combination of steps: seawater rinsing followed by ice pack treatment. "In the coming weeks, I look forward to meeting with members of the Jellyfish Advisory Group to discuss our new findings and how we can revise the current protocols." He said.
Now before any of you get too clever and start asking silly questions such as what type of vinegar should we use? And is distilled as good as malt? What about white wine vinegar or sherry vinegar or that stuff the French call wine – Beaujolais isn’t it? That’s vinegar most of the time isn’t it?
The simple fact is that vinegar, any sort of vinegar will do. As long as it’s not diluted – which means straight from the bottle chaps. The research also pointed out that use of ice packs should be discontinued and only vinegar followed by heat immersion or the application of hot packs are effective.
Now we know that some of you sharp-eyed types out there might have spotted the name Yanagihara and thought to themselves, “hang on”. “Isn’t that the same Dr Yanagihara founder and principal of Alatalab Solutions, LLC, manufacturer of Sting No More®products”? And you’d be right, she is one in the same. But before you start concocting conspiracy theories about the contents of Sting No More products and the possibility Dr Yanagihara might be the secret owner of a large vinegar manufacturing plant, let us be clear that Yanagihara has already declared a potential conflict of interest as the inventor for USPTO applications PCT/US2012/000095 and PCT/US2015/037974. A.A.Y. and as the founder and principal of Alatalab Solutions, LLC, manufacturer of Sting No More®products. The University stated: management of this disclosed potential conflict of interest was achieved under an approved University of Hawaii Conflict of Interest (COI) plan. All aspects of the COI plan were followed while conducting this research study and in the independent analysis of data. No other member of the group declared a conflict of interest. No. We have no idea what all that means either but we suppose that no one at the University thought there was a problem so why should any of us?
Anyway, Yanagihara et al have already started studying the next stinging jellies on their list. As they've examined two of the three main classes of dangerous stingers, they have their sights set on the last remaining class: true jellyfish (class Schyphozoa). Again collaborating with Doyle, they are working on evidence-based first aid measures for lion's mane (Cyanea capillata), one of largest jellyfish in the world. Which means of course that all this advice might change in the near future. But then there are few things in life you can depend on other than the fact that you are born, you will pay tax and you will die. Oh and that scientists will be adamant about their findings right up to the point they’re contradicted. Until then however we will be revising our advice on our snorkelling hazards page to take account of this research and look forward to revising it again in the near future.
Oh one last thing. The best advice for jellyfish stings is – don’t get stung in the first place. If the area you are snorkelling in is known for jellyfish, wear a full wetsuit including a hood and gloves
Those of you who’d like to read the full research paper can find it here.