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Home › Scuba Information › Diver Injuries › Box Jellyfish Sting

Treatment for Box Jellyfish Stings

The potent venom released during the medusa-phase of most cubozoans (cube-shaped jellyfishes) is so powerful it can kill a human in only a few minutes.

This section explains the importance of making an immediate response to the symptoms of box jellyfish sting, and why emergency treatment is crucial to avoid fatalities.

Is the Box Jellyfish the Deadliest Sea Jelly?

You can find cubozoans in almost all tropical and subtropical seas. But, the deadly specimens exist in areas of the Indo-Pacific.

Most biologists consider the Australian box jellyfish (Chironex fleckeri) as being the most venomous of all marine animals.

Other notorious and highly venomous jellyfishes include:

• Bonaire banded box jellyfish (Tamoya ohboya)
• Four-handed box jellyfish (Chiropsalmus quadrumanus)
• Irukandji jellyfish (Carukia barnesi)

Pro Tip: Click through for Chirodectes maculatus facts and information - a worthy contender for the rarest species of all jellyfishes known to mankind.

Risk Factors and Preventative Measures

There are thousands of microscopic barbed stingers on the tentacles of sea jellies. Each stinger contains venomous neurotoxins inside a tiny bulb (with a coiled sharp-tip).

So, brushing anything against a tentacle will trigger it to release the stingers. The toxin that's released affects bare skin and can even enter the bloodstream.

Some of the typical recreational activities that will increase the risk of getting stung by a jellyfish, include:

• Swimming in water where there is a jellyfish bloom (large numbers of jellies), especially if you're not wearing protective clothing.
• Sunbathing, or allowing children to play, on beaches where jellyfish have been washed up onto the sand or pebbles.

In general, the jellyfish season in the tropical waters of Southeast Asia and Australasia is at its worst from October through to May.

During these months, the recommended tips for avoiding jellyfish stings, include:

• Box jellyfish tend to bloom in certain environments. Check with the local health department (or a certified lifeguard) to see if the ocean is safe for swimming.
• Research the area before you go scuba diving or try snorkeling to determine whether jellies are present at the intended dive site.
• Try to avoid having unprotected areas of skin in the water. Hence, wearing a full neoprene wetsuit, booties, a hood, and gloves will be safer. Have some household vinegar available.
• In fact, authorities in some areas of Australia, especially Northern Queensland, place net enclosures in the water. Doing so helps to prevent box jellyfish from getting close to the beaches.

Important: The stingers of these venomous marine creatures are able to fire the toxins even if the organism has been dead for several months (e.g. on the beach). It is best not to touch dead jellyfish, including the Portuguese man-of-war (bluebottle), hydroids, and sea wasps.

Box Jellyfish Sting Symptoms

Medical advice suggests the size of the box jellyfish's bell (main body) influences the severity of the sting. Hence, you should consider it as potentially life-threatening if the bell is bigger than fifteen (15) centimetres (6 inches).

Manifestations may include:

• Blistering with a burning pain on the skin
• Signs and symptoms of shock
• Multiple 'whip-patterned' lesions (skin welts)
• Broken tentacles adhering to the skin
• Irrational or unusual behaviour (usually due to intense pain)
• Abdominal pain (sometimes in the chest)
• Apnea (a cessation in the normal breathing rate)
• Sweating, nausea, and vomiting
• Hypotension (low blood pressure)
• Abnormal heart rhythms
• Cardiac arrest (in the most severe cases)

Emergency Treatment for Jellyfish Stings

If you can get access to an anaphylaxis response kit you can respond to a victim suffering an allergic reaction. But, according to the DAN Diver Network, the recommended emergency response for someone who got stung by a box jellyfish is as follows (in this sequence):

1. Activate the nearest EMS (emergency medical services) and monitor victim's ABCs (airway, breathing, and circulation). Be ready to perform CPR (cardiopulmonary resuscitation) at any moment.
2. The tentacles of cnidarians are coated with nematocysts (stinging cells). So, if you rub the area the tentacles may roll over parts of unaffected skin. Hence, doing so will worsen the envenomation process.
3. Apply generous amounts of household vinegar onto the area for at least thirty (30) seconds. Doing so will help to neutralise any remnants that are hard to see. Let the vinegar stay on the skin for a few minutes.
4. Flush the affected area with a powerful stream of seawater. It will help to remove any unfired nematocysts. Do not flush the stings with fresh water. Doing so causes unfired nematocysts to start firing (through a process called cytolysis).
5. Often, the application of heat can help to mask the perception of pain. Plus, heat (e.g. hot water) might also help to break down hazardous substances (via thermolysis) to denature toxins.
   1. If you immerse an affected area in hot water, it must not be hotter than 45° Celsius (113° Fahrenheit) and for no more than ninety (90) minutes. Test the heat level of the water on yourself first and do not rely on a test for tolerable temperature from the victim.
   2. Repeat as often as is necessary. You can also apply a cold pack (e.g. ice inside a dry plastic bag) if hot water is unavailable. Always try to seek a higher level of care and professional medical evaluation.
6. Repeat as often as is necessary. You can also apply a cold pack (e.g. ice inside a dry plastic bag) if hot water is unavailable. Always try to seek a higher level of care and professional medical evaluation.

Pro Tip: Anyone who is running a PADI dive center will have a duty of care for helping injured divers. Thus, use common sense and be prepared to have them evaluated by a medical professional.

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