First Aid Considerations - Reptiles

[FChen17213]

Dear Jason,

In both everyday civilian hikes in the wild and field work for military personnel, I know that it is wise to carry an individual first aid kit. In terms of your extensive experience in the Australian SASR in both Australia and in the Middle East, is it wise/typical for people to carry anti-venom for venomous reptiles and do medics carry various anti-venom in case of snake bites for areas densely populated with such species?

I know that Australia is home to many of the world's most venomous species including the inland taipan, eastern brown, tiger snake, death adder, and Belcher's sea snake so I am assuming you are by far the most qualified to answer such questions. Do you have any advice on how to minimize the chance of minimizing such a bite or getting out of such an encounter? Do areas densely populated with such species change any sort of tactical considerations in terms of where to be or not to be?

Thanks for your time and look forward to taking another RB1 Class this year.

[Jason Falla]

Thanks for the question.

The Australian military trains its personnel in the treatment of dangerous land and marine animals. We take precautions but do not let them influence our tactical movement.

Antivenom is not something medics carry for a few reasons. Logistically one is cost, and another is maintaining correct storage temperature, and another administering the Antivenom.

In Australia we have venom detection kits for our snakes, America doesn't have this feature for our snakes, so choosing the right antivenin to carry is dificult and expensive if you carry more than one.

Lastly most antivenom needs to be given in a ICU facility, its not matter of pushing antivenin into an IV bag and pushing it into the system.. The horse serum can cause Anaphylaxis when given which can be life threatening also. Its a fine line between pushing antivenin and anti histamines to reverse snake venom.

The Pressure Immobilization Bandage (PIB) is the best way to treat snake bites in the field. PIB can prevent life threatening symptoms from occurring for many hours which give most people time to get to emergency departments.

Redback One has developed an off-the-shelf Snake Bite kit that can be carried on the man into the field. The kit comes complete with step by step instructions on how to apply the PIB correctly. The kit also comes completely stocked with everything necessary for treatment.

These kits will be available soon through RB1 at a price of around $100.

Thanks.

[a0cake]

Jason is there an ETA on the snakebite kits? The rattlers are going to start being a problem for us in my neck of the woods shortly. Thanks.

[Jason Falla]

We should have them for Summer 2012.

[Uncas47]

Checked your website Jason' and am unable to find the PIB kit. Can an Israeli bandage be employed as a substitute, and should any type of tourniqet be applied upstream?
Thanks for your help and advice, having a plan is always better than the alternative.

[Jason Falla]

https://sphotos-b.xx.fbcdn.net/hphotos-ash3/643974_492071524136459_36802408_n.jpg

I thought that I had already replied to this so sorry for the lateness!

The PIM method is the only treatment that has been approved for use on snake bites here in the U.S.

The 4" modular bandage that is typically supplied in IFAK style kits will suffice as it has an elastic quality that will apply pressure to the limb.

Cheers,

[Ironman8]

https://sphotos-b.xx.fbcdn.net/hphotos-ash3/643974_492071524136459_36802408_n.jpg

I thought that I had already replied to this so sorry for the lateness!

The PIM method is the only treatment that has been approved for use on snake bites here in the U.S.

The 4" modular bandage that is typically supplied in IFAK style kits will suffice as it has an elastic quality that will apply pressure to the limb.

Cheers,

Are you placing the PIB on or above the bite wound?

[Jason Falla]

The PIB is placed from the from the bite site down to the distal portion of the extremity then all the way to the proximal portion.

The concentric wraps should overlap by 1/2 with each turn.

Caution should be taken not to wrap too tightly by creating a venous tourniquet and occluding venous and lymphatic return.

The intent of the PIB is to delay the onset of envenomation, allowing the victim to self extract to a treatment facility.

[Jason Falla]

Important Notice: The American Red Cross and American Heart Association today (18 Oct) announced changes to guidelines for administering first aid. Among the revisions are updated recommendations for the treatment of snake bites, anaphylaxis (shock), jellyfish stings and severe bleeding.

As per the ARC & AHA: The treatment for snake bites has been amended slightly to recommend applying a pressure immobilization bandage to any venomous snake bite, with pressure being applied around the entire length of the bitten extremity.

The jury is still out when it comes to protocols regarding snake bites even at large medical institutions across America and among paramedics in the field and as most of us non Steve Erwin types do not know the difference from an Elapidae species of snake to a Crotalus, the PIB should in our opinion be applied to the affected area regardless of the type. We would prefer to err on the side of caution when it comes to bites from either type of snake.

We will be discussing the use of the PIB and how it is applied soon.

[FChen17213]

Thanks for the info Jason. Thankfully, the only elapidae in the United States is the coral snake. We don't have mambas, cobras, brown snakes, adders, taipans, or boomslangs. Boomslangs are a different classification too. They are not elapids. The copperhead, rattle snakes, water moccasin, etc and common snakes in the US are all vipers. Not that vipers aren't deadly, as saw scale vipers (echis) claim many lives in Asia, but elapids like cobras, mambas, and kraits annually kill many more people than vipers I think.

