Also about prevention and first aid

I was not used to snakes because there are no wild ones in Iceland. But since I often saw snakes on my traveling in Asia, I decided to learn about prevention against them and first aid for snake bites.

In Malaysia I visited a snake farm and saw different types which can be seen in the video.

There are many types of snakes in Australia, including the ten most venomous snakes in the world. When I was there, I talked to reptile handlers at the Australian Zoo, which was made famous by its owner Steve Irwin, known as “The Crocodile Hunter”, who died in 2006. There I saw an exhibition of the most venomous snakes and I found it worrying that it was very difficult to see them in their natural habitat. The books I used as reference for this article were published in Australia.

Prevention

• Leave snakes alone. If a snake is cornered it can be very vicious. Over 80% of bites in Australia are because people try to catch or kill snakes. Like most animals, they only want to be left alone to live their lives in peace, and usually bite people only when they are frightened.
• Turn your shoes upside down and shake them before putting them on.
• Wear closed shoes, socks and jeans. Do not wear sandals.
• Wear gaiters, which are protective leg clothing wrapped below the knees. There are special snake proof gaiters.
• Because snakes picks up vibrations from the ground through its body, it is best to stromp along as loudly has possible. Most snakes will slither away long before you arrive, if they feel that you are coming. But the Death Adder (Acanthrophis antarcticus) will stay perfectly still and bites very quickly if it is touched.
• Look for snakes before you put your foot down, especially when stepping over logs and stones where snake could be.
• Never put your hands into hollow logs or thick grass without looking first.
• When in the bush, check your sleeping bag, towel and clothes before using them.
• Always use a torch around camps and farm-houses at night, because most snakes are active on summer nights.
• Keep the area around the house clean and tidy. Snakes don’t like to cross open spaces because it exposes them to predators.
• Keep large populations of potential prey some distance from the house.
• Make sure barns and sheds are kept free of mice and rats that may attract snakes, and help keep the grass well cut, particularly in playgrounds and other places you go to.

Symptoms

Snake bites are sometimes painless and may not be noticed. Most bites involving serious envonomation cause some or all of the following symptoms:

• Serve headache.
• Nausea and vomiting.
• Abdominal pain.
• Muscular pain and weakness.
• Drooping eyelids.
• Difficulty breathing.
• Difficulty in swallowing.
• Blurred vision.
• Desire to urinate or defecate.
• Paralysis.
• Unconsciousness.
• Death.

Victims of Australian snakes generally die of suffocation, bleeding problems or kidney failure. Suffocation can occur because the main nerve leading to the diaphram (the large muscle between the chest and the abdomen) stops sending the impulses which keep your breathing.

First Aid

Even though some snakes are not dangerous it is best to treat all snake bites as they were dangerous and give the victim first aid. A snake usually bites near the ankle or the hand so it is easy to use first aid. But a Brown snake (Pseudonaja textilis) may wind itself up into a ´S´ shape and so people are often bitten on the knee or higher by this snake. Believe children if they say they have contact with a snake. Some young children may describe the snake as a stick or a rope.

Basic life-support techniques like Cardiopulmonary resuscitation (CPR) will not be described here though it sometimes must be used because of a snake bite.

1. Phone or send for medical assistance.
2. Reassure the victim and encourage them to remain calm and as still as possible.
3. Use the Pressure-immobilisation technique.
4. Bring transport to the victim if at all possible.

Use a broad elastic bandage like crepe bandages used for sprained limbs. Any flexible material can also be used, for example pantyhose or you can tear clothing or other material into strips.

As soon as possible, bandage from below the bite site, upward on the affected limb. Starting at the fingers or toes, bandaging upward as far as possible to compress the lymphatic vessels. Leave the tips of the fingers or toes unbandaged to allow the victim’s circulation to be checked. Make the bandage as tight as for a strained ankle, but not so tight that it restricts blood flow. To save time and not move the limb, don’t remove clothing just bandage over them. Bandage the arm with the elbow in a bent position, to ensure the victim is comfortable with their arm in a sling.

It is helpful to mark the position of the bite on the bandaged limb with a pen or pencil. If the hospital needs to take a swab of the bite, the bandage can be cut at that place rather than being removed.

