Scuba Diving First Aid – Marine Life Injuries

This is an excellent first-aid resource for scuba divers.  It’s so nice to see some detailed information available on the internet for the benefit of divers.  The article deals with a wide range of common, and less common, marine life injuries that are risks to scuba divers.
Well worth reading, printing and laminating to stay with your scuba kit on the dive boat!

The following text is an excerpt from Neville Coleman’s: ’DANGEROUS , VENOMOUS and POISONOUS MARINE LIFE of the Asia Indo – Pacific Region‘. An excellent book on scuba diving first aid.




Blogger Authors Notes:

May 2012 – Neville Coleman sadly passed away on 5th May, 2012, aged 73 Years

 Jun 2012 - ‘Dangerous Sea Creatures’ remains SOLD OUT and has been replaced by a 3-part eBook series. Dangerous, Venomous and Poisonous Marine Life - LINK


The original concept began many years ago as one of the major projects undertaken on the “Australian Coastal Marine Expedition” (1969 to 1973) that aimed to record, observe, photograph, and eventually preserve the marine fauna of Australia. In regard to the dangerous, venomous and poisonous animals (of which very little was then known) the idea was to experience these animals underwater and conduct experiments to determine the standard of their harmful, or potentially harmful, effects on a human, namely, me!

I set about to face each and every so-called danger, so that eventually, by discovering the truth about the animals, my own highly-developed fears would be conquered. I figured that if experimented on my self and survived, I would no longer be scared of that creature and could write it off the very long list of nightmares I had to deal with every night.

Brilliant in theory, but in practice the reality of things did not find me very brave and sometimes the dreams of facing six white pointers on my own with only the wire framer of my close-up lens between us, did not inspire my diving in two metres visibility.

Yet, it was the determination to beat my media-programmed fears of the underwater creatures that drove me on and continued to drive me on for another 40 years.

 The World of Water

Of the 200,000 life forms inhabiting the oceans of the world, from tiny microscopic dinoflagellates to the mighty blue whales, there are only a small percentage of creatures that have and adverse affect on humans.

Humans are not the normal, natural prey of marine creatures, yet in the past we have considered ourselves (due to extraordinarily irresponsible media exposure) to be on the menu of every creature in nature. In short, humans have always been at war with nature. Our ignorance and fear have bestowed totally ridiculous powers to many of these creatures, when in truth most have no understanding whatsoever of our existence (most cannot even see us!)

This material is written and produced in the sincere knowledge that most of our fears are only in our heads and our greatest journey, is between our ears. Those animals which inhabit the world of water (once an unknown and fearsome place) are only beings, in many ways similar to ourselves.

By knowing, recognising and understanding them a little more in their world, we can go amongst them with respect, rather than fear, wondering at how such fascinating creatures with their amazing abilities to defend themselves against a host of predators, survive?. That their astounding protective devices sometimes work on inexperienced human visitors is unfortunate. However, any person involved with the aquatic environment must be realistic and be aware that accidents and incidents can happen. Hopefully with the visual aids, information, appraisals and advice contained here, the prospect of harmful encounters will be minimised.

After 40 years and over 12,000 logged dives experiencing and experimenting with dangerous, venomous and poisonous animals across the oceans of the world from the Seychelles to the British West Indies: from Japan down  to New Zealand  I remain virtually unscathed. This was not achieved out of any attempt at bravado, but with a thorough understanding and a great deal of respect for the aquatic environment and its inhabitants, despite the overwhelming sense of my own fragility.


First Aid

First Aid personnel should be aware of conditions that may threaten a person’s life. Awareness can help prevent a foreseeable hazard from becoming a risk that may lead to acute illness/injury. Life can be threatened by environmental conditions, for example, a rough sea as well as by the condition of the casualty who may be ill (shellfish poisoning) or injured (shark bite).

Rescue Diver

Courtesy DAN

In the Event of Emergency:

Respond Correctly

  • Act calmly and quickly to assess the situation
  • Ensure their own personal safety THEN the safety of other people in an emergency
  • Know how to call for Emergency Service Assistance
  • Be able to recognize and provide initial management of acute illness/injury.

