It has been estimated that 7,000–8,000 people per year are bitten by venomous snakes in the United States, and for around half a dozen people, these bites are fatal. In 2015, poison centers managed over 3,000 cases of snake and other reptile bites during the summer months alone. Approximately 80% of these poison center calls originated from hospitals and other health care facilities.
Venomous snakes found in the U.S. include rattlesnakes, copperheads, cottonmouths/water moccasins, and coral snakes. They can be especially dangerous to outdoor workers or people spending more time outside during the warmer months of the year. Most snakebites occur when people accidentally step on or come across a snake, frightening it and causing it to bite defensively.
• Avoid surprise encounters with snakes: Snakes tend to be active at night and in warm weather. They also tend to hide in places where they are not readily visible, so stay away from tall grass, piles of leaves, rocks, and brush, and avoid climbing on rocks or piles of wood where a snake may be hiding. When moving through tall grass or weeds, poke at the ground in front of you with a long stick to scare away snakes. Watch where you step and where you sit when outdoors. Shine a flashlight on your path when walking outside at night.
• Wear protective clothing: Wear loose, long pants and high, thick leather or rubber boots when spending time in places where snakes may be hiding. Wear leather gloves when handling brush and debris.
• Never touch or handle a snake: Never handle a snake, even if you think it is dead or nonvenomous. Recently killed snakes may still bite by reflex. There have even been cases of detached snake heads being able to bite, reflexively.
• Bring a partner: If you are planning to spend time in a snake-prone area, it is best not to go alone in case you are bitten by a snake or have another emergency. If you must go alone, make sure you bring a fully charged mobile telephone, and stay wherever your phone gets a signal.
• Do not panic; keep still and calm.
• Call the poison center or emergency department immediately. The experts at the poison center have been specially trained to treat snakebites. Every snakebite is different, and the poison center specialist will tell you what you need to do next, based on your specific situation. If you need immediate medical care, the poison center specialist can tell you where to go and call ahead to the right medical facility to make sure you get the care you need, quickly. If the person who was bitten is having trouble breathing or losing consciousness, call 911 immediately.
• If you are in a remote location and do not have mobile phone service, ask someone to drive you to the nearest emergency medical facility. Only drive yourself as a last resort.
• Keep the part of your body that was bitten straight and at heart-level, unless told otherwise by the specialist at the poison center.
• Remove all jewelry and tight clothing.
• Wash the bite with soap and water and cover the bite with a clean, dry dressing, if available, and if doing so does not cause delay.
• Being able to describe the snake to medical professionals can help them decide on the best treatment for you, so try to remember the color and shape of the snake, but don’t move closer to it. Only take a photograph of the snake if you can do so from a safe distance. You do not need to bring the snake with you in order to get the proper medical treatment!
• Note the time the bite happened.
Do NOT do any of the following:
• Do not pick up, attempt to trap, or kill the snake.
• Do not apply a tourniquet or attempt to restrict blood flow to the affected area.
• Do not cut the wound.
• Do not attempt to suck out the venom.
• Do not apply heat, cold, electricity, or any substances to the wound.
• Do not drink alcohol or caffeinated beverages or take any drugs or medicines.
Role of antivenom
The only specific antidote to the toxins in snake venom is hyperimmune globulin from an animal that has been immunised with the appropriate venom. Albert Calmette’s introduction of serum antivenimeuse for the treatment of envenoming in 1895 was quickly accepted without formal clinical trials. More than a century later, immunoglobulin antivenoms are accepted as essential drugs but reappraisal is needed. The limitations of antivenom treatment should be recognised. Patients with respiratory, circulatory, and renal failure need urgent resuscitation as well as antivenom.