Australia has both venomous and non-venomous species of snakes, both of which can lash out and bite, the venomous one injecting venom, the non-venomous potentially puncturing the skin and causing infection. After an Australian snake bite, it common for signs of local damage like bruising or tissue discolouring to be missing, potentially giving the patient and first-aiders a false sense of security. Don’t be fooled! Every snake bite must be considered a medical emergency until resolved, even if the patient presents well.

Getting a positive identification of the snake used to be extremely important in order to administer the correct antivenom, however, the reality is that it is extremely hard to positively identify a snake species in the heat of the moment, and under challenging light conditions. With the advent of polyvalent antivenoms (i.e. antivenoms that work against several species) a positive identification isn’t essential, however, being able to administer a specific antivenom is less likely to cause complications. Having said this, don’t chase after a snake or try to catch or kill it to get a positive identification. Always treat the bite as if the snake was unidentified if the identification is uncertain.

Here, we cover snake species found in the Greater Sydney Region. For other areas of Australia, see this website .

Generally speaking, we can separate venomous snakes into two groups: those with the fangs at the front of the mouth, and those with fangs at the rear. Pythons are a different kind of snake that does not kill its prey with venom but instead squeezes its prey to death.

FRONT FANGED SNAKES

Highly venomous snakes have hollow fangs that are long, thin and hollow. These fangs act like syringes where they are able to quickly deliver venom in one swift bite. Highly venomous species tend to have front fangs.

The following front fanged species are found in the greater Sydney region:

Common Death Adder (Acanthophis antarcticus)
Family: Front Fanged Venomous
Venom: Extremely venomous

Golden-Crowned Snake (Cacophis squamulosus)
Family: Front Fanged Venomous
Venom: Mildly venomous

Eastern Small-Eyed Snake (Cryptophis nigriscens)
Family: Front Fanged Venomous
Venom: Highly venomous

Yellow-Faced Whipsnake (Demansia psammophis)
Family: Front Fanged Venomous
Venom: Mildly venomous

White-Lipped Snake (Drysdalia coronoides)
Family: Front Fanged Venomous
Venom: Mildly venomous

Mustard-Bellied Snake (Drysdalia rhodogaster)
Family: Front Fanged Venomous
Venom: Mildly venomous

Red-Naped Snake (Furina diadema)
Family Front Fanged Venomous
Venom: Mildly venomous

Marsh Snake (Hemiaspis signata)
Family Front Fanged Venomous
Venom: Mildly venomous

Broad Headed Snake (Hoplocephalus bungaroides)
Family: Front Fanged Venomous
Venom: Highly venomous

Tiger Snake (Notechis scutatus)
Family: Front Fanged Venomous
Venom: Extremely venomous

Spectacled Hooded Snake (Parasuta spectabilis)
Family Front Fanged Venomous
Venom: Mildly venomous

Red Belly Black Snake (Pseudechis porphyriacus)
Family Front Fanged Venomous
Venom: Highly venomous

Eastern Brown Snake (Pseudonaja textilis)
Family Front Fanged Venomous
Venom: Extremely venomous

Eastern Bandy Bandy (Vermicella annulata)
Family Front Fanged Venomous
Venom: Mildly venomous

REAR FANGED SNAKES

Rear-fanged snakes are less efficient at injecting venom than front fanged snakes as so must bite and hold their prey in order to envenomate them. This group of snakes has a mix of venomous and non-venomous species. In the greater Sydney region there is one mildly venomous and one non-venomous.

Brown Tree Snake (Boiga irregularis)
Family: Solid Toothed & Rear Fanged
Venom: Mildly Venomous

Green Tree Snake (Dendrelaphis punctulatus)
Family: Solid Toothed & Rear Fanged
Venom: Non-venomous

PYTHONS

Pythons fall into a separate snake family again and are all non-venomous. Pythons do not have fangs, but instead have sharp, backward-curving teeth for grabbing prey.

The two pythons found in the Greater Sydney region are the closely related Carpet and Diamond Python (Morelia spilota).

Carpet Python and Diamond Python (Morelia spilota)
Family: Pythons
Venom: Non-venomous

SNAKE LOOK-A-LIKES

Some lizards with very small or no legs look deceptively like snakes. At a distance, these species can be easily confused with snakes, although close up there are clear differences. Unlike snakes, rest assured legless lizards are non-venomous.

According to the ‘What snake is that’ identification website, the key differences to keep an eye out for are:

• Tongue: Snakes have forked tongues which they use to ‘taste’ the air for scent particles. All species of legless lizards have a fleshy tongue.
• Eyes: Most species of lizards have moveable eyelids. Snakes have fixed transparent scales that cover their eyes which are known as the brille or spectacle.
• External ear openings: All species of legless lizards have external ear openings. Snakes do not have ears, and as a result are unable to hear airborne sound using an ear. Snakes are very sensitive to vibrations and actually have some remnant bones of the ear attached to the lower jawbone.

Here are some great tips to avoid getting surprised by snakes on the track:

• Snakes do not hear in the same way we do, instead they detect vibrations. By walking heavily, you can warn any concealed snakes of your presence, making them more likely to flee on their own accord. By comparison, if a snake is caught unaware and only detects your presence at the last minute, it’s far more likely to get startled, and lash out aggressively.
• If you see a snake on the path, do not disturb it. Tell other people in the group that the snake is there, and give it a wide berth. If you can’t get around the snake, back away slowly and change your route plan.
• Never attempt to touch or move a snake, especially to ascertain if it’s venomous or not. It can be challenging to identify the species of a snake in the heat of the moment, so the best approach is to assume that all snakes are venomous and act accordingly.
• Keep your actions smooth and calm. Avoid waving arms around or making sudden movements that the snake could interpret as hostile.
• Avoid walking through long grass where snakes are easily concealed. It’s easy to accidentally startle or step on a snake.
• If a snake’s head is raised, this could indicate that the animal feels threatened, and it is winding up ready to strike. Take action to reduce the threat to the animal, which most likely means backing away and finding an alternative route.
• Snakes often bask alongside a log. To avoid startling a snake, step onto rather than over logs.
• Snakes are ectotherms, that is, they are dependent on external sources of body heat to function. Hence, it’s common to see snakes out sunning themselves first thing in the morning and may be slow to move away from you.

