Snake Bite FAQ

Kyoto: Hiking from Kibune to Kurama

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The following more elaborate protocol is taken from the "Emergency Medical Technician 1A Protocols" for Fresno County in California. The protocol is designed for EMS personnel in an urban setting:

I. Priorities

A. Assessment. Vital signs, site of wound, measure the circumference of the extremity, mark and record, note extent of swelling and record time.

B. Keep patient quiet and reassure.

If snake is available and dead, place in a secure container and bring to the emergency department. Use caution. Do not engage in a search for the snake.

C. Code 3 transport [lights, siren] is indicated for patients in shock, uncontrolled bleeding or with concurrent severe injuries.

Code 2 [normal driving, no lights, siren] transport for patients with stable vital signs without immediate life threat.

[Folks that choose to transport a snakebite victim by personal auto to a hospital should note these instructions. Life-threatening systemic reactions are rare with snakebite, so safe driving within the speed limit is the way to go. Given the amount of panic associated with snakebite, it might be best to allow an ambulance transport the patient, and thereby reduce the risk of an automobile accident]

II. Treatment

A. Oxygen 6 L/min by nasal cannula. [If not trained in O2 delivery, then don't do this, RP]

B. Apply elastic bandage 2-5 inches proximal to the bite if transport >10 minutes. Do not apply to hand or foot. No other tourniquet should be used. This should be applied to a tightness which allows you to slip one finger underneath.

C. Immobilize affected extremity at or slightly below the level of the heart.

D. Keep patient at rest.

E. Mark area of swelling with pen line and record time.

III. Further Evaluation

A. If the snake was an exotic pet or zoo animal (e.g. coral snake, cobra, krait), neurotoxic symptoms may precede local reactions. Observe for mental status change, respiratory depression, convulsions, or paralysis.

B. Do not allow any person to apply ice or cooling. Do not allow incision of the wound.

C. The best course of action following envenomation is rapid transport to the emergency department where intravenous antivenin can be administered.

D. Reassure patient. Mortality from snakebite is rare, particularly in young, healthy patients.

Once again, this protocol does not mention all the neat things thattrained EMS folks do for every patient. See the discussion following the wilderness protocol above.

So two quite different approaches. One, designed for the wilderness, allows the patient to walk toward treatment. The other, designed for an urban setting with ready access to the EMS system, had the patient remain at rest, with the wound immobilized at or below the level of the heart.