Experts at the Comprehensive Snakebite Program at UAB and Children’s of Alabama provide steps on what to do if bitten by a venomous snake. According to the Centers for Disease Control and Prevention, an estimated 7,000-8,000 people are bitten by venomous snakes in the United States each year. Snake season is mid-March to mid-November. Bites can happen at any point throughout the season, but experts at the University of Alabama at Birmingham Snakebite Program say they typically see an increase in snakebites in August through November.
While non-venomous snakes may cause some tissue damage that should be observed in the days following the bite, the most dangerous types of bites in the United States are from venomous snakes like North American pit vipers, which consist of rattlesnakes, copperheads and water moccasins.
What to do if bitten by a venomous snake
“The first step you should take after a venomous snakebite is to take a deep breath and stay calm,” said William Rushton, M.D., co-director of the UAB Comprehensive Snakebite Program. “Sometimes, people’s first response is to panic, but there is no need to panic. If you are bitten by a venomous snake in Alabama, we have the resources and expertise to be able to get you through it.”
The next step is to note the time the bite happened and remove any jewelry or clothing that may cover or restrict the extremity. Next, safely travel to the nearest health care facility. While people who are envenomated can call 911 for an ambulance, having a friend or family member drive the bitten individual to the hospital is perfectly acceptable. Rushton says it is better to get care closer to the time of the snakebite, but the main goal is to get treated soon after being bitten by a snake. Rushton recommends elevating the bitten extremity at heart level or higher to help decrease swelling.
On the way to the hospital, individuals should try to call the Alabama Poison Information Center at 1-800-222-1222, if they can, to alert them of the snakebite. The APIC is staffed with specialists in poison information and backed up by UAB medical toxicologists who will inquire which hospital the patient is going to, gather information about the snakebite from the patient, open a chart for the patient and call the hospital ahead of time to alert them that the patient is on the way. If the individual is unable to call the APIC on the way, the hospital will call the APIC when they arrive.
Patients who are bitten by a snake within the Birmingham area can take advantage of the UAB and Children’s of Alabama Snakebite Program, where they will be treated by a collaborative team of health care providers who are specifically trained in treating snakebites. These providers can be found in the Children’s of Alabama Emergency Department, UAB Emergency Department and inpatient teams.
What not to do if bitten by a venomous snake
After being bitten by a venomous snake, individuals should not try to kill the snake or capture the snake.
“It is imperative to remember that the snake is afraid and is trying to get away from you,” Rushton said. “There is no need to try to harm the snake or capture it. We do not need you to take an image of it. The most important step you can do is get to the nearest health care facility, so health care personnel can treat the wound.”
The Alabama Poison Information Center provides information for treatment on both venomous and non-venomous snakebites. If bitten by a snake, call the APIC at 1-800-222-1222.
Contrary to some misinformation about treating a snakebite wound, Rushton says victims should not cut the wound, try to suck the venom out of the wound, or use electric shock, cauterization or alcohol in an attempt to treat the wound. Do not apply heat or ice to the wound or use a tourniquet on the affected extremity. Do not drink alcohol or caffeinated beverages or take any drugs or medication prior to seeking care for the wound.
Symptoms of venomous vs. non-venomous bites
For individuals who may not know if they were bitten by a venomous or non-venomous snake, Rushton says there are a few symptoms to look out for with a venomous snakebite. Within the first couple of hours after a venomous snakebite, the individual will often develop significant pain while trying to use the bitten extremity, and the individual will develop a fair amount of swelling and bruising.
Non-venomous bites are localized wounds that may have a small amount of tissue damage. With non-venomous bites, Rushton recommends washing the bite with soap and water and observing it over the next 24-48 hours to make sure there are no signs of infection such as spreading redness or foul-smelling drainage. If there are signs of infection, make an appointment with a health care provider. The APIC is a great resource that will talk people through the treatment options for both non-venomous and venomous bites.
In addition to treating snakebites at the Comprehensive Snakebite Program at UAB and Children’s of Alabama, Rushton and his team conduct research to continuously improve snakebite care for patients across the state. Read his most recent study about the amount of antivenom needed for a rattlesnake bite here.
Treatment
While different health care institutions may have their own protocols for venomous snakebites, Rushton says there are general steps that each institution will take to treat the bite.
Patients treated at UAB and Children’s will immediately be met with an interdisciplinary team who have specialized training in snakebite treatment. Early phases of care include standardizing wound measurements, providing pain relief, assessment for systemic symptoms and advanced testing for blood thinning. Patients will receive serial measurements and overnight monitoring for blood thinning. All patients at UAB and Children’s are evaluated by a medical toxicologist who coordinates care in conjunction with the admitting physician. Once patients have been stabilized with antivenom, patients are assessed by physical or occupational therapy to encourage early mobilization. Wound care specialists with experience in snake envenomation are available to manage localized wounds and to provide non-opioid pain management. Treatment continues after hospital discharge.
At outside institutions, Rushton says, patients can expect to undergo some bloodwork when they arrive, which helps the physician determine whether the venom has gotten into the bloodstream. Health care providers will then observe the bite for any signs of rapid onset pain and symptoms of bruising, swelling and limited limb mobility. Patients will also be given antivenom to avoid further damage to the tissue and be admitted overnight for observation. At discharge, patients may be offered the opportunity to receive follow-up treatment at the UAB Snakebite Clinic. If patients do elect to receive treatment from the program, the APIC will send this information to the clinic, so they can schedule a follow-up appointment with the patient within five to 15 days of the bite.
Outpatient follow up for all patients age 5 or older is available at the UAB Comprehensive Wound Care Clinic, where wound care specialists coordinate care with medical toxicology. The clinic provides long-term lab monitoring of potential venom injury, provides strategies for treatment of limb swelling and administers localized wound care. Physical therapy referral is available for those patients who require improved limb function recovery. Medical toxicologists at the APIC will also coordinate follow-up care with the patient’s primary physician if they elect not to be seen in the clinic. Most patients will recover from their injuries within two to three weeks.