The bite site may be puncture marks, bleeding or scratches.

Signs and symptoms of a snake bite include:

• Headache
• Impaired vision
• Nausea
• Vomiting
• Diarrhoea
• Breathing difficulties
• Drowsiness
• Faintness
• Problems speaking or swallowing.

St John Ambulance makes the following management recommendations.

THINGS TO DO:

1. Follow DRSABCD .
2. Reassure the patient and ask them not to move.
3. Apply a broad crepe bandage over the bite site as soon as possible.
4. Apply a pressure bandage (heavy crepe or elasticised roller bandage) starting just above the fingers or toes of the bitten limb, and move upwards on the limb as far as can be reached (include the snake bite). Apply firmly without stopping blood supply to the limb.
5. Immobilise the bandaged limb with splints.
6. Ensure the patient does not move.
7. Write down the time of the bite and when the bandage was applied. Stay with the patient.
8. Regularly check circulation in fingers or toes.
9. Manage for shock.
10. Ensure an ambulance has been called.

THINGS NOT TO DO:

• DO NOT wash venom off the skin.
• DO NOT cut the bitten area.
• DO NOT try to suck venom out of wound.
• DO NOT use a tourniquet.
• DO NOT try to catch the snake.

Australia has both venomous and non-venomous species of spiders to humans. As with snakes, treat all spider bites as venomous unless proven otherwise.

DEADLY AND DANGEROUS

Funnel webs have extremely venomous bites. They are among the most deadly spiders in the world, however, fatalities are extremely low since the development of effective and readily available antivenoms.

Mouse spiders are also up there. According to the Australian Museum: “Some mouse spiders have a very toxic venom which is potentially as dangerous as that of the Sydney Funnel-web Spider… Because of their potential toxicity to humans, first aid treatment should be provided as recommended for funnel-web spider envenomation. Fortunately, funnel-web spider antivenom has proven effective in cases of mouse spider bite”.

Redbacks are common across Australian and readily found in urban areas. Although only the female bite is dangerous to humans, more than 250 antivenoms are administered a year over the summer months.

Funnel web spiders (Atracinae)

Mouse spiders (Missulena)

Redback spider (Latrodectus hasselti)

VENOMOUS – PAINFUL BITE

Black house spider (Badumna insignis)

LOW RISK SPIDERS

Wolf spiders (Lycosidae)
Wolf spiders rarely bite, especially if left unhandled. They are common around houses, but low risk to humans.

Trap door spiders (Ctenizidae)

Garden orb weaving spider (Eriophora transmarina)

St Andrew’s Cross spiders (Argiope)

Golden orb weaver (Nephila)

Huntsman spiders (Sparassidae)

White-tail spiders (Lampona)
A common misconception is that white tailed spiders have a deadly bite and cause skin necrosis. Yet, their venom is non-lethal. In some cases, bacterial infection is the biggest source of danger to people that have been bitten.

The NSW government has this advice for avoiding funnel web and redback spider bites:

• Keep your garden free of rubble and rubbish where spiders can hide.
• Wear shoes, gloves and long sleeved shirt when working in the garden.
• Check shoes and households items for spiders.

For bushwalkers, we recommend:

• Take care if moving rocks or logs.
• Wear shoes around campsite, especially at dusk and dawn when it’s harder to see.
• Check shoes and anything else left out for spiders and insects before use.

In general, we split Australian spiders into three medically relevant groups and treat accordingly: big black spiders (funnel webs, mouse spiders), redback spiders and all other spiders.

General signs and symptoms of spider bites include:

• Sharp pain at bite site
• Profuse sweating
• Nausea, vomiting and abdominal pain.

Additional signs and symptoms of a Funnel web spider bite:

• Copious secretion of saliva
• Muscular twitching and breathing difficulty
• Small hairs stand on end
• Numbness around mouth
• Copious tears
• Disorientation
• Fast pulse
• Markedly increased blood pressure
• Confusion leading to unconsciousness.

Additional signs and symptoms of a red-back spider bite:

• Intense local pain which increases and spreads
• Small hairs stand on end
• Patchy sweating
• Headache
• Muscle weakness or spasms.

Possible signs and symptoms of other spider bites:

• Burning sensation
• Swelling
• Blistering.

St John Ambulance makes the following management recommendations:

1. Follow DRSABCD .
2. Lie the patient down.
3. Calm and reassure the patient.
4. Apply management for:

• Funnel-web / Mouse spider
  • If on a limb, apply a broad crepe bandage over the bite site as soon as possible.
  • Apply a heavy crepe or elasticised roller bandage starting just above the fingers or toes of the bitten limb, and move upwards on the limb as far as can be reached (include the bite). Apply firmly without stopping blood supply to the limb.
  • Immobilise the injured limb with splints and ensure the patient does not move.
  • Ensure an ambulance (000) has been called or emergency beacon activated.

• Red-back spider
  • Apply an icepack (cold compress) to the bitten area to lessen pain.
  • Seek medical attention if patient develops severe symptoms.

• Other spider bites
  • Wash with soap and water .
  • Apply ice pack (cold compress) to relieve the pain.
  • Seek medical attention if patient develops severe symptoms.

