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DOUBT ABOUT BENEFIT OF PRESSURE IMMOBILISATION BANDAGES FOR JELLYFISH STINGS - study finds
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Pressure immobilisation bandages (PIB) should not be recommended
for the treatment of Australian jellyfish envenomation until there is good scientific evidence to support its safety and benefit. It may in fact be harmful.
This is the finding of a review of studies on the usage of such bandages in first aid management of jellyfish stings.
The study, published in Emergency Medicine, the journal of the Australasian College for Emergency Medicine, found there appears to be no experimental data, in vitro or animal studies to support the use of such bandages.
"The PIB technique has been the accepted method of first aid treatment for Australian elapid snakes since Sutherland described it in 1979," said study author Dr Mark Little, staff specialist and toxicology fellow in the Department of Emergency medicine at Sir Charles Gairdner Hospital in Perth.
"PIB is currently recommended as the first aid treatment for jellyfish stings in Australia by the Australian Resuscitation Council, the Queensland Ambulance Service, and the Queensland Surf Life Saving Association. However it is not recommended by the Northern Territory Department of Health."
Dr Little reviewed of all published cases of jellyfish envenomation in Australia.
Most of the "jellyfish" literature is in relation to envenomation by the Chironex fleckeri, which is usually found in tropical Australia and has resulted in the deaths of 67 people in Australia.
The last death was near Cairns in 2000.
"Unfortunately, there are few good data on marine envenomations with most of the literature being Chironex envenomation case reports, and there is minimal information on the effect of PIB on other jellyfish envenomation," Dr Little said.
"The evidence for the continued use of PIB in the treatment of Australian jellyfish sting is based on anecdotes, and direct extrapolation of its use in elapid snakebite envenomation."
Expert opinion is divided, he said.
"The claim that the venom is sequestered in the limb with the use of PIB has not been demonstrated, and as death due to Chironex fleckeri usually occurs on the beach it is likely that the venom is injected directly into blood vessels.
Unlike snake or funnel web spider bites where the PIB is used, the "venom delivery system", i.e., the nematocyst of the jellyfish, is still on the skin.
Pressure (equal to PIB) applied to an electrically discharged nematocyst resulted in increased venom release, Dr Little said.
"There is no uniformity in Australia on the first aid treatment of jellyfish stings. There is no strong evidence that PIB is of benefit in treating patients with jellyfish stings and there are suggestions that harm may occur as a result of the use of PIB," he concluded.
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