# Sting Ray First Aid



## gibsoni (Jun 22, 2009)

Hi Guys,

I have been on the more cautious side when walking the shallows having witnessed kayakone's injury at the pin. I am told that hot water is the go and Kayakone carries hot water with him and I am now going to do the same, particularly in my backpack when wading the shallows.

My question is: How much? Trev (kayakone), you are in a unique position of maybe knowing how much it takes to have effect. Would 500mL in the right spot do?

A more general question: What other marine specific first aid gear should we have on us? I assume it will vary with area.

Does anyone carry those anaesthetic patches? Might just take the pain out of having a hook in your arm enough to get back...?

As we all know, a less serious injury on land can be more serious when on the water when we rely on being able to paddle (or for those of you have gone to the dark side, peddle) back home.

(Should prob be in the safety forum, but I know I rarely check in there myself)

Cheers, Iain.


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## gibsoni (Jun 22, 2009)

Just read:

Hot beach sand

An instant hot pack like the kind used in glove warmers may be a good thing to keep on hand in your first aid kit when venturing into stingray territory.

A good read: http://www.wikihow.com/Treat-a-Stingray-Sting


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## emufingers (Aug 11, 2010)

First aid chemical heat pack are available. They are also useful for hypothermia. Just place then under the victims armpits. Quite cheap and easily recyclable and they don't get too hot .


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## gibsoni (Jun 22, 2009)

Indie,

As I think I mentioned in my last Pin trip report, there was a section through there that was THICK with ray. There must have been hundreds in this stretch, the whole of the exposed banks were riddled with ray holes and I disturbed one every few strokes.

You may know where I mean...top route near CTP.


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## kayakone (Dec 7, 2010)

Understandably, I'm 'interested' in developments on this thread.

Ray


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## Cresta57 (Oct 30, 2011)

My o/h suffered with acute lower back pain recently after a fall, while we were at the Brisbane Boat Show she came across a woman demonstrating "instant" hot packs. They work by clicking a small metal disk inside the pack which triggers a chemical reaction. Within a few seconds they are lovely & hot & stay that way for a number of hours [depending upon size]. They are reactivated simply by boiling for a few mins in water. I was sceptical but they work absolutely fantastically. They have been a godsend on numerous occasions. http://www.shinbio.com.au/ We bought the full package at the boat show & don't regret it at all.


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## gibsoni (Jun 22, 2009)

Ray, care to recount your experience upon application of water? Interesting to know how quickly the effect was felt. i.e. how little water makes a significant difference. Also, does the spine always stay with the ray, Ray?

Cresta, we had a heat pack exactly the same as what you explain for warming up babies milk bottles. I'll have to see if we still have that. From a physics perspective, you cant pass water. Firstly the specific heat of water is so high that its going to be unbeatable in fast heat transfer as well as the fact that you can pour water continually meaning a replenished source of heat. I am sure though that a heat pack would be a world better than nothing if you dont have water on you. Off to find mine.


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## goanywhere (Feb 22, 2011)

If you have a thermos take one of tea or coffee, but not too hot. Make it up in a jug, bring it down to drinkable but not too hot, and put it in the thermos. That way you have some for a coffee or tea when you're out, and something to pour on a sting if you get unlucky. Flathead can cause a nasty wound too if you're not careful, and hot water helps with this too.

Another handy inclusion in your first aid kit is PawPaw ointment. (Make sure you get one that has all natural ingredients and not petroleum jelly etc.) It's antiseptic somewhat water resistant, and takes pain out of almost any wound, or even sunburn, and can be applied onto almost any kind of injury, even a bleeding cut, to minimise infection.

I have a senior first aid certificate, but my course didn't include much that would be useful to kayakers. Marine first-aid courses contain training on treating stings and marine wounds, and how to deal with hypothermia, but there are some unique situations we might find ourselves in that the average marine first-aid course doesn't cover. Maybe a forum dedicated to first aid might be an idea Admins.


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## fisher (Aug 30, 2005)

Unfortunately I have first hand knowledge of the repercussions of standing on a sting ray. It was only a small one - about the size of a dinner plate - but the tail and barb came over the top of my foot with the barb burying itself near the joint of the big toe. Imagine someone getting a rusty/serated pocket knife and driving that into your foot, and then twisting and turning it in a frenzied attack. Thats how I'd describe the pain. Oh, and I was wearing wetsuit boots at the time.

