As part of our Surf Doctor series, SA local Craig Jarvis has been tapping up the world's best surfing doctors on what to do in some of the most dire situations you, or a friend, might find themselves in. Check out what to do if someone has a heart attack in the water HERE, what to do about a shark attack HERE and there's more coming soon.
We are not dealing with shark bites and shark attacks here. That is for a different time and deserves undivided attention. For now, we want to talk a bit about the other sea creatures, and what to do, quickly, if attacked. With facts and information from Surfing Doctors.
The Lion King
My wife and I went snorkelling at the old Lohi's camp in the Maldives. It was many years ago and the island and the camp were still being developed. There was a massive hole in the sand and coral seabed in front of our chalet, where the camp owners had obviously sucked out dead coral and sand to form a foundation somewhere else. We swam off to investigate. Towards the bottom of this hole was a giant turtle. It was gently flapping around in the surges that were circulating. We watched, amazed, as this gentle creature stared back at us, quietly going about its business of scavenging or searching for food.
The pain was still unbelievable and getting worse. I pissed in my boardies
We didn't have swimfins so were just floating with goggles and snorkels. I soon got a little tired from fighting the tidal current on the surface of the water and decided to stand on the lip of the hole, in water that was about four foot deep. I put my bare foot down on the sand and coral, and at once felt a stab of the most intense pain I had ever experienced. I bellowed into my goggles and snorkel, much to my wife's shock. I looked under the water and saw a tiny fish, bristling with all sorts of armour, glaring back and flaring its weaponry at me. I proceeded to doggy-paddle miserably to the shore, sick with pain.
I have a medium pain threshold, but this discomfort was something else. I crawled across the beach with my wife behind me. I was moaning like a child, and I dragged myself onto the bed, close to tears. I looked down at my foot. There was just a tiny blue mark on the fleshy underneath one of my toes. The pain was still unbelievable and getting worse. I pissed in my boardies.
I was panicky, feeling that the amount of pain I was feeling must surely equate to a severe amount of poison in my system. Was the poison going to attack my heart? Was I going to die quickly? Was this the end of me? Was it really going to be an episode of Death In Paradise, in real life?
"Can I maybe get you a drink?" My wife asked, not really knowing what to do at this stage, and above the pain, I let out a little whimper.
As I lay there writhing on the bed, it slowly started feeling better. We got some hot water and started wiping my foot with a cloth soaked in boiling water. Within ten minutes, the pain had gone enough for me to sip on a warm rum and coke without worrying about my impending doom, and with half an hour, I was able to stand again. A little shaky at first, after the adrenalin had run its course.
Later that day, after a shower and a clean up of the bed, we went down to the curio shop, found a book on fish, and identified the fish that had stung me – the Lionfish. A complete bastard that, as the book explained*, has "an elongated dorsal fin spine and enlarged pectoral fins, and each species has a particular pattern of zebra-like stripes. A person punctured by one of the sharp spines will immediately feel intense pain. Rapid swelling of the affected body area develops along with the possibility of making the movement of limbs very difficult."
Lionfish stings can cause nausea, breathing difficulties, paralysis, convulsions and collapse, thus the peeing in my boardies. Even death may occur in exceptional circumstances. Most people, like me, survive despite the great pain, which is ultimately a good result.
The actual procedure should have been something more common-sense based, like this:
• Look for pieces of the spine, and remove.
• Clean the area with soap and fresh water.
• Control bleeding.
• Apply hot water to help the venom break down.
• Take pain medication if available
• Apply a topical antibiotic cream.
• Use an ice pack to reduce swelling.
Similar procedures apply to many marine toxicology situations, although some situations can escalate quickly. Here are a few other animals that could turn on you while surfing.
The bite of a Blue-Ringed Octopus is most likely going to kill you, although they don't bite many people. The venom will paralyse a human, and you will need supplementary oxygen pretty quickly. There’s not much else you can do until you have anti venom, but to make sure airways are operating.
The other shocker is the Box Jellyfish "chironex fleckeri." This is the most venomous sea creature and can cause death in 30 seconds. Mainly found in North Queensland and across to Darwin, you don't want to have a run-in with one of these. The victims quickly start screaming and become irrational, and paralysis occurs quickly.
Vinegar does help in removing the nematocysts (the poison). Anti venom is going to be needed pretty quickly. You’re probably not going to die. It's only when there is full contact with a long stretch of tentacles that death is possible, and most stings actually do not cause severe envenomation. It’s just really painful. So there is that.
The tiny Irukandji jellyfish (1 cubic cm) causes chaos when stung. The worst symptoms are that it generates so much pain, and pushes your blood pressure through the roof to the point you could have a brain haemorrhage. Patients all talk about the impending doom syndrome. Victims who have survived a sting have described the abject terror, the overwhelming feeling of defeat, and doctors have described the awful look of victims experiencing the terror of impending doom. Like getting caught inside at Jaws. Once again, vinegar can neutralise any active cells remaining on the skin.
We all know the pain of a sea urchin. Most surfers have stood on an urchin or 10 throughout a surfing career, and it is pretty straight forward treatment and procedures. Sometimes there are intense venom urchins, but mostly you just need to go through the motions — hot water, and then some digging and needling to remove the spines. Lots of hot water and an antibiotic cream is a good idea for any deep spines that need to be extracted.
You have heard of my story of the Lion Fish, but there is also the terrible Stone Fish, the worst of the venomous fish. Found in the northern waters of Australia and Indonesia, as well as all over Fiji, they can grow up to 47cm in length and have 13 dorsal spines that go straight through shoes, and booties.
The Stone Fish is also renowned for the extreme pain levels it delivers, and the resulting delirium can last for days. It makes you pretty woozy and with a general all-over-the-shop kind of feeling. Immediate procedures include hot water above 45 degrees C, repeated a few times. Removal of all foreign objects and plenty of pain medication and antibiotics.
This fish is a particularly nasty affair, and it has one of the most potent non-protein poisons in nature, a neurotoxin called a Tetrodotoxin. This toxin has a more significant effect on sensory neurones as opposed to motor neurones. The most discussed side effect of the poison is called 'general parasthesia' which victims refer to as 'floating on air.' Unfortunately, this toxin is heat stable and water stable, i.e. it is not destroyed by cooking/boiling water. Actually, there is no antidote, and the only way to get the poison out is full bowel irrigation, and let's leave it at that.
*Lion-fish, Turkey fish, Fire-fish.