"New" snakebite advice

I’ll follow replies to your question with interest. As someone who travels into reasonably remote areas with or without others, I’ve never figured this out.

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Yes, this one has always troubled me..............

"Do NOT allow the victim to walk or move their limbs. Use a splint or sling to minimise all limb movement. Put the patient on a stretcher or bring transportation to the patient."

So we are one hour into a hike in a gorge and I get bitten on the leg by a snake. O.K. we have the necessary elastic bandages in our little first aid kit and a satphone, but what then? My leg is all strapped up in a splint and I'm not allowed to walk. My wife can't carry me. Do we just sit down and chat about the odds of help getting to us in time? Or what?

Hi Allan

Now being a Boy Scout, you should "Be Prepared"..........


Being on the hike, you should always carry a PLB, SPOT or the like.

When I was speaking to the guys in Canberra about my PLB, I asked them the very question regarding a snake bike. I was very surprised that he said, YES, activate it immediately, as yes it is a life threatening situation.

The chap was most helpful and said do not move, activate, stay calm and wait for help, as once they have picked up your distress signal, help will be on its way.



Cheers and I hope Roz is never put into that situation......lol



Take Care



Stephen

Why was their response a surprise? Of course you would activate a PLB if you had not other communications.

Of course we all travel as prepared as we can but the question is "what if" you cannot contact help and you cannot travel - what do you do medically for the patient.

Now I have heard that your body can cope with the venom as it is released through the body if you have the bite wrapped up with the right bandage etc up the limp but I dont know.

What if a brown has climbed into your sleeping bag and has bitten you on the side of your body - what do you do? Wrapping your torso in a compression bandage is not likely to be effective - what do you do then.

Advice is great if you get bitten on your pinky and within range of reasonable help - but "what if" you are not.

Stephen,

That works for me if you have a coms device. I guess the question is what you do if you don’t.

Say you stop the car to walk to a trig point to take a few pics. No first aid kit or sat phone and no passing tourists.

Do you sit down (after wrapping your leg in your undies) and talk to your maker or do you walk back to your car?

So the advice is to keep calm, apply a pressure bandage and sit there until what?

William p it sounds like you probably just drop dead!

Canning Stock Route snake bite?

Should I get bitten, which was hugely unlikely as I saw few snakes despite being on foot for two months, my plan was to find some shade, lie down, relax and go to sleep. I would either wake up or not. Either way, I would choose it to be a peaceful experience.

Hi Skulldug

You have hit the nail on the head.

I am not sure if it ever made National news a few years ago about there was a young lad that was driving from Melbourne to Darwin during the month of December. His parents had contact with him until about Port Augusta and he just vanished......

His parents were very concerned and thought was it going to be a "Wolfe Creek " as his bank account was not touched and was a classic case of being murdered.
North of Glendambo during January, a station hand noticed a vehicle just off of a bush track but did not go up close to check it out and thought no more of it. About a month later the vehicle was still there and Police were called in.

All the young lads gear was in the vehicle and it was bogged in soft sand, with some logs under the back wheels to try and aid with the recovery, but no body. A search of the area and the body was found.....

To cut a very long story short, the poor lad had driven off the main highway to camp, became bogged and was collecting dead wood from the ground to try and free his vehicle, was bitten by a Mulga Snake and died around 200 metres from his car.

So in a situation that you are on foot with no communications, there is not a very positive outcome. As we all know, Australia was the top 10 most poisonous snakes in the world and our good old common Brown snake come in no 2



Cheers


Stephen

All good advice...

But what do you do if you can't follow the suggested course of action?

It all becomes best endeavours; do what you think is best under the circumstances you are presented with and if you are carrying a PLB activate it immediately and without hesitation - well, that is what we would do...

Out of interest, this is from a link on the Flying Doctor website...

"Australian Snake Bites

In Australia there are about 3,000 snake bites per year, resulting in about 500 hospital admissions.

