Paramedic’s Corner: Common myths about snakebite treatment (Part II)
By: Ambulance Director Gary Carmack
Posted: Tuesday, August 4, 2009 1:56 pm
Ambulance Director Gary Carmack
The most important way to handle snakebite is to avoid being bitten. Some prevention strategies include these:
1) Awareness is probably the most important factor to prevent snakebites. Be careful when walking in tall grass and around rocks. Use a good light if it is dark.
2) Wear boots and long pants during snake season.
3) Before sitting down on a log, rock, or on the ground, do a careful inspection so as not to surprise a snake.
4) Look before reaching. The majority of the copperhead bites I took care of as a paramedic were from people reaching down in their garden to pick something. Bites to the hand seem common.
The only cottonmouth bite I personally know of was a boy with whom we went to school. He was on the river and a long way from a hospital when he was bitten on a finger. He survived the cottonmouth bite, but lost his finger.
I only know of one alleged rattlesnake bite here locally. Hopefully I can interview the lady someday and write about it. I went to high school with her husband so hopefully I can interview her. I have never seen a rattlesnake here and I have never worked a rattlesnake bite.
Once a snakebite happens, the most important part of treatment is to notify the emergency medical services (EMS) personnel and rapidly but safely get to a hospital. While waiting, keep the patient warm, calm, supine, and motionless to decrease venom spread and absorption. There is one exception to this: when bitten by a snake in the back country with no rescue available, the victim must walk out.
Also, because swelling will happen, be sure to remove any rings, watches, and constrictive clothing shortly after the snakebite but before the swelling starts.
The most salient point to make is there is no real treatment for snakebite other than antivenom. The only really important pre-hospital or “street” care is transportation to the hospital. The paramedics will start oxygen and an IV during transport to an emergency room. The sooner the transport begins, the better; often envenomation signs and symptoms are delayed for a few hours. Therefore, calling EMS and getting to a hospital after the snakebite is important. The hospital staff can monitor the patient for envenomation and be prepared to administer the antivenom if needed. The antivenom is usually needed for rattlesnake and cottonmouth bites, rarely (if ever) for copperhead bites.
There are many myths, misconceptions and incorrect treatments for snakebite that have been recommended over the years, but are not supported by the literature. Some of these are extremely dangerous and often cause more harm than the snakebite itself. Listed are some of these myths and things to “NOT DO”:
1) The “rest, not walking out” advice cannot be followed when bitten by a snake while alone in isolated backcountry with no other way out except walking. A person bitten by a snake must get to a hospital where antivenom is available, especially if a rattlesnake bite has happened. Deaths from snakebites in North America are very rare, but they are possible. Note that this only refers to being way out in the backwoods, alone, or when there are not enough people to carry you, and with no ability for rescue. Of course, if the victim can be carried out, that is best. Rest, no exertion, and waiting for the ambulance are correct in normal circumstances. However, the only proven care is antivenom, so any delay getting to a hospital is incorrect.
2) “Cutting and suction” is useless, dangerous, and should never be used. The sucking does nothing but suck. The cutting does nothing but cut, and it may be deadly. Frightened and anxious people frequently cut an artery and the victim could bleed to death. In other words, the victim might survive the snakebite, yet succumb to the therapy. Cutting and suction should never be used.
3) Cold packs or ice are worthless and actually cause more harm by increased tissue damage. Cold packs or ice should never be used.
4) Electric shock is totally ineffective and should never be used.
5) Splinting, tourniquets, lymph constrictors, or elastic wrap have not proven to help and many times may actually worsen the patient.
6) Do not give alcohol. OK, I know we all grew up watching old cowboy movies and soon as they were bitten by a snake, they took a big swig of whiskey. It may deaden the pain, but alcohol will increase the venom absorption.
7) Some people actually teach that you should catch or trap the snake to bring it to the emergency room for identification. There is no need to take the risk of more snakebites as the same antivenom is used for all North American pit viper venoms. Therefore if envenomation occurs, the physician’s decision whether to administer the antivenom or not is based on clinical findings, not snake identification. Never try to catch the snake. One quick, safely obtained photograph would be OK, but only if it doesn’t involve risk and does not delay getting transport to a hospital. Also, be careful handling dead snakes. Frequently they bite when people think they are dead.
Just remember, do little other than calling EMS and causing the snakebite victim to be taken rapidly and safely to a hospital.