It is interesting to learn that the AHA and other organizations have changed their position. Although, copperhead bites require immediate medical attention, I have heard that some hospitals do not administer anti-venom in many cases because the venom does not amount to a life threatening condition or loss of an extremity. In the case of a bite, should someone treat a bite differently with regard to the species involved or should all bites require immediate rush to hospital via ambulance or medevac For example, the Brown Snake will require instant medevac, but the copperhead will not be as urgent?

[TacticalMedic]

Hi Chen.

That's quite a list of snakes you mention and you are basically correct in some parts of your statement but not all of it. I would caution any appropriate individual that there is a fine line before classifying snakes that require instant medevac and others that are not as urgent. Many factors need to be considered no matter what snake bit you. Some snakes may have less potency to their venom but the venom yield is high. Get that snake to bite, some one young or old and end result would be the same, death. I hope what follows answers your other questions or thoughts.

Just following this thread and with some consideration I would offer a few extra words of information regarding the current state of first aid treatment for snake bites in the United States.

As Jason stated earlier in this thread, in 2010 the American Heart Association and American Red Cross said that the Australian Pressure Immobilization Bandage (PIB) would be the first aid treatment for ANY venomous snake bite. Since then, and in recent months it appears the AHA & ARC have changed there stance and now only recommend it for Elapidae species of snakes, such as the Coral Snake. This change has come about in my personal opinion, possibly by a large group of medical professionals jumping up and down creating some fuss over adopting a method the Australians have been using for over 40 years successfully. Their arguments against this method for Crotalid species stands because they are afraid that by inhibiting the movement of venom would cause catastrophic tissue damage. Scientific studies have been done in the United States on Porcine (Pigs) models that prove otherwise. Now, known experts are now becoming open minded to possibly retracting their stance upon further evidence. I guess with all the pressure AHA & ARC have had in the past couple of years it would be fair to understand why they changed their mind to apply the PIB ONLY to Elapidae species. I personally believe this is quite a narrow minded approach for the reasons following.

Consider these questions... Do you the reader know what kinds of Elapidae and Crotalid species of snakes are in the United States??

Do you know what a venomous or non venomous snake is if one bit you while walking about in your yard or in the wilderness, day or night?..I am guessing...probably not, unless of course it had something rattling?...

Why is that? Its the same in Australia, We have Brown Snakes that are highly venomous and we have other highly venomous snakes that are Brown that shoud be black or other colors. We also have Non poison snakes that mimic colors of venomous snakes, (similar to the American venomous "Coral Snake"/ and Non-venomous "King Snake").

So really what I am saying is the average lay person has no idea whether the snake that bit them was venomous or not. So what do we do?..

Well in Australia, we "ALL" treat all snake bites the same way . We consider it best practice to Err on the safe side and apply the PIB, than don't apply it and have life threatening envenomation go un-treated, leading to possible death.

Did I mentioned that AHA & ARC is narrow minded?? It is true that we have only one indigenous Elapidae snake species in America. Sadly though technically true, it is not totally true. America is one of the few countries in the world where Snake collectors can purchase, breed and keep exotic snakes and it is not uncommon for them to get bitten and in some cases escape and bite innocent people. Florida is a classic place where events like this occur with alarming frequency and with a little research you can find examples on the world wide web of people being bitten inside and outside their residences in and out of the urban environment.

As a current practicing 911 Paramedic working in a busy service in Houston Texas. I have discussed snake bite first aid and treatment with many of my paramedic colleagues and with my medical director and they all have a relative do nothing approach, until I put it to them about what I have discussed in this thread. This is due to their lack of knowledge in this field. I know all to well about the possibilities of making emergency calls to a residence keeping these exotic species of snakes. I know if a medic made a call to a place that kept exotic snakes and did nothing but transport, I would fear the end result would result in death given the bite from a particular deadly species such as a Cobra, Mamba. People die all the time from such instances.

I state for the record that the PIB technique if applied correctly will slow the venom absorption to critical organs and buy you the time you need to get to the medical department and for them to source and administer appropriate antivenin. Even in Crotalid species the application of a good PIB when in the remote wilderness could be the only thing that keeps you alive long enough to make it safely back to emergent care, regardless of suffering catastrophic potential tissue damage.

Sadly I have spoken to a few exotic snake handlers and told them about the PIB method and some of them had heard of it, most haven't. They all generally agreed and indicated that if bitten, that they would just get in the car and head straight to the nearest hospital quickly rather than wait for 911 with no first aid treatment. This in grained response to avoid taking prompt and appropriate first aid could be to their detriment. I wonder how they would fair when they got to the Hospital and they had no antivenom? The time wasted in not applying the PIB means that this day could mean there last because in some cases there is no second chance.

In recent months I have been working closely with Jason to put together a great snake bite kit with associated easy to read printed directions. A kit that I personally carry on my battle rig and in my personal vehicle. Regardless of the current distention within the medical field I will always apply a PIB to any snake bite, so I have all my bases covered. I consider these kits a necessary item for all who those who keep exotic snake species, live on large Ranches out west, hikers that regularly visit remote regions where it could take the better part of the day to get to an emergency facility, and spec-ops operatives that operate world wide to name a few. Or you can take a gamble and don't apply one.. Your call...