Simple Steps to Assist a Snakebite Patient

By Sanda Ashe

MOST IMPORTANT!
Do not delay in getting to a doctor!
Do NOT apply tourniquets, cutting, electric shocks or application of medicines! These will all do more harm than good.

Contents:
In the Field
Useful Questions
Post-treatment Recovery
Simple Steps to Assist a Patient with Venom in the Eye
Simple Steps to Living Safely with Snakes

In the Field:
If the snake is dead, take it, in a container, with the patient to the doctor. If the snake has hidden itself do not waste time looking for it. Remove patient and onlookers out of the danger area. If you are bitten by a dangerous snake while alone in the bush, make your way slowly but steadily to where you can call for help.
Be very calm and reassuring to all. Excited or hysterical onlookers will increase fear and anxiety in the patient. Quickly arrange a method of transport to the doctor.
Seat the patient while removing any constrictions on the bitten area (ring, watch, tight clothes, etc). Immobilise the bitten limb with a sling for an arm, a splint for a leg, or wrap both legs gently together. Carry the patient on a litter or stretcher.
While getting the patient to the doctor, question him/her about the circumstances of the bite. This will help to calm the patient and will give you important information to pass on the doctor if the patient is unable to respond by then.
Keep a watch on the patient as you travel to the doctor. If pain is severe, administer paracetamol - tell the doctor when you arrive. A sudden drop in blood pressure may cause the patient to faint. If so, elevate the legs until s/he recovers. If the patient collapses, s/he should be placed in the recovery position on his/her left side with chin up and out to keep airway clear and prevent breathing in vomit. If paralysis causes the patient to stop breathing, artificial or mouth-to-mouth respiration must be maintained until the doctor takes charge.

Useful questions:
 - Did you see the snake? Describe it.
 - Did the snake rear up, spread hood or spit? Describe its actions.
 - Did it make any sound?
 - Where were you bitten - up a tree, in long grass, wading in water, in bed?
 - At what time were you bitten?
 - Have you taken any medications or alcohol, including traditional herbal medicine, before or after the bite?

Post-treatment Recovery:
After a patient comes home from hospital, s/he will require plenty of time to recover. Drinking a lot of liquid will help the kidneys. If the patient fails to pass urine regularly or experiences other problems, s/he should return to the doctor. For a while after recovery, the patient may have short periods of low blood pressure and feel exhausted or might even faint. The person should rest until the feeling passes. If the bite has caused tissue damage, the resulting wound must be treated very carefully with regular visits to the doctor until it has healed properly. Such wounds can easily get infected and become chronic ulcers, or leave the patient permanently disabled, so it is worth taking trouble now instead of having endless trouble later!

Simple Steps to Assist a Patient with Venom in the Eye:
 - Wash the eye(s) with plenty of water or any other bland solution (in emergency, fresh urine will do for eyes only). Then rinse the mouth, wash the whole face, and any other exposed body part. Change the patient's clothing if necessary. Dried venom can easily be transferred to the eyes.
 - The affected eye will be very painful, tear copiously, nose will run and saliva increases. Blow nose carefully, spit out extra saliva and be careful to mop eyes softly in an outward direction.
 - Venom in the eye is very painful and alarming, so be calm and firm when dealing with the patient. Once the eyes have been well washed, the patient MUST go to a doctor to check for eye damage. It is not such as acute emergency as actual snake-bite, but treatment should not be delayed. Shade the eyes with a hat or dark glasses as glare is very painful for the patient.

Very Important:
Do not allow patient to rub eyes!
Wash eyes immediately!
Apply NO medications!

Simple Steps to Living Safely with Snakes:
All snakes are killers of small animals. Snakes are very important to us because they are a major control of disease-carrying vermin and crop raiders like rats, mice, bats, and birds. They are important to the balance of nature.
Some snakes are venomous enough to endanger our lives if they bite us, so we need to take some simple precautions to reduce the chances of an accident. We DO NOT advise that every snake should be killed.

In the house: Do not keep livestock in the house, especially chickens. Snakes can smell them and come in to hunt. Keep your animals in secure pens at night a little distance from your house. Store food in containers to discourage rats and mice - rats come in to hunt for them. Raise beds above floor level and use a mosquito net, also a safeguard against centipedes, scorpions and snakes.
In the compound: Clear heaps of rubbish away from the house. Do not have piles of firewood, thatching material, coconut husks or similar near the house. Do not have shade trees overhanging the house. Keep grass short or ground clear around your house, and clear underneath low bushes so that snakes cannot hide close to the house.
Use a lamp or torch if you have to go outside the house at night. Wear shoes, especially during the rainy season, because rising water levels force many snakes hidden underground to come to the surface. Animals often give warning of a snake in the area. Be alert to alarm calls and unusual behaviour. It might save you from a nasty surprise!
In the bush: Try to watch where your feet are treading. Long, thick grass or deep leaves may be hiding a snake. Be careful when moving rocks or fallen wood. Lift the far side first so that any snake, scorpion or centipede can escape away from you instead of over your feet. Do not put your hand down holes without checking first that no animals are living in it. Better yet, do not put hands or feet anywhere you cannot see into first.
Be very careful when clearing bush for planting. Look first before grasping a handful of grass or bush to cut.
General Advice: Learn exactly which snakes in your area are venomous enough to be dangerous. Speak to a local snake expert; write to your National Museum's Reptile Department or a university library; visit a zoo or good snake park. It is easy to learn to identify the few types of dangerous snakes and you will no longer need to worry about the many other harmless ones. Encourage the harmless snakes to live around you because they will be helping to control the vermin. Learn the local names of snakes commonly found in your area.
Do not attack dangerous snakes unnecessarily! If you are close enough to kill it, it is close enough to hurt you. If it is out in the bushes, just leave it alone and warn your householders to stay away from the area until the snake has left. If it is trying to come into your living space, you may be able to scare it away by making a disturbance from a distance. For example, tap the branches well ahead of a climbing snake to turn it away, or throw handfuls of sand ahead of a snake on the ground. Do not use stones in case you accidentally hurt the snake, which may then become angry. Make sure nobody is blocking its escape route. Do not encourage a big, excited crowd to gather. It is much safer to do the job quietly and calmly.
Antivenom is the only specific cure for a lethal dose of snake poison. Do not wait for a bite to happen before finding out if your doctor keeps a supply of antivenom. Because it is quite expensive and needs to be kept refrigerated, many rural clinics do not stock it. If bites are common in your area, you may arrange a collection to purchase a supply of antivenom to store in a centrally located refrigerator. In this way, one stock may serve a large area. Contact your Health Department on where to obtain the correct antivenom for your area.

ACKNOWLEDGEMENTS
I am grateful to all who helped, sponsored, spoke at and attended the 2nd Snakebite Seminar held at Hemingway's Conference Centre, Watamu, Kenya in 1999. Speakers:
James Ashe, Bio-Ken Snake Farm, PO Box 3, Watamu
Dr. Harry Mwimali, Veterinary Clinic, PO Box 99, Malindi
Damaris Rotich, Curator of Herpetology, National Museums of Kenya, PO Box 40658, Nairobi
Dr. James Southern, SA Vaccine Producers Ltd, Reintfontein, PO Box 28999, Sandringha, 2131, SA
Prof. David Theakston Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
Prof. David Warrell, John Radcliffe Hospital, Headington, Oxford, OX3 (DU, UK

I would like to thank Prof. Warrell and James Ashe for corrections & suggestions.