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Lionfish Sting First Aid and Treatment

If you are “stung” by a lionfish: DONT PANIC!

Lionfish Sting First Aid Response and TreatmentYou are most likely not going to die, though you might wish you had depending upon how many spines penetrated the skin, the depth of the puncture, your own tolerance to pain and your body’s physical reaction to the venom. For most people the throbbing, intense pain is going to last for a few hours and will remain less painful for 12 hours or longer. One thing is for sure, everyone reacts differently and has a different experience.

It is important to note that when we refer to “lionfish sting” we are actually talking about having one of the lionfish’s 18 venomous spines puncture the skin and causing a wound deep enough to allow the venom that coats the spines to enter the body and go to work.

Lionfish Sting Response and First Aid

Prepare ahead of time
Minimize your chance of getting stung by wearing these puncture proof dive gloves and using a lionfish containment unit. Carry these reusable heat packs in your dive bag whenever you are lionfish hunting. If you still get stung, follow these instructions…..

Surface Safely
If you are diving you must get to the surface and onto land or a stable platform in a safe and controlled manner. Most divers (the author included) report that the pain does not come on immediately and the venom takes several minutes to begin to work. Let your dive lionfish sting signalbuddy know that you have been stung and call the dive. It is important to work out a signal for being stung to use underwater if you will be hunting or handling lionfish. We use a “finger gun” pointing to the wound area, then a thumbs up. Keep in mind that a diving related injury like decompression sickness or lung embolism is far more dangerous and likely to cause death than the sting.

Remove Remaining Spines
Inspect the wound closely for any signs that pieces of the spine might have broken off and are still in the skin. Gently remove them if you are able.

Clean and Disinfect Wound
Using clean, freshwater flush the injured area as completely as possible. If you have a first aid kit available disinfect the wound with antiseptic towelettes and apply triple antibiotic ointment if possible.

Control Bleeding
If necessary, apply direct pressue to the wound in order to stop the bleeding.

Apply Non-Scalding Hot Water or other heat
Even though you will probably start to see swelling of the injured area, DO NOT APPLY ICE. The venom is protein-based and begins to breakdown with the application of HEAT. Heat will bring a noticeable relief to the pain and shorten the effectiveness of the venom. For this reason we always advise that a thermos of hot water be taken on any trip in which contact with lionfish is possible. Keep in mind that sources of hot water may also come from boat engine cooling water exhaust or water heated in a metal container on top of an engine block. Many resources will tell you that the water needs to be between 100°-115°F, but there really is no practical way to measure that or time to get water to the correct temperature in most instances. Immerse the wound in water that is as hot as the victim can stand without scalding or burning the skin. Soak for at least 30 minutes but as long as desired. If the affected area cannot be immersed then apply clean cloths soaked in hot water and change out or re-soak frequently to keep the heat up. If you do not have hot water available, then reusable heat packs like these are a great alternative; they are an important item to include in any marine first aid kit.

Take Pain Medication
If the victim can tolerate over the counter pain medications, now is a good to time take them.

Seek Medical Treatment
While many people do not seek medical treatment for a lionfish sting, we HIGHY RECOMMEND that you do. Not only do treatment facilities have access to some really nifty pain medications that you WILL want, there can be other complications that aren’t immediately apparent, too:

  • Severe pain can cause shock which may involves shortness of breath, weakness, fainting and cardiac arrest.
  • Diabetics and those with compromised immune systems may react very badly to the venom and it’s systemic effects.
  • There is a very real possibility that people who are allergic to the venom may go into anaphylactic shock. Many people die every year from anaphylaxis.
  • There may be pieces of spine left in the wound that you cannot see without an X-ray or other inspection.
  • There is ALWAYS the chance that any injury caused by a marine creature can become terribly infected.
  • There has been at least one case of paralysis in both arms and legs of a home aquarist who was stuck in the finger. The paralysis went away completely in a short time, but it was a good thing he had sought medical treat when the symptoms of envenomation began to grow worse.
  • Lionfish venom can cause tissue necrosis (tissue death) that has the ability to spread if not treated immediately when identified.
  • Of course, there are many other issues that could come up. (We’re hunters NOT doctors.)

You can also call the Poison Control Hotline at 1-800-222-1222. The Aquatic Toxins Department is available 24 hours a day. Everyone is welcome to call and multiple languages are supported however this is not a toll-free call from outside of the United States – 011-800-222-1222.