Special thanks to Fran Van Den Berg for reviewing and contributing to this article:
FRAN VAN DEN BERG
Citizen Science Officer
National Parks Association of NSW

Ticks are parasites that live off blood of humans and animals. Ticks get to blood by attaching themselves to the skin of their host with sharp mouthparts, piercing the skin and injecting saliva into the area to prevent blood clotting. In the case of the paralysis tick, it’s the transfer of the highly toxic saliva from that can have serious medical implications for the host.

Special thanks to Henry Lydecker for reviewing and contributing to this article:
HENRY LYDECKER | PhD Candidate
School of Life and Environmental Sciences | Faculty of Science
THE UNIVERSITY OF SYDNEY

In Eastern Australia, 95% of tick bites are due to the Paralysis Tick (Ixodes holocyclus), and most tick-borne illnesses are the result of a Paralysis Tick bite.

This species may also be referred to as the grass tick, seed tick and bush tick depending upon the development stage: the egg, larvae (around 1mm and light brown in colour when not full of blood), nymph (around 2mm and pale brown) and the adults (4–5mm in length, without blood).

Ticks are usually more likely to be found in more humid, less windy, more dense vegetation, more leaf litter, so avoiding these areas can be a way of dodging tick bites.

Unfortunately, bushwalks generally go through these habitats! Long sleeved shirts and pants are key for reducing the likelihood of tick bites, as well as insect repellent containing DEET or Picardin.

In addition the NSW governemnt website suggests:

• Tuck long pants into socks and long sleeved shirts in pants.
• Use light coloured clothing so that ticks are easier to spot.
• Check yourself regularly for ticks. Tick prone areas include back of the head and neck, groin, armpits and back of knees. Get a friend to check areas like your back that are hard to inspect, or use a mirror.
• After you get home from a trip, put all clothing in a hot dryer for at least 10 minutes to kill any remaining ticks.

Although tick bites are not uncommon in Australia, there has been very little medical research into tick-borne illnesses or best practice in tick removal to date. Here’s the best of our knowledge so far!

For most people, tick bites cause local swelling, redness and itchiness at the bite site, but generally pose no medical problems as long as the tick is removed quickly.

On rare occasions, people development allergic reactions (and even anaphylaxis) to ticks. While rare, allergic reactions can be serious, so consult your doctor if you have a history of allergic reactions with tick bites, or if you are concerned about possible allergic reactions.

There are two main tick-borne diseases that can occur in Australia, Queensland Tick Typhus and Flinders Island Spotted Fever. Very occasionally, ticks bites may lead to tick paralysis.

Queensland Tick Typhus
Queensland Tick Typhus is is a condition caused by a bacterium Rickettsia australis, and is transmitted by the Tick species Ixodes holocyclus and Ixodes tasmani. A blood test is the clinic confirmation of the condition, and is treated with antibiotics (although fatalities have occurred rarely).

Symptoms include:

• Rashes
• Eschars
• Headaches
• Fever
• Flu-like symptoms
• Lymph node tenderness

Flinders Island Spotted Fever
Flinders Island Spotted Fever a condition associated with the bacterium Rickettsia honei, and is also transmitted by ticks.

Symptoms include [note]Stewart RS Flinders Island spotted fever: a newly recognised endemic focus of tick typhus in Bass Strait, part 1: clinical and epidemiological features. Med J Aust 1991;154:94–9; Graves SR, Dwyer BW, McColl D, McDade JE Flinders Island spotted fever: a newly recognised endemic focus of tick typhus in Bass Strait, part 2: serological investigations. Med J Aust 1991;154:99–104[/note]:

• Fever
• Headache
• Myalgia
• Transient arthralgia
• Maculopapular rash
• Cough (in some cases)

Tick paralysis
Very occasionally, ticks bites may lead to tick paralysis, an extremely rare, but severe conditions. In the few known cases, tick paralysis has been have recorded in the very young, very old, or otherwise immunologically impaired.

Early signs and symptoms of tick paralysis to include:

• Rashes
• Headache
• Fever
• Influenza like symptoms
• Tenderness of lymph nodes
• Unsteady gait
• Intolerance to bright light
• Increased weakness of the limbs
• Partial facial paralysis

PET OWNERS BE CAREFUL: Tick paralysis is serious (often fatal) in dogs. Owners walking their dogs near the bush need to check pets carefully afterwards for ticks.

Lymes disease
Lymes disease is a seroius tick-borne disease that if left untreated, the infection can spread through the bloodstream to the brain and heart.

Several species of ticks in Africa, Asia, Europe, and North America are known to carry and transmit species of Borrelia bacteria that are known to cause Lyme disease in humans.

Australian ticks like the Paralysis tick have been suspected as possible vectors of Lyme disease, but multiple studies have failed to find any Borrelia species bacteria in these ticks. The only known species in the Borrelia genus that occurs in Australia is only found in one species of Australian tick that is only known to bite Echidnas [note]Loh, Siew-May, et al. “Novel Borrelia species detected in echidna ticks, Bothriocroton concolor, in Australia.” Parasites & Vectors 9.1 (2016): 339[/note]. This species of bacteria is not in the same group as those known to cause Lyme disease, so it is unlikely to be a health threat.

There are, however, advocacy groups in Australia (Primarily the Lymes Disease Association of Australia) that acknowledge Lymes Disease (or Lyme-like diseases) to occur in Australia, and advocate for Lymes Disease to diagnosed and treated accordingly.

Many health workers and public health researchers believe that Queensland Tick Typhus and Flinders Island Spotted Fever are the most common tick-related health issues in Australia. It is widely suspected that patients who believe they have Lyme’s disease actually have a subclinical infection of tick typhus (although there is currently no research to support this).

