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What is the first aid treatment for snake bite?

Updated: Sep 26, 2021

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What is the first aid treatment for snake bite in Australia? What do I do if I got bitten by a snake? What are the snake bite management guidelines in Australia? These are some of the most commonly asked questions Scott and I get asked every Spring. Snakes are on the move, in the need of food and looking to mate, and are more commonly seen than in the colder months. Read on to learn more about snakebite in Australia.



Snake Bite and First Aid in Australia


First it needs to be said that snakes do NOT go out of their way to bite you. Snakes do not possess venom purely so they can ruin the day of any human or beloved pets they may encounter. Snake venom has evolved over the millions of years to aid them in three primal needs – immobilization of prey, a digestion aid, and for self-defence. Snakes do not hunt you down and chase you for miles. It is in fact, the complete opposite. Generally they rather flee the upcoming interaction with a human than engage. The common misconception on snakes is size. Look at it from their point of view. You’re huge compared to them. Only a complete fool would take on something they perceive as a threat that has that much of a size advantage (and the advantage of limbs and opposable thumbs!) The picture below is of an Eastern Brown Snake, Pseudonaja textilis. How big is the snake?

Eastern Brown Snake, Pseudonaja textilis

For those that answered with “5ft long” - you’re more correct than those that answered with “Who cares, kill it”. That Eastern Brown, Pseudonaja textilis is indeed roughly 5ft/150cms in length. But it is approximately 4cm high. 4cm is how big that Eastern Brown actually is. If you are unlucky enough to be bitten by a snake, chances are you have come across one accidently and startled it, or you have harassed one to the point it feels that the only option is to defend itself and flee.



snake bite flow chart




The amount of people that actually get bitten and/or die from snakebite each year is very low. Statistically, here in Australia you have more chance of dying from a horse or a cow, a kangaroo, hornets, bees and wasps (mostly from allergic reactions) transport accidents and diseases. With a bit of knowledge on snake safety and proper first aid, those numbers will decrease year after year.







If you can avoid it, don’t go bushwalking by yourself. In an emergency you need that second person. The help they can provide can cut down time wasted immensely. Apart from the help that they can physically provide, the mental help is invaluable. Your mind races. You cannot help it no matter how hard you try to still it. A second person will not only do all the first aid steps for you, but be able to take your mind elsewhere to avoid panic setting in at the thought of what you think may happen. Panicking will increase the speed of the lymphatic flow. In the occurrence of a snake bite – it’s the last thing you want.



Precautions

Most snake bites result for two reasons. The first is an accidental shock received by the snake while it was minding its own business and neither parties noticed each other until it was too late. The second is people without adequate training trying to either catch or kill a snake. We can offer you some pointers to minimise the risk of a bite on an accidental encounter, but we can’t fix stupid. I should also point out that all Australian wildlife is protected. Hefty fines apply for harming or killing our native wildlife. If you are new to an area or holidaying in a new area, bushwalking in an area that is new to you, always find your nearest hospital in case of emergency. Always carry a first aid kit with you and regularly check that nothing has expired in your first aid kit.


  • Always look where you are walking or putting your hands (if gardening). Carry a torch at night so you can see where you are going in your yard if you live near bush or water.

  • Always wear closed in footwear and long trousers when out bushwalking. Walk on the path and don’t deviate.

  • If you come across a snake, don’t move. Stay still and wait for it to move on.

  • If you live in areas where venomous snakes frequent, know what snakes are in your area. There is book on the market that covers every snake species in Australia and very inexpensive at $25 + p&h. A Naturalist’s Guide to the Snakes of Australia by Scott & Tyese Eipper. See recommended reading below for the link to purchase the book.

  • Keep your yards tidy and the grass low. Unkempt yards invite rodents which will in turn entice snakes looking for a meal.

  • Don’t leave your shoes lying around outside. If you do ALWAYS check them before sliding your feet in.

  • Clean up after outdoor pets such as birds in aviaries, guinea pigs in outdoor hutches etc. Spilt food encourages rodents. Snakes eat rodents…..

  • Flyscreens and screen doors will give you extra peace of mind.

  • Plug any holes in retaining walls, but take care not to jeopardise the structural integrity by blocking drainage etc.

  • If taking any debris to the tip, lift carefully whilst looking under it. Logs, sheets of tin, large rocks, a pile of dead shrubbery etc are inviting places for snakes to seek shelter.

look where you are walking in the bush






In this photo, we see a few of the factors that are not ideal if you wish to avoid an encounter with a surprised snake. Deviation from the walking path, not looking where you are walking, and not wearing closed in, protective shoes.