If the victim has been bitten in the face or trunk it may be impossible to apply a bandage. Instead hold a pad of cloth firmly against the bite and seek medical attention.

Try to restrict any movement of the limb while doing this, to prevent further circulation of a suspected toxin.

Bind some type of splint to the limb like a piece of timber, a spade, branches, rolled up newspapers or anything that doesn’t bend. This is important to prevent muscle, limb and joint movement that would circulate the venom. Mere pressure or immobilisation alone to the bitten limb is insufficient, a combination of both is necessary.

The bandage and splint should be quite comfortable so that they can be left for several hours. Don’t rush: you have several hours, with any luck at all, before the symptoms really begin to hit. Don’t let anyone take off the pressure bandage ´just to have a look´. The symptoms may appear very rapidly as soon as the bandage is removed. The doctor will decide when to remove the bandages.

Take the victim to a doctor or hospital as quickly as possible. Try to bring a car to the victim. If that is not possible then try to make a stretcher and carry the victim to the car. If possible the victim should be carried rather than allowed to walk, regardless of where the bite has occurred.

The first aid for sea snake bite is the same as for land snakes but the doctor may have to give the victim a sea snake antivenom. If this is not handy, then Tiger Snake (Notechis scutatus) antivenom can be used.

Reasons for this first aid

The trick is to stop the venom reaching the victims general circulation. The venom diffuses through local tissues after it has been injected and is collected in the lymphatic vessels that drain excess fluids away from these tissues. These lymphatic vessels then carry the venom back to the bloodstream. It was once thought that the venom was carried in the bloodstream, and so painful and dangerous tourniquets were recommended to isolate the circulation in the bitten part of the body. Fortunately, this isn’t the way the venom reaches the general circulation. Most of it is in the lymph and not in the blood at this stage, and the lymphatic vessels run very close to the skin. An elastic bandage wrapped firmly around the bitten limp (as for a sprain) will slow down lymphatic flow so much that very little venom will reach the general circulation for many hours. Keeping calm will help a lot too.

This technique will slow down the onset of symptoms so much that victim will probably have many hours, even days before the venom poses any real danger to his life.

Venom toxicity is usually measured by the amount of venom needed to kill 50% of the laboratory mice into which it is injected. The most toxic snake-venom in the world comes from the Inland Taipan (Oxyuranus microlepidotus). This snake releases enough venom in a single bite to kill 50% of a total of 218 000 mice.

Even the deadly species may well decide not to inject any venom when they bite. Even if they do inject venom, the fangs of most Australian snakes (even some very large species like brown snakes) are very short and thus are unlikely to penetrate thick clothing.

To produce antivenom, horses are injected with non-lethal doses of snake venom at regular intervals so that they build up an immunity to the venom. The blood serum from these horses contains many antibodies which neutralize the venom and so can be injected into snake bitten victims to counteract the effects of the bite.

Traces of venom (or even venom in your urine or bloodstream) can be identified with a special venom detection kit (ELISA-VDK) held at major hospitals in Australia. For this reason, the wound should not be washed, wiped or cleaned in any way until after the hospital staff has swabbed for venom. The main advantage of knowing what species of snake bit the victim, is that much less antivenom needs to be injected to neutralize the venom. If the species of snake is unknown, a general-purpose antivenom can be used. It is effective against many species, but large volumes are needed, with the consequent possibility of allergic reactions to all of this horse blood serum suddenly pumping through the victims system.

Antivenom should only be given by a qualified medical practitioner, mostly because of the possibility of allergic reactions (which may kill the victim quicker than the snake could!). Antivenom also needs to be refrigerated for storage, so it’s not really feasible to carry it with you in the bush.

The pressure-immobilisation technique is so simple and effective that it has revolutionized snake-bite treatment in Australia. It was discovered by a combination of hard work and accident. Dr. Struan Sutherland, of the Commonwealth Serum Laboratories, had developed a sensitive assay that enabled him to measure levels of venom in the bloodstream. This technique allowed him to inject an animal with a know amount of venom in one limb, and take blood samples from another limb to see whether any first aid techniques could slow down the rate that the venom reached the general circulation. This was a big improvement over previous experiments, which could only guess at venom levels by the general symptoms of the subject. Monkeys were used, because of their general similarity to humans. Earlier research by Barnes and Trueta had shown that simply immobilising the bitten limb seemed to retard venom movement. Dr. Sutherland was experimenting one evening with inflatable splints, but the splint he used developed a leak and no others were available at the time. Instead he just applied a pressure bandage firmly to the monkey’s leg, never dreaming that it would work. The next few hours showed that there was a cheap and simple, but remarkably effective, first aid treatment for Australian snake-bite.

