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RFDS issues new snake bite management advice

Particularly for the VK ops, The Royal Flying Doctors have issued new advice for snake bite treatment.

Key point - no longer are you required to ID the snake type for effective treatment.

Shared for your info.

VK1MIC.com

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Makes since not to delay treatment. With most having cell phones, cameras handy just snap a pic and start treatment.

It’s not so much about delaying treatment or lack of cameras, the issue is more that people try to either kill the snake - usually resulting in a bite themselves - or they misidentify the snake. The two most common snakes seen in eastern VK are the eastern brown and tiger snake. The problem is there are tiger snakes that are bigger than browns, browns bigger than tigers, tigers with stripes, tigers with no stripes, browns with no stripes, and browns with stripes. The only way to truly split them is to compare features like fangs, which is herpetologist territory and requires the snake, so they test the venom around the bite site instead.

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Now its not even tested the anti venom is a mixed product targeting the main family group “with a generic polyvalent anti-venom” as per the advice linked.

I was bitten while in the bush in Australia back in the 1980s. I was on my own and 40 miles from the nearest town. I decided that my best bet was to lay down in my tent and die comfortably. Fortunately I didn’t.

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Recommendations for North America are different, because our venomous snakes are not as dangerous.

The major differences are to wash the wound, treating it as a puncture wound, and that a walking self-evacuation is possible if that is the fastest way to an emergency room. Compression bandages are recommended.

The 2017 edition of the Boy Scout wilderness first aid doctrine includes this somewhat contradictory advice about evacuation.

Go for help. The patient should not walk unless it is unavoidable for evacuation. The treatment of choice for snake bite is your car keys—which means you need to evacuate the patient swiftly. [Page 25: https://filestore.scouting.org/filestore/pdf/680-008.pdf]

Helicopter evac is available almost everywhere in the lower 48 states, including from the top of Mt. Whitney. I would probably send for help and move the bitten person to a helicopter-friendly location.

NOLS also has recommendations and a video: https://blog.nols.edu/2015/06/19/snake-bites-heres-what-to-do-video

wunder

And here is the advice in a very practicel sense:
Deniliquin Rescue Squad - NSW Volunteer Rescue Association Inc.

December 29, 2018 at 11:15 PM

Some useful information I found shared by a friend. Worth a read🤓

That bite of summer has well and truly come early this year and with that heat, comes snakes.
This article was written by Rob Timmings
Rob runs a medical/nursing education business Teaching nurses, doctors and paramedics. It’s well worth the read
#ECT4Health

3000 bites are reported annually.
300-500 hospitalisations
2-3 deaths annually.

Average time to death is 12 hours. The urban myth that you are bitten in the yard and die before you can walk from your chook pen back to the house is a load of rubbish.

While not new, the management of snake bite (like a flood/fire evacuation plan or CPR) should be refreshed each season.

Let’s start with a
Basic overview.

There are five genus of snakes that will harm us (seriously)
Browns, Blacks, Adders, Tigers and Taipans.

All snake venom is made up of huge proteins (like egg white). When bitten, a snake injects some venom into the meat of your limb (NOT into your blood).

This venom can not be absorbed into the blood stream from the bite site.

It travels in a fluid transport system in your body called the lymphatic system (not the blood stream).

Now this fluid (lymph) is moved differently to blood.
Your heart pumps blood around, so even when you are lying dead still, your blood still circulates around the body. Lymph fluid is different. It moves around with physical muscle movement like bending your arm, bending knees, wriggling fingers and toes, walking/exercise etc.

Now here is the thing. Lymph fluid becomes blood after these lymph vessels converge to form one of two large vessels (lymphatic trunks)which are connected to veins at the base of the neck.

Back to the snake bite site.
When bitten, the venom has been injected into this lymph fluid (which makes up the bulk of the water in your tissues).

The only way that the venom can get into your blood stream is to be moved from the bite site in the lymphatic vessels. The only way to do this is to physically move the limbs that were bitten.

Stay still!!! Venom can’t move if the victim doesn’t move.
Stay still!!

Remember people are not bitten into their blood stream.

In the 1980s a technique called Pressure immobilisation bandaging was developed to further retard venom movement. It completely stops venom /lymph transport toward the blood stream.

A firm roll bandage is applied directly over the bite site (don’t wash the area).

Technique:
Three steps: keep them still
Step 1
Apply a bandage over the bite site, to an area about 10cm above and below the bite.
Step 2:
Then using another elastic roller bandage, apply a firm wrap from Fingers/toes all the way to the armpit/groin.

The bandage needs to be firm, but not so tight that it causes fingers or toes to turn purple or white. About the tension of a sprain bandage.

Step 3:
Splint the limb so the patient can’t walk or bend the limb.

Do nots:
Do not cut, incise or suck the venom.
Do not EVER use a tourniquet
Don’t remove the shirt or pants - just bandage over the top of clothing.
Remember movement (like wriggling out of a shirt or pants) causes venom movement.

DO NOT try to catch, kill or identify the snake!!! This is important.

In hospital we NO LONGER NEED to know the type of snake; it doesn’t change treatment.

5 years ago we would do a test on the bite, blood or urine to identify the snake so the correct anti venom can be used.
BUT NOW…
we don’t do this. Our new Antivenom neutralises the venoms of all the 5 listed snake genus, so it doesn’t matter what snake bit the patient.

