New rules for treating jellyfish stings

New rules for treating jellyfish stings
Since July 1, county lifeguards are being directed to treat jellyfish stings with hot water or saltwater. Some argue the long-prescribed vinegar method remains the best way to ease the pain. Photo courtesy of Wikimedia

ENCINITAS — Jellyfish have been known to sting upwards of 100 people on Encinitas beaches during peak days. 

In the past, those stung and staggering towards lifeguard towers in pain were sprayed with vinegar. But now they’re given another treatment.

As of July 1, lifeguards countywide are supposed to attend to jellyfish stings with hot water or saltwater, according to officials from the San Diego County Emergency Medical Services.

Not everyone is a fan of the policy change; some residents argue that vinegar remains the best remedy for easing the hurt of a jellyfish encounter.

However, a body of new evidence says otherwise, said Dr. Bruce Haynes, medical director of county EMS.

“Vinegar has been widely used locally, but literature indicates that’s not the best course,” Haynes said.

Haynes, who oversees EMS protocols, said all county lifeguards are expected to follow the new jellyfish procedure. He doesn’t expect lifeguards to object, but if they do, EMS could reconsider the policy change.

“My advice is to try the treatment for a time,” Haynes said. “After that, we’re open to discussion.”

The updated policy came about after a regularly scheduled two-year review of county EMS guidelines.

A task force made up of paramedics, toxicologists and other medical professionals recommended reworking jellyfish treatment guidelines to reflect recently released studies.

From there, the EMS Base Physicians Committee gave the new policy its blessing and forwarded it to Haynes, who ultimately approved it.

Haynes noted one study was especially influential to county EMS — “Evidence-Based Treatment of Jellyfish Stings in North America and Hawaii,” a 2012 review from UC San Diego’s Department of Emergency Medicine.

Never mind folklore, baking soda and urine aren’t effective fixes for jellyfish zaps according to Dr. Richard Clark, one of the authors of the review. And vinegar works on some local jellyfish species, but not others.

“For certain species, there’s actually some evidence vinegar can make the pain from stings worse,” Clark said.

Clark’s review notes that the American Heart Association recommends vinegar for jellyfish stings. But Clark said that vinegar is better for taking the bite out of injuries inflicted by jellyfish species like Portuguese man-of-wars that aren’t found in San Diego waters.

“No treatment was found to be uniformly effective for all jellies, but hot water helps with most of the varieties,” Clark said.

As well as dousing jellyfish stings with vinegar or hot water, the new EMS policy says lifeguards should scrape venom sacs from the skin.

Clark said if lifeguards aren’t in sight, beachgoers could remove the sacs in a pinch, as long as they’re careful.

“Flick off the venom sacs with a credit card or some other kind of flat surface,” Clark said. “The goal is to get rid of the sacs without crushing them. If crushed, the venom will spread.”

He added it’s best not to use bare hands to remove the venom sacs. After scraping, hot water or salt water should be applied, followed by the topical cream lidocaine.

Despite the review, Carlsbad resident Mark Bergseid said vinegar is proven. He noted his 7-year-old daughter was stung at Stone Steps Beach in Encinitas on the last day vinegar was offered.

A lifeguard sprayed her injury with diluted vinegar, and Bergseid said his daughter “immediately started feeling better.” He doubts that heated water or saltwater would have produced such quick relief.

“I’m glad it was the last day,” Bergseid said. “She would have been screaming for half an hour she was in so much pain.”

He added county EMS should take another look at its policy in light of his daughter’s experience and other beachgoers who have benefited from vinegar.

At the Moonlight Beach lifeguard tower, bottles of vinegar were pulled last week to comply with EMS guidelines, according to Encinitas Lifeguard Capt. Larry Giles.

Giles said he hasn’t received enough feedback from his lifeguards to form a “positive or negative” impression of the policy change.

“I’ll survey staff over the next few weeks to get their response,” Giles said. “In a month, I’ll talk to the county and give them input.”

Removing vinegar hasn’t gone unnoticed by beachgoers; Giles said he’s received a handful of complaints.