Regardless of the label, tick-borne diseases can be serious. Consult your health professional immediately if you have any concerns following a tick bite.

Tick-induced meat-allergies
A peculiar meat-allergy has also emerged in recent years, affecting people found in coastal Eastern Australia. The tick-induced mammalian meat allergy (MMA) has seen some people bitten by paralysis ticks to develop a severe allergic reaction to meat products and sometimes dairy and gelatine. If you believe you have developed red meat allergy, consult your doctor for referral to a specialist.

TRAVELLING ABROAD?
If you travel abroad, consult local guides for information about ticks and tick-borne diseases that are relevant there. If you fall sick upon returning to Australia, make sure to discuss your travel with your doctor.

The NSW government health website suggests the following for tick removal:

“Ticks should be removed as soon as possible using fine tipped forceps or fine surgical scissors. Hold the tick as close as possible to the surface of the skin and pull with steady pressure. Avoid squeezing the body of the tick during removal. If you are unable to do this, see your doctor to remove the tick. Do not use methylated spirits, nail polish remover, alcohol, petroleum jelly or any other products on ticks prior to removal as it will cause the tick to inject more toxins.
Note: In individuals with a history of allergic reactions to tick bites, ticks should be removed as soon as possible, but only by a doctor and where resuscitation facilities are readily available”.

After removal, apply antiseptic cream to the bite area. If tick removal is difficult, or you begin to suffer rash, swelling, signs of infection, muscle weakness in the bite site area or flu like symptoms, seek medical attention urgently.

DO NOT:

• Do anything to irritate the tick because this makes it harder to completely remove it (e.g. squeezing, rubbing, scratching).
• Grasp the tick by the body.
• Apply methylated spirits, kerosene or fingernail polish.
• Use a lighted match, or cigarette.

NOTE

The Australasian Society of Clinical Immunology and Allergy recommends killing ticks by freezing them off using ether-containing sprays (e.g. Wart-Off Freeze®, Elastoplast Cold Spray®). This method is still in the research and development phase, and while promising, is not currently recommended by the NSW government health website.

A recent literature review published in early 2017 concludes [note]Coleman N and Coleman S. Methods of tick removal: A systematic review of the literature. AMJ 2017;10(1):53–62[/note]:
“The best method is to remove the tick as soon as possible after it is detected, using either fine-tipped tweezers or a reputable commercially produced tick removal tool to pull the tick away from the site of attachment……Other methods of removal, such as freezing, while promising, have not yet been scientifically validated.”

So the conclusion is: stick to tweezers, until other methods are validated.

Here we run through all the other common creepy crawlies found in NSW that bite and sting (information based on articles from the Australian museum).

Bed Bugs (Cimicidae)
Bedbugs are blood feeders and most active at night. Reactions vary from none to severe irritation and localised swelling.

Honey bees (Apis mellifera)
Bees sting as a last resort defence mechanism killing themselves in the process as they drive a barbed stinger into flesh. Bee stings generally cause local pain and swelling, but can cause severe allergic reactions in some cases.

European wasps (Vespula germanica)
Unlike bees, wasps do not die upon stinging. Stings generally cause local pain and swelling, but can cause severe allergic reactions in some cases.

Biting and non-biting flies
Within Australia, horse flies or March flies (Family Tabanidae) are the most significant biting flies. House flies (Musca domestica) can also cause problems by carrying millions of bacteria in its gut, mouthparts or feet.

Mosquitoes (Culicidae)
Mosquitoes are blood suckers that carry diseases such as malaria and transfer the disease to humans via salivary glands. Malaria is not a major health problem In Australia, but other mosquito-borne diseases are increasing (e.g. Ross River Virus, Dengue and Murray Valley Encephalitis).

Ants
Myrmecia (the bull ants and jack-jumpers) and Odontomachus ants are aggressive animals with the potential to inflict painful stings. Ants can pose threats to people with allergic reactions.

Scorpion
Found under logs, rocks and in shallow burrows in earth banks. Can inflict painful sting.

Centipede
Found under logs, rocks and in shallow burrows in earth banks. Can inflict painful sting.

Caterpillar
Australian Lepidoptera (moths and butterflies) have caterpillars with stinging hairs and/or fragile spines which can cause painful stings to people that accidentally touch them.

In general, with all creepy crawly bites, wearing insect repellent, long sleeved clothing and checking shoes before putting them on are good ways to minimise the risk of being bitten.

The NSW Health Direct website lists 6 common signs and symptoms of creepy crawly stings:

1. An intense burning feeling.
2. Redness around the sting site.
3. Pain which generally eases after an hour or so.
4. Swelling around the sting.
5. In cases of allergic reaction, swelling may be more severe and affect a larger part of the body, for example the whole leg or arm may become swollen.
6. Allergic reactions may cause further swelling, pain and in some cases blisters will form.

By comparison, a creepy crawly bite that only leaves a puncture mark on the skin, generally has the following signs and symptoms:

• Skin irritation;
• Inflammation or swelling;
• A bump or blister around the bite mark.

Skin rashes, itching, stinging sensations, and/or swelling are all common. On rare occasions, patients go into Anaphylactic shock.

Itching is a common outcome of creepy crawly stings, but scratching the itch can cause more damage by breaking the skin and opening a wound to infection.