How venom is injected from a snake bite in Australia

If you are unlucky enough to be bitten a venomous snake, a little bit of knowledge can go a very long way. Rationality at this time will be your best friend. It is a common misconception that when bitten by a venomous snake, the venom has been injected into the bloodstream. Due to the fang size on Australian elapids, the venom is usually injected into the subcutaneous tissues. It then gets pulled into the lymphatic capillaries and travels via the lymphatic system before entering the blood stream via the thoracic duct and into the venous system. The venom now in the bloodstream travels into the heart and then be pumped around the body. As excitement and a high heart rate increase lymphatic flow, it is crucial to remain calm and still. Knowing how the venom is working in your body should give you the peace of mind that if you follow the guidelines set out by the medical experts and remain as calm and still as you can, that your chances of survival without complications is very high


lymphatic system of a human




This diagram shows how far the injected venom has to travel, especially if bitten on a lower limb, for it to enter the bloodstream and start to be pumped around.










Treating Snake Bite


DRSABCD. This applies for any first aid emergency.


D - look for Danger. R - check for Response. S - send for help. A - clear the Airway. B - sustain Breathing. C - start CPR (if required). D - apply a Defibrillator if indicated.


  • If you can still see the snake back away from the snake. If you can, try to remember as much as you can about the snake. Chances are the snake will of high tailed it straight after the interaction. The following steps are much, much more important.

  • If you are with someone who has been bitten after following DRSABCD make sure the person who has been bitten remains calm, while you stay calm. Panicking gets the lymphatic flow pumping and is the last thing you want for someone with any form of venom in their system. Keep them as motionless as you possibly can.

  • Call 000. Do not wash the bite site.

  • As gently as possible to avoid over movement, remove any objects from the bitten limb. If swelling takes place items such as rings, watches, bracelets etc may result in extra harm by limiting blood flow. Don’t remove clothing, bandage over it. Removing clothing will result in unnecessary movement for the patient.

  • Apply the pressure immobilization bandage.

  • Put a marker on the bite site. With a pen, mark the place where the bite is with either a circle or a X, and note the time. This helps medical staff be able to locate the bite site and what they should be expecting at a certain time of the envenomation. Pic of bandage marked here


Do not leave the person unattended. Stay by their side until the first responders arrive. If it is unavoidable that you must leave their side, return as soon as you possibly can. Not all snake bites will result in a person being envenomated. Pythons aren’t venomous and venomous snakes can also give dry bites (a bite from a venomous animal where no venom has been detected and no symptoms are present.) If you are unsure what species of snake has bitten you or your companion, it is best to treat it as a venomous snake bite and follow the above steps.


What to expect:

If the bite was indeed made by a venomous snake (or spider etc) you may notice symptoms such as pain, swelling, redness around the site of the bite. There may also be blood, a stinging, burning or an itching sensation at the bite site. Nausea, vomiting, headache, blurred vision, sagging eyelids, dizziness, the voice may become altered, there may be difficulty breathing, talking or swallowing, confusion, drowsiness and anxiousness, feeling feint, muscle weakness, diarrhoea and the urine may be darker. In severe cases a bite can bring on paralysis or a coma.

snake bite on the thumb



As you can see, a bite does not stand out and if you have scratches on your hands or legs may easily be overlooked.






Correctly applying a compression bandage for snake bite.

Snake venom is transported in the lymphatic system. It is imperative to stay calm and still to reduce lymphatic flow. In Australia this is effectively done by applying firm and uninterrupted pressure over the affected body part. This is referred to as the Pressure Immobilisation Technique (PIT). The bandage should be wrapped snugly – not constricting but also not loose. It should not be wrapped that tight that it cuts off circulation. Your toes/fingers should not become purplish or blue in colour, cool to touch, or feel numb or tingly. It is important to get this right when you wrap the bite initially as you really don’t want to be forced to have to unwrap the bandage and re-wrap, allowing the venom that was previously contained to now flow through the body.


Setopress high compression bandage

Snake bites to the head, neck and torso cannot be effectively treated with a pressure immobilisation bandage. In the event of a bite to these regions, apply a pad of fabric to the bitten area, keep the person as still as possible and seek urgent medical attention. Bites to these regions account for less than 2% of all bites, most bites occur on the lower limbs.