Apparently hot water works - as hot as you can stand it. But I can't say it worked for me - the only respite I got was with a local anaesthetic from the doc who also removed fragments of the barb that were still in the foot. Infection is just about guaranteed if you don't get to the Doc quick smart - so whilst hot water might be a useful first aid response, knowing how to get to the nearest hospital should be paramount in ones thinking.

If you know the rays are about, try shuffling the feet rather than treading.


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## gibsoni (Jun 22, 2009)

Anyone got any knowledge on what sort of materials a stingray barb wouldnt get through?

Would it go through the sole a dunlop volley? What about the canvas top?


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## fisher (Aug 30, 2005)

gibsoni said:


> Anyone got any knowledge on what sort of materials a stingray barb wouldnt get through? Would it go through the sole a dunlop volley? What about the canvas top?


Most of the times the barb goes into the top of the foot - if they can get through a wet suit boot the old volleys wouldn't stand a chance.


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## kayakone (Dec 7, 2010)

Anyone who has kayaked through shallows will know that there are thousands of rays out there. It's the walking/wading where you are most exposed. Also see viewtopic.php?f=3&t=51633&p=540917&hilit=how+to+avoid+stingrays#p540917



fisher said:


> gibsoni said:
> 
> 
> > Anyone got any knowledge on what sort of materials a stingray barb wouldnt get through? Would it go through the sole a dunlop volley? What about the canvas top?
> ...


That is correct. I doubt wetsuit boots are much of a defence. The Jumpinpin attack was the 2nd in 15 years, though really, playing Bear Grylls, I asked for the first attack. Same result each time though...terrible pain and a very dangerous infection.

First encounter: 
I was sea kayaking years ago from Sandy Cape (Fraser Island) to Hervey Bay. Last camp was north of Moon Point, where I caught a flattie in the creek. Next I tried the sand flats outside, as I reasoned there should be flatties there. So I was wading across the flats in about a foot of water, casting ahead in arcs, then wading out through that territory. Suddenly I saw a stingray in front of me, just 2 metres away. The fishing hadn't been good lately, so the hunter gatherer in me said, ' knife it', cause there's a good feed in those flaps.

I moved slowly up to it (it was facing me), knife drawn (Steve Irwin was still alive then). It didn't move. Closer. Closer. I poised above ready for the strike (aim between the eyes). Strike. Got it...straight through. In a millisecond the tail came up over the body and drove the barb deep into my wrist. *A truck had hit me*. Instantly in horrendous pain, I collapsed into the water in front of the ray. It couldn't move...it was pinned to the sand by my lovely $ 20 knife. Stuff it I thought, I'll let it go, so I made a quick grab to remove my knife and release it. I did, but by way of thanks it barbed me again then took off. Two holes in me, doubled up with excrutiating pain in 10" of water, 200 metres from shore and help. I was losing consciousness.



fisher said:


> Unfortunately I have first hand knowledge of the repercussions of standing on a sting ray. Imagine someone getting a rusty/serated pocket knife and driving that into your foot, and then twisting and turning it in a frenzied attack. Thats how I'd describe the pain. Oh, and I was wearing wetsuit boots at the time.


The pain came in terrible waves, my body locked in the foetal position, face under water....I was drowning in 10"of water. Then the pain would pass for 20 - 30 seconds, a breath, and I started to crawl to shore. Another wave of paralysing pain, another period under water. I couldn't believe I was going to die this close to shore, in such shallow water. Even between the bad periods I couldn't stand. I crawled slowly torwards shore. Even crawling slowly I had trouble breathing. A 4WD went by 100 metres away and I tried to cry out, but made no sound, as another wave of pain knocked me down again. This seemed to go on forever. Between waves of indescribable pain I crawled sooo slowly ashore. I won't describe it. I believe I may have been in danger of anaphylactic shock.