Many receive antivenom; on average two per year will prove fatal.

About half the deaths are due to bites from the brown snake; the rest mostly from tiger snake, taipan and death adder. While some deaths occur soon after the bite, it is uncommon to die within four hours of a snake bite.

Deaths from anaphylaxis following bee, hornet, tick or other arthopod bite happen as frequently as deaths from snake bite."

Cheers, Baz - The Landy

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Just as I thought....... there is no patent answer to the question of what to do after immobilisation until help arrives. Seems that there is not much you can do so maybe Gaynor's philosophy of "find some shade, lie down, relax and go to sleep" may be appropriate.

To Stephen, Yes mate, I am reasonably prepared with satphone and PLB. In this, and most such, situations I would grab my satphone..... after having activated the PLB. If I am snake bitten I want a rescue helicopter onsite in 10 minutes flat! With a PLB, they do not know the nature of the call (you may just be out of V.B.) so response may be variable. I am aware that in some real PLB activations, the first response was to send the local police out in a road vehicle. With the phone I can scream at them and if they tell that all their helicopters are busy I can resign myself to die.

To William P, Yep, I too have pondered on treatment if the bite is on the torso. The published advice is for limbs only, which is the most likely site, but what to do if elsewhere? Take Gaynor's advice??

Skulldug..... A chat with "your maker" may be helpful.

Nutta, you may have it in one. Collect your cigar.

And Baz, It is always nice to have two offered alternatives. Perhaps it is Nutta's or Gaynor's? God help us..... but then was it not God who put bloody snakes on the Earth anyway? Not funny God!!

It may be urban myth or it may be true but there was a story circulating some time ago where a bushie was outback with his horse and he was bitten by a snake. Realising he could not get help he gave his horse some of his water to drink from his hat and he set it free .. and he sat under a tree and prepared to die. Quite some time later he awoke and felt OK. He started walking and found his horse grazing some distance away, which he then rode to get assistance.

The medicos said that by sitting under the tree and relaxing it slowed his heart beat down and over the period of time that he was at rest the venom had dissipated.

It may be one of those perennial 'feel good' stores that come up all the time. Be nice if it was true, although I carry snake bite kits so I am not prepared to test the theory .. or myth ...
Cheers

Jack

I had this conversation around a fire with some aboriginal guys I was working with. No ifs no buts, lie down and play dead - they all agree. I have also read anecdotal evidence of humans being able to very slowly metabolise poisons if lying down with lowered heart rate.
One thing both traditional and current medicines all agree on - if you get up and start walking, you are a dead man.
Your choice I suppose.

Yep as already said - there is only one thing "not" to do - don't move the patient. If you cannot raise help you will have to sit it out and take your chances. The one thing that is very clear is that you have a better chance of survival sitting it out than moving.

Not all snake venom is the same however and how a human reacts to venom is different to how say a dog reacts to venom. If you look at the leading species of snake in Australian that cause death, it's the brown snake (41%) so if you just focus on how their venom works, it is easier to understand.

See this link for the science on Venom of brown snakes, and this link gives more details on the Coagulopathy and Haemorrhagin Effects of brown snake venom in humans.

So if you read all that, you're either going to die of kidney failure or you'll bleed out (or internally bleed and not even know it) if you unlucky enough to get a serious brown snake bite.

Allan,

You raised exactly what I have ponderd over many time as well I certainly in past have travelled alone.

I think this is why the old man has a rather laxed view point to using PLB sat phones etc. Not much use to you if your unconcious down a mine shaft or in a overturned vehicle and immobile.

