First Aid Treatment for Lionfish Stings

Written by Tegan

A lionfish or scientifically speaking the Pterois volitans (red lionfish) and Pterois miles (devil firefish) are typically nocturnal creatures that are quite docile. The docile factors makes it easy for divers to get up close with these fish and accidental contact is a the most common reason they are stung.

These fascinating creatures are an invasive species through the North Atlantic, Caribbean and even into the Northern Part of South America’s Atlantic sea.

While I have never been stung by a Lionfish I have heard stories of divers dealing with the insane pain. There is a quite popular phrase that states ‘It won’t kill you but it will make you wish you were dead.’ For me the mere thought is enough for me to keep a wide berth of them.

Poisonous Venom

Like many creatures, venom is used for protective purposes and the Lionfish is no exception. The venom is contained in their spines or fins and is then injected through needlelike bristles. These are found along the dorsal, pelvic and anal fins.

While the poison is not life-threatening, it is a very painful experience and immediate first aid is going to be very beneficial.

Lionfish venom includes a protein, a neuromuscular toxin and a neurotransmitter (acetylcholine). Because the venom is protein based heat is the best way to relieve the pain by breaking down the protein.

The pain from a sting can last many hours and can have other effects on the wound area. Swelling or rapid edema as well as subcutaneous bleeding can result.

One can expect any swelling around the wound to clear within a few days. Skin discoloration from the sting can last a little longer.

Which sting is worse- A big fish or small fish?

How badly the sting will hurt depends on a few factors. These include how many spines penetrate the skin, how deep those spines penetrate, the size of the lionfish, the amount of venom injected and the location on the body the person was stung. In addition another factor is the immune system of the victim.

Contrary to belief a smaller lionfish is likely to cause a more painful sting that a larger one. Why? In smaller lionfish the spine tip is smaller and much sharper. The venom is located closer to the tip in the fish and therefore when stung more venom will be injected. Not to mention with larger lionfish chances are you will see it before it stings you. All in all you need to be very wary of these fish regardless of size!

First reactions

It is important to try and remain calm but this is easier said than done. Inform your dive buddy or leader that you have been stung and begin to ascend safely to the surface. Do not skip the decompression step, it is imperative to ascend safely. Your life is not in danger so although you will be in pain please still ascend as safely as possible.

I have also heard of people squeezing the sting area until blood comes out, the idea is that a bit of the venom will also come out. Considering the pain you’d be in, I’d be trying anything.

First Aid for Lionfish Stings

Immediate first aid is key to preventing future infections around the sting area. These are considered the most important, easy to follow steps:

  • Remove any spines from the wound area
  • Wash the wound/area very thoroughly using fresh water and soap
  • If bleeding, control it
  • For pain relief- immerse the affected area hot or warm water. You don’t want to add another injury to the sting. No hotter than 113°F / 45°C for 30 to 90minutes. Repeat as required until the pain subsides. It is important here to check the water temperature on a body part that is not affected by the sting. Sometimes the pain from a sting can skew ones judgement of water temperatures.
  • Ice/cold packs will help to reduce the swelling. They can also be used for pain relief if you prefer that to hot water.
  • Apply topical antibiotic ointment or cream.
  • Apply bandaging if needed.
  • Pain control medications can be used if necessary.
  • Seek a professional medical evaluation. You may need to update your pain managment or if the area starts to become infected you may need antibiotics.
  • If you are anaphylactic then life support may be required in very rare instances.
  • In the event of an emergency, call emergency services or the DAN Emergency Hotline at +1-919-684-9111.

Bottom Line

Overall a Lionfish sting is going to be a very painful experience. Vigilance and staying away from this species while scuba diving is best. If you do get stung make sure you remain calm, notify your buddy or dive leader and safely ascend to the surface. Do not miss your decompression stop. Follow the above first aid treatment procedures and seek medical attention if your pain doesn’t subside or an infection begins to occur.

About the author



Part time mermaid, full time ocean addict, Tegan has been scuba diving and snorkeling for most of her life. She has a wealth of knowledge of the underwater lifestyle and is a key contributor and product tester for all things water related

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