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Venomous Snake Bites - New Protocol or did I miss a major change?
About two months ago I ran across an incident that I still am shaking my head over.
An elementary school nurse called poison control for a rattlesnake bite (in central AZ). She was told by poison control to (mind you this is in the MIDDLE OF THE PHX METROPOLITAN AREA - 5 min ambo ride from hospital) elevate the limb immediately, apply a tourniquet and to ice it until 911 arrived. Fire got on scene and the medic got on the nurse about elevating the limb. She insisted that poison control told her to do this. Not only did I hear about the call, but I also ended up teaching a CPR & First Aid class 1 week later to this same nurse and other school personell. When I stressed with snake bites to call 911 first, keep the limb below heart level, ice, keep child calm etc she totally flipped out and started yelling that I was teaching incorrect information. Now I checked with ECSI, ASHI, Red Cross and American Heart. Everyone agrees do not elevate and do not tourniquet especially that close to help. However, at her insistance I called poison control from my cell on speakerphone to ask them about snake bites I was floored when I was told in no uncertain terms to "Immediately elevate the limb, tourniquet and apply ice." When I questioned the person who answered why they would elevate and tourniquet and when did this become standard, she informed me that she was an RN had worked answering the phones at poison control for 15 years and it had always been done this way!
Now I've lived in the desert for 36 years, most of it outdoors hiking and on horses, and NEVER have I been told to elevate a rattler bite! Not in Girl Scouts, not in desert survival, not in EMT school, heck not even in first aid instructor training or search and rescue desert survival training. Has anyone heard of this? Is anyone treating venomous bites this way?
An elementary school nurse called poison control for a rattlesnake bite (in central AZ). She was told by poison control to (mind you this is in the MIDDLE OF THE PHX METROPOLITAN AREA - 5 min ambo ride from hospital) elevate the limb immediately, apply a tourniquet and to ice it until 911 arrived. Fire got on scene and the medic got on the nurse about elevating the limb. She insisted that poison control told her to do this. Not only did I hear about the call, but I also ended up teaching a CPR & First Aid class 1 week later to this same nurse and other school personell. When I stressed with snake bites to call 911 first, keep the limb below heart level, ice, keep child calm etc she totally flipped out and started yelling that I was teaching incorrect information. Now I checked with ECSI, ASHI, Red Cross and American Heart. Everyone agrees do not elevate and do not tourniquet especially that close to help. However, at her insistance I called poison control from my cell on speakerphone to ask them about snake bites I was floored when I was told in no uncertain terms to "Immediately elevate the limb, tourniquet and apply ice." When I questioned the person who answered why they would elevate and tourniquet and when did this become standard, she informed me that she was an RN had worked answering the phones at poison control for 15 years and it had always been done this way!
Now I've lived in the desert for 36 years, most of it outdoors hiking and on horses, and NEVER have I been told to elevate a rattler bite! Not in Girl Scouts, not in desert survival, not in EMT school, heck not even in first aid instructor training or search and rescue desert survival training. Has anyone heard of this? Is anyone treating venomous bites this way?
Replies to This Discussion
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Permalink Reply by Oldman on
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The best way to treat a snakebite, is to stay away from them. I have dealt with rattlesnakes most of my life, and I hadn't heard elevating and tourniquets for better than 20 years.
Dr.Sean P Bush is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society and is a leading expert in treating poisonous
snakebites, and Professor of Emergency Medicine, Envenomation Specialist at Loma Linda University Medical Center
in Califorina. Here is his recommended protocol.
Prehospital Care
Do nothing to injure the patient or impede travel to the ED.
* Give general support of airway, breathing and circulation per advanced cardiac life support (ACLS) protocol with oxygen, monitors, 2 large bore intravenous lines, and fluid challenge. Minimize activity (if possible), remove jewelry or tight-fitting clothes in anticipation of swelling, and transport the patient to the ED as quickly and as safely as possible. Use a pen to mark and time the border of advancing edema often enough to gauge progression.
* In recent studies, no benefit was demonstrated when a negative pressure venom extraction device (eg, The Extractor from Sawyer Products) was evaluated; additional injury can result. Incision across fang marks is not recommended. Mouth suction is contraindicated.
* Lymphatic constriction bands and pressure immobilization techniques may inhibit the spread of venom, but whether they improve outcome is not clear. Limiting venom spread actually may be deleterious for pit viper envenomation if it increases local necrosis or compartment pressure. Tourniquets are not recommended.
* Maintain the extremity in a neutral position.
* First aid techniques that lack therapeutic value or are potentially more harmful than the snakebite include electric shock, alcohol, stimulants, aspirin, placing ice on the wound, and various folk and herbal remedies. Cost and risk of acute adverse reactions generally preclude field use of antivenom.
* Attempts to capture or kill the snake cannot be recommended because of the risk of additional injury. If uncertainty exists about whether a particular snake is venomous, consider taking photographs of the snake from a safe distance of at least 6 feet away using a digital or Polaroid camera.
I don't see anything about elevation either.
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Permalink Reply by PFC Harmon on
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I live in Tennessee and me and my wife are avid backpackers. I have been through wildland survival and wildland medical classes taught by the forestry service, on top of emt school, being an eagle scout and forest search and rescue where they stressed snake bites and have never heard of this. Sounds like you are doing right.
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Permalink Reply by Brian Dumser on
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Sounds like the people at Poison Control need to get with the current program! My biggest pet peev is people who do something stupid and then say, "We've always done it this way."
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