Novel Emergency Treatment for Lionfish Envenomation

I have been a skier for many years and have often benefitted from using HotHands, a hand warmer packet that slips inside my ski mittens to fight off the cold.

I thought these might be useful in the case of a lionfish envenomation as a prompt and safe method to apply heat to inactivate the toxin. I have seen a few people who applied too much heat and suffered a significant skin burn. So, I added a few warmers to my "save-a-diver" medical kit. I didn't expect that I would be the first to try it.

On a recent trip to Roatan, I pierced a medium-sized lionfish with my Hawaiian sling. While trying to cut off the spines, I was hit in the index finger. I knew what to expect, as I had been stung twice before.

After finishing the dive, I dried my hands well and took out the handwarmer; these little pads are activated by air exposure and inactivated if allowed to get wet. I applied one to the sting site. The pain was well underway by then. As the pad quickly warmed, it gave immediate improvement in the pain, as I had hoped. As the pain worsened and spread toward my wrist, I added a second pad on the other side of the finger and moved the pads around my hand as needed. The pain was much more tolerable with the heat application. The pain and swelling peaked in about 90 minutes. After about three hours, with the addition of some acetaminophen and a beer, I no longer needed the pads. They can last for 10 hours, and a pack of ten HotHands on Amazon runs about $7.50.

I will keep a supply in my medical kit and hope never to need them again. If packed carefully, they should last for at least a year of storage.

- William Barstow, MD
Redmond, Oregon