General Do's And Don'ts of a Snake Bite

Do's

Remove everyone from risk.

Calm the patient. This is far more important than you may think! Nearly all snakebites are successfully treated in the US. Most poisonous snake bites are not fatal. Panic only increases danger to the victim by increasing heart rate, and it spurs carelessness among everyone.

Use your snakebite kit immediately. The first few minutes are the most effective for venom removal. Follow the instructions provided in the kit.

Seek medical help at once. Recent studies indicate the single most effective thing you can do is calmly transport the victim to a medical facility. In most cases, severe complications DO NOT occur until several hours after the bite. If you're deep in the wild, make wise use of your time, but don't rush.

Remove tight watches, sleeves, jewelry, etc. Cut these items off if you have to. Note that rings and bracelets are especially hazardous as they will severely restrict blood flow to their particular extremity once swelling begins. Amputation is a likely outcome if these items are not removed.

While enroute to a hospital, apply a loose yet constricting band between the bite and the heart. This is NOT a tourniquet and should not be any tighter than a semi-tight watch band.

Keep the patient still if possible and immobilize the injured limb with a splint.

Treat the site like a puncture wound. If possible, wash the wound with copious amounts of soap and water. Once at the hospital, a doctor will likely give the patient a tetanus shot in addition to other treatments.

Keep the affected extremity at heart level or lower.

Avoid alcohol. It only increases metabolism and impairs judgment.

Don'ts
DO NOT GIVE ANTIVENIN IN THE FIELD! Many snakebite victims experience allergic reactions to antivenin and this potential requires that the person giving the antivenin must be ready and able to provide advanced heart and lung support -- something only available at a hospital via trained medical personnel, sophisticated machines, and powerful drugs. Further, more than six vials are often needed to treat one bite. More drawbacks come into play when the detrimental effects of heat and agitation (due to carrying the vials in a backpack) are considered.

Don't kill the snake! It was only defending itself and such an attempt may produce yet another bite.

Don't try to capture the snake -- it's not necessary. There are only two types of venom -- neurotoxin and hemotoxin (antivenin for pit viper bites is the same for all species). Based on the geographic area and the patient's symptoms, a doctor will usually know which type of antivenin to use.

NEVER cut an "X" at the bite site. This is ineffective and increases trauma in the area of the wound.

NEVER suck out venom with the mouth. The person sucking poison from the wound with his/her mouth will absorb the poison through his/her gums the same way a person absorbs nicotine from chewing tobacco. Further, the human mouth carries at least 42 species of pathogen† and this action could give the snakebite victim a major infection.

Don't excite the victim or allow him/her to walk if avoidable. Doing so will increase venom circulation.

Never apply a tourniquet, constricting band, or "Australian Wrap," unless you are well-trained in its use. As with snakebite kits, recent studies suggest this is of no help and even detrimental. (If, for some reason you do apply one, write a capital T (for tourniquet) on the victim's forehead AND the TIME you applied it. Relax it for 1 minute every 15 minutes.)

Do not apply ice, a cold pack, or freon spray to the wound. This does not retard the spread of venom.

Never apply electrical stimulation from any device in an attempt to retard or reverse venom spread. Studies show this does NOT retard or reverse the spread of venom.

Snake Mythology

Cows, monkeys and dogs are revered by some cultures yet consumed as food by others. So, too, snakes are respected in some parts of the world and despised in others. The way that people feel about snakes is heavily influenced by cultural beliefs and mythology.

Some cultures held snakes in high esteem as powerful religious symbols. Quetzalcoatl, the mythical "plumed serpent," was worshipped as the "Master of Life" by ancient Aztecs of Central America. Some African cultures worshipped rock pythons and considered the killing of one to be a serious crime. In Australia, the Aborigines associated a giant rainbow serpent with the creation of life.

Other cultures have associated snakes with medicinal powers or rebirth. In India, cobras were regarded as reincarnations of important people called Nagas. Our modern medical symbol of two snakes wrapped around a staff, or 'caduceus,' comes from ancient Greek mythology. According to the Greeks, the mythical figure Aesculapius discovered medicine by watching as one snake used herbs to bring another snake back to life.

Judeo-Christian culture has been less kind to snakes. Tales of the Garden of Eden and the serpent's role in "man's fall from grace" have contributed to a negative image of snakes in western culture. In Appalachia, some Christians handle venomous snakes as part of ritual ceremonies, relying on faith to protect them from bites. Among Catholics, Saint Patrick is credited with ridding Ireland of snakes, a feat celebrated by many as a good thing.

Deep rooted cultural biases may be responsible, in part, for widespread fear and disdain for snakes. However, modern myths, from folk tales to plain old misinformation, also contribute to their negative image

Modern Myths
Size. Snakes are almost always described as larger than they really are. Stories about New England water snakes eight and ten feet long are simply not true. Northern water snakes rarely exceed three and a half feet in length, with the largest stretching only four and a half feet. While the black rat snake, our largest native snake, can reach lengths of just over eight feet, most New England snakes are less than three feet long.