As I am a rather large unit read : over the 6 foot tall (griffae) bit of padding (semi beached whale) and hairy like a gorilla ( you get the idea) best thing for me is say - there is the shovel go dig my own grave cos no bastard will ever try and lift and rescue me - no truer word has been said to me by another SES volunteer

I also say that these days like with some "attacks" ie asthmatic or anaphylaxis with advances in modern medical treatment a Epipen designed for snakes bites should be designed for such occasions - the golden hour is the most critical and in majority of cases "assistance" can be alot longer than that many hours or even days depending on location

If all hope seems lost, don't forget to make a will>

Too many aussies die without making one, they always think it won't happen to me, unfortunately, it does, every minute of every hour another aussie dies, eg melamona 5 every hour,

So, in outback, no help forseeable, make a will, your wife, gf, family will love you forever, otherwise, the Govt. gets the lot, do you really want to give ALL your hard-earned to the Govt, make a will today, not next week, next month, cardiac arrest, 23 DIE per day, one cardiac arrest every 10 minutes, 8,443 attacks in 2015

One of my workmates’ wife dropped dead earlier this year - early 50’s - intestate. What that poor bugger has been through over the last 6 months I wouldn’t wish upon an enemy.
I wholeheartedly concur - make a will!

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Yep, every first-aid kit should contain a will form.
Don't die interstate.

Sorry. Couldn't resist it. lol

Having had a chance to absorb all of this, I'll add my two bob's worth.

Assuming that you are solo, have left the vehicle with no first aid kit or communications, little prospect of passers-by and you are unlucky enough to get a deep wet bite from a large brown snake, I can't subscribe to the notion that you sit quietly waiting for the after-life.

The first aid guidelines say you should immobilise the person, slow circulation with a bandage and seek medical help.

I personally would do as much of the above as possible. That means make-shift bandage, walk slowly back to the car, call for help.

Skull

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I would agree with that Skull.

Within sight of the vehicle I don't even think about it. But if going any further afield I pocket the two bandage rolls from the glovebox. If going on a proper hike we carry the small first-aid kit and comms.

Certainly not going to sit-and-wait unless I know that help will soon arrive.

Actually, you ARE supposed to sit and wait (if at all possible).

As a long time bushwalker, an ex snake catcher and having completed remote outdoor first aid courses, we were privy to some fairly specialised people and information.
You should always have those 2 compression bandages close by, when hiking, yes in your little pack with map, compass, water etc.
A PLB would be ideal of course, and what you do otherwise depends on circumstances, should you be unlucky enough to suffer a snake bite.

You should just get comfortable, find shelter if possible and you don't have full bushwalking kit with tarp etc, food, ample water etc.

If you are envenomated at all, venom travels through the lymphatic system under the skin and enters the bloodstream at lymph nodes (groin, armpits, neck), the object of compression / immobilisation is to stop the movement, while not restricting blood flow.
Walking / limping will certainly aid the movement of the venom to the blood, so avoid movement at all costs.

Even movement of being carried or in a vehicle is not perfect, as your body moves the limb just moves to compensate with the bumps etc.

Venom breaks down within a reasonably short time in the body, the best advice was . . . keep the patient still and calm, comfortable and fed / well hydrated as conditions require.
Monitor and record vitals, and be prepared to do CPR if needed, though in such a case it is probably not going to be something that will help much.

After 48 hours you can make a move to extract yourself to assistance, slowly as as calmly as possible.

Of course this is after you have eliminated all options like setting off a PLB, or sending one or 2 of the party to get help.

One of the findings of the Australian Snake Bite Project:

A bystander performing CPR is the most likely thing to save a person who collapses after venom enters the bloodstream.

This was reported at theconversation.com on 31 July 2017.

The link to this article: Australian Snake Bite Project

Les - good advice and most likely correct but my point is that published information on this aspect should be included in the official advice - at present it ends with call for help.

Yes John, CPR is all you can do to a point, once systemic envenomation has occurred.
It's then only a matter of time before damage to organs and nervous system occur, possibly leading to the effects claim a victim by shutting down organs, or clotting blood to the point where it just can't be pumped through the body.