The Australian governement health website recommends the following steps to relieve itching:

• Try not to scratch the area – keep your nails short to prevent breaking the skin if you do scratch.
• A cool bath or shower may help to soothe the itching – gently pat yourself dry with a clean towel, but do not rub or use the towel to scratch yourself.
• Avoid perfumed skin care products.
• Try to wear loose cotton clothing, which can help prevent you overheating and making the itch worse – avoid fabrics which irritate your skin, like wool or scratchy fabrics.
• An ice pack may relieve the itching but should not be placed directly against the skin – you can make an ice pack by using a bag of frozen peas wrapped in a clean cloth.
• There are medicines available to ease the symptoms of itching – speak to a pharmacist for further advice and to make sure any medicines you take are suitable for you.
• If you are in pain, get advice on medicines from a pharmacist, or from a doctor on medicines you can take.

Bee stings
The Australian governement health website recommends the following steps if you are stung by a bee:

• Do not use tweezers to remove the sting; bees leave behind a sac of venom, and if you try to use tweezers you will release more venom from the sac.
• If the stinger is still in the skin, gently try to remove it by scraping it carefully from the side with the edge of a firm object, such as a fingernail or credit card.
• When you have removed the sting, wash the affected area with soap and water and dry the area gently.
• If the pain is persistent and continues, massage the area around the sting or bite for 10 minutes using an ice-pack. This will only provide temporary pain relief.

Mosquito bites
The Australian government health website recommends to wash the area with soap and water and apply antiseptic. Cold packs may help with local pain and swelling.

Scorpion or centipede
The Australian government health website recommends the following steps if stung by a scorpion or centipede stings:

• Apply an ice pack to the sting or bite site.
• Clean the wound with antiseptic or wash with soap and water to help prevent secondary infection.
• Use a painkiller.

Caterpillar
The Australian government health website recommends to take these steps if stung by a caterpillar:

• Remove visible caterpillar hairs with tweezers.
• Apply and remove adhesive tape to the area to remove the finer caterpillar hairs.
• Do not scratch or rub the area, this may cause the hairs to penetrate deeper into the skin.

Special thanks to Margot Law for reviewing and contributing to this article:
Margot Law
Citizen Science Officer
National Parks Association of NSW

There are a lot of marine creatures that bite or sting, an evolutionary development to defend and hunt underwater. Some deliver venom via spines, tentacles or teeth, while others aren’t venomous but have sophisticated teeth for attacking prey and defending themselves (e.g. sharks).

The most common marine stings are from jellyfish, mainly bluebottles, followed by spiny fish and stingrays. Box jellyfish are the most dangerous, but only found in the tropics. Likewise blue-ringed octopi and sea snakes pose significant risks, but are attacks are uncommon.

We can split marine species into a few groups: animals that are lethal and non-lethal (i.e. those that give a painful bite)

HIGHLY VENOMOUS

• Box jellyfish (Cubozoa)
  The box jellyfish is the most venomous animal in the world and can cause cardiac arrest within minutes. Box jellyfish are a significant threat, but in the tropics only.
  
  

  Photo credit: gautsch. via Foter.com / CC BY-SA

• Blue-ringed octopus (Hapalochlaena)
  The blue-ringed octopus is a small but deadly creature with enough venom to kill 26 humans. Bites are often painless, resulting in victims not being aware that they’ve been bitten until severe symptoms set in. To make matters worse, there is currently no blue-ringed antivenom, putting it high on the list of deadliest marine creatures.
  However, whilst blue ringed octopus venom is deadly there have only been three deaths in the last century, two in Australia. It’s most important though to avoid turning over rocks in shallow water, especially with bare hands as this is when you can be bitten.
  
  

  Photo credit: Angell Williams via Foter.com / CC BY

• Sea snakes (Hydrophiinae)
  Although the majority of sea snakes are highly venomous, venom injection is rare and very few human fatalities have been reported. They are another species that is only found in tropical waters. Under these conditions, be wary of sea snakes and manage all bites as though venom has been injected. Nevertheless, be wary of sea snakes and manage all bites as though venom has been injected.
  
  

  Photo credit: Daniel, Daniel Kwok via Foter.com / CC BY-NC-ND

• Irukandji jellyfish
  Irukandji are small jellyfish with four long tentacles. Their tentacles can be as small as few centimetres long up to 1 metre. Victims report excruciating pain that is delayed starting for 5-120 minutes, but can last for months. Although often hospitalised, fatalities are rare (3 reported over the last 100 years).

News.com.au reports the following experiences from a victim:
“I cannot begin to explain how excruciating the pain is,” jellyfish toxicologist, Professor Jamie Seymour of James Cook University, told news.com.au.
“I’ve been stung 11 times and each time I’ve ended up in hospital.
“It’s very mild to start with, then it takes about 15 to 20 minutes to kick in and it’s overall mind-numbing horrific pain.
“The last time I got stung across the top of my lip, then I got pins and needles in my feet, pain like red hot pokers in my joints and then overwhelming racking body pain and throwing up for 18 hours.”




Photo Credit: Marc McCormack, Source:News Corp Australia

Whilst Irukandji stings are historically rare,there are concerns that the threat is increasing and heading further south from the tropics. It is hard to know as Irukandji stings are often difficult to prove as the animal is so small and symptoms are delayed.

• Stonefish (Synanceia)
  Stonefish are highly venomous and can be fatal if not treated. Often, stings are the result of accidentally stepping on the fish as it is well camouflaged against rocks and coral. Amazingly, stonefish are able to stay out of water for up to 24 hours, so it’s possible to get stung by an individual washed up on the beach. Stonefish antivenom is the second-most administered in Australia.
  
  

  Photo credit: Bill & Mark Bell via Foter.com / CC BY-NC-SA

• Scorpion fish
  Scorpion fish are found in shallow waters around Sydney and are often seen by divers. They have sharp spines coated in a venomous mucus that stings and a puncture to the chest or abdomen may be fatal. Scorpionfish are the most likely animal to cause a painful sting in NSW as they are so common. They are rarely fatal but the sting is debilitating. You are most likely to be stung by putting your hand on one accidentally – so when in the water don’t touch!
  
