Snakebite Prevention & Treatment

There are about 143 species of snakes in Southern Africa, of which only 37 have fangs and venom that could cause clinical symptoms to humans. Amongst these only 11 are potentially lethal for humans.

Dangerous snakes bite humans only as an extreme self-protective behaviour when they feel threatened.  Non-venomous snakes, like pythons, can bite as well if threatened, and their sharp teeth can cause severe pain and injuries as well as infections if not adequately treated.

According to statistics, the annual records of snakebites rate in bush areas ranges from one to three snakebites over 10,000 people, and the mortality rate is only 1 to 2%.

Snakes do not hunt humans. Even the largest python, although it might show interest in a child, would never attempt to hunt an adult. All incidents between humans and snakes happen because the snake has been disturbed or threatened by humans. Most snakes do not want to interact with humans any more than the humans want to interact with them and the snakes disappear as fast as possible. Others, like puffadders, do not disappear but rather rely on their camouflage. This is one of the main causes of snakebites (because people do not see the snake and step on it).

A True Story From the Bush

“The black mamba suddenly rose up from the grass. I froze in position without even breathing. The snake’s body was raised half length of the snake and the head was at the same level of my chest, less than two metres away from me. The mouth was open and I could clearly see the black colour inside. I wanted to move my hand to my revolver, but then I realized that I wouldn’t have had time to shoot, because as soon I had tried to extract the gun, the mamba would have struck and bitten me.

It was so close… damn close! I didn’t know what do.

I just closed my eyes, waiting for its bite, but nothing happened. I started to slowly count in my mind. Not even a single hair of my body was moving.

When I reached 200, I slowly opened my eyes.

I was expecting to see the evil creature still there with its black mouth open, but nothing was there. The black mamba was gone.”

(A true story from Andy Tavella, Zimbabwe PH)

Prevention is the best way to avoid troubles with snakes and the best way to avoid a snakebite is to avoid snakes and not disturb them. Below we will look at the rules for avoiding snakebites.

Cut Down on Snake Bites

• Keep places like gardens clear of rubbish and tall grass or thick vegetation:

Snakes feel comfortable where there is grass or vegetation to hide in.

Rubbish attracts mice and rats, on which most snakes feed, and their presence automatically means potential snakes. (Never kill snakes like the brown house snake. They are harmless to humans and they act as very efficient pest control, preventing other snakes from being attracted to the area.)

• Do not leave food out of the fridge, boxes or cupboards. Most of the snakebites in rural areas occur because snakes get into huts attracted by milk or other food. (In rural areas people sleep on the floor and any movement during sleep can be interpreted as aggression by a snake that has accidentally got into the hut.)
• Never put your hands or limbs into burrows, holes, crevices, tree holes or wherever you cannot see. Snakes hide in old termite mounds, tree holes and abandoned burrows.
• Do not walk barefoot in tall grass.
• Never walk barefoot at night (the time when most snakes are active.) Use a torch when you walk at night. (“There are no dangerous snakes, except the one you step on”.)
• If you are walking in the bush it is desirable to wear closed shoes and reasonably thick long trousers so that your feet and legs are not vulnerable to snakebite.

• Do not lift rocks or logs without caution.
• Do not leave tents open. If zips are kept closed, snakes cannot get in (as well spiders and other insects). In houses, keep doors and windows closed to avoid snakes entering.
• If sleeping in areas where snakes are common, check your bed before getting into it, underneath and under blankets and bed sheets. If any snake is found, immediately call an expert and never attempt to remove it or chase it away.
• Do not attempt to kill a snake or chase it away with a stick or other equipment (Remember that some cobras can spit venom in your eyes and also some venomous snakes, like the puff adder, can strike from a considerable distance.)
• Never attempt to handle a snake if you are not an expert with advanced knowledge of snakes. If you are not able to identify a snake species, you cannot know if the snake is harmful or not.

What to do if you encounter a snake

As we already said, snakes are not interested in humans as a prey, so no snake will ever attempt to attack a human if not provoked. Most of the snake encounters result in nothing much more than a fright for both human and snake.