This technique was adopted by organizations which teach first aid such as the Australian Resuscitation Council and St. John Ambulance. It was not long before numerous case reports supported its efficacy in preventing systemic envenomation and a scientific study using lymphoscintigraphy confirmed that lymph movement is indeed retarded by the technique. In Papua New Guinea it was noticed that this technique was the only treatment required in the successful management of 41 of 44 victims with unequivocal signs of Death Adder envenomation in.

Struan Sutherland (1936–2002) was the ultimate authority on the medical management of envenomated victims in Australia for almost 3 decades. Besides inventing the pressure-immobilisation technique, he also helped to develop the snake venom detection kit. He founded the Australian Venom Research Unit in 1994 at The University of Melbourne, which now provides a 24-hour advisory line: (03) 8344 7753. The laboratory containing this unit is now named, in his honor, the Sutherland Laboratory. He was appointed consultant in clinical envenomation to the World Health Organization in 1979. He received the Australian Medical Association Prize for Medical Research (1977), the James Cook Medal of the Royal Society of NSW (1984), the Medal for Outstanding Contributions to Tropical Medicine of the Australasian College of Tropical Medicine (1997) and the Distinguished Fellow Medal of the Royal College of Pathologists of Australia (1999). His contribution to public and scientific service was recognized with a posthumous award, Officer of Australia, in the Order of Australia in 2002. He co-authored a children’s book “Take Care—Poisonous Australian Animals”, which is one of the book I used for this article.

What not to do

One of the reasons why I am writing about first aid for snake bits is that there have been many different recommendations for such aid and many of them have not been proven to be beneficial and some are obviously outright harmful. Some are even very bizarre.

• Though it helps a lot if you can work out what kind of snake bite the victim, don’t try to catch it or kill the snake so it can be identified.
• Don’t wash the bitten area because hospitals do a special test on the fang marks. This lets the doctor know what type of snake has made the bite.
• Puring gunpowder onto the bitten area and setting fire to it.
• Injections of other poisons, such as ammonia, potassium permanganate and strychnine.
• Amputating the bitten part with an axe.
• Application of a tourniquet.
• Incision of the wound.
• Suction of the wound.
• Electric shock treatment.

Bibliography

First Aid Information: Snakebite (all land and sea snakes), Australian Venom Research Unit, Melbourne, viewed 25 February 2009, < http://www.avru.org/firstaid/firstaid_snake.html>

Shine, Richard 2005, Australian snakes: a natural history, Reed New Holland, Sydney.

Dr. Sutherland, Struan & Kennewell, Susie 2005, Take care!: poisonous Australian animals, Hyland House Publishing Pty Limited, Flemington.

Swan, Gerry & Swan Marlene 2006, How to treat bites and stings, Reed New Holland, Sydney.

Tibballs, James 2006, Struan Sutherland—Doyen of envenomation in Australia, Elsevier Ltd, Toxicon 48 (2006) 860–871.

The music is provided by my friend Chuck Jonkey in Los Angeles. He is musician/composer and known as the “Indiana Jones of the music world” because he has travelled around the world to collect sounds, instruments, environmental recordings and ethnic tribal music. He is the owner of the independent record label Sonic Safari Music, where e.g. ethnic tribal music and music by him can be bought. His collection of strange musical instruments is enormous, which he uses sometimes in his music. Chuck Jonkey’s music has been featured in many feature films e.g. Rambo IV (2008), J.F.K. (1991), The Doors (1991) and TV shows, e.g. Nip / Tuck (2003), Survivors and shows at Discovery Channel. He has also composed several hundred musical pieces for Microsoft’s software products.

To order the CD with music in the video from Sonic Safari Music you can click on the cover.