When you’ve lived through it and you are back in the water lionfish hunting again, say, “Hi!” to the next one you spear…

Giving the Finger to a Dead Lionfish

About the Author:

L. Scott Harrell is the co-founder of the World Lionfish Hunters Association. He now owns a scuba diving marketing consultancy in Cozumel, Mexico and offers expert PADI scuba instruction and private divemaster services. You can hunt lionfish in Cozumel, too!

Comments (38)

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  1. Kathleen Foland says:

    Hello, i want to learn more about lionfish and the potential culinary uses especially in Belieze as a location. Thank you

  2. Cathy Julian says:

    We have a portable electronic heat and cold pack that heats to 112 Fahrenheit. We are interested in promoting into the diving industry and will be at the dema show this week. Will you be there?

  3. jeff luft says:

    Was stung today while snipping off spines.. on my pointer finger. I continued to hunt till I had to use my middle finger to pull the trigger. . By the time I reach shore… the next 3-4 hours were th most painfully moments of my life.. I just got out of the hospital in Jamaica.. relaxing at my hotel and my finger is still soar and big! Lesson learned

  4. Angie says:

    I got nailed badly today. Pain was so bad I didn’t know what to do with myself. We’re selling them commercially and getting lots at 16-17 inches. They are SCARY at that size. I soaked in very hot water for about 30 minutes. Then I soaked in ice water to handle the swelling. I also took 3 Aleves and was able to make 2 more dives as the venom deactivated after about an hour.

  5. Mike K says:

    Was stung yesterday at the lionfish roundup in Jupiter Beach for the Martin County Artificial Reef Fund. No one new what to do. This site was very helpful, because I’ve never felt such pain. Lasted 3-4 hrs….thankfully. A thermos on every hunting boat should be required!!

  6. Amanda says:

    Two hours later and my middle finger feels like it’s about to fall off! Two shots in the butt and I’m still soaking my entire hand in hot water. Was snorkeling at fort Zachary in key west. First one ever to get stung. Hurts like hell and I have a pretty high pain tolerance. Stay away if u are swimming!!! Don’t put in ice. Try to lay down someplace cool, had to have a bag of ice ony head as I felt like I was going to pass out from the pain. Beware…

  7. Jim Lawson says:

    I was stung 3 hours ago in Aruba hunting them with a local dive shop. Total rush but excruciating pain is just getting better now. My hand is fairly swollen and it just a light brush on one finger. I can’t imagine a real bad one with multiple hits. The reefs that are not dived regularly are covered with them. The only hope is that the Sharks start eating them soon.

  8. Ashley says:

    I was hit last week severely for the first time in Key West. I spearfish regularly and have been pricked many times though it only stings for 15-20 minutes. This time a wave caught the small dead lionfish on my spear and pushed it spine first down my spear and it harpooned me through my dive glove in 5 places.
    Worst encounter Ive had. Severe pain swelling and discoloration for at least 6 hours with radiating pain up the whole arm and into the neck and even chest. After 5 days I still have slight/minor symptoms of swelling and tenderness at puncture wound sites, but no sign of infection. The main intervention is soak in hot water, not scalding, as soon and as long as possible.

  9. richard lynch says:

    I jumped off my surfboard in Barbados and landed on a lion fish on the reef. Very unlucky!!I had six deep puncture wounds each with a spine broke off in each. Morphine, local anaesthetic etc….I don’t know!!! I was in a dark horrid place for 4 hours. My arms and face went numb, my speech was slurred, I thought I was on my way out. I thought I was giving birth out my foot. Its over a week now and my foot is still hurting, swelling hasn’t completely gone and some of the puncture wounds have black marks on them. I think I was particularly unlucky as I stamped on the little satan of a fish. I wouldn’t wish the pain against my worst enemy! Actually I would.

  10. cathleen b says:

    was stung 11 days ago, worst pain ever!!! but now the sting site itches SO badly, it wakes me up, have tried hydrocortizone, etc. anyone else experience this? how long will this phase last? swelling nearly gone. I hate the little mothers!!

  11. Hank Karr says:

    Good article; thanks for making it available. My question is this, “are there any long term neurological affects to a lion fish sting?” I have a patient who was stung some time ago (date unknown). I do not think there is, but I would like to be safe. You may reach me either at the email above or you can call Avon Medical Center at (863) 453-2500 we are open 8-5 est. Thanks in advanced for you reply. Have a great day. Hank

  12. Craig says:

    Worst sting ever! Just got stung off Barra Beach Moz, it’s been an hour now and there is no sign of pain going away, followed the instructions on this website it’s very helpful as no one has any clue about this sting.