In cases of a witnessed collapse the call for Emergency Service Assistance should be initiated immediately. Speed is imperative to allow the Emergency Service to provide advanced life support effectively. A collapsed casualty should be managed only after the safety of First Aid personnel and other people has been assured.

Prioritize Casualties

Where there is more than one casualty, CARE OF UNCONSCIOUS CASUALTIES HAS PRIORITY. First Aid personnel should not be distracted by casualties who are calling out – they are obviously conscious.


In all injuries/illnesses REASSURANCE plays a vital role. Reassurance:

  • Look after the mental and physical aspects of the casualty. It reduces the effect of shock and gains the casualty’s confidence and so the casualty will be more cooperative with first aid management.
  • Always try to arrange your management so as the casualty cannot see their injuries.
  • Normal body warmth should be maintained.
  • In most situations, the casualty should be given nothing to eat or drink.
  • The casualty should be protected from the environment and their skin should be protected from hard objects.

Prevent Further Illness/Injury

The prevention of further illness/injury may be achieved by:

  • Gentle handling of the casualty
  • Assuring the casualty that persons who are ill/injured are being cared for
  • Informing the casualty that the Emergency Service has been or will be called asap.

Moving the Casualty

A casualty should only be moved for:

  • An environmental risk
  • Positioning of the unconscious
  • Clearing and opening an airway
  • Control of bleeding
  • Transport to Emergency Service only when advised by Emergency Service personnel.

If other persons are available to assist in the movement of a casualty, request their help. Emergency Service personnel have specialised equipment that can support a casualty during movement. They may also be able to provide pain relief to a casualty before and during movement. Allow the Emergency Service personnel to come to the casualty; do not (unless instructed by the Emergency Service) take the casualty to the Emergency Service.

Always follow the EMERGENCY ACTION PLAN in the management of all illnesses/injuries.

ALWAYS BE MINDFUL:  When we lose consciousness our HEARING is the last sense to be lost and first to function.

Emergency Action Plan



If the environment is unsafe remove the hazard or risk, if safe to do so. If the hazard or risk cannot be removed, carefully move the casualty to safety, if safe to do so. Once the casualty is in a safe environment assess for consciousness.


If they are conscious reassure them, minimise movement and manage illness/injury. If the casualty is unconscious place them on their side. Arrange for Emergency Service Assistance.


Clear and open the casualty’s airway.


If breathing – place the casualty in a stable side position. If not breathing - commence EAR - Expired Air Resuscitation and check for pulse.


If there is a pulse continue EAR - Expired Air Resuscitation. If there is no pulse commence CPR -  Cardiopulmonary Resuscitation.

Control Bleeding

  • Most EXTERNAL BLEEDING with no protruding object, can be stopped by applying DIRECT PRESSURE and ELEVATION of the wound.
  • Apply a pad directly against the wound with firm pressure and secure with a dressing ensuring the pad remains over the wound.
  • Elevation should be used with direct pressure when it will cause no pain or aggravate the injury.
  • All fractures must be securely supported before elevating.
  • Send for an ambulance.
  • Monitor casualty’s vital signs and keep the person still.
  • Provide supplementary oxygen if available.

To see the full text:  visit this LINK

Marine Life Injuries


Surgeonfish do not attack people underwater nor do they attack fishermen. Injuries arise when divers pick the fish up during a night dive or when fishermen are removing them from nets. The razor-sharp scalpels on each side of the tail junction are flailed from side to side by the action of the tail flapping, causing deep, painful wounds.

Powder Blue Surgeonfish Acanthurus leucosternon


Single or multiple deep cuts, generally to hands. Severe bleeding, pain, swelling to affected area, shock.

