Hot water immersion v icepacks for treating pain of Chironex fleckeri stings: a randomised controlled trial

We agree with Little that it is time to standardise first aid recommendations for jellyfish stings, as suggested by Seymour in his editorial.1 Our study adds to the evidence that forms the basis for some of the first aid recommendations for Australian jellyfish stings. However, the use of ice packs or heat will not save lives. The importance of having credible and non-conflicting Australian Resuscitation Council guidelines is that, for Chironex fleckeri envenoming, the critical messages that will save lives will hopefully now get the attention and support that the guidelines should engender; notably, that people and especially children should not enter the sea during the tropical stinger season, and that early cardiopulmonary resuscitation on the beach may prevent death.

In our trial,2 heat or ice were not used before recruiting patients to the study. Lower limb stings were treated in a bath filled with hot water that had passed through a thermostatic mixing valve set at 45°C. For smaller stings, a bucket was used, which was continually refilled with water from the same tap.2 We agree that the severity of stings was less than the severity reported in the previous study by Currie and Jacups.3