After a desperate struggle for 10 minutes or so, a new pain began, the pain of anguish, of watching 4WDs go past. Some slowed, all looked, not one stopped. Surely someone will realise I need help. I mean how many fisherman do you see crawling ashore and regularly collapsing in spasms under the water. Surely something was wrong (maybe they were all jetskiers). Finally one stopped past me and came back. Then another, then voices, "call 000", blankets, recovery position. Still every 20 -30 seconds those terrible waves crashed over me. Finally, a doctor, on holidays, with his medical bag, telling me he's going to wait for the spasm to pass then he's going to inject pethadine into me to reduce the pain. It didn't do a thing. An ambo was on his way across the island. In and out of consciousness. More pethadine, no effect.

The ambo arrived, more pethadine. I was having trouble breathing again. 2 hours of agony. At last, the Medivac chopper arrived. I love choppers, but this was the worst chopper ride of my life, but not just because of the pain. We flew at 500 feet above the sand flats to Hervey Bay Hospital. _*All I recall were the 20,000 stingrays on those sandflats*_. Finally in safe hands, where more pethadine and even morphine failed to work. Ten minutes later another doctor came in and put my arm into a dish of hot water (probably about 50 c). Anyway as hot as I could stand. The pain was totally gone in 5 minutes!!

Then antibiotics for the deep puncture wounds, and I happily drove home one hour later (zero pain). Typical of wounds in a marine environment, it got badly infected, and swelled up massively, going a horrible colour over a few days. More antibiotics, and after a few more days they didn't reverse the infection, then more. Deeper and deeper trouble over 4 weeks as it spread up my arm and into the underarm glands, turning my arm a horrid reddish black colour, and showing red trails into my neck and jaw, up towards the ear, and also onto my chest. I eventually ended up in hospital again where I was informed that I was "in danger of losing my arm". They eventually they beat it with S7 antibiotics that cost $ 250 for 10 tablets. _Scary hey?_

If you're going to play with stingrays I recommend a thermos of hot water onboard. Things I learnt from this:

1. Get out of the water fast.....run, crawl, scream for help (between waves of crippling pain). A person hit by a ray could drown in 5 cm of water.

2. Maintain clear airway, block sun and monitor breathing and heart rate.

3. FIRST AID: Get hot water(50 - 60 C, i.e. as hot as the patient can stand, but not scalding) and a tub/bucket to immerse the limb. This is URGENT and is the only method that will kill the pain. _Strong pain killers, Pethedine, and Morphine will have little or no effect._ Remain immersed for 10 - 15 minutes with regular top-ups to maintain temperature. There is some relief within 30 seconds, and hardly any pain after a minute or two.

4. Seek a doctor/hospital ASAP for strong antibiotics that target marine wounds (e.g. Doxycycline hydrochloride 100 mg and Flagyll 400 mg combined, one tablet of each/ twice a day, or stronger, right from the beginning). It is important thereafter to monitor progress, as marine puncture wounds can result in very dangerous infection that can result in loss of limb. Cleaning of sand/ broken barb particles requires a doctor.

I now carry a thermos. These heat packs sound a more practical solution, providing they produce a temperature of 45 C or more.

Goodnight all.

Ray


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## gibsoni (Jun 22, 2009)

Trev,

Thanks very much for a very valuable contribution. A healthy dose of fear about the reality of a sting ray encounter and some good advice on treatment.

Thanks for telling your story, I was gripped. I can only imagine how far 200m is in that state and not to see anyone stopping... glad you're here with us today!

Any comments on water quantities? I was assuming you could just slowly pour water over the puncture site, dribbling it on over maybe 1 minute. Maybe that's not enough?

Iain.


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## Cresta57 (Oct 30, 2011)

Don't know if the poison is of similar a chemical make-up to that of "Happy Moments" Their poison is pure protein based & can only be broken down by heat. I dropped one of those in my lap a few years ago & was spiked in my thigh. I said to my son that the tales of instant agony must have been old wives tales as there was just a little stinging from the spikes. Within 60 seconds I was in agony, the only hot water was a flask of coffee, I used that to dull the pain. 
Since then I've treated them with a healthy respect. However fishing with a mate last year he caught a large happy moment & swung it into the boat, panicked & swung it into my calf. We had no hot water & ended up revving the motor to catch warm water from the telltale. That wasn't hot enough to do any good so I suffered all the way back to the ramp.