First Aid Management:

  • Reassure the casualty
  • Reduce shock
  • Soak wound in hot water (non-scalding) for up to one hour or until pain is relieved. Add heat as water cools
  • Wound should be thoroughly scrubbed with soap and water to remove any toxic substances, foreign matter, fish mucus, tissue or membrane
  • Apply bandage or adhesive strip to ensure wound closure
  • Seek Emergency Service Assistance


Horrid Stonefish Synanceia horrida

The Horrid Stonefish (Horrid) Synanceia horrida is one of the real threats to waders and reef walkers along the forshores of bays , tidal creeks muddy coastlines. Always take care when wading around muddy foreshores. (photo: Neville Coleman)

Several species of stonefish exist and all are highly venomous, difficult to see in natural habitat and occur in intertidal areas, and deep water. Venom is injected from twin sacs arranged either side of the 13 strong, needle sharp dorsal spines and contain between 5 to 10 milligrams of unstable protein. Most wounds occur in the feet due to walking on top of the fish. Death has resulted in a number of cases. Antivenom is available. ( photo: Neville Coleman)

Horrid Stonefish Synanceia horrida

Exposed venon sacs and hypodermic – type spines of the Horrid Stonefish Synanceia horrida. (photo: Neville Coleman)

Any deep penetration injury such as venomous fish spinings must be fully explored for possible retention of foreign matter (tips of fish spines) as serious complications can result if they are left in the wound. Healing may take many months. After effects can be life threatening and take years to correct.


Immediate and excruciating pain.  Some casualties scream incessantly and flail limbs, unconsciousness may result. Near drowning may occur in a snorkeller or diver. Reaction will depend on how many spines entered the body and if they went through shoes, boots or just bare feet.

First Aid Management:

  • Rescue casualty
  • Reassure the casualty
  • Reduce shock
  • Spines sometimes break off deep in wound and require exploratory surgery. =Injuries are contained to deep punctures
  • Manage as for stingray penetration injury
  • Resuscitation may be required
  • Seek urgent Emergency Service Assistance


Sea urchins of the family Toxopneustidae have been responsible for the deaths of several people in Japan, one at least who drowned after being bitten. Venomous pedicellaria (small, needle sharp fangs on a flexible stalk) occur all over the surface of this sea urchin, with the greatest number around the mouth. The venom blocks nerve muscle responses and paralyses the muscles.

Flower urchin Taxopneutes pileolus

The Flower urchin Toxopneustes pileolus is a common inhabitant of sheltered rubble areas throughout the Indo – Pacific. With its characteristic pedicellaria ( petals) displayed it is easy to recognise. However, in most cases the urchin is covered in sea weed or rubble which makes it difficult to see in the field. This urchin has caused the deaths of 3 divers in Japan, so it should never be picked up with bare hands.( photo: Neville Coleman)


Localised pain at first, then spreading in area and intensity. There may be no easily identifiable bite or puncture mark. Weakness, giddiness, muscle aches, shock, speech problems with eventual collapse and neuromuscular paralysis leading to reduced shallow breathing which may eventually cease.

First Aid Management:

  • Rescue casualty
  • Reassure the casualty
  • Reduce shock
  • Lie casualty down with affected limb elevated
  • Immerse injury in hot water (non-scalding) for up to an hour or more as required to relieve pain adding heat as it cools down
  • Resuscitation may be required
  • Seek urgent Emergency Service Assistance


Bristle Fireworm

The Tropic Bristleworm, or Fireworm Eurythoe complanata is extremely common and may be found beneath every dead coral slab or rock in the intertidal areas of the Indo – Pacific. Always be on alert when lifting rocks in search of bait, or shells, or species for photography. ( photo: Neville Coleman)

Contact, usually comes about from persons reef walking and/or shell collecting turning dead coral plates with bare hands to see what’s underneath, or when bristle worms are caught on fishing lines or come up inside fish that prey on them and stinging occurs when fish are being cleaned.

Bristleworm Spines Finger

These spines might not look very threatening BUT if you have a handful of them, or two handfulls ( as I recently had the misfortune to experience coming up an anchor buoy rope covered in fireworms in a strong current) you can have very swollen, itchy and limited use of affected part for some days afterwards.
( photo: Neville Coleman)


Casualties suffer various degrees of distress depending on the extent of spining. In general, any spined area has instant burning sensations,becoming puffed, white and swollen, eventually turning red,with burning irritations continuing for some time. Casualty may feel faint and show signs of cardiovascular disturbance with increased pulse rate, some chest pain and overall illness.

