There are four techniques that are used to manage bites and stings: pressure immobilisation, ice pack, hot water and vinegar. Each are specific to the type of species that the bite/sting came from, but in all cases we follow DRSABCD, first making sure that the patient and other people in the group are safe.

If you know what animal bit or stung the patient, follow procedures specific to that animal group. Use this Quick and easy table of reference from St John Ambulance to work out the technique to use:

After the incident, ensure that the patient has a current tetanus vaccination. In some cases, pain relief is appropriate g. paracetamol or an antihistamine (to reduce swelling, redness and itch), but consult with a medical professional first.

If you are unsure what animal bit or stung you, apply a precautionary approach, and manage it as though it is a venomous bite, and seek medical help immediately.

The four procedures we’ll cover here are:

• Pressure immobilisation, to reduce the movement of venom in the lymphatic system.
• Ice pack for pain management by reducing the flow of blood to the affected area and reducing inflammation and swelling that causes pain.
• Hot water & vinegar to denature the protein in the stinger.

The pressure immobilisation technique was developed in the 1970s as a technique to slow the movement of venom throughout the body. Research has shown that when pressure is applied to the bite area, less venom reaches the bloodstream.

Pressure immobilisation is appropriate for bites from Funnel-web and Mouse spiders, snakes, Blue-ringed octopus, cone shells and sea snakes. Do not use pressure-immobilisation for spider bites other than from a funnel web spider, jellyfish stings, stonefish and other fish stings, bites by scorpions, centipedes, beetles.

This video from the Australian venom research unit shows how to pressure immobilise a lower limb.

For bites to the lower limb, the Australian venom research unit suggests the following steps:

1. DRSABCD, send for help by calling 000 if in reception, or triggering an emergency beacon.
2. Apply a broad pressure bandage over the bite site as soon as possible. Crepe bandages are ideal, but any flexible material may be used. Clothing, towels etc may be torn into strips. Panty hose have been successfully used. Do not take off clothing, as the movement of doing so will promote the movement of venom into the bloodstream. Keep the bitten limb, and the patient, still. Bandage upwards from the lower portion of the bitten limb. Even though a little venom may be squeezed upwards, the bandage will be more comfortable, and therefore can be left in place for longer if required.
3. The bandage should be as tight as you would apply to a sprained ankle.
4. Extend the bandage as high as possible up the limb.
5. Apply a splint to the leg. Any padded rigid object may be used as a splint. E.g. spade, piece of wood or tree branch, rolled up newspapers etc – with towel or clothing as padding.
6. Bind it firmly to as much of the leg as possible. Keep the patient still and relaxed. Lie the patient down to prevent walking or moving around. Monitor patient and wait for rescue services to arrive.

For bites to other parts of the body, the Australian venom research unit suggests the following.

In all cases, follow DRSABCD, call 000 or trigger an emergency beacon.

Bites to the hand or forearm
Bandage as much of the arm as possible, starting at the fingers. Use a splint to the elbow.
Use a sling to immobilise the arm. Keep the patient still. Lie the patient down to prevent movement walking or moving around.

Bites to trunk
If possible apply firm pressure over the bitten or stung area. Do not restrict chest movement. Keep the patient still.

Bites to head or neck
No first aid for bitten or stung area. Keep the patient still.

DOs and DON’Ts
The Australian venom research unit also makes the following points:

• DO keep the patient still and limit patient transportation as much as possible.
• DO apply pressure-immobilisation first aid even if the venom appears to have already got into the bloodstream: the application of pressure-immobilisation first aid may prevent further absorption of venom from the bite or sting site during transport to hospital.
• DO keep bandages and splints on until the patient reaches medical care.
• DO NOT cut or incise the bitten area.
• DO NOT apply an arterial tourniquet. (Arterial tourniquets, which cut off the circulation to the limb, are potentially dangerous, and are no longer recommended for any type of bite or sting in Australia.)
• DO NOT wash the bitten area or suck the bite. The type of snake involved may be identified by the detection of venom on the skin. If the snake can be safely killed, bring it to the hospital with the victim.

Cold therapy is used for pain management. The idea is to use ice to reduce the flow of blood to the affected area and reducing inflammation and swelling that causes pain.

An ice pack is a plastic sack filled with liquid or gel that can be used to treat injuries including bites and stings, swelling and sprains. Ice packs are generally kept in refrigerators and are often seen in an urban context at sporting competitions.

For remote areas, people can carry instant ice packs instead. These ice packs consist of two separate bags containing ammonium nitrate, calcium ammonium nitrate or urea. When the user breaks the seal between the two bags, the contents mix and cause an endothermic reaction to occur which sucks all the warmth from the surroundings and lowers the ice pack temperature.

Ice packs should be used for red-back spiders (and other spiders excluding Funnel-web and Mouse spiders), bees, European wasps, ants, ticks, scorpions, centipedes. In general, these species cause painful bites, but generally do not lead to medical complications.

For ice pack treatment, St John’s ambulance suggests:

1. Follow DRSABCD (in most cases, SABCD parts are not required).
2. Apply a cold compress or ice pack directly over the bite site to relieve the pain.
3. Seek medical aid if necessary.

Hot water helps to relieve some types of stings by denaturing and inactivating the venom.

For some marine species, immersing the sting area in hot water provides relief, and is the recommended first aid for the following species by St John’s Ambulance: Blue-bottle (Pacific Man-O-War) jellyfish, Bullrout fish, Catfish, Crown-of-Thorns starfish, Stingray, Stonefish and nontropical minor jellyfish. These species can cause fatalities and an emergency 000 call or activation of an emergency beacon must be made.

St John’s Ambulance suggests the following steps:

1. Follow DRSABCD action plan.
2. Calm patient.
3. Place patient’s stung limb in hot water (around 40 ℃). Beware the injured person will have an a distorted sense of pain, so the temperature must be as much as the first-aider can tolerate without causing burns.
4. Ensure call for ambulance has been made – triple zero (000) – or emergency beacon activated.

Likewise, vinegar helps to relieve other types of stings by denaturing and inactivating the venom.

The species that vinegar is the recommended treatment for include:
Box, Irukandji and Jimble jellyfish, sea anemones and tropical marine stings of unknown origin.

St John’s Ambulance suggests the following steps:

1. Follow DRSABCD action plan.
2. Calm patient.
3. Flood stung area with vinegar for at least 30 seconds.
4. If vinegar not available, flick tentacles off using a stick or gloved fingers.
5. Ensure call for ambulance has been made – triple zero (000) – or emergency beacon activated.