Read that again- one injection for all snakes!
Polyvalent is our one shot wonder, stocked in all hospitals, so most hospitals no longer stock specific Antivenins.

Australian snakes tend to have 3 main effects in differing degrees.

Bleeding - internally and bruising.
Muscles paralysed causing difficulty talking, moving & breathing.
Pain
In some snakes severe muscle pain in the limb, and days later the bite site can break down forming a nasty wound.

Allergy to snakes is rarer than winning lotto twice.

Final tips: not all bitten people are envenomated and only those starting to show symptoms above are given antivenom.

Did I mention to stay still.
~Rob Timmings
Kingston/Robe Health Advisory

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Similar, but obviously “watered down” advice here in the UK seeing we have only one species: https://www.nhs.uk/conditions/snake-bites/

I have only ever seen two adders during SOTA activities and probably no more than six or seven in my lifetime. Almost treading on one on the island of Islay while walking between summits was the closest encounter. Out of sight, out of mind - it would be a real shock if a UK activator was bitten. Now someone will tell me they have been!

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Thanks Compton very informative (and clarified why a tourniquet shouldn’t be used).

There’s a lot to be said for living on a temperate island (well once the present political high jinks are resolved :woozy_face:)

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Thanks to @VK1MIC Wade and @VK2HRX Compton for this useful info.

Whilst in VK1 & 3 in 2017, we saw quite a few Brown snakes, not really taking much notice until a park ranger told us what they were (eek)! The snake bite kit they recommended and which we then bought later, pretty much summarises what Rob T has listed to do in the event of a bite.

I can’t help thinking that if one did bite me or my XYL, second priority and very tempting after treatment would still be splatting it with a big rock! :wink: :slight_smile: :rofl::snake: I suppose they have as much right to visit SOTA summits as we do though ha ha!

73, Simon

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I think the general experience is that after striking at an apparent enemy, many snakes get out of the place with some speed. the idea of fishing out a phone or camera and taking a photo (that is not affected by the operator having the shakes from shock) is just not realistic, in my view.

The other factor that could have saved Richard, is that as noted in the RFDS notice, snakes don’t necessarily bring out the big guns when they strike. ie. you can be hit by a snake as a warning, and even be bitten, with puncture marks, without being envenomated. The hospitals try to see whether there is any venom around a wound. There often isn’t. The shock to the bitten is often significant due to the reputation of these events. The other factor is bacteria, there are a lot of nasty bacteria out there that are carried by these animals and infections from those are also tested for while a snake victim is being observed in hospital.

We had a 1.4m (est) brown snake visit the rock wall alongside our house a few weeks back. after an hour or so he had moved on so we just stay on alert. Note we are not in suburbia, we have a 2.6 hectare block (and we mainly grow weeds).

All this needs to be placed in context of the likelihood of encountering snakes in the bush (or in semi rural properties like ours). in 8 years of living here we have seen only a few snakes. I killed one because it had been damaged by a bobcat driver (most country people believe the only good snake is a dead one) and it was not going to do well even if it was allowed to wander off to the bush. I have seen some very young ones (looking like a good fat earthworm but the wrong colour and with more movement along the body). and in almost 6 years of SOTA activations I have only seen one snake, on Devil’s peak. And they are a part of the ecology and are a predator for other animals that we would not like to overrun the place.

in almost 50 years of visiting Mt Ginini for vhf contest purposes, I have never seen a snake up there. I have seen a dead funnel web spider though. there is an alpine species. For that reason I never wear open sandals or bare feet up there.

In Australia we know there are redback spiders in every shed, but knowing they are there is the first line of defence, also knowing they have very poor eyesight means you have an advantage. Their webs are always disorganised and random, unlike the beautiful webs made by other spiders. And the female is much larger and many times more dangerous than the male, which is a very tiny spider.

Like the snakes, it pays to keep your eyes open and be prepared to give way to a potentially more powerful creature and take appropriate action.

Note that in the reports on snake bites, a large proportion of bites were experienced by people trying to kill the snake. It’s nearly always better to leave them alone and let them go away.

Thanks for pointing out this new advice, Wade. I had seen it elsewhere but it is a good idea to post it here given there are often overseas visitors to VK country areas and best for them to be informed.

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And sometimes the snake wins.

The coroners report is at https://www.coronerscourt.vic.gov.au/sites/default/files/2018-12/shanekyletatti_569614.pdf which makes interesting reading - if you have an interest in this stuff.

Note that the snake bite occurred in 2014 before polyvalent anti-venom was readily available.

A recent death is currently being investigated and may well also be from a snake bite. https://www.vice.com/en_au/article/xwjb3k/a-drug-overdose-at-beyond-the-valley-may-have-actually-been-a-snake-bite

Stay safe out there - and just leave the snakes alone.

And for those going to Mt Hotham in Feb this year for the SOTA event I’ll tell you the story about how I slept with a red belly black snake after activating VK2/ST-007. We both walked and slithered away in the morning.

And the little buggers can get you as well potentially causing mammalian meat allergy with cardiac arrest as a complication:

I carry the freeze spray

http://www.tiara.org.au/how-to-remove-a-tick/