The water is warming up, people are flocking to the beach, and stingray punctures will happen to beachgoers all summer long. Remember to shuffle your feet when you are heading into the surf zone. They are resting on the bottom in pretty shallow water, so if you shuffle it disturbs them and they move out of the way. If you don’t shuffle and you happen to step on a stingray, you will know it! Stingrays can cause deep puncture wounds and release toxic venom. Most people tolerate the puncture wound with no more than a fair amount of pain, but it’s important to be vigilant when a stingray hits a bather because occasionally an individual may have an allergic reaction to the venom in a stingray puncture wound. Victims of stingray punctures may also be at risk for drowning, especially if there is a chest wound or the victim remains in the water for a long time after the attack occurs.
SELF CARE
Care of the injured person begins at the scene and is first directed at safe rescue and removal of the victim from the water. Almost all stingray injuries need to be checked by a doctor. First aid measures should be started, but a medical evaluation is also warranted. Here are the initial steps:
1. Lay the injured person down.
2. If the person is vomiting, position them on their side so they do not
inhale the vomit. Inhaled vomit is life-threatening.
3. Ensure the person’s airway is clear of any obstruction.
4. Stop the bleeding by applying direct pressure with a clean cloth or
whatever is available such as a beach towel.
5. You may attempt to remove the stinger with tweezers to decrease toxin
exposure if doing so will not cause further injury. Be careful not to
injure yourself with the stinger.
6. If there is no pain, then treat as a puncture wound or laceration by
cleaning and disinfecting with soap and water.
7. If there is pain, bleeding, or more than a minor wound, and symptoms
such as faintness or sweating are present (indications that venom has been
absorbed into the body), arrange for transportation to a medical facility.
8. If in a remote area, treat the pain by immersing the injured area in hot
(not scalding) water (110°F) for 30-90 minutes. The heat neutralizes the
painful effects of the venom.
9. Oral pain medication such as acetaminophen (Tylenol) or ibuprofen
(Advil) can be given if the person is not vomiting and not allergic to it.
MEDICAL TREATMENT
Stingray injury care is mainly directed at monitoring the injured person’s vital signs, providing pain relief, and treating the wound.
1. Vital Signs: Treatment for abnormal vital signs is the first step.
2. If blood pressure is low, fluids are given through an IV.
3. Additional medications may be needed to maintain a proper blood
pressure.
4. Sometimes, hospitalization is required if the person is very ill.
5. Pain: There is no antivenom (antidote) to stingray toxin. The venom is
a protein and is broken down by heat, so placing the injured area in hot
water for 30-90 minutes can dramatically relieve the pain. A word of
caution: If the area is numb or desensitized (as is the case with some
diabetics), care must be taken to prevent a burn injury from the hot water.
6. Pain medication, such as narcotics, given through an IV may be needed
until the heat has neutralized the toxin. Numbing medications injected into
the injured area help to relieve the pain and allow the doctor to explore
the wound to look for underlying injured structures without causing further
pain.
7. Wound Care: The doctor cleans the wound, removes foreign matter, and
looks for injuries to tendons, nerves, blood vessels, and other body
structures. If it has been more than 5 years since the last tetanus
booster, one should be given.
8. Antibiotics are usually given because the wound is contaminated with
bacteria from the stinger and from the seawater.
9. The wound is left open, and then closed with stitches a few days later
if it has not become infected. If the wound is repaired on the initial
visit, it is usually closed loosely to allow any infection to easily drain.
10. If important structures, such as nerves, tendons, or arteries, are
damaged, then a surgeon (such as a hand specialist) needs to be consulted to
assist in the management of the wound. Cleaning and repair in the operating
room may be needed.
OTHER TIPS FOR THOSE WHO ARE STUNG
1. Try to relax and not panic. Despite the tragic death of Steve Irwin,
stingray stings are rarely fatal. Stingrays sting to scare us away.
Although the sting can be very painful, it usually does not result in
long-term disability. The pain is most extreme during the first 30-90
minutes after the sting.
2. If you are stung, you should make your way back to shore by shuffling
your feet (so you won’t be stung again).
3. Expose the sting site by removing any clothing around the affected area,
for example, wetsuit booties.
4. Beach lifeguards sometimes keep buckets of hot water around the station
on busy summer days. You may want to ask to use it.
5. Care for the Wound: Add a squirt of antibacterial solution or mild soap
to the hot water. Once you’re finished soaking, rinse-out the wound with
clean water. Sometimes pieces of the barb will come out. Wrap the wound in
a makeshift bandage from any available clean, lint-free cloth soaked in hot
water once the wound has stopped oozing.
6. The venom will often become gel or jelly-like and ooze from the open
wound–this is desired.
7. DO NOT elevate the injured body part as this can cause the venom to
spread.
8. If the sting site is a small puncture wound, keep it open and allow it
to drain.
9. If stung in the hand, be sure to remove your rings. By doing this, if
swelling occurs, your circulation will not be compromised.
10. Vinegar, urine, orange juice, ki-ora or other liquids besides hot water
will NOT be effective against stingray venom.
11. Whenever you swim, especially in tropical waters, always be cautious.
Stingrays, sharks, and other dangerous sea life may be around. Also, watch
out for the people around you that may need your help.
12. Finally, please assist in transferring folks who are stung to a medical
facility.
DESIGNATED MEDICAL CLINICS AND EMERGENCY ROOMS
If you’re stung in this area, please visit your designated medical clinic during normal work hours, or an emergency room of your choosing after normal work hours and on the weekends.
If after you’re stung you begin to feel tightness in the chest, swelling anywhere on the face or neck, difficulty in breathing, welts (hives) anywhere on your body and/or nausea, you are likely having an allergic reaction. You will need to get to an emergency room immediately. Allergic reactions can be minor to severe. Any abnormal reactions (besides occasional itching, minor swelling, and pain at the sting site) should be acted on immediately. Individuals with compromised immune systems such as diabetics or those with HIV/AIDS also should pursue immediate medical treatment after being stung.
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