Snakebite – what to do, and the advice that makes it worse

Snakebite is one of the few emergencies where the traditional first aid is a bigger problem than a delay would have been. Every item below is still widely believed in South Africa, and every one causes harm.

• Do not cut the wound. It does not remove venom and it adds a wound that bleeds badly and becomes infected.
• Do not suck the venom out, with your mouth or with a suction device. It does not work.
• Do not apply a tourniquet. Cutting off the blood supply to a limb that is already swelling causes tissue death and has cost people limbs that would otherwise have been saved.
• Do not apply ice, which worsens tissue damage from a cytotoxic bite.
• Do not use electric shock, paraffin, herbal poultices or alcohol.
• Do not give the person anything to drink or eat, and specifically no alcohol and no painkillers containing aspirin or anti-inflammatories, which affect clotting.
• Do not go looking for the snake or try to catch it. A second bite is a real risk, and a photograph from a safe distance is more than enough.

1. 1Move the person away from the snake, calmly. Most second bites happen during attempts to kill or capture it.
2. 2Keep them still and calm, and keep the bitten limb as still as possible. Movement moves venom.
3. 3Remove rings, watches, bangles and tight clothing from the limb immediately, before swelling starts. Once it swells, a ring becomes a tourniquet you cannot remove.
4. 4Note the time of the bite and what the snake looked like if you saw it — from memory or a photo taken from a distance.
5. 5Get to a hospital as fast as safely possible. Call an ambulance, or drive if that is genuinely quicker where you are.
6. 6Watch the breathing on the way. If it becomes laboured or the eyelids start drooping, say so immediately on arrival — that is the pattern that needs the most urgent treatment.

• ambulance10177Emergency Medical Services
• local_police10111South African Police Service
• sos112Universal Emergency (mobile)
• psychology0800 029 999SADAG Mental