For stings from: stonefish, lionfish, stingray, crown-of-thorns starfish, and sea urchins use hot water.  

  • Check the water is as hot as can be comfortably tolerated (with the first aid giver's hand)

  • Place the stung area in hot water for 20 minutes

  • Remove briefly before reimmersing

  • Continue this cycle if pain persists

Often the pain may be so severe that people are reduced to being hysterical or incoherent.  Pain relief is extremely important.  The FIRST step in pain relief is hot water, until the victim  doesn't complain of any more pain when cooling takes place.  Other methods are local anaesthetic and least preferred is strong narcotics. 

Spines from Sea Urchins, Crown-of-thorns starfish, stonefish and stingrays will need to be removed.  Often they become fragments.  Sometimes an x-ray or ultrasound (and/or surgical exploration) may be needed.  All penetrating chest and abdominal wounds from stingrays need to be explored in a hospital.  

stonefish on the coral, Philippines.jpg

Indications for antivenom include: weakness and paralysis, severe pain, or multiple punctures. Evacuate.  


Pain and swelling are the most common symptoms from a lionfish.


Known for their deep penetrating injuries or severe lacerations.

crown of thorns  starfish.jpg

Vomiting is a major feature of envenomation.

Purple and red sea urchins eat a piece o

Pain and tenderness may persist for days to weeks.  

Sea Urchin