Besides, CPR is bloody hard work !!
Even if you have several trained first aiders capable of performing CPR in turn, it's likely after a couple of hours it is simply too tiring to go on.
A solo first aider, as desperate as they may be, would be lucky to manage half an hour by themselves.

William, the usual snake bite first aid treatment always presented is based on being able to get emergency services like ambulance within a very short time.
Other than this it is probably too confusing and too many variables for the medical people to give further advice.
Certainly some training people do like wilderness first aid may touch more on long term aspects of all first aid, but even then it's not common to know about venom breaking down quite quickly, and who's to say how long your common species may vary in time etc.

Personally, if I was bushwalking or near my vehicle with camping gear, it would be very easy for a companion to do the first aid, set up shelter, keep you comfy without needing to move, and I'd just stay like this for a few days, then do the walk / passenger out thing as calmly as I could.

G'day Phil,
Wise advice. I have encountered hundreds of snakes in my travels & while doing Wildlife surveys.
I have a healthy respect for them & am comfortable in their presence. One thing I always point out to people that fear them is they have venom & bite to defend themselves also to disable their prey.
They do NOT seek out humans with the intention of biting them. In fact when a snake bites it can chose whether to inject venom or not.

Cheers
Stu

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Hi Phil,

Yes, your'e right about handlers and idiots, but what if I myself, me that is, Number One, was one of the "two per year" casualties. Wouldn't be funny.

I haven't seen too many wild snakes (I don't mean annoyed ones, I mean snakes-in-the-wild) but a couple were too close for comfort. On an occassion of walking down into a ravine, as I stepped on a large rock on the path, my forward foot hovered over a snake coiled on the path against the rock. My next step delivered me about 20 metres further down the path! But had I not spotted the snake I would have stepped directly on it. Shall I speculate what may have happened then?.......Statistic number two!!!

Gday Allan,
Happy to accept that you are not a snake handler and we know you are not an idiot!!
So your chance of being killed by a snakes has dropped from one in 12million to say one in 50 million! More likely that you will win lotto!

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That is a huge relief Phil. I'll keep an eye on the letterbox. lol

Allan, Two killed a year is pretty good as Phil said. At least we don't have Big cats like Africa and Grizzly bears like USA and Canada. We are lucky not to have those big predatory animals.... Just don't tread on a snake!! Good luck with the Lotto win. Regards Michael

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One in 50 million! How could I possibly fail?

Don't go taking off on the Great walk around Cooloola at this time of year and your chances will get better again. Big lazy black snakes lie on the path in the sun. At least they are relatively easy to spot.

But what about those killer bees. As many people have died from bee stings than snakebite! Feel sorry for the spiders - they now rate less than the humble ant with zero deaths since 2000.

Good question, never spotted anything that appeared new either. Maybe its just the overall advice that is new ...and not any specific element.

Cheers
Greg

The update seems to be nothing more than: don't try to identify the snake due to possible danger.

Wrt questions about being bitten on the torso, or head or anywhere else which is difficult to bandage, common sense should apply. Compression bandages are to slow the spread of venom which travels via the lymphatic system - not, as we know, via blood as was thought many decades ago. If it's impractical to bandage (eg don't have enough bandage) logically you move to the next option which is patient/limb immobility. If that's also impractical (eg you're alone and have no emergency device), the choice is to use minimal exertion while you try to get yourself to the nearest help (ie walk, don't run, to the truck), or "wait and hope". Personally I'd be plumping for the former in most cases.

If you're waiting for assistance and have bandaged/immobilised a limb then yes you leave the bandage on until medical help arrives.

That's my take on what I've read and been taught over the years. Easy to say, probably not so easy to do when you're in the wilderness with, say, just your partner and you have to decide whether to stay with the victim or return to the vehicle.

Decent summary here: Australian Snake Bites

Bazooka - I dont disagree at all but in the official advice from medical authorities these aspects should be covered and not be silent. It should not to be left to us to surmise what to do based on information on forums.

