Snake Bite FAQ

Kyoto: Hiking from Kibune to Kurama

advertisement

Now, what about treatment? What do you do if you or a member of your party becomes one of the unfortunate few to actually get bitten?

The first thing is to remain calm. Remember, snakebite is not usually deadly in spite of all the hype about it. Even without treatment you will almost certainly recover. If you can identify the snake do so. If it is dead, take it with you to the hospital in a safe container to be sure of getting the right antivenin. Do not risk more bites in order to kill it. Remember the first rule of rescue: Do not create any more victims or risk further injury to the current victim.

Trained first aiders base their treatment of patients on a protocol: a simplified set of procedures. We describe below two different protocols for the treatment of snakebite.

A Wilderness Protocol

The following treatment protocol is provided by Jeff Isaac and Peter Gothin in The Outward Bound Wilderness First Aid Handbook (Lyons and Burford, 1991). This same protocol is taught to Wilderness First Responders and Wilderness Emergency Medical Technicians certified by the National Association for Search and Rescue:

"Transport the patient as quickly as possible to antivenin (antidote). Although local discomfort may be severe, systemic signs and symptoms maybe delayed for two to six hours following the bite. Walking your patient out is reasonably safe unless severe signs and symptoms occur. It is also significantly faster than trying a carry. Splint the affected part if possible. Expect swelling. Remove constricting items such as rings, bracelets, and clothing from the bitten extremity.

Do not delay. Immediately following the bite of a snake thought to be poisonous, evacuation should be started. It can always be slowed down or cancelled if it becomes obvious that envenomation did not occur, or the snake is not poisonous. Most medical experts agree that traditional field treatments such astourniquets, pressure dressing, ice packs, and "cut and suck" snakebite kits are generally ineffective and are possibly dangerous. Poisonous snakebite is one of those conditions that you cannot treat in the field. Don't waste valuable time trying."

Boy, this is an awfully simple protocol! Doesn't seem to leave much for the first aider with an anxious desire to do something to occupy himself with. Well, at least they suggest you could make a nice splint.

Actually, a first responder, EMT, or other trained person would know that there would be a number of other steps to field treatment that were notexplicitly stated in this protocol. He might want to evaluate the patient's ABC's, take a history, record the time and events associated with the bite, thoroughly evaluate and document the chief complaint, conduct a physical exam, develop a plan for treatment and evacuation, and begin recording a regular series of vitals. He would also record all changes in signs and symptoms with the time that they occurred. None of these activities, however, would be allowed to interfere with moving the patient to definitive care (antivenin). Folks with a lesser set of skills would want to do what they could.

As part of the history, the first aider should ask whether the patient has(a) asthma, hay fever, hives, or other allergies, (b) allergic reactions upon exposure to horses, or (c) prior injections of horse serum. The two antivenins in use in North America are both raised in horses, and patients with allergies to horses or horse serum can exhibit adverse reactions (see the discussion of hospital care below). The first aider should also ask whether the patient has been bitten by venomous snakes in the past, and, if so, whether he received antivenin and what the reaction to it was. Finally he should inquire when the patient last received a tetanus booster.

Don't forget to wear rubber gloves when handling patients, for your safety and theirs. Playtex dishwashing gloves are a good choice for wilderness use, but disposable latex surgeon's gloves work fine too. If it is necessary to assist a patient's respirations, use a pocket mask.

If the group is sufficiently large, it might be best to send two runners ahead to summon aid. At the very least, it would be nice to have an ambulance waiting at the trailhead. There is a maxim in wilderness first aid: move the patient to treatment, and move treatment to the patient. The best evacuation strategies will cause both of these things to happen simultaneously.

If it is going to be more than one hour to hospital treatment, you may choose to rinse and disinfect the wound. More on how to do this follows below.