In case of a snake encounter, the following are some suggestions for best actions:

• If you find a snake in the house, tent or vehicle, call a snake handler to remove it. In the meanwhile, keep an eye on the snake (to check that it remains in one place or know where it is going if it moves away) without attempting to corner, chase or cover it. Take a picture of the snake and (if possible) send it to the snake handler. Most of the time it is a harmless snake and the handler can immediately reassure you.
• If you encounter a snake in the bush, just stand still. Snakes are not attracted by static objects and often they are not even able to detect them. The snake will move away without harming you. In case of a cobra raising the body and flattening the neck in an aggressive posture, just stand still, no matter the distance involved. Soon, the cobra will relax and move away. If you are not able to identify the cobra species, close your eyes to protect them in case it is a spitting cobra. In general a good method to deal with a snake encounter, after standing still, is to close the eyes and count from 1 to 500 before reopening the eyes. By that time the snake will be gone!
• If a snake accidentally moves over any part of your body (e.g. over your feet when you are sitting) just stay still and wait for it to pass. Nothing will happen and the snake will move away.
• If you come across a snake that is crossing the road, just slow down, put your hazard lights on if other cars are following, and let the snake continue on its way. Do not get out of the vehicle to check on the snake or attempt to move it from the road.
• If you accidentally run over a snake with your vehicle, drive past before stopping. The snake can be injured and very aggressive. Do not approach it. Remember the snake can be stuck around some mechanical part of your vehicle (like axels or chassis) and it could be a harmful snake. Be sure the snake is still on the road or has gone away, but do not lie down under the vehicle to check. If you open the bonnet to check on the snake, do it carefully and slowly because the snake can be hiding there ready to bite. Call a snake handler if you are not sure.

Snakebite Treatment

The majority of snakebites in Southern Africa affect lower or upper limbs, particularly feet and hands. Snakebites on head, neck and chest are extremely rare.

In case of snakebite, the priority is to slow down the spreading of venom in the victim’s body, although in the case of cytotoxic venom one seeks to spread the venom to dilute it, minimizing its effect. However, since the snake responsible for the bite cannot be always identified, the protocol is to assume that we are dealing with a neurotoxic or haemotoxic venom.

The symptoms experienced by the victim will give us an indication about the type of venom, but since first aid has to be put in place rapidly it is administrated following the usual basic rules of general first aid:

• Safety
• Self-Protection
• Response
• Help
• ABC, CPR OR Stabalisation
• EVAC

Safety

Before taking any other action, ensure that the environment is safe and any danger is no longer present. In the case of a snakebite, move the victim to a safe place and ensure that the snake is no longer around, to prevent a second bite. The worst outcome is when the person providing first aid gets bitten too because the danger has not been removed first.

Self-protection

• Always wear gloves and other protective gear before starting the first aid. Remember that in administrating first aid, you can come in contact with bodily fluids or with the venom itself.
• Stay calm: stress compromises the ability to think properly and remaining calm will help the victim to stay calm as well.
• Do not try to capture, kill or take a picture of the snake which would expose you to a second bite. Moreover, time is very important in snakebite first aid and it is not advisable to waste it.

Response & Help

• Check if the victim is conscious or not and before taking any further action, call for help if possible. Phone numbers of ambulance services, Police or ZIMPARKS must be always available. However, network problems can be often experienced in the bush, hence another method might be used to ask for medical assistance and transportation from people who happen to be around.
• After medical assistance or any other help has been successfully requested, carry on the First Aid procedure according to the victim’s state of responsiveness.

ABC, CPR or Stabilization

Different actions have to be taken according to the victim’s response.

Unconscious victim

• Place the victim in horizontal position, lying on his/her back.
• Check the airways.
• Check if pulse is present. If it is present, check if breathing is present. If not, start CPR.
• If pulse is present, but breathing is absent, start Rescue Breathing.
• If both pulse and breathing are present, turn the victim on their side and keep monitoring pulse and breathing.
• Circle the site of the bite with a pen, marker or any other means, and write the time the snakebite happened.
• Document the progression of swelling from the first circle to the rest of the limb or affected area.
• Wait for the requested help.

Conscious Victim

Place the victim in a comfortable position and keep him/her calm. (Fear can speed up the spread of venom.) Avoid unnecessary movement of the victim.

If the snake has been identified:

Apply pressure bandage in case of black or green mamba or non-spitting cobras. In case of black mamba or Cape cobra, if the hospital is more than 90 minutes away, consider the use of a tourniquet.

Apply limb immobilization in case of adders, spitting cobras, boomslang or twig-snake.

