Bites and stings – first aid

Many animals and insects can bite or sting. Most bites and stings cause only minor symptoms and can be treated on the spot with a basic first aid kit. A few, however, are serious and need a fast, calm response: this may mean applying a pressure bandage, immobilising the affected limb, and keeping the person still until medical help arrives.

Whatever the cause, try to stay calm and reassure the injured person. Do not apply a tourniquet, and do not cut the wound.

When pressure bandaging and immobilisation are used#

Pressure bandaging and immobilisation help slow the spread of venom, but they are only recommended for certain bites and stings. They are used for:

• snake bites (including sea snakes)
• bites from highly venomous spiders such as funnel-web and mouse spiders
• blue-ringed octopus bites
• cone shell stings

They are not recommended for most other bites and stings, where pressure can increase pain or is simply not helpful.

How it works#

The lymphatic system is a network of vessels that drains fluid (lymph) from the body’s tissues back into the bloodstream. Bandaging the wound firmly compresses the nearby lymph vessels, which helps keep venom from leaving the puncture site. Immobilising the limb slows the spread further, because the lymphatic system relies on muscle movement to push lymph through its vessels.

How to apply a pressure bandage and splint#

• Keep the person calm and still. Lie them down if possible.
• Remove any jewellery from the limb if you can do so easily.
• Apply a broad pressure bandage over the bite site. If you have no bandages, use whatever is available, such as towels or strips of clothing.
• Mark the bite site with an “X” using a pen or marker, so it can still be seen on the outer bandage.
• Apply a second, firmer bandage using a heavy crepe or elasticised roller bandage (10–15 cm wide). Start just above the fingers or toes and work up the limb.
• Make the bandage firm but not too tight. You should not easily be able to slide a finger between the bandage and the skin, but it should not cause numbness, tingling or any colour change in the fingers or toes.
• Keep checking the colour, temperature and feeling in the fingers or toes.
• Splint the limb using any rigid object (such as a piece of wood or a rolled magazine) gently bound to it, so the limb cannot move. For a leg, you can bind both legs together to limit movement.

Keep the person lying down and completely still. Do not let them walk to the rescue vehicle – bring the vehicle as close to them as possible. Write down the time of the bite and the time the bandage was applied.

Important: Do not cut the wound, do not try to suck out the venom, and do not give the person alcohol to drink. A tight tourniquet to cut off blood flow is no longer recommended.

Snake bites#

Snakes are most active in warm weather and are often found near wetlands and waterways. If you see a snake, stay calm and move away from it.

A snake bite is not always obvious. Some people may not feel the bite, and symptoms may take an hour or more to appear. Treat any suspected snake bite as an emergency and act quickly.

Signs and symptoms may include:

• bite marks on a limb, ranging from obvious puncture wounds to almost invisible scratches
• pain, swelling, bruising or bleeding at the bite site
• swollen, tender glands in the groin or armpit of the bitten limb
• faintness, dizziness or nausea
• initial collapse or confusion, sometimes followed by partial recovery

First aid for snake bite#

• Lie the person down, ask them to keep still, and reassure them.
• Remove jewellery from the limb if you can.
• Apply a broad pressure bandage over the bite site and mark it with an “X”.
• Apply a firm elasticised roller bandage (10–15 cm wide), starting just above the fingers or toes and working up the limb as far as you can reach. Apply it as firmly as possible.
• Immobilise the limb with a splint and keep the person completely still.
• Keep checking the colour, temperature and feeling in the fingers or toes.
• Note the time of the bite and when the bandage was applied.
• Do not wash venom off the skin or clothing – it may help identify the snake.
• Call your local emergency number for an ambulance and stay with the person until help arrives.

Spider bites#

Treatment depends on the type of spider and whether it is venomous. Most spider bites cause only minor, local symptoms, but a few species can cause serious illness.

