First-aid measures against snakebites

India is estimated to have the highest snakebite mortality in the world. The World Health Organization (WHO) estimates place the number of bites to be 83,000 per annum with 11,000 deaths. Most of the fatalities occur due to the victim not reaching the hospital in time where definite treatment can be administered.

There are about 236 species of snakes in India, most of which are nonpoisonous. Most people remain under the misconception that all snakes are dangerous; however, this is not the case. Bites from nonpoisonous snakes, apart from causing a panic reaction and local injury, do not harm the patient.

There are 13 known species that are poisonous; of these, four, namely common cobra (Naja naja), Russell’s viper (Dabiola russelii), saw-scaled viper (Echis carinatus) and common krait (Bungarus caeruleus) are highly venomous and believed to be responsible for most of the poisonous deaths in India.

Speaking about this, Padma Shri Awardee Dr KK Aggarwal, President Heart Care Foundation of India & Honorary Secretary General Indian Medical Association said, “One must always remember the basic first aid measures against snake bites. Timely action and treatment can completely eliminate mortality rates. One must also remember that not all snake bites are poisonous and unnecessary panic must be avoided. Initial first aid is directed at reducing the spread of venom and expediting transfer to an appropriate medical center.”

One must remember to:
*Remove the patient from the snake’s territory and help them stay calm and as still as possible.
*Attempt to identify the snake only if it is safe for the patient and the rescuer.
*Remove any jewelry from the affected extremity. Footwear can be removed, but other clothing can be left alone unless clearly tight and causing circulatory compromise.
*Immobilize the injured part of the body with a splint.
*Fashion a splint out of any rigid object (e.g. padded piece of wood or tree branch, rolled newspaper, sleeping bag pad, or backpack frame).
*Transport the patient to the nearest medical facility as quickly as possible.
*Do not allow the victim to walk because exertion and local muscle contraction may increase snake venom absorption.
*Do not manipulate the wound except to permit gentle bandaging or, if indicated, pressure immobilization or placement of a pressure pad.
*Withhold all alcohol and any drugs that may confound clinical assessment or interfere with treatment (E.g., anticoagulants, aspirin, non-steroidal anti-inflammatory medications, or beta blockers).

Methods to avoid: The following methods, while used widely in the past and advocated by some, cause more harm than good and should be avoided.
*Incision and oral suction
*Mechanical suction devices
*Electric shock therapy

For example, a common misconception is that one should apply a tourniquet, suck out the poison, and spit it out. However, this approach is strongly discouraged, since it can damage nerves, tendons, and blood vessels and lead to infection. Furthermore, venom removal by suction is minimal. Tourniquets may cut off arterial blood flow and cause significant ischemic damage, especially when left on for a prolonged period.