If the snake has not been identified:

• Monitor signs and symptoms of the victim.
• If there are symptoms of paralysis or similar, apply pressure bandage. If the hospital is more than 90 minutes away, carefully consider the use of tourniquet.
• If there are swelling, bleeding or mixed symptoms, apply limb immobilisation.
• If there are no symptoms, apply limb immobilization.
• Circle the site of the bite with a pen, marker or any other means, and write the time the snakebite had happened.
• Document the progression of swelling from the first circle to the rest of the limb or affected area.

Bandaging and Immobilisation

Expose the bite, cutting clothing and removing constrictive objects like rings and shoes. Avoid unnecessary movements, for example in removing clothes. Wash away excess venom using water.

Snakebites are generally treated like bone fractures, applying a pressure bandage and immobilising the limb by means of a rigid and elongated object, like a stick or a metal bar.

Pressure bandage

The purpose of a pressure bandage is not to stop blood circulation, but to slow down the spread of venom. Apply the bandage over the entire limb if possible.

Apply pressure on the snakebite site using hands, then apply the bandage.

Once the bandage is applied, check for circulation (press fingertips and check the change of colour).

Limb Immobilisation

After the bandage has been applied, immobilize the limbs to minimize movement and the spread of venom. Immobilization can be obtained by splinting the limb, using whatever rigid and elongated object is available (bars, metal pipes, branches, rafters, etc.)

Tourniquet

A tourniquet is not recommended and should not be considered as a first option for snakebites. The effect of a tourniquet on snakebites can cause complications and severe damage to tissue and limbs. Only apply a tourniquet if it is a confirmed black mamba or Cape cobra snakebite and the nearest hospital/clinic is more than 90 minutes away.

• Do not use improper tourniquet materials, like shoestrings, wires or thin ropes. Make sure you always have a proper tourniquet in your first aid kit. If a proper tourniquet is not available, use non-elastic and wide materials like a belt, a blood pressure cuff, a piece of cloth. Twist the tourniquet until the pulse below the tourniquet is no longer palpable.
• When using a tourniquet, write on the victim’s forehead the time the tourniquet has been applied.
• Once the tourniquet has been applied, do not remove it. Never use a tourniquet if you are not sure.

EVAC

EVAC means “evacuation”, in other words, the transportation of the victim to a hospital, clinic or medical facility.

If an ambulance or an emergency vehicle is not available, transportation must be carried out minimizing the victim’s movements. A stretcher can be made to transport the victim.

DO NOT:

• Suck the snakebite site. Sucking has almost no effect, since venom spreads quickly not only through the blood but also in the lymphatic system. On the other hand, venom can penetrate the mouth of the person who sucks through micro-cuts or scratches.
• Cut or squeeze the snakebite wound.
• Apply electric shock treatment (it is of no benefit)
• Apply a tourniquet unless it is a confirmed black mamba or Cape cobra bite, and the nearest hospital or clinic is more than 90 minutes away.
• Inject antivenom if you don’t have adrenaline and you don’t have experience in administering them.
• Give alcohol to the victim.

Venom in The Eyes

Venom in the eyes from a spitting cobra can cause severe pain and, if not treated, eventually causes permanent blindness. Hence it is important to remove the venom as soon as possible.

• Wash the venom away using copious amounts of water or other available fluids (but obviously not alcohol, fuel, acids or other corrosive or toxic liquids). If nothing is available, urine can be used.
• Apply a bandage on the eyes to protect them.
• Transport the victim to a hospital, clinic or any medical facility.

Administration of Antivenom

Two antivenoms are produced in Africa: the polyvalent and the monovalent. The polyvalent is effective on most of the venomous snakes, but not on the boomslang, twig snake, sea snakes and small adders. The monovalent antivenom is effective on boomslang venom only. For some snake venoms there is no antivenom available, for example, for the twig snake.

Antivenom is administrated by injection and may cause an allergic reaction and anaphylactic shock in 20% of cases. Adrenaline must be always available when an antivenom is being used. Excessive doses of adrenaline may cause heart failure and the correct dose depends on weight, age, the medical condition of victim, and many other factors. It is advisable to leave the antivenom treatment to medical professionals.

Symptoms of Different Types of Venom

Each type of venom affects particular parts of the body, hence symptoms vary according to the venom that has been injected. The following table shows the main symptoms caused by each venom (miotoxic venom is not included):

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In conclusion, the prevention and treatment of snake bites requires a combination of awareness, preparedness, and prompt action. By adhering to the guidelines, the risks associated with snake bites can be significantly reduced, and the chances of a positive outcome for the victim can be improved.