General symptoms of a spider bite may include sharp pain at the site, swelling, blistering, sweating, nausea and abdominal pain.

Bites from highly venomous spiders (such as funnel-web and mouse spiders) can cause more severe symptoms, including profuse sweating, increased saliva and tears, muscle twitching, difficulty breathing, a fast pulse, high blood pressure, and disorientation or confusion leading to unconsciousness. These are medical emergencies: follow the basic resuscitation steps (check for danger, response, airway, breathing, and start CPR if needed), apply a pressure bandage and splint, and call your local emergency number.

For other spider bites, including those that cause muscle weakness or spasms, life-threatening reactions are uncommon. First aid:

• Lie the person down, keep them still and reassure them.
• Wash the affected area with soap and water.
• Apply a cold pack or iced water for 15 minutes, and reapply if pain continues.
• Use simple pain relief such as paracetamol (acetaminophen).
• Do not bandage the area, because pressure will increase the pain.
• Seek medical help if symptoms worsen.

Scorpion stings#

Scorpion stings vary widely between regions; some species cause only painful, local swelling that may last a few hours, while others can be dangerous.

• Apply a cold pack to the sting area for 15 minutes, and reapply if pain continues. Change the cold pack as needed to keep it cold.
• Use simple pain relief such as paracetamol.
• Seek medical attention if the pain worsens.

Bee stings#

Bee stings can cause anything from mild, temporary pain to significant swelling or a severe allergic reaction.

• Remove the sting as soon as possible by sliding or scraping it out with a fingernail, rather than pulling at it.
• Wash the area and apply a cold pack to reduce swelling.
• For significant pain and swelling, an over-the-counter pain reliever (such as paracetamol) or an antihistamine may help.

If the person is allergic to bee stings, they may develop anaphylaxis, a severe and life-threatening reaction. If this occurs, they need an injection of adrenaline (epinephrine) from an auto-injector (such as an EpiPen®). Lay the person flat, give the adrenaline if available, keep them completely still, and call your local emergency number.

Anyone stung in the mouth, or stung many times in one incident (more than 10 times for adults or more than 5 times for children), should be taken to hospital.

Wasp stings#

Unlike bees, wasps do not leave a stinger behind, so there is nothing to remove. Wasps release a scent chemical (pheromone) that can alert other wasps to attack.

• Clean the area with soap and warm water.
• Apply a cold pack to reduce swelling and pain.
• Use pain-relieving medication or creams as needed. An over-the-counter pain reliever (such as paracetamol) or an antihistamine may help with significant pain and swelling.
• Prolonged swelling at the sting site may respond to antihistamines – seek medical advice.

Around 1 in 10 people stung two or more times become allergic, which means a future sting could trigger anaphylaxis. Anyone stung in the mouth, or stung many times (more than 10 times for adults or more than 5 for children), should go to hospital. Call your local emergency number if needed.

Ant and centipede stings#

Like bees and wasps, ant stings can carry a risk of severe allergic reaction.

• Wash the area and apply a cold pack to reduce swelling.
• For significant pain and swelling, an over-the-counter pain reliever (such as paracetamol) or an antihistamine may help.

If the person is allergic to ant stings, they may develop anaphylaxis and will need an adrenaline injection (such as an EpiPen®).

Centipede stings can be treated with a cold pack to reduce swelling.

Tick bites#

Ticks are parasites that feed on blood. Although there are many species, some can cause harmful reactions, and a few can cause paralysis. Symptoms of a tick bite may include local irritation, and in some cases paralysis that develops several days after the tick has attached and can continue for up to 48 hours after it is removed.

After spending time in tick habitat, do a thorough body check and remove any ticks promptly. To remove a tick:

• Use a freezing ether-containing aerosol spray (available from pharmacies) to kill the tick. It should die in about 10 minutes, after which the remains can be brushed away.
• Small larval ticks can be killed with a permethrin-containing cream and then brushed off.
• If you cannot remove the tick this way, see your doctor.

