In Part 2 of this blog, we will be looking at what is currently the suggested best practice for dealing with a snake bite injury and a couple of things that we learnt from our experience in Part 1 of this blog.
First Aid Advice*
1. Firstly look to your safety and the person who has been biten. Don’t risk being bitten yourself or extra bites for your patient. If the snake is still present it will potentially look to slip away as quickly as it is able.
2. Move the patient and yourself away from the snake. Not far but preferably to a comfortable location, sit or lay down your patient. Keep them calm, try and reassure them that you will look after them. Ask them to not move if possible. If you believe that the snake is venomous, which unless you are 100% sure it isn’t, you should, you need to get busy.
3. If the bite is to the hand, remove rings or jewelery in case of swelling around the bite. Remove or cut away tight clothing around the bite for similar reasons.
3. Given that you have a first aid kit (see Takeaway Lessons below), place a sterile gauze pad over the bite and then firmly but gently bind the bitten limb from the bite toward the heart. This needs to be firm but avoid cutting off circulation to the limb. If you have the bandages, go as far up the limb as you can. Current thinking is that toxins from snake bites travel more readily through the lymphatic system rather than the blood stream. Firmly bandaging the limb restricts lymphatic drainage and limits movement of the limb which may assist in moving toxins through the body. Try and keep the bitten limb lower to the ground than the rest of body. Further splinting of the limb to restict movement is also suggested if practical.**
4. How far away are you from medical assistance? Do you have mobile/cell phone reception? Can you send someone away to get help or is it just you and the patient? If you are multiple hours or days away from assistance you need to consider moving the patient. If possible this needs to be done without the patient moving themselves. This means carrying the patient either yourself if possible or creating some sort of stretcher with the equipment you have in your packs and around you. Assisting your patient to walk themselves out or leaving the patient, if is just the two of you to go for help, are the absolute last resorts if other avenues are exhausted.
* Disclaimer – “Advice” is just what it means, this is the suggested practice for treating a snake bite in an emergency situation, of course your first and best choice is always a medical or paramedical expert. If in doubt or if snake bites are potential issues you might have to deal with – do a first aid course yourself.
** Compression bandaging of the limb is currently suggested for only Australian snakes due to the toxicity and make up of their venom, however bandaging and splinting the limb to restrict movement is suggested for all potentially venomous snake bites worldwide.
1. Do your research before you go on your next overseas/interstate climbing destination. Knowing if there are venomous snakes in the location you are going to is not probably the top of your priority list, but a general knowledge of potential risks can help you tailor what you should have in your first aid kit.
2. Avoidance is better than treament. If you are in an environment where there is likely to be snakes, consider wearing enclosed shoes and long pants. Sometimes snakes are not where you anticipate them being, for instance, in our friends case in part one of this blog, but in many cases being a bit hot and getting sweaty in a tropical environment is a better option than jungle bashing in flip flops.
3. Buy yourself a first aid kit and don’t forget to pack it in your climbing backpack. Lots of folks don’t have one and when something happens at the crag, do you really want to be the one saying “I thought you had a first aid kit?”. Even a basic, simple, light and cheap first aid kit could be a lifesaver. We will go into suggestions for a DIY first aid kit and what you should put into it in a future post.
4. If you buy a first aid kit, chuck in a couple of extra compression bandages, they are cheap and light. We found out the hard way that one compression bandage may not be enough to correctly wrap a limb. They are useful for sprained ankles (much more common than a snake bite) and you can use them to pack a wound if needed, they are a very versatile unit in your kit.
5. Once you have that first aid kit, if you spend a lot of time climbing outdoors, you should also consider some sort of basic first aid course. If you don’t have the cash or the time to do one, consider a small first aid booklet that you can stash in your first aid kit. We recently completed a WFA (Wilderness First Aid) through Insight Adventures in Yangshou, China that was extremely thorough. The Red Cross runs cheap first aid courses around the world that can teach you the basics, such as bandage techniques and CPR.
Interesting Side Notes
1. The local Thai people were quick to concoct a local snake bite remedy that seemed to be a mixture of a local fern and lemon juice, that they wanted to apply to the wound as a poltice. Perhaps the acidity of the lemon juice assists in breaking down the proteins in the venom(?). They were also extremely keen to tourniquet the leg, which, according to current western medicine, is a bad idea as when it is released there is a sudden flow of deoxygenated blood back into the system. Although obviously they have the local knowledge and experience, we politely and respectfully declined the local remedy at the time.
2. The incident caused a lot of local interest. There was a growing crowd and they were all very keen to have a look at the bite itself, which meant that they were constantly trying to unwrap the compression bandage that had been applied. We had to at one stage create a bit of a human barrier as they were starting to crowd the patient. Some cultures react differently in an first aid/emergency situation, you may not get the personal space or offers to provide assistance in some countries, that you may have expected or hoped for.
3. Talking to one of the boatmen after the incident, he was telling us that the bite was probably from a viper. He said that cobras (which are local to the area), tend to rear up and strike in a vertical side-on pattern around the calves as opposed to this bite that was low and more front-on to the patient’s heel. It was also just after heavy rain at night, which is when vipers are more actively hunting frogs. This piece of local knowledge seemed to be spot on correct in the aftermath of the event.
1. Wikipedia – Snake Bites – (warning gratuitous necrotic tissue damage photo, also interesting insight into snake bite and blood alcohol correlation)
2. WHO – World Health Organisation Venomous Snake distribution information – (something to keep you awake at night when you are planning your next overseas trip – hint: they are pretty much everywhere!
Scott has been a traveling climber for the past three years. He has had his fair share of snakey encounters, though thankfully none of the bitey variety.