If you looked up ‘snake bite treatment’ just four years ago, you would’ve probably come across some information that recommended using a tourniquet to reduce blood flow. Today we know that this is more likely to cause harm than good. The only real treatment for a snake bite is anti-venom, and it’s essential to get a snake bite victim to a hospital or medical professional with antivenom as quickly as possible. That said, there are several things you can do to mitigate the effects of a snake bite in the time it takes you to get a patient to professional medical help. But, before we get into these, let’s take a quick look at antivenom and how it works.
Types of venom and antivenom
There are three broad categories of snake venom: neurotoxins, which attack the nerve system; hemotoxins, which destroy red blood cells; and cytotoxins, which break down cells (necrosis). Some snakes’ venom is actually a combination of different toxins, but for the sake of simplicity, I’m going to make a few generalisations: neurotoxic venom is found mostly in elapids (cobras, mambas, sea snakes, coral snakes) while hemotoxic venom is most common in viperids (true vipers, bush vipers, pit vipers and rattlesnakes). Cytotoxic venom is found in both viperids, like the major adders, and elapids, like cobras.
Neurotoxic vs cytotoxic and hemotoxic symptoms
Bites by snakes with a cytotoxic or hemotoxic venom are more obvious in that there’s usually bleeding and swelling at the site of the bite, but a bite by a snake with neurotoxic venom can be difficult to identify. If you think someone has been bitten by a snake but there are no visible puncture marks, look out for blurred or double vision, slurred speech, nausea, and difficulty in swallowing or breathing (signs of a neurotoxic bite). Not all bites involve a venomous injection, but if it is obvious that someone has been envenomed, it’s important to get them to a medical professional who can administer antivenom as soon as possible.
Monovalent and polyvalent antivenoms
Antivenom can be either monovalent (produced for a single species) or polyvalent (developed to treat the bites of many snakes found in a specific region). Polyvalent antivenom is more effective when given early (within 6 hours after the bite), but it can be administered up to 48 hours later in serious cases. Obviously it helps to know the species of the snake involved so that a doctor or medic can administer the antivenom with confidence, but don’t put yourself in harm's way to get a good look at a snake – a cobra can strike from over a meter and half away.
What to do if someone is bitten
Try to identify the snake
But only if you can do so safely. Medical professionals generally want to know what kind of snake it was before they administer antivenom. If you can take a photo without getting within striking distance, do so. Otherwise, try to remember the size, color and shape (especially the head) of the culprit. If you haven’t visited the local reptile park yet, here’s a good reason to.
Call emergency services
Assuming that you or someone in your party has been bitten while on the trail, you’ll either need to get the patient to the roadside or get the medical services to come to you (In more remote areas, a medic might have to be flown in by helicopter). If you cannot carry the patient, the latter is preferable. On the phone, remain calm, tell the dispatcher where you are and where you’re heading (if you can move the patient), and describe their symptoms as well as the snake.
Keep the patient calm
First, check your demeanour. You want to seem calm and collected to inspire the same in your patient. A panic reaction will only raise their heart rate, spreading the venom faster and increasing the chances of them going into shock. Tell your patient that you have to get them to the car or hospital and that you’re going to carry them. It can help to joke about them getting a free ride (just this once).
Remove constricting items
The bitten area may swell, and you don’t want to restrict blood flow – especially in the case of cytotoxic bites, since concentrating the venom in one area will destroy cells faster. Remove any rings or constricting items such as watches, bracelets, and tight-fitting clothing (shoes too if the leg was bitten). A properly stocked first aid kit should have a pair of surgical shears capable of cutting fabric.
Apply a pressure bandage (neurotoxic bites)
If someone has been bitten by a neurotoxic snake, it’s possible to reduce the rapid distribution of venom through the lymphatic system by applying a pressure bandage. However, for the bandage to be effective, it has to be applied at a very specific pressure, so it’s recommended that you use only a SMART bandage. This purpose-made bandage features printed rectangles that stretch to form squares when the right amount of pressure is applied. See this video for instructions.
Immobilise the patient during transport
Venom spreads more quickly through the lymphatic system when the limb is allowed to move – something you should try to prevent if you have to move the patient yourself. To immobilise the limb, there are two things you can do: splint the bitten limb and carry the patient on a makeshift stretcher. Only employ a splint if the bite is not cytotoxic and there’s no swelling. If you have a rope on you, you can make a stretcher using this and two branches.
Watch for signs of shock
Shock is a real danger in the case of most snake bites, and if you see any signs of shock (such as paleness) setting in, you need to treat the patient immediately. Lay the person flat, raise their feet slightly, and cover them with something – like a jacket or emergency blanket – to make them as comfortable as possible. Do not give the victim anything to eat or drink, and do not give them any medication. Do talk to them in a reassuring tone and try to calm them. Only attempt to move the victim once signs of shock are no longer evident.
What not to do
Don’t try to catch the snake
You are not Steve Irwin. Do not go chasing reptiles into the bush. You don’t need to catch a snake to identify it, and killing it won’t help either. Taking a photo or just noting it’s length, colour, and shape should be sufficient for identification. And even then, keep your distance.
Don’t try to cut or suck out the venom
Sucking venom out of the wound and cutting the skin around the bitten area don’t work. Snake venom is absorbed into the lymphatic system very quickly, and you’ll remove very little venom by trying to suck it out. Cutting the victim would be worse in that it would raise the chances of secondary infection and could put the victim into shock.
Don’t wash the bite wound
Warm water does nothing to denature snake venom, so if you clean a wound, it will only be to prevent secondary infection. But know that traces of venom left on the skin can be used in combination with a snake bite identification kit to identify the species. Leaving the wound unwashed can make it easier to determine the right antivenom to administer.
Don’t use a tourniquet
A tourniquet can cut off blood flow completely and may result in the loss of the affected limb. Besides, venom is distributed through the lymphatic system and not veins. If you don’t know how to apply a pressure bandage (or don’t know whether the snake was cytotoxic or not) it’s best not to dress the bite wound.
Don’t give the patient painkillers
Do not give the patient painkillers, alcohol or caffeinated drinks. Antivenom, too, cannot be administered by a layman as it can bring on adverse side effects that have to be countered with other drugs.
How to avoid getting bitten
Usually, if you leave a snake alone, it will leave you alone. That said, you also want to avoid the kind of surprise encounters that will make a snake feel threatened. Be careful around tall grass and brush piles, and when scrambling around rocky areas and downed timber. Try to step onto and not over logs and rocks. Snakes will often sun themselves partially by lying half in and half out of the shade cast by such objects. And, if you find a dead snake, do not attempt to pick it up. Snakes can bite for up to an hour after death, and some are just very good at playing possum.
Tip: Save all emergency contacts under favorites or list them with the prefix AA so that they are the first numbers to appear when you open your contacts.
