WHAT TO DO IF BITTEN BY A VENOMOUS SNAKE
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Allow bite to bleed freely for 15-30 secs.
Cleanse and rapidly disinfect area with Betadine, assuming not allergic to iodine, fish or
shellfish. Remove clothing (pant legs, shirt sleeves, rings and jewelery on bitten side)
If bite on hand, finger, foot or toe, wrap leg/arm rapidly with 3" to 6" Ace or crepe bandage
past the knee or elbow joint immobilizing it. Overwrap bite marks. But first, if possible,
apply hard direct pressure over bite using a 4 x 4 gauze pad folded in half twice to 1 x 1.
Tape in place with adhesive tape. Soak gauze pad in Betadine(tm) solution if available and
victim is not allergic to iodines, fish or shellfish.
Strap gauze pad tightly in place with adhesive tape
Overwrap dressing above, over and below bite area with ACE or crepe bandage, but not too
tight. Wrap ACE (elastic) bandage as tight as one would for a sprain. Not too tight. Check
for pulses above and below elastic wrap; if absent it is too tight. Unpin and loosen. If
pulses are strong (normal) it may be too loose.
Immobilize bitten extremity, use splinting if available.
If possible, try and keep bitten extremity at heart level or in a gravity-neutral position.
Raising it above heart level can cause venom to travel into the body. Holding it down, below
heart level can increase swelling.
Evacuate to nearest hospital or medical facility as soon as possible
Try and identify, kill and bring (ONLY if safe to do so) offending snake. This is the least
important thing you should do. Visual identification/description usually suffices, especially
in the U.S. and in regions where the local fauna is known. Local symptoms will alert doctors
to whether the bite is venomous or not.
Bites to face, torso or buttocks are more of a problem. ACE/crepe bandaging can not be
applied to such bites. A pressure dressing made of a gauze pad may help to contain venom.
(see Pressure dressing procedure)
Antivenom is the only and best treatment for snakebite and you must get as much as is necessary as
soon as possible. Antivenom administration should not be delayed. Up to 20 or more vials of Wyeth
ACP may be needed to neutralize the effects of rattlesnake and other crotalid venoms in North
America. Protheric’s Cro-Fab™, a highly purified monoclonal polyclonal antivenom may require far
less. It is the only antivenom containing specific antibodies to Mojave Type A and B toxins which
may be present in North American rattlers other than Mojave Rattlesnakes.
http://www.rci-enr.net/neo-slither/articles/rattlesnakevenom.pdf
WHAT TO TELL THEM AT THE HOSPITAL
1. Ask staff to contact their designated Poison Control Center Immediately
2. Ask hospital staff, if they are not familiar with snakebite emergencies, to use physician
consultants available thru the nationwide Poison Control network.
3. Any additional questions may be directed to: sgrenard@siuh.edu or sgrenard@si.rr.com or
more expediently if necessary, at 718-227-6234 or cellular at 347-452-0105.
What Not to Do if Bitten by a Venomous Snake
1. Contrary to advice given elsewhere DO NOT permit removal of pressure dressings, Sawyer
or ACE bandage until you are at a facility ready and able to administer antivenom. As soon
as the dressings are released the venom will spread causing the usual expected problems of
venomous snakebite. The hospital at this time must be prepared to administer the antidote
(antivenom)*
2. Do not eat or drink anything unless okayed by medical sources
3. Do not engage in strenuous physical activity
4. Do not apply oral (mouth) suction to bite
5. Do not cut into or incise bite marks with a blade
6. Do not drink any alcohol or use any medication
7. Do not apply either hot or cold packs
8. Do not apply a narrow, constrictive tourniquet such as a belt, necktie or cord
9. Do not use a stun gun or electric shock of any kind. For more information on electric shock
treatment please click on SHOCK TREATMENT
10. Do not remove dressings/elastic wraps until arrival at hospital and antivenom available.
11. Do not waste time or take any risks trying to kill, bag or bring in offending snake
*Remember ACE or other wide bandaging must not be wrapped so tight as to cut off systemic
venous or arterial circulation. Properly applied such bandages will NOT compromise the systemic
circulation.
IT GOES WITHOUT SAYING BUT WE'LL SAY IT ANYWAY......
Never hike, camp, work or collect specimens in areas where there are venomous snakes unless
accompanied by at least two companions. One to stay with the victim and the other to go get help.
All parties should know what to do.
If you come across any snake in the field and don't know positively what it is or isn't, do not
approach it, try and examine it or photograph it (unless you have a long telephoto or zoom lens).
Move away from it as expediently as possible.
If you work with venomous snakes in a public (zoo/exhibit) or private collection or in a museum or
university laboratory, never open their cage without a companion nearby who is familiar with
snakebite first-aid
A telephone with an outside line should always be located in the room or area where venomous
snakes are located in case there is a need to call for help.