First Aid Management:

  • Reassure the casualty
  • Reduce shock
  • Bristles appear as fine white tufts and these need to be removed or broken off before any management can proceed
  • Using tweezers or forceps to remove single spines isn’t really practical because they are so fine and fragile they break off.
  • It’s best to scrub out the surface spines on a rock, or in the sand
  • Once the spines are rubbed out the irritation becomes less. Burning and stinging sensations can be alleviated with local anesthetic ointments or lignocaine spray, followed by antibiotic ointments
  • I found that adhesive strips and ointment shielded the wounds from further irritation and the prickly sensations were gone in a couple of weeks
  • Allergic reaction could occur
  • Seek Emergency Service Assistance


Magnificent sea Anemone Heteractis magnifica

The Magnificient Sea Anemone Heteractis magnifica is generally considered to be relatively harmless. However, precautions should be attended if contact with any sea anemones might be encountered. Different people can have varied adverse reactions. ( photo: Neville Coleman)

Injuries from sedentary sea anemones to hands and arms when taking underwater photographs or accidentally touching well camouflaged species when reef walking in pools, looking for shells at low tide, snorkelling or scuba diving. Injuries are liable to become small ulcers if continually wet.

Sea Anemone stings arm

Wounds produced from the Magnificent Sea Anemone when a diver ( in a shortie wetsuit) layed down on it while taking images of anemonefish.
( photo: Neville Coleman)


Immediate pain lasting up to an hour or more. Nausea, shock, noticeable skin damage with white dead skin patterns from the nematocysts surrounded by red tissue and swelling, resulting in deep seated blisters and eventual ulcers. Healing can take up to a month.

First Aid Management:

  • Rescue casualty
  • Reassure the casualty
  • Reduce shock
  • Flush area with vinegar
  • Ice packs reduce pain
  • Manage as for burn – apply cold water
  • Keep wound out of the sun
  • Extra care should be taken if continuing to immerse area in salt water
  • Seek Emergency Service Assistance


Flecker Box Jelly Chironex fleckeri

Flecker’s Box Jelly Chironex fleckeri is the largest of the box jellys and has caused the deaths of well over 60 people. Precautions must be taken when entering the coastal waters unprotected in northern Australia, Papua New Guinea, Indonesia and the malaysian Archipelago. (photo: Neville Coleman)

People swimming, playing, snorkelling, scuba diving, fishing, wading or surfing in and around inshore tropical waters during the months from October to May without full protection are being badly stung or killed by cubomedusae. Death is induced by drowning or heart attack symptoms brought on by the venom’s spasmodic affect on the heart producing cardiac shock by contraction (not allowing the heart to refill with blood for the next beat). Antivenom is available.

Snorkel Lycra Suit

Full body stinger suits, or at the very least shorts and tee shirt are mandatory if entering the waters in northern coastal waters during the months form October to May. There are also many other deadly box jellys in the waters. Some may be smaller , BUT just a deadly.


Instant pain-induced screams, panic due to not knowing or being able to see the assailant. At this stage the casualty may swallow salt water and drown or be rendered unconscious by the excruciating pain. Death generally occurs within the first 15 minutes with very young or elderly victims if badly stung. Whiplash markings are visible within minutes and often develop into thick purple or brown weals. Skin is burnt so badly and so deeply that the lesions appear whitish. Shock and cardiovascular problems are often evident; cold-clammy skin and rapid pulse with irrational behaviour, depression, paralysis and respiratory distress.

First Aid Management:

  • Rescue casualty
  • Reassure the casualty
  • Reduce shock
  • Flush injuries, especially any clinging tentacles with vinegar for 30 seconds. This will inhibit further discharge of any remaining nematocysts
  • If vinegar is not available any clinging tentacles can be picked off with tips of fingers. The skin on fingertips is quite thick and in my experience I felt no stings at all in doing this
  • Apply the Pressure Immobilisation Technique
  • Do not apply pressure bandages over stings untreated with vinegar or to minor stings
  • Resuscitation may be required
  • In the management of pain ice packs do give some measure of relief. Vinegar does not alleviate pain
  • It must be remembered that very few people get stung close to facilities so that in most cases management is limited and distances vast
  • Seek Emergency Service Assistance


For more information, see: Neville Coleman Website and Book Store




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