Poisonous Snakes. The regularity with which people kill a snake first and ask questions later might lead you to believe that the world is overrun with venomous snakes. In fact, venomous snakes only make up about 10 percent of snake species worldwide, and in Massachusetts only two of the state's fourteen species of snakes are venomous (timber rattlesnake and northern copperhead). Both are rare, reclusive and generally confined to isolated areas.

Folk Tales. Folk tales about snakes are handed down from generation to generation and include such things as snakes that charm prey, swallow their young for protection, poison people with their breath, roll like hoops, and suck milk from cows. These folk tales could be just interesting and amusing stories except that many people still believe them. As we learn more about the true nature of snakes, we can begin to base our perceptions of them on fact rather than fiction.

Hoop Snakes
Myth: When frightened, hoop snakes will bite their tails and roll downhill like a wagon wheel.

Reality: Anatomically, snakes are not well equipped for rolling and there are no reliable accounts of this ever occurring. The hoop snake myth may have been associated originally with mud snakes found in the southern United States. Mud snakes will occasionally lie in a loose coil shaped like a hoop, but they slither away from danger like other snakes.

Swallowing Young
Myth: When confronted with danger, mother snakes swallow their young, spitting them out later once danger has passed.

Reality: Parental care is not very well developed in snakes and there is no evidence that mother snakes protect their young in this way. The myth may result from the fact that some snakes eat young snakes of their own species or of other species, though usually not their own brood.

Charming Snakes
Myth: Snakes have the ability to charm prey, especially birds, so they cannot flee.

Reality: There is no evidence that snakes charm their prey. Small animals may become "frozen with fear" when confronted by snakes but they are not charmed. Birds may flutter about in front of a snake in an attempt to lure it away from their nests; occasionally a bird may actually be captured by the snake, giving the impression that it was charmed. The fact that snakes never blink may also have played a role in this myth's origin.

Sucking Milk
Myth: Milk snakes are so named because of their ability to suck milk directly from the udders of cows.

Reality: Although milk snakes are common around barns that house cows, they completely lack the anatomy necessary to suck milk (or anything else for that matter). Barns are attractive to milk snakes because they provide abundant food in the form of small rats and mice.

Poisonous Breath
Myth: Puff adders (hognose snakes) mix poison with their breath and can kill a person at a distance of twenty-five feet.

Reality: Although the bite of a hognose snake can produce swelling and a burning sensation, these snakes rarely bite people and are not considered venomous. When confronted, they do puff themselves up and hiss, but their breath is harmless.

Cottonmouths in New England
Myth: Swimmers in New England are advised to watch out for venomous cottonmouths, also known as water moccasins.

Reality: Simply put, there are no water moccasins in New England. The cottonmouth, or water moccasin, is a venomous snake of the southeastern United States that occurs no farther north than the Great Dismal Swamp of Virginia. Many people mistake non-venomous water snakes for water moccasins.

MYTHS OF SNAKES AND SNAKE-BITES

Introduction
Since Adam and Eve, snakes have long been portrayed as evil creatures to be feared. Our history is long, and myths and phobias are hard to break. Built into their religious practice, Pentecostal Movement preachers in the hills of Tennessee handle rattlesnakes. They now struggle with local law enforcement since rattlesnakes are protected in many states. Aboriginal groups in Australia hold the snake in high esteem, and it is a symbol of fertility. Native Americans felt that snakes symbolized life cycles and truth.

There are widespread myths regarding snakes:

Snakes hold their tails in their mouths to create a circle and will chase you.
When you kill a snake, another one will chase you (ironically, what IS true is excessive killing of snakes leads to the overpopulation of rodents and more disease
states).
Snake Bite Facts
In the United States, only about 12 people a year die from snakebites.
The estimated chances of dying from a snakebite in the outdoors is approximately 1:10 million.
Victims of snakebites in North America usually have two common denominators, tattoos and alcohol intake.
There are approximately 23 different subspecies of rattlesnakes in the United States including the coral snake, copperhead and cottonmouth (or water moccasin), which comprise the venomous snakes indigenous to the United States. We emphasize indigenous to the United States in that due to the internet, more and more exotic/foreign snakes are being brought into the United States illegally. This is an extremely dangerous practice, posing enormous diagnostic and treatment risk for emergency rooms across the United States. Every month, there are incidents that occur where someone is tired of their exotic and most likely illegally owned pet and releases it, or possibly it escapes. Example: A few months ago, a friend of Survive Outdoors from Indiana was helping someone move when he found a king cobra in the bushes outside of the home. The cobra was poised and ready to strike; luckily no one was bitten.
There are two types of venomous snakes, falling into two separate categories, the pit vipers which include the rattlesnakes, copperheads and coppermouths, and the elapids, which are coral snakes.

