Treating Scorpionfish stings

Focus on First Aid

Watch where you’re stepping – there may be a Scorpionfish underfoot!


Scorpionfish are often mistaken for a sand-covered piece of coral as they blend in very well with their surroundings. Photo: Submitted

Injuries from this ‘master of camouflage’ are rare if we exercise care in the water, but they can occur. Scorpionfish are often mistaken for Stonefish and it’s important that we distinguish the difference between the two.

Both animals belong to the family ‘Scorpaenidae’ but they are divided into two distinct groups. Stonefish (Synanceia) are widely considered to be the most venomous fish in the world. Fortunately for us this dangerous creature is not found in the Caribbean (they mainly inhabit waters of the Indo-Pacific region).

Scorpionfish (Scorpaena), however, are commonly found in the Caribbean and do inhabit shallow reef areas around Cayman.

Most of us have encountered these fish while snorkelling or diving but we often mistake them for a sand-covered piece of coral. Scorpionfish blend in very well with their surroundings and are often covered in algae and hydroid growth to further confuse their predators and prey. If they are startled or threatened they will swim very fast for a short distance (scorpionfish lack a swim bladder) and display bright yellow, orange, or red patches on the underside of the pectoral fins.

Common to all Scorpionfish are 12-13 dorsal spines, two pelvic spines, and three anal spines covered in a loose integumentary sheath. Each spine has a shallow groove and is connected to a pair of pressurized venom glands.

When we step on the fish’s back the sheath is pushed down the spine, compressing the venom glands at the base. The protein-based venom then travels down the groove in the spine and into the wound.

In most cases moderate to severe pain and localized swelling are the only symptoms however in rare cases patients may experience anaphylaxis or a severe allergic reaction to the venom. This reaction may be characterized by swelling of the mouth and throat, difficulty breathing, vomiting, cramping, a drop in blood pressure or loss of consciousness.

If a reaction is suspected treat as a medical emergency and alert EMS (note: if allergic symptoms appear but subside, do not cancel EMS as symptoms may return hours later due to biphasic reaction). Assess the scene for possible hazards, don barriers (gloves, etc.), and conduct your primary assessment (ABCDs).

Immerse the area in very hot (but not scalding) water for 30-90 minutes and remove any remaining pieces of fish spine. This should quickly reduce pain.

Do not stop minor bleeding as this will help clean the wound; however if a blood vessel is pierced apply hard direct pressure over the wound. Clean the affected area with soap and water then apply a local antiseptic if available.

Monitor the patient’s lifeline (ABCDs) until EMS arrives or the patient is transported to medical assistance.

If the patient has only pain and swelling and EMS is not activated, encourage them to see a doctor immediately in case of secondary infection.

Scorpionfish stings and injuries from other bottom dwellers such as urchins and fire coral can be easily avoided. Consider wearing rubber soled shoes when wading in shallow reef areas and never, ever walk on the coral itself – stay on the sand.

When snorkelling or diving remember the golden ruleā€¦.look but don’t touch!

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