Stop peeing on it!

Many beach locations recommend the use of vinegar for jellyfish stings, and some go so far as to stock it at lifeguard(surf rescue) stations. But why did they decide to do that? Were there lots of studies performed?

The 2010 American Heart Association and American Red Cross International Consensus on First Aid Science With Treatment Recommendations certainly recommends vinegar based on 2 studies, but if you don’t have any, they recommend baking soda based on one study. They also recommend hot water or hot packs, unless you don’t have those, then you can apply cold. The cold option is comical, because they have 1 bad study that is pro cold, and 2 better studies that are anti-cold. So they made two recommendations, and then recommended the exact opposite if the first option isn’t available. Because SCIENCE.

Then what are you supposed to do? This article discusses potential treatments for jellyfish (and siphonophores) in North America. They did a literature search of anything relevant to jellyfish stings and came up with 2040 articles, of which they used 9. From those nine articles they found 10 more in the references. Those 19 articles included some randomized trials, a non-randomized trial, some observational studies, and then non-controlled trials, basic science trials, case reports and expert opinion.The authors did a good job of discussing the limitations of the articles reviewed, and recommend further research in the field with well designed trials.

The evidence can be summarized as follows:

  • Evidence is all over the map, mainly due to a myriad of poorly done studies
  • Hot water relieves pain effectively
  • Vinegar does not help jellyfish stings, but reduces pain in Portuguese Man-o-war stings
  • Seawater does not help pain
  • Lidocaine does help pain, especially at 4% concentrations
  • Urea or ammonia solutions are not helpful. Thankfully there were not studies performed with actual urine.

Ward NT, Darracq MA, Tomaszewski C, Clark RF. Evidence-based treatment of jellyfish stings in North America and Hawaii. Ann Emerg Med. 2012 Oct;60(4):399-414. [PMID 22677532]

Of note, this prompted a reply from Paul Auerbach, who mentioned that he has 100 anecdotes that show vinegar has never made stings worse, and also appropriately recommends further research.

Auerbach PS. In reply to evidence-based treatment of jellyfish stings in North America and Hawaii. Ann Emerg Med. 2013 Feb;61(2):253-4 [PMID 23331652]

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EBM Gone Wild

Wilderness Medicine

Emergency physician with interests in wilderness and prehospital medicine. Medical Director of the Texas State Aquarium, Padre Island National Seashore, Robstown EMS, and Code 3 ER | EBM gone Wild | @EBMGoneWild |

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