  13. Craig says:

    Worst sting ever! Just got stung off Barra Beach Moz, it’s been an hour now and there is no sign of pain going away, followed the instructions on this website it’s very helpful as no one has any clue about this lion fish sting.

  14. Adam says:

    Well hello Scott. Just reading a little bit about Lionfish and saw your article here. Great info and wel written. Have a good one man!

  15. Adrian Harte says:

    Higuys, its no laughing matter, i got hit down at a 106ft off the hilton in Barbados in the Lionfish-Derby sunday 13/11/16, the team killed in all 1003-lionfish, i got hit but the pain did not start till i reach the surface, they drove me to a clinic and got IV-drips of Tramadol and Morphine to kill the pain,did not work, then they said cannot give u any more drugs, you will have to bare the rest of the pain which was 7-hours, today is the 15th, and my hand still very swollen and heavy, the first hours you feel like having the hand chopped off.
    Never again will i hunt Lionfish

  16. Just reading a little bit about Lionfish and saw your article here. Good!Great info and wel written. Have a good one man!

  17. Mike says:

    I am a commercial diver. (over 30 years!) I was working off Indonesia on a pipeline once a number of years ago. I was moving along the pipeline in very poor visibility when I saw a number of Lionfish swimming in and out of my view. As careful as I was, I ended up getting stung down between three of my fingers on my right hand. I quickly removed my glove (made with kevlar!!) and saw 4 puncture wounds on my hand with blood streaming from the holes. I was struggling to recover myself to the diving bell as the hand was too painful to allow me to use it and pull myself back up. So with help from my bell partner, I managed to recover into the bell and back to the surface. We had an endless supply of hot water, so I immersed my hand in water that I could just tolerate. I took a couple of painkillers (anti-inflammatory) and continued to change the water periodically for approximately 2 hours. As mentioned, the pain is very intense and initially, the last thing you want to do is put the affected area into something hot!!! My hand was absolutely burning!! I was absolutely amazed that the pain just stops. One minute, excruciating pain, next minute, absolutely fine.
    Hope that helps.

    • Judil says:

      Was stung 2 days ago in Choc Bay on St. Lucia. Dove for years in BVI & St. T., but water was churning up & I was standing about 20 ft front shore. Felt bites and lashes and couldn’t shake the fish. Everyone said jelly fish. I know what it’s like to be stung by schools of jelly fish & man 0 wars. I felt teeth. My leg has outline of the fish and huge bite marks from mouth. I used ice pack at first. Useless. Heat and Vinegar to help draw the venom. Luckily I had benedryl and morphine. It’s excrutiating.

  18. Kamal says:

    Hi i’m a plastic surgeon and i invented a new technic to treat envenomations not yet adopted by the medical community. If some of you are interested you can have a look to this link:

    This short movie illustrates the mechanism. No more pain after injection of local anesthesia, then no venom or at least less after wash away by interstitial saline serum injection. It’s not very simple but may be helpful.

  19. Josh says:

    Hi all, we are currently in the midst of our honeymoon in the Seychelles. I went snorkelling near some rocks yesterday on what was a wavy day, saw a few lionfish and stonefish but wasnt aware how seriously nasty they are before getting stung sadly.

    Suddenly I felt a sharp stabbing pain like I had my toe bitten off by a shark. I raced back to shore to assess what I thought was going to be a blood bath, only to find a puncture mark with just mild bleeding (like you would get from a toothpick/pin stab). The pain began almost immediately, I hobbled to the hotel reception and explained something stung me, they assumed it was a sea urchin, but at this point I was sweating heavily and in agony, in fact so painful I was shaking. My whole foot and ankle doubled in size within a few hours. I got a taxi to hospital where the doctor said venom/poison has entered via the puncture. The nurse loaded me with a jab of painkiller and an IV for something else, antibiotics and steroid pills.

    A few hours later the pain reduced from 10/10 to 5/10 thanks to the painkillers, then I went researching online to learn the ice pack the hotel gave me was not the right choice, I ran a bath of hot water and soaked foot for a few hours which took the pain down to 0-1/10.

    If it happened again I would happily soak my foot in boiling water if confronted with facing the venom from that fish.

    Awful experience, thanks all for the educating posts.