Some older removal methods are no longer recommended, because handling or agitating a tick can make it release more toxin:

• pulling at the tick with forceps or tweezers, which can leave the head or mouthparts behind
• holding a flame or hot match to the tick, which also risks burns
• using methylated spirits, alcohol or other substances to kill the tick before removing it

Most tick bites heal without problems. After removal, wash the area and apply antiseptic and a dressing. Seek medical attention for symptoms such as fever. Some people may have an allergic reaction to future tick bites.

Stings from sea creatures#

Blue-ringed octopus#

A blue-ringed octopus is not aggressive, but its bite is venomous and can cause paralysis. Symptoms may include numbness around the mouth, tongue, face and neck, a tight chest, and difficulty breathing.

• Call your local emergency number for an ambulance.
• Apply a pressure bandage and use a splint to immobilise the limb.
• Watch the person closely. If they stop breathing, start CPR and continue until medical help arrives.

Cone shell stings#

Cone shell stings are venomous. Symptoms may include pain and swelling, prolonged muscle weakness (including the breathing muscles, which can lead to respiratory failure), disturbed vision, and problems with speech and hearing.

• Call your local emergency number for an ambulance.
• Lie the person down and ask them to keep still.
• Apply a pressure bandage and use a splint to immobilise the limb.

Stings treated with hot water#

For stings from creatures such as stonefish, stingrays, sea urchins and similar marine animals, the hot water method can help relieve pain:

• Use water that is as hot as the injured person can comfortably tolerate – do not burn them.
• Immerse the affected area for about 20 minutes (for example, by showering, soaking a hand or foot, or pouring hot water over the sting).
• If pain returns, briefly remove the area from the water, then re-immerse it and continue.
• Offer simple pain relief such as paracetamol.
• Seek urgent hospital treatment if symptoms are severe.

Jellyfish stings#

For a serious jellyfish sting (such as from a box jellyfish), seek immediate medical help and call your local emergency number; antivenom may be available for some species.

• Stop the tentacles stinging by gently removing them with gloved fingers, forceps, a firm object (such as a credit card), or by flushing with sea water.
• Immobilise the limb and bandage firmly for the most dangerous stings.
• For milder jellyfish stings, wash the tentacles off with sea water and use cold packs or an anaesthetic cream to reduce pain.
• If the person collapses or stops breathing, start CPR.

Allergic reactions and anaphylaxis#

Reactions to a bite or sting range from mild local swelling to anaphylaxis, a severe and life-threatening allergic reaction. Call your local emergency number for an ambulance if signs of anaphylaxis appear, such as:

• swelling of the face, lips or eyes
• hives or welts
• abdominal pain and vomiting
• difficulty breathing or swallowing

In a severe allergic reaction:

• Lay the person flat – do not let them stand or walk.
• Give an adrenaline auto-injector (such as an EpiPen® or Anapen®) if available.
• Be ready to start CPR if the person stops breathing.

Preventing bites, stings and infection#

• Wherever possible, avoid bites and stings by using insect repellent and wearing appropriate clothing.
• If you are bitten or stung, apply first aid and seek medical attention if symptoms are severe or an infection develops.
• Animal bites (such as from a dog or cat) carry a high risk of infection, so seek medical attention.

Key points#

• Most bites and stings are minor, but some are emergencies – call your local emergency number when in doubt.
• Pressure bandaging and immobilisation are used only for certain bites and stings (snakes, funnel-web and mouse spiders, blue-ringed octopus and cone shells), because the lymphatic system relies on muscle movement to move venom.
• A pressure bandage should be firm but never cause numbness, tingling or colour change in the fingers or toes.
• Snake bite symptoms may take an hour or more to appear, so act quickly even if the person seems well.
• Anyone with signs of anaphylaxis needs to be laid flat, given an adrenaline injector if available, and taken to hospital urgently.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).