Hi all and welcome to 2018. The first blog of the year will look at the very ugly and potentially deadly stonefish. In light of recent media coverage of four stonefish envenomation’s in South East Queensland (3 x females aged 11, 12 and 35 at Tallebudgera Creek on the Gold Coast and a male at Bulcock Beach at Caloundra), we thought it an excellent idea to familiarise ourselves with this fascinating creature, which is considered the most venomous fish in the world.

There are two types of stonefish found in Australia – the Reef Stonefish (Synaceia Verrucosa) and the Estuarine Stonefish (Synanceia Horrida). Both are extremely well camouflaged fish, with eye placement being one of the ways to tell the two apart (Reef – separated by deep depression, Estuarine – elevated and separated by bony ridge). Both stonefish have 13 spines with 2 x venom glands located at the base of each spine. The venom is discharged through ducts located within the spines. The amount of venom injected into the person is dependent on how much pressure is placed on the spine – the more pressure placed on the spine, the more venom is injected.

So, what to do if we stand on a stonefish… Marine envenomation is a component of the provide first aid course, which should be updated every three years. However, if you’re a little rusty, this is what to look for and the first aid you should do.

Signs and Symptoms

Signs and symptoms may include the following:

  • Pain – pain will be immediate and intensely excruciating.
  • This pain may last for several days.
  • Single or multiple puncture marks – these may be bleeding
  • A bluish tinge may be seen around the envenomation site
  • Localised swelling around the envenomation site
  • In extreme cases, whole limb swelling may occur
  • If left untreated, muscle paralysis, breathing difficulties and death may occur.

The good news with Stonefish envenomation is that there have been no recorded deaths in Australia since European arrival. The development of an antivenom in 1959 further helps reduce mortality with Stonefish envenomation. It should also be noted here that other signs and symptoms including nausea, vomiting, low blood pressure, slow heart rate and incoherent behaviour are generally associated with the patients’ pain response, not the effect of envenomation. So what do we do to help them?

First Aid Treatment

  • Ensure rescuer will not become envenomated. When walking in potential stonefish habitat, wear stout soled shoes, or shuffle feet along ocean floor.
  • Phone 000 or 112 calling for ambulance, state suspected stonefish envenomation
  • If the spine is embedded – manage as per penetrating injury (pad base of spine and apply pressure to pads, DO NOT REMOVE SPINE)
  • If the wound is to a limb, place affected limb in hot water as hot as patient can bear (45°C for no longer than 30mins at a time)
  • If the patient is unresponsive and not breathing normally, follow DRS ABCD emergency action plan.

How does the hot water immersion work? No one knows… Pressure Immobilisation Technique is not used as it is a localised envenomation and the venom does not enter the lymphatic system (such as you would encounter with snake envenomation).

In wrapping up, prevention is better than the cure. When swimming or wading in the ocean, we’re entering the home of the Stonefish. Take care where you walk and what you wear on your feet and don’t pick them up. And if the worst were to happen, having completed a first aid course will give you the confidence to provide accurate and timely assistance. First aid courses can be undertaken with us at Helensvale, Mermaid Beach, or on site at your workplace.

Information for this article was sourced from the following sites:

http://www.qm.qld.gov.au/
https://australianmuseum.net.au/
http://oceana.org/
https://www.ambulance.qld.gov.au/clinical.html
https://resus.org.au/guidelines/

About Craig Middleton
Craig is the company' Training Manager and has been at Paradise First Aid since 2016. Craig spent most of his adult life putting out fires and cutting cars up as a firefighter. In his spare time, he could be found jumping off cliffs, searching and rescuing people out of the bush, driving boats in floodwater and climbing on roofs after storms as a volunteer with the SES. Craig left the fire and rescue arena to do a Bachelor of Paramedic Science, graduating with Distinction, coming on board as a trainer and assessor part way through his degree.

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