Marine stings and cuts in the Maldives: first aid guide

Almost nothing on a Maldivian reef wants to hurt you; animals sting, spike or bite only in defence. Nearly every injury comes from touching or standing on the reef, walking barefoot in the lagoon, or getting too close to an animal guarding its nest. The coral reefs guide explains why the same habits that protect you also protect the reef.

• Wear water shoes when you walk in the lagoon or on reef flats. Firm soles help against coral, urchins and fish spines.
• Shuffle your feet in sandy shallows. Stingrays bury themselves and swim away from vibration, so a shuffling step warns them before you tread on one.
• Look, don’t touch. Keep hands and fins off coral, rocks and animals. A rash vest guards against small stings as well as sunburn.
• Float, don’t stand. To fix your mask, swim to sand or open water. A snorkel vest makes this easy.
• Go with a local guide for your first snorkel; guides know the sites and carry basic first aid. See snorkelling in the Maldives.

Coral cuts are the most common reef injury. They heal slowly in the tropics and easily become infected.

First aid

• Rinse the cut well with clean fresh water, then wash it with soap and gently remove any coral or sand.
• Apply antiseptic and a light dressing, keep it dry for a day or two if you can, and check it daily.

Seek medical help if it gets redder, hotter, more swollen or more painful, oozes pus, or you develop a fever: signs of infection.

Fire coral is not true coral but a jellyfish relative, growing as mustard-brown plates and branches with pale tips. Stinging hydroids look like small feathers or ferns on rocks, ropes and wrecks. Both cause a burning sting and an itchy rash that can last days.

First aid

• Leave the water and rinse the area with seawater, not fresh water.
• Lift off any visible fragments with tweezers or the edge of a card. Don’t rub with sand or a towel.
• For the itching that follows, ask a pharmacist about an antihistamine or a soothing cream.

Seek medical help if the rash spreads widely, blisters, or if you feel unwell.

Jellyfish are not common on Maldivian reefs, though small numbers do drift in at times. There is no well-documented season for them, so take local advice on the day.

First aid (based on NHS guidance)

• Get out of the water and rinse with seawater, not fresh water.
• Remove any tentacles with tweezers or the edge of a card; don’t use bare hands.
• Soak the area in water as hot as you can comfortably bear for at least 30 minutes, or use hot towels. Test the temperature on unhurt skin first.
• Don’t use ice, don’t cover the sting tightly, and don’t urinate on it.
• Advice on vinegar differs between types of jellyfish, so follow a local first-aider rather than guessing.

These fish carry venom in their spines, purely for defence. Stonefish and scorpionfish are camouflaged and sit still on the reef or sand, looking like rock. Lionfish, with long striped fins, hover in the open. Stings nearly always happen when someone treads on, kneels on or handles one.

A sting causes sudden, severe pain and swelling. Stonefish stings are the most serious and can cause vomiting, weakness, breathing difficulty or collapse.

First aid (based on Divers Alert Network and NHS guidance)

• Get the person out of the water and keep them calm and still.
• Call for help. For a stonefish sting, or any sting with symptoms beyond local pain, get medical care straight away.
• Remove any visible spines carefully with tweezers, without bare hands.
• Immerse the wound in water as hot as the person can tolerate without scalding, for 30 to 90 minutes. Pain can dull feeling, so test the water on someone else’s skin or on the unhurt limb first.
• Wash the wound with soap and fresh water and leave it uncovered unless it is bleeding.

DAN explains that heat helps because the venom is protein-based, though it may ease stonefish pain less. A stonefish antivenom exists, one more reason to reach proper care fast.

Stingrays are gentle, and you will often see them near jetties. Their tail carries a barbed spine, and injuries happen almost only when someone treads on a buried ray, so shuffle your feet. See stingrays and eagle rays in the Maldives for more on these animals, and remember that all rays are protected and feeding them is banned.

First aid

• Leave the water and control any bleeding with firm pressure.
• Soak the wound in hot water (as hot as can be tolerated, without scalding) for at least 30 minutes to ease the pain.
• Don’t try to pull out a barb that is deeply embedded.
• Always get medical help after a stingray injury; NHS guidance says every stingray sting should be checked, as fragments can stay in the wound.

Long-spined sea urchins sit in cracks and on reef flats, and their brittle spines break off in feet or hands.

First aid

• Remove any spines you can easily grip with tweezers. Don’t dig for deep or broken spines.
• Soak the area in hot water (as hot as is comfortable) to ease the pain, then wash it well.

Seek medical help if spines are deep, near a joint, or if the area becomes red, swollen and painful, which may mean infection.

Most fish keep their distance. The exception is the titan triggerfish, which guards a cone-shaped zone widening upwards from its nest on the sand and will bite fins, hands or heads that come too close. If one rushes at you, swim away horizontally, not upwards, keeping your fins towards it. The reef fish guide shows what titans look like.

Moray eels may bite a hand pushed into their hole. Stop any bleeding with pressure, clean the bite well and get it checked, as bites infect easily. Reef and nurse sharks are not a real risk to calm snorkellers, and feeding sharks is illegal; see sharks in the Maldives.

Get medical care quickly if there is:

• trouble breathing, chest pain, swelling of the face or throat, or fainting (possible allergic reaction)
• a stonefish sting, or any fish sting with vomiting, weakness or confusion
• a stingray wound, or a sting on the face, eyes or genitals
• heavy bleeding, or a spine or barb stuck deep in the skin
• pain that does not settle after hot-water treatment
• signs of infection in the following days: spreading redness, heat, pus or fever

In an emergency, call 911, the single national emergency number, or 102 for an ambulance. Most local islands have a health centre for first care; serious cases go to Malé, where the main hospital is IGMH. See health and safety in the Maldives.

On a local island

The health centre is the first stop. In Dhiffushi, that is the island health centre. Moving a patient to Malé means a boat trip, so check that your travel insurance covers medical evacuation and water activities.

• tweezers, antiseptic and waterproof dressings
• your usual painkillers and an antihistamine
• personal medicines, such as an adrenaline auto-injector if you have a severe allergy (see bringing medicines into the Maldives)
• water shoes and a rash vest

Our packing list covers the rest.