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## gibsoni (Jun 22, 2009)

Found my heat pack that produces heat via an exothermic reaction, set off by distortion of a metal disc in the pack. Gets pretty hot. Its made for warming baby bottles so wraps around well, has velcro to hold it there etc. Reset it by boiling in water.

Made by bambinoz, found them online for $8. Could be worth considering.....


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## bombora (Mar 8, 2006)

Actually talked to some experts on stingray wounds and yep as hot as you can stand the water. I wonder if the heat packs get hot enough. Got to try it out on a mate who stepped on one while we were surfing. He's a tough nut but could see in his face this wasn't fun. Luckily I live nest to the beach so straight back to my place. The HOT water (as hot as you can stand, seriously just below scalding) did the trick. BUT the experts i chatted with really made a point that almost all stingray barb wounds get terribly infected and that hospital grade cleaning of wound is advised. Kayakone's horrendous experience is a sobering read.


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## kayakone (Dec 7, 2010)

Thanks Iain for the info re the heat packs.

I am getting one tomorrow and am going to test it for suitability. *Now, where can I find a stingray? * :shock: :shock:

If alive, I will report findings tomorrow. 

Trevor


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## keza (Mar 6, 2007)

kayakone said:


> Thanks Iain for the info re the heat packs.
> 
> I am getting one tomorrow and am going to test it for suitability. *Now, where can I find a stingray? * :shock: :shock:
> 
> ...


Once you shove the thermometer up it's butt, let us know what temp you get doc.


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## kayakone (Dec 7, 2010)

What's a few more holes? Naw, I'm going. Wouldn't miss it!

These packs sound like they might be the duck's nuts....be great if they did the trick. Could be much more practical than a thermos (and a must for all remote trips, come to think about it, a day trip anywhere).

Trevor


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## gibsoni (Jun 22, 2009)

I just activated my heat pack and stuck in the digital (medical) thermometer and it went to 45 deg and then told me it was too high (flashing H), well and truly dead if your that hot..... so we'll have to await Trevor's test.


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## grinner (May 15, 2008)

indiedog said:


> Good stuff Iain. I know Grinz put up a first aid kit inclusion list not long ago. I thought it was in the DIP trip proposal. Just had a quick look but couldn't find it. Hopefully he'll cut and paste it again.
> 
> I never carry hot water or a method to heat water. I know around CTP etc there are a lot of rays so may consider taking something in the future even if it's left in the car when I go into areas that I know the risk is higher.
> 
> Cheers, Indie


indie, i'll bring a really good one to DIP for you. you can keep it then for future events you organize.
i'll bring some morphine and other supplies. ive been caught out too many times without any kit.
one of those big southerly busters that trevor wrote about rolled into horseshoe bay one day with almost instant 4 foot waves.
a young bloke was trying to hold his jet ski and popped his shoulder out. now he wailed a lot louder than trevor when he was spiked. he wailed so loud i thought there must be a female tennis final going on. anyway it would have been good to have something to quieten him down.
the heat packs sound like a good idea. i know whenever i see dodge camping he always has a brew on so maybe we can con him into coming up.

those big rays are very inquisitive and indeed i think they may have learnt to come near walking humans in case we stir up food particles. one followed along behind me one day like a pet dog.

as others have said, you will often need almost a surgical scrub (aneasthetise the area and scrub with a brush) to remove the last little fragemnts of barb . if you leave even a tiny bit , it will jsut keep breaking open like a sore that will not heal.


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## gibsoni (Jun 22, 2009)

Doc, any real medical evidence for what works best?

I am thinking hot water would be markedly better than the heat packs as you have physical contact of the water with the venom and wound, and so get good heat transfer quickly to denature the proteins.

However, I reckon based on feel only that this heat pack goes to 50 deg and holds it for a while. Will await Trevs measurement.


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## noidearog (Jan 18, 2012)

Many years ago when I did my scuba diving first aid course, the one thing I did remember, for stone fish and rays immerse the puncture in hot water, for as long as possible.


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## 62woollybugger (Oct 16, 2009)

When I did one of my first aid refreshers, I was discussing this with the instructor. He explained that most marine venoms are protein based. When you cook meat, you are breaking down the proteins & as you know, fish cooks at a relatively low temperature & quite quickly. Heating the stung area basically cooks the venom proteins & breaks them down. I don't know how much truth is in this, but it makes sense to me.