  

  Photo credit: Marine Explorer via Foter.com / CC BY-NC-SA

VENOMOUS
Here, we list species that tend to give painful to excruciating bites, but are generally non-leathal. However, be warned, without appropriate medical action, each species still has the potential kill (e.g. patient experiences a severe allergic reaction, breathing difficulties, or has small body frame – children at risk).

• Blue-bottle (Pacific Man-O-War) jellyfish (Physalia physalis)
  Blue bottles are common throughout marine areas of Australia, and an unwelcome guest for beachgoers. Bluebottle threat is mostly when there is an onshore breeze as this blows the animals on to beach areas. They are between 2-15 cm, and more common on exposed ocean beaches rather than protected waters. A sting, while uncomfortable, is not life-threatening, however, for the very young or elderly there may be medical complications. Avoid the temptation to poke or play with washed up bluebottles as stinging cells in the tentacles may still be active.
  
  

  Photo credit: Biusch / CC BY-SA 3.0

• Jimble jellyfish (Cubozoan)
  Although related to the Box jellyfish, the Jimble jellyfish is nowhere near as potent. It is the only Cubozoan that lives in colder Australian waters, and is occasionally present in high densities in Sydney Harbour.
  
  

  Photo credit: https://australianmuseum.net.au/uploads/images/3476/jimble_big.jpg

• Coneshells
  Brightly coloured coneshells are armed with small harpoons that can sting. Although most stings are no worse than a bee sting, in Australia, there are tropical species that have caused human fatalities. Hence, all species must be treated as potentially dangerous.
  
  

  Photo credit: richard ling via Foter.com / CC BY-NC-ND

• Catfish
  Catfish are recognised by their distinctive whiskers around their mouth. They also have sharp, bony spines on the edges of the dorsal and pectoral fins with venom that lock into place when they are threatened. Catfish stings are extremely painful at the site of the sting.

  On the east coast of Australia, the best known species is the eel tailed catfish, which occurs in coastal rivers.
  

  

  Photo credit: Sylke Rohrlach via Foter.com / CC BY-SA

• Crown-of-Thorns starfish (Acanthaster planci)
  Crown-of-Thorns has a very wide Indo-Pacific distribution, and is increasingly common around Australia. Crown-of-Thorns lives on corals so it is only found in northern NSW. Since the 1960s there have been population outbreaks where overabundance of the starfish put pressure on the coral species they feed on and coral goes into decline. Overpopulation of the starfish is a concern for vulnerable coral with slow regeneration rates.

  This starfish has spines that can perforate human skin causing sharp pain, persistent bleeding, tissue swelling and nausea. Embedded spines need to be removed surgically.
  

  

  Photo credit: Misenus1 via Foter.com / CC BY-NC-SA

• Stingray (Myliobatoidei)
  Stingrays have stingers on their tails that can cause pain, swelling, muscle cramps from the venom. Although death is rare, is can happen. Most famously, Steve Irwin was killed in 2006 when the stinger penetrated his thorax.

  The Black Stingray is one of the largest stingrays in Australia, and is found off the coast of Sydney. Although venomous, they are not usually aggressive towards humans. This video beautifully captures how the stingray moves in water: https://www.youtube.com/watch?v=VPfXvWrVK3Y&feature=youtu.be
  

  

  Photo credit: Marine Explorer via Foter.com / CC BY-NC-SA

Stingrays and stingarees are only dangerous if provoked, that is, if you grab them or accidentally tread on them. If walking in shallow water shuffle your feet sideways rather than stepping high – this moves them out of your way if they are around.

• Sea Urchins
  A relative of starfish, sea urchins are found on coral reefs, rocky shores and beaches. They feed on plant matter growing on ocean surfaces, or burrow to find decaying matter. Black Sea Urchins (Centrostephanus rodgersii) are the most common species found in Sydney waters and are recognised by their distinctive black spikes.
  
  

  Photo credit: Marine Explorer via Foter.com / CC BY-NC-SA

  The mostly likely injury from any urchin species is a spine in you, especially from a black urchin as they are super-abundant in swimming, snorkeling and diving areas around Sydney.

  The Toxic flower urchin (Toxopneustes pileolus) has also been sighted around Sydney. It’s considered dangerous as it can deliver medically significant (and extremely painful) stings when touched – avoid touching!

  Other venomous urchins include Diademas and Sea lamingtons (Tripneustes gratilla).
  

  

  Photo credit: Misenus1 via Foter.com / CC BY-NC-SA

  
  
  

  Photo credit: Marine Explorer via Foter.com / CC BY-NC-SA

  Diademas look very similar to the Black Sea Urchins, but are distinguished by the blue v-shaped flecks on the body and their much sharper, longer spines. Their spines have venomous tips.

  Sea lamingtons (Tripneustes gratilla) are usually found in tropical waters, however, they have been sighted in Sydney harbour. In general, they are a common, but not dangerous species.

OTHER

• Shark Bites
  Shark encounters are incredibly rare, and when they do occur, often attract significant media attention. Thus, the risk of attack often appears much higher than it actually is.

  Data from the Australian Shark Attack File (ASAF) on shark attacks over the last 20 years, shows that shark fatalities remain low, at 1 fatality per year[note]West, John G. “Changing patterns of shark attacks in Australian waters.” Marine and Freshwater Research 62.6 (2011): 744-754[/note]. West 2011 also highlights that the seeming increase in attacks is related to an increasing human population and therefore increased water-use for recreation: “The increase in shark attacks over the past two decades is consistent with international statistics of shark attacks increasing annually because of the greater numbers of people in the water”.

