First aid for jellyfish stings

There is conflicting information about first aid for jellyfish stings, and numerous remedies have been suggested with little evidence. The Toxicology and Toxinology Expert Group recommend:

• in all cases
  • wash the sting site with sea water (not fresh water) and remove the tentacles
  • consider hot water immersion; there is limited evidence that hot water immersion reduces the pain of jellyfish stings, apart from bluebottle jellyfish stings; however, it is still reasonable to try this intervention for all jellyfish stings
• for major box jellyfish stings, to reduce pain
  • apply vinegar liberally as soon as it is available; the benefit of vinegar for other types of jellyfish stings is unclear and may increase local pain
  • apply an ice pack; ice packs are as effective as hot water immersion and are associated with a shorter length of stay in the emergency department
• for bluebottle jellyfish stings, to reduce pain
  • use hot water immersion; this is significantly more effective in reducing pain than the application of ice packs.