Pit Viper
The pit viper has thermoreceptors, or “pits,” on their heads. These organs help the snake locate prey and adjust the amount of venom used according to the size of their prey. The glands, or venom sacks are connected to the fangs, which act like hollow hypodermic needles. These fangs are voluntarily controlled by the snake. They can raise either one or both fangs, or neither. When fangs break off, there is usually another fang below, or there may be one next to it. Therefore, snakebites can present as one puncture wound, two, three or even four (see photo of timber rattlesnake for example of multiple fangs).

The pit viper can strike about 50% of its body length, and has been recorded to strike at about 7 feet per second. The forked tongue is equivalent to our nose. The snake senses chemicals in the air with their tongue, aiding in the location of prey. Their pupils are elliptical, and all pit vipers in the United States have elliptical pupils, as opposed to non-venomous snakes which have round pupils.

The age of a rattlesnake cannot be determined by the number of rattles. Rattles frequently break off, and therefore is an unreliable method to determine age.

Elapids
Elapids in the United States consist only of the coral snake. They have red, yellow and black bands around their bodies. King snakes are very similar in color. However there is a slight difference in band sequence. Mnemonics have been created to aid in remembering the differences, such as “red on yellow, kill a fellow, red on black, venom lack,” or “red on yellow, kill a fellow, red on black, friend of Jack.”

It is best not to pick up any snake, thereby greatly reducing your chance of being bitten.

Elapid fangs are fixed as opposed to the retractable fangs of the pit viper, and are much smaller. A coral snake must chew on its victim to inject enough venom to cause damage.
Small children are bitten by handling the snake, and due to its attractive coloring, it becomes a visual “draw” for the child, who wants to pick up the “sparkling gemstone.”

Venoms
Venoms of the pit viper contain peptides and proteins. The venom leads to damage of vascular cells and red blood cells. Proteolytic enzymes damage muscle and are responsible for tissue death. There is also a histamine release by the body after the bite.

Juvenile rattlesnakes do have more toxic venom; however, they do not inject the large amount of venom as adult rattlesnakes do.

Coral Snake Bite Symptoms
Coral snake venom is different than pit viper venom. As per Auerback, it is thought that adult coral snakes carry enough venom to kill 4-5 adults. The coral snake venom is primarily a neurotoxin. Fang marks are rarely seen. Swelling is rare. Symptoms may not occur until 10-14 hours later. Symptoms may begin as nausea, vomiting and sweating. Neurological symptoms may include lethargy, difficulty speaking, hard to swallow, drooping eyelids, and in severe cases, respiratory depression or arrest.

Dry Bites
Dry bites are referred to as “misses,” no venom injected due to the lack of venom, a glancing blow, or penetration could not occur because of the clothing worn by the individual. Dry bites account for about 20-30% of all snakebites.

Pit Viper Bite Symptoms
There are many symptoms associated with the bite of a pit viper. Fang marks are always present, followed by swelling, pain, and black and blue marks on the skin. Sweating, chills and muscle twitching are commonly seen. Some feel numbness on the tongue, and reports of a metallic taste are not uncommon.

Snakebite Treatment for Pit Vipers
General support/reassurance; keep the victim calm; move the individual away from the snake, if possible; do not try to kill the snake—two people being bitten is worse and you cannot aid the first victim (note: amputated snake heads can still bite as a reflex).
Minimize all activity.
All jewelry, rings, bracelets and watches should be removed immediately.
Do not incise the wound as this causes more tissue damage.
Do not use electrical shock at the bite site as that has been shown not to work.
Sawyer extractor kits are controversial. Studies on pigs have shown little to no effect, while others recommend to only use the suction device if you can reach the victim in the first 3 minutes.
Do not suction with your mouth as the bacterial in your mouth will most likely cause more harm.
Apply cool compresses, not ice.
The Australian wrap method has proven benefit. Please see diagram. Do not wrap too tightly, but similar to wrapping a sprain.
Splint is very important. Immobilize the extremity, maintain the extremity at heart level, do not elevate above heart level.
Do not use Anti-venom in the outdoors. Many have anaphylactic type reactions from the anti-venom.
Transport, transport, transport.
Call ahead if possible to the ER. Many emergency rooms do not stock anti-venom and they may need to fly anti-venom in.
Anti-venom is very, very expensive. When traveling into the outdoors for an extended period of time, check into search and rescue insurance. Many times anti-venom is covered. It is as cheap as $12-20 for a weekend, and is well worth it if something unfortunate should occur.
Snakebite Treatment for Coral Snakes
Remember, bite symptoms from this snake are usually delayed.
In this situation, if possible, it could be very helpful to capture the snake for identification purposes since it does mimic the king snake.
The Australian wrap method is highly touted for this bite.
Transport, transport, transport.
All other treatment for the coral snake should be the same as for the pit viper.
Summary
Snakes, like sharks, have a bad reputation, as the media love to sensationalize these critters. Fear sells. If you see a snake, please do not kill it! It does a tremendous amount of good, compared to any harm done. Understand reality and not fall prey to your fears and phobias.