  Most shark species are not dangerous. Even large species like the grey nurse shark (Carcharias taurus), where females can reach up to 2.2 m in length. It’s commonly thought that shark attacks on humans are mostly a case of mistaken identity; sharks thinking that a human is something else like a seal for instance (surfers from below resemble the shape of seals), and taking an exploratory bite. In most cases, the shark does not come back after one bite, and less than a third of attacks are fatal[note]West, John G. “Changing patterns of shark attacks in Australian waters.” Marine and Freshwater Research 62.6 (2011): 744-754[/note].

  

  Great White Shark. Photo credit: Elias Levy via Foter.com / CC BY

  
  
  

  Tiger Shark. Photo credit: kris-mikael.krister via Foter.com / CC BY

  
  
  

  Bull Shark. Photo credit: AlKok via Foter.com / CC BY-NC-SA

The Australian government has the following recommendations for avoiding marine bites and stings:

• Swim at patrolled beaches between the red and yellow flags and inside stinger nets if they’re available.
• Don’t enter the water when the beaches are closed.
• Wear a full-body lycra suit for extra protection (particularly from tropical stingers during stinger season).
• Don’t touch marine stingers if they are on the beach – they can still sting you.
• Enter the water slowly to give marine stingers time to swim away.
• Ask a lifeguard for help or advice if needed. While Box jellyfish are a significant threat, it can be reduced by covering up all bare skin (like wearing a thin rash suit) and in some areas swimming is simply avoided during the threat period (spring and summer).
• Additional advice:
  • Do not deliberately provoke, disturb or touch marine wildlife.
  • Avoid turning over rocks in shallow water, especially with bare hands – this is when you can be bitten by animals like the blue ringed octopus.
  • If walking in shallow water, shuffle your feet sideways rather than stepping high – this moves Stingrays and stingarees out of the way if they are around and resting on the seafloor.
  • Obey instructions from lifeguards and landmanagers – do not enter the water if beach is closed.

After any marine bite or sting, seek medical help immediately if you experience:

• Difficulty breathing
• Difficulty remaining conscious
• Chest pain
• Swelling around the sting site
• Vomiting
• Spasms
• Shock
• Severe bleeding

For stingrays, symptoms include intense pain, nausea, weakness, and fainting. For tentacled creates, symptoms are rashes, blisters, headaches, chest pain, muscle pain, sweating and runny nose. For coneshells, reactions include swelling, numbness, blurred vision, and respiratory failure. In rare instances, a person may experience cardiac arrest.

Adapted from St John’s Ambulance guidelines.

Pressure immobilisation	Cold compress (ice pack)	Hot water	Vinegar
Funnel-web and Mouse spiders	bees	Blue-bottle (Pacific Man-O-War) jellyfish	Box jellyfish
snakes	wasps (European)	Bullrout fish	Irukandji jellyfish
Blue-ringed octopus	ants	Catfish	Jimble jellyfish
coneshells	ticks	Crown-of-Thorns starfish	sea anenomes
sea snakes	scorpions	Stingray	tropical marine stings of unknown origin
	centipedes	Stonefish
	Red-backed spider	non-tropical minor jellyfish
	all other spiders

Pressure immobilisation

1. Follow DRSABCD.
2. Calm patient and keep still.
3. Apply a pressure immobilisation bandage.
4. Ensure call for help has been made—triple zero (000) – or emergency beacon activated.

Cold Compress

1. Follow DRSABCD.
2. Calm patient.
3. Apply a cold compress or ice pack directly over the bite site to relieve the pain.
4. Seek medical aid if necessary.

Hot Water Treatment:

1. Follow DRSABCD.
2. Calm patient.
3. Place patient’s stung limb in hot water (as hot as you, the first aider, can tolerate).
4. Ensure call for help has been made—triple zero (000) – or emergency beacon activated.

Vinegar Treatment:

1. Follow DRSABCD.
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 help has been made—triple zero (000) – or emergency beacon activated.

Special thanks to John Turnbull for reviewing and contributing to this article:
John Turnbull
Author of Marine Explorer and Ex-President of National Parks Association of NSW.

We are pretty familiar with insects and animals that bite and sting. The plant world also has a few unfriendly ways of arranging protection, with some making you itchy whilst others can leave you in pain for months. Soft-skinned walkers beware. It seems that Australia can boast that we have the most painful plant in the world, the Stinging Tree. Somehow this makes us a little proud….

Remember that it’s not just the living trees that sting, it’s dead leaves too. That means that if you spot a stinging plant, beware of leaf litter surrounding the area too.

Stinging trees are generally found in rainforest on the eastern parts of Australia. Australia has four common types: two that are large rainforest trees growing up to 30 to 35 m. The other two, only bushes often between 0.1 to 1m tall. All four species have a similar stinging mechanism but D. moroides (the Gympie Gympie) is generally considered to have the worst sting.

Gympie-gympie (Dendrocnide moroides)
Common names	stinging bush, gympie stinger, mulberry-leaved stinger, gympie gympie, gympie, stinger or moonlighter
Tree height	around 2 metres
Leaf size	large vaguely heart shaped leaves (about the size of your hand)
Link on Wiki	Gympie-gympie

Giant stinging tree (Dendrocnide excelsa)
Common names	Australian nettle tree, fibrewood, gimpi gimpi, giant stinging tree, gympie
Tree height	over 30 metres high
Leaf size	leaves are large and heart shaped with serated edges, however unlike the D. moroides, the D. excelsa’s leaves join the stalk at the notch between the overlapping lobes
Link on Wiki	Giant stinging tree
Location	found in rainforests in NSW and southern QLD

Shiny leaf stinging tree (Dendrocnide photinophylla)
Common names	fibrewood, small-leaved nettle, mulberry-leaved stinging tree, and gympie
Tree height	similar to the Giant stinging tree, but much narrower, up to 20 metres
Leaf size	leaves are glossy on the upper surface, long and narrow shaped (6-12 centimetres long) with wavy or sometimes toothed margins
Link on Wiki	Shiny leaf stinging tree
Location	found in rainforests on the east coast of Australia between Sydney to Cooktown

Atherton Tableland stinger (Dendrocnide cordata)
Common names	gympie, stinger
Tree height	up to 4 metres
Leaf size	heart shape leaves but with a broad notch at the base which is inserted the leaf stalk
Location	found on the Atherton Tablelands

As a general rule, if you are unsure or can’t remember the specific features of stinging trees, keep clear of plants with heart-shaped leaves with saw-toothed margins that look furry.