Everything bar advice on what to do if you're alone or in a pair can be found on reputable websites William. There are good explanations on symptoms, the physiological effects etc which are at least handy to know.

Whether to 'lie down and hope' or try to get to your vehicle (where you might have comms or might make a dash for help) is something no-one can provide a hard and fast guide on - far too many variables including location, how well the victim is, the state of the bite, the snake involved etc etc. Suffice to say that I have scant regard for the advice to do nothing but lie down and hope for the best unless there is no other alternative. Thankfully chances are most of us will never have to make such a decision.

Michelle,

Regarding your comment that
"antivenom is generic, which means there is no requirement for people to know the species of snake that has bitten them"

should not dilute the requirement
Not to wash the wound and to place a folded pad over the bite as "It is extremely important to retain traces of venom for use with venom identification kits"

The statement actually contradicts itself there, I THINK they are removing peoples need to put themselves in harms way to try and identify the snake, as they can do it from testing the traces.

CSeaJay - this link probably explains it better than I can. Essentially, they use a polyvalent antivenom that has been created using venom from various species of snake.

Probably the biggest takeaway from this information in regards to first-aid is to determine IF envenomation has occurred - as Australian snakes have the ability to bite with or without injecting venom so it is the symptoms that trained first-aiders/medical staff look for. If you want to improve your snake bite first aid, then knowing the physical signs of envenomation for the main venomous snake species would seem worthwhile.

Each State in Australia has a specifically formulated polyvalent antivenom to suit local snake species, however it is certainly preferable to use a snake-specific antivenom to reduce the chance of reactions but it will ONLY be used if there is no doubt on the species.

I've copied the following from an online source and simplified the medical terminology to plain English (and I'm no authority on the matter):

Non-specific features of envenoming include: headache, nausea, vomiting and abdominal pain

Systemic envenoming by brown snake bite are: - lightheadedness, muscular weakness, blurred vision, and feeling faint or sudden collapse. The hallmark of brown snake envenoming is severe bleeding that does not clot caused by the toxin stopping normal blood coagulation (gums, bite site or brain bleed).

Tiger snake and brown snake envenoming may be indistinguishable initially as both feature "defibrinating coagulopathy" (blood clotting disorders) however, in tiger snake envenoming, paralysis and rhabdomyolysis (muscle pain with muscle weakness with red/black urine) will evolve over the ensuing hours after the bite has occurred.

Taipan envenoming also features a severe defibrinating coagulopathy, but it is usually associated with EARLY paralysis and rhabdomyolysis

Black snake envenoming is associated with a mild anticoagulant coagulopathy, normal fibrinogen levels and myolysis (raised CK).

So, there are both symptomatic clues to help identify what type of snake has bitten a person, as well as a visual confirmation of the snake (photo, or capture).

Once systemic envenomation signs are present, unless you're in a hospital or RFDS care, you're pretty much going to die, or suffer some serious permanent damage to organs etc.

I spend a lot of time in WA swinging a metal detector in front of me. Give them a tap on the head and they soon move on. :)
Dave.

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It wasn't quite like that at Woomera in the 1950's Michelle.

I was handed a vehicle with no comms. When I asked for a map I was told that none would be given. No safety instructions, no first-aid kit, no water container offered. "Frontier Country".......No OH&S then! A little later I got comms but that was so that they could call me for my services.

There was no official "roll call" at end of day but it was understood among those of us who had to return our vehicles to the motor pool, that if they were not returned by "pool closing time" then maybe the motor pool supervisor would contact the Ops officer (who by now would probably be settled in the Mess) By now darkness would have fallen so any search would not commence until next morning.

Incidentally, I think the one and only snake I saw at Woomera was a very small one in my home garden. What sensible snake would hang around with missiles falling out of the sky?

Not reliant on PLBs but they are the failsafe in 99% of situations. One piece of kit in a range of items to be considered.