“We’ve used vinegar for more than 50 years,” Giles said. “So people understandably want to weigh in on a transition like this.”

Encinitas doesn’t keep statistics, but Giles noted the consensus seems to be that this has been a moderate year for jellyfish stings. July and August typically see more jellyfish, along with people in the water.

“The combination leads to more stings,” Giles said.

Nigella Hillgarth, executive director of the Birch Aquarium, said blooms of jellyfish are drawn to shores in the summer by warm water and deep ocean currents.

A handful of jellyfish species are regularly spotted in San Diego. The most common being purple-striped and moon varieties. Purple jellyfish can grow up to 12 inches long, while moon jellyfish are typically about 10 inches.

In recent years, Hillgarth said there’s been an uptick in rare black jellyfish with 25-foot long tentacles off the San Diego coast, likely because they’re in search of food. Their stings can be especially painful, but they aren’t life threatening.

“More research should be dedicated to the different jellies and how exactly their stings affect humans,” Hillgarth said.

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  1. beachlife says:

    Been in, on, around and under the surface of the oceans/beaches 40+ years and I have experienced and seen more marine stings than I can count; heard all the folklore medicines, myths and so on, the absolute best sting relief is and likely will always be vinegar..5% acetic acid or better…Been that way for years!!

    With all due respect to the professional parties cited in this article, I have to ask; why fix what isn’t broken??Lidocaine is a topical anesthetic..period!! Which means the application for sting pain does nothing more than cover over the pain injury rather than provide meaningful first aid…vinegar has been proven time and again to neutralize stinging nematocysts and lidocaine does nothing but numb.

    What happens when the lidocaine wears off? Is this more an out of site out of mind recommendation in the face of TWO warnings by the FDA regarding self application of lidocaine in the face of staggering medical statistics of negative effects including anaphylactic shock, shortness of breath and a host of other potential bad reactions?

    Respectfully, it seems the recommendation is based on a compilation of information derived for a predisposition to “discover” something new rather than actual on site application..why else would vinegar be the gold standard around the world including SoCal only to be cast aside for a more dangerous remedy? It appears once published, medical professionals drink the kool-aid rather than determine for themselves….I just don’t get it but to each their own…I’ll stick with a vinegar thank you…Cheers!! BL

  2. Bing says:

    I believe hot water releases histamine thus numbing skin… How do you propose hot water be dispensed? Has to be pretty hot. Will remote towers have this ability? I also agree with prior poster: it’s the acid that disrupts the nematocysts (sp?) ability to deliver venom… Or soul I thought.

  3. Maggie says:

    My daughter was stung 2 weeks ago and STILL has bumps that really itch at times! We are using cortisone cream and Benadryl but I never knew the bumps and itching last this long! Anything else we can do for this? Thanks!

  4. Brian says:

    I am curious to know how long to expect the rash to last as well. I was stung on two spots on my arm/hand 8 days ago on Hilton Head Island (South Carolina). A lifeguard sprayed vinegar on the sting. The large sting area is about 3 inches long and 1 1/2 inches wide. I wasn’t aware of the need to scrape the sting to remove any ‘remains’ nor was I advised to. The large sting hurt for several hours and then subsided. 3 or 4 days ago the large sting started to itch a lot and then a day after that the smaller sting started to itch as well. I have put some cortisone cream as well as some topical antibiotic on it (alternating not at the same time) which helps soothe some but the itch definitely comes came with a force later.

  5. Sharon says:

    How long can the bumps expect to last. Its been 2 weeks that I’ve be hit on the ankles,
    And the bumps are getting redder and larger, more prominent, I actually made a dctr. Appt. Tomorrow to have it checked. Does it get worse before it can heal? Love to hear some imput, concerned.

  6. Katrina says:

    Hi. I was stung by jelly fish about 2 months now and the itch and bump is still visible. have been to doctor already and i was prescribed with hydrocortisone ointment but nothing has changed. is this normal? i have already scheduled for another doctor appointment this week. want to hear some input. please help, the jelly fish stung on my feet is not pleasing in my eye. thank you

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