The Australian Venom Research Unit (AVRU) recommends the Setopress High Compression Bandage for use as a Pressure Immobilisation Technique for dealing with envenomation from all Australian venomous snakes, Funnel-web spiders, Blue-ringed octopus and also from the sting from the Cone shells. Setopress High Compression Bandages have a guide for visual application, making it simple and straightforward for people under stress or without prior medical training to correctly use the bandage.

Setopress bandage on hand after snake bite

These two bandage photos were staged to show how easy the Setopress bandages are to use correctly. It is very obvious to see the squares and the correct tension of the bandage in use.



The one bandage offers two compression options. The bandage has brown rectangles imprinted on one side, while the other side has green rectangles. Provided the bandage is applied properly, the rectangles will become squares. The brown square will deliver over 40mmHg of pressure and the green square will deliver 30mmHg of pressure. The brown indicators are the ones you should be referring to for snakebite. When the brown rectangles are stretched to become brown squares the lymphatic return should be reduced enough to greatly decrease the circulation of venom through the system. The squares imprinted on the bandages are offset marginally to allow for the correct amount of overlap when covering squares with each layer wrapped.

Setopress bandage on arm after snake bite

There are a few other reasons this bandage is highly recommended for snake bite. You will only need one bandage for the bite. The Setopress is 3.5m in length – this is long enough to cover a very long limb! Bandaging the whole limb after a snake bite is required to stop the flow and movement of the patient. It is also wider than most other crepe or elastic bandages at 10cm in width. Another great advantage of the Setopress bandage is after being able to see that you have bandaged the limb correctly you will know the feeling of exactly how much pressure is right for a compression bandage, making it easier to do if you ever need to do it without a Setopress bandage. Lastly there is the peace of mind knowing that you have bandaged correctly and done the best you can for your patient.



DON’TS

There are many misconceptions surrounding snake bite. Some are older procedures that we no longer use due to research and new products, some are just Hollywood stunts.

  • Do not cut the bite site, attempt to suck the venom out, use any suction device to remove the venom, squeeze the bite like a pimple, try to burn the affected area, apply hot or cold packs, electric shock the site, or anything else that is not immediately applying a compression bandage.

  • Do not clean, wipe, or wash the bite site. Do not touch the bite site – if you have open cuts on your fingers, you run the risk of envenomation elsewhere.

  • Do not apply a tourniquet. Tourniquets' are applied to cut off blood supply to a limb. This may lead to gangrene or amputation.

  • Do not waste time trying home remedies. Get straight to the hospital.

  • Do not attempt to “walk it off”. Get straight to the hospital.

  • Don’t apply any chemicals, creams etc to the bite site.

  • Do not try to catch or kill the snake. Not only are you wasting valuable time to get to the hospital for treatment, but you are also running the risk of spreading venom further and run the risk of being bitten again/as well.

  • Never give or take any stimulants after a snake bite. Even food should be avoided unless directed by a medical professional.

  • Don’t allow yourself or the patient any unnecessary movements. Keep them/yourself as still as you possibly can.

  • Do not remove the pressure immobilization bandage. You will be removing the item that is stopping the venom from flowing through the system. The minute you remove the bandage without seeking medical assistance you are basically “opening the floodgates”.




Recommended reading/viewing, references:

Eipper S. & Eipper T. 2019, A Naturalist’s guide to the Snakes of Australia, John Beaufoy Publishing, Oxford

www.wildlifedemonstrations.com

https://www.wildlifedemonstrations.com/product-page/a-naturalist-s-guide-to-the-snakes-of-australia-pre-order link to purchase A Naturalist’s Guide to the Snakes of Australia

https://www.youtube.com/watch?v=Z_K3fDRdq7A&t=304s

https://www.molnlycke.com/products-solutions/setopress/

https://www.ncis.org.au/wp-content/uploads/2020/03/NCIS-fact-sheet-Animal-related-deaths.pdf?fbclid=IwAR0T5oPVKqjjUeVMovu1q9J0qCQR0rNT7MNMaVrCLh-LlNUoMt-_w3zSme0



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Common Tiger Snake, Notechis scutatus scutatus

Disclaimer

Neither Scott or myself are first aid trainers or medical practitioners. This information is a guide for Australian snake bite only and is correct at time of publication. All medical advice should be sought from professional medical staff. If you keep venomous snakes, spend a lot of time in the bush or your garden, live in an area that has a high traffic flow of venomous snakes we strongly recommend that you do a first aid course which includes snake bite.







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