  20. Lauren says:

    I was stung by a lionfish in Barbados on September 11, 2017. I got immediate medical attention. Spent 3 1/2 hours at the doctor’s office with my hand soaked in hot water with vinegar. I got a steroid injection as well as an antihistamine. I was on steroids for 3 days as well as an antihistamine. My initial reaction included swelling of my finger which then traveled to my other fingers, my hand and wrist. Dizziness, on and off black outs, drop in blood pressure, nausea, etc. The swelling had subsided over the next 5 days or so and everything seemed to be healing fine. Some residual pain. Now the site (right hand, middle finger, I got 9 spine punctures, not too deep) is swelling again, HORRIBLY itchy. I am trying to not touch it. Only my finger is swelling, it has not traveled to my other fingers or hand, does not appear any different, just swollen again and still sore and stiff. Puncture sites are not oddly irritated or discolored.

    Anybody else have a “flare up” during healing? If it gets worse, I will go back to the doctor. Definitely more affordable in Barbados than here for that medical attention…

    • Andy Lowe says:

      Wow, that sounds like a pretty bad sting. I’ve not heard of anyone having a ‘flare up’ later on, but there seems to be a wide variation in people’s reactions to stings. Hope you feel better soon!

  21. Ken says:

    I“m now 3hours on pain!f..kng lion fish sting me on my feet at night swimmg…
    Thank you for thise advice

  22. Akeem says:

    Got stung in finger yesterday while my hand was in the sand, I’m not sure if it even was a lion fish. I felt something soft in the sand &assume it was my partners feet & them BAm, I actually felt it pierce me really hard like it got hit with staples from a stapler machine. I only took an anti inflammatory & now my finger is swollen & pains alot. This happened at buccoo beach in Tobago.

  23. don says:

    I was stung on the sole of my foot in 2003. i suffered about 2 hours as the pain would subside and then come full-force, and subside again. It felt like fire inside my foot. My brother-in-law brought me to a doctor. The old doctor sliced a lemon (as in a citrus fruit), rubbed the juices onto the affected area – and the pain was gone in about 10 seconds! the following day, i was playing tennis with my brother-in-law and i beat him.

  24. Theresa says:

    I stepped on one of these yesterday afternoon and while the intense pain did go away with the use of a hot watre soak, my toe is still blue and the top of my foot is pretty swollen. The puncture was deep in the side of my toe going down toward my foot.
    Most intense pain ever!

  25. Cheryl says:

    I stepped on a lion fish while in chest deep water off the beach in Mayakoba, Mexico five years ago. I took a step and felt searing pain. When I picked my foot up, I saw two puncture marks that were bleeding. By the time I got to my husband who was at the pool, I was pale, disoriented and faint. He called for the lifeguard who mistakenly thought I had been stung by a stingray. However, he did put my foot in a pail of hot water and called for the resort doctor. I was in immense pain and felt like I was going to pass out, so they carried me to my room where the doctor met us. The pain had traveled up my entire leg to my hip and I was thrashing around like I was having a seizure. The doctor injected me with something and called for an ambulance. Unfortunately, I had ice on my foot from the time I was taken to my room until I arrived at the Playa del Carmen hospital. The ER doctor recognized that I had been stung by a lion fish and again put my foot in hot water and started IV pain meds. I convulsed in excruciating pain for the next four hours. I asked the doctor if I was going to die because it certainly felt that way! After 4 hours of no improvement, he gave me a nerve block in my foot which gave me instant relief. He then admitted me. The relief was short lived so I was given another nerve block which lasted much longer. I remained on IV pain meds all night. The next day, the pain was tolerable so they discharged me with oral pain meds and antibiotics. My foot was very swollen and I could not bear weight on it. I hobbled around for a week until I returned to the US. I then went to a university hospital, but they had no idea what to do. I think they gave me a tetanus shot. I called DAN for advice and they had never heard (at that time anyway) of a reaction like mine with swelling and pain weeks later. They suggested I have the foot x-rayed to make sure there weren’t any spine fragments left in it. I saw an orthopedic surgeon that specializes in the foot about a month after the incident. It was still swollen, I was still limping and I had developed numbness. They took an x-ray and ultrasound but didn’t find any fragments. He said I had nerve damage from the venom and did not know what my prognosis was but put me on gabapentin. The swelling worsened to include not just my foot but also my ankle and calf. Luckily a friend who is an anesthesiologist happened to see me and became quite alarmed. He said he though I had developed complex regional pain syndrome and I needed immediate attention. The next morning, I was given a spinal block. After that, the swelling and pain were greatly improved, but I continued to limp and have numbness (for which I continued on the gabapentin) for 18 months! I realize my reaction seems extreme and thankfully not the norm, but use extreme caution when in close proximity! I finally ate one of those suckers when I was in Miami. Not only was it delicious, but it gave me great joy to eat one!

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