Other stinging plants are the ground-hugging nettles. They occur in many different environments, but particularly wet, shady areas.

How do they sting?
The leaves and some branches and fruits of Stinging Tees are covered in tiny hairs, hollow silica needles that range in length from 0.2 to 2 millimeters. They look deceptively soft and furry, yet they are effectively glass hypodermic needles. Do not touch!

Interestingly, it seems that the pain is not just because of the needles but due to the fact they carry a neurotoxin. According to an ABC article “One scientist, Oelrichs, purified the poison and injected himself with it and suffered intense pain. He proved that the toxin, not the silicon hairs, caused the pain. If you have stabbed yourself with the hairs, you can release the neurotoxin from the hairs by heating or cooling your skin, or just touching it. This neurotoxin is very stable. Experiments have been done with hairs that were collected nearly a century ago, and they can still cause pain.” This article goes on to point out two interesting facts. Firstly, that the tree seems to have no effect on most Australian native animals. Secondly, and more interestingly, is that the plant does not seem to do any actual damage to your body. Unlike the venom from a snake or spider that causes damage to your body in many ways, this toxin seems to “just” cause pain.

Signs and symptoms – how bad is the sting?
The sting of Stinging Trees is pretty bad! In fact, after being stung by a stinging plant the pain can recur for more than two months. And it’s not just the living leaves that sting, dead leaves too can cause problems.

“Stinging trees (Gympie-Gympie) are the bane of people in the Australian tropical and sub-tropical coastal areas – especially after disturbances such as cyclones, which trigger the germination of seeds. It becomes quite an issue when children wander into small plants – and are really badly stung.”

Poisonous plants of Australia by Selwyn Everist (1974) has 684 pages – a lot of poisonous plants. At page 515 he says the following about stinging plants: “If the leaves or the twigs make direct contact with the skin, the hollow, silica-tipped hairs penetrate and there is at first a slight itch, followed in a few seconds by a severe prickling effect which quickly becomes intense pain of a complex nature. The pain is described … as composed of a background of tingling on which is superimposed an intermittent stabbing pain with sharp radiations passing in all directions.” He goes on to say the pain lasts for around eight hours (maybe 30 hours). The pain then can continue to recur for more than two months. More recent research cited by the ABC suggests that the “The pain comes immediately after touching the plant, and it gradually increases to a peak after about 20-30 minutes”. On top of this, it seems that some people can be allergic to the sting and suffer life-threatening anaphylactic shock, although deaths are very very rare.

Prevention
So let’s not allow these plants stop us from heading bush. Avoid the need for first aid by learning to spot these plants and giving them the respect they deserve. They are part of the Australian native ecosystem and deserve their space. Oh, and make sure you always have enough toilet paper so there is no risk of grabbing a leaf from one of these trees by mistake.

• Know how to ID plants
• Protective clothing: When walking in some areas, body armour could help :), but since the trees generally grow in warmer areas this has limited practical application. Long thick pants, a shirt and a hat can help protect from brushing against the leaves. Wearing thick gardening gloves will also reduce the risk of getting stung if your hands grab a leave or branch. Just be aware through that the clothes and gloves may collect needles whilst you are walking – so be mindful of this when removing and handling the clothing.

Management
Always work through the standard DRSABCD protocol. Avoid anyone else getting stung.

For stinging trees
The federal government healthdirect website suggests that you follow these four points:

1. The most important thing is that you do not rub the area, as this can break off the hairs and make them very difficult to remove,
2. Remove visible hairs with tweezers,
3. Apply and remove adhesive tape or hair removal wax strip to the area to remove the finer hairs, and
4. Do not scratch or rub the area, this may cause the hairs to penetrate deeper into the skin.

This simple treatment was developed in the 1990’s by Dr.Hugh Spencer of the Australian Tropical Research Foundation (AUSTROP). Although the original recommendation is to use the sugar-based depilatory “Waxeeze”, which is readily available from most pharmacies, any wax strip-based depilatory will work.

The rationale is to remove the hairs without disturbing them. Remove the visible hairs manually and then remove the remaining smaller hairs using wax strips. If the wax isn’t pre-applied to the strips, then first spread it onto cloth or strips. Do not apply wax directly to the skin because it’s likely that the hairs will break, causing immense pain to the patient, and making them hard or impossible to remove.

The use of pain relieving medication may also help reduce the signs and symptoms.

In 2013, AUSTROP published their updated protocol to deal with stinging trees via a blog post. They have had positive that applying a dilute solution of hydrochloric acid soaked in a cloth on the affected area will help neutralise the proteins. This is reported to be very painful for around 5-10 minutes but “the pain and after-sensitivity is completely gone in about 12 hours after treatment (as opposed to waiting for 3-6 months!)”. Although this method has been the subject of several student studies, the research base for it is very limited, and we strongly suggest that you speak with your doctor before trying this or before adding any hydrochloric acid to your first aid kit.