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## gibsoni (Jun 22, 2009)

Kayakone, any test results on temperature yet?


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## kayakone (Dec 7, 2010)

Still running hot. The doctor thinks I'm mad.


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## kayakone (Dec 7, 2010)

gibsoni said:


> Kayakone, any test results on temperature yet?


Sorry Ian...I forgot to post results. Lapse's http://www.akff.net/forum/viewtopic.php?f=3&t=54043 prompted me.

47 C, so perfect for treating stingray wounds in the field (without hot water), with no risk of scalding.

Available here: http://www.bambinoz.com.au/ for $18 per pack (T: 07 3857 0691)

Trevor


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## gibsoni (Jun 22, 2009)

Thanks Trevor,

Good to hear.

Hows the foot and mobility now? Close to normal?

cheers, Iain.


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## kayakone (Dec 7, 2010)

Foot normal? No, never will be. The GP at Jacobs Well _that never bothered to even look at the wound_, yet wrote a script for antibiotics (illegal Pete?), is being reported to the Health Quality Complaints Commission. The fact that she didn't even see me (an appointment was made over the phone by the VMR) meant that sand and possibly barb fragments are in there forever. She should have seen me and at least attempted to sterilize the cut and puncture and remove any foreign material. ....interesting to find out if she bulk-billed Medicare for a consultation that never happened. Anyway RBWH decided eventually to not operate as a lot of tissue would have been traumatised, with no guarantee of getting every skerric of foreign material.

Brett (exp2000) passed this on to me...
"I remember one year, I got stung by lionfish three times in one season (pearl diving). By the third time I was completely over it and just did not want to know. But I have never been close to passing out. We used the hookah engine to heat up some water on that occasion.

I imagine that because of the size of the wound, a stingray barb would be like many lionfish stings at once.

Mike, who taught me how to collect marine fish, woke up in his boat at 3 o'clock in the morning still out at Flat Rock.
He'd been stung by a lionfish while diving and just managed to make it back to the boat before passing out."

From a dive forum "The pain is intense.... Got a nasty sting this past summer and I can tell you it's worse than a bee sting or even Portuguese Man O' War sting.
After shooting 2 large lionfish in about 100' of water here of Fort Lauderdale, I was stringing them up. Went to snip the spines off per usual but realized that I had forgotten my scissors. My mistake was trying to cut the spines off with a regular dive knife that was not that sharp. You live and learn.
The pain is intense, first my hand went numb and then the index finger where I got stung just felt like it was on fire. We called the dive. Hot water is supposed to mitigate this feeling. I sucked it up and the intense pain went away after about an hour however a slight numbness in my hand continued for 2 full days after the sting.
I have whacked several dozen of these little buggers and have given seminars on how to handle them. The key is to take your time and use sharp scissors while the fish is still on the spear shaft. Be sure to snip ALL the spines top, bottom and both sides. Then, filet, cook and enjoy. They make excellent table fare similar in taste and texture to hogfish.
I don't think there have been any documented fatalities from lionfish here in North America to date. However, the main concern is that some folks may have an allergic reaction and go into anaphylactic shock.

So another potentially deadly sting to be aware of is that of the Lionfish (good photos in this one):
http://home.eisf.org/files/active/1/Lio ... 20Info.pdf

Closer to home http://www.barrierreefaustralia.com/the ... onfish.htm

Another one to be extra careful of is 'Happy Moments' aka 'Black Spinefoot', often caught bottom fishing reef or rubble (but they are tasty). I caught one kayak fishing in the Keppels. Recognizing it instantly (instead of watching TV, I read Grant's Guide) I picked it up cautiously with a firm grip using long-nose pliers, and proceeded to get the hook out so it could be bagged for dinner. Unfortunately they have a soft mouth, which tore through, and it fell straight down onto my thigh...YEEEOOOW!
http://www.scuba-equipment-usa.com/mari ... us%29.html

And a 'world authority' (  ) on the subject of marine stings is none other than Grinz......viewtopic.php?f=3&t=52838

Enjoy your day on the water :lol:

Trevor


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