Never handle or attempt to handle venomous snakes without at least one trained companion present
If you are not an experienced venomous snake handler, don't try handling or catching them without
first obtaining extensive experience and training by someone who is trained
If you maintain a private or laboratory collection of live venomous species, keep all cages under lock
and key; rooms where such cages are located should have a double door and vestibule, be
completely visible through glass paneling from the outside and be off-limits to all but authorized
personnel. If a snake appears missing from a cage you may be able to locate it before entering the
room in preparation of re-securing it. Such rooms should be completely sealed. No open or screened
windows and no "mouse-holes" or pipe holes through which a snake can escape. Sink drains should
be also be capped and toilets, if present, always kept covered.
Finally if you deal with venomous snakes always make sure you have or know where to locate a
supply of specific antivenom for the species you are involved with.
DISCUSSION:
This document suggests the use of containment or sequestration of injected venom at or near the bite
site using broad (3"-6" wide) compression bandaging such as crepe or ACE(tm)-type elastic
bandage. This is the standard worldwide accepted first-aid treatment for bites by elapid snakes such
as cobras, mambas, coral snakes and many Australian species. This method has delayed on the onset
of serious snakebite symptoms as long as 24 hours in Australia where victims of deadly bites were
that far from medical assistance. The method remains controversial in the U.S. although a number of
top snakebite experts have recently recommended its use in crotalid bites in printed references
appearing in peer-reviewed journals. A recent study conducted at the Naval Medical Center (San
Diego) and Loma Linda University Medical center in experimentally envenomated pigs indicates
that the ACE wrap works to contain the venom and buy time to get to the hospital. A complementary
study at Stanford, however, indicates that people are often unable to apply the wrap with sufficient
pressure to work effectively. We recommend wrapping it tightly but maintaining a palpable pulse in
the absence of precise means of measuring the under-wrap pressure (which should be 60 to 70 mm
Hg or slightly less ... slightly below average diastolic blood pressure).
The use of containment/sequestration for certain types of North American pit viper (rattlesnake,
moccasin and copperhead) bite is felt by some to increase the risk of disfiguring local tissue injury,
which, while not necessarily life-threatening by itself may necessitate skin grafts and extensive
repair and treatment once the acute, life -threatening phase of the event has passed. Some experts
feel the spread of venom to vital organs can be life-threatening and that you have no way of knowing
how life-threatening a snakebite is in the first moments of the event. Therefore, users of this method
must recognize that there is a trade-off: containment as a life-saving measure at the risk of local
tissue damage which while not necessarily life-threatening, could be disfiguring, painful and/or
which could require prolonged and extensive follow-up treatment, plastic surgery, orthopedic
surgery and rehabilitation.
We therefore urge readers who decide to use this method on ANY type of snakebite to do so as a life
or death decision and to make this decision in pre-recognition of the above information. In addition
some U.S. crotalid bites, particularly from large species, results in widespread damage to limbs even
when bites were to digits and hands or feet. Thus the wide-area, low-pressure wraps can prevent the
spread of venom and more widespread damage. Again some experts feel that this increases the
intensity of more localized damage. So while snakebite mortality without these dressings may be
low, we have been appraised of too many unnecessary and tragic deaths and widespread
disfigurement without its use and in general advocate its use if it is properly applied. Disfiguring
local injury can be limited to a much smaller area compared to crotalid (pit-viper: rattlers,
copperheads, cottonmouths) snakebite where this type of containment has not been used.
Compression bandages are a standard in Australia but these are mostly elapid bites although some
have some SERIOUS local tissue or muscle effects as well. The venom of the King Brown Snake, a
widely distributed species (Pseudechis australis) has as its main target: skeletal muscle tissue. Bites
by Cobras which also have local effects also have direct acting cardiotoxins so containment can be
life-saving in bites by these snakes.
In spite of drawbacks, the late Dr. Sherman Minton (pers.communication) says containment is the
safest course of action when it is not known what type of venom you are dealing with or how long it
will be before treatment with specific antivenom can be started.
Many strenuously oppose the out of hand dismissal of containment, used in Australia for nearly 30
years successfully, by a few experts in the United States. Denial of the value of this method by these
U.S. experts has resulted in the death of professional and hobbyist handlers of cobra and other elapid
snakes who erroneously were led to believe that the method should not be used because of their
admonitions that local tissue destruction is its only effect and should NOT be used under any
circumstances. There have been animal studies done using rattlesnake venom on pigs (Bush et al)
and monkeys (Sutherland) demonstrating that it serves to prevent spread of venom and suppress
widespread swelling.
There are harmless as well as venomous snakes in many regions. Consider any snakebite venomous
until medically evaluated as otherwise or determined by a knowledgeable person.
The best thing you can do is not get bitten. Protective clothing, footware and gloves should be used
at all times when there is risk of snakebite.
Venom is excreted in the urine. IV solutions, good hydration and voiding of dilute urine will help to
eliminate venom. Do not drink any water in the field but wait for solutions to be given intravenously,
in the field by paramedics or in the hospital.
Steve Grenard
Staten Island University Hospital South
375 Seguine Avenue
Staten Island NY 10309
sgrenard@siuh.edu
sgrenard@si.rr.com (always cc to second e-mail address)
718-226-2034 (M-F 9-2) 718-227-6234 (eves and weekends)
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This document made available through the generosity of the author, Steve Grenard, to New York
Search & Rescue and to the public at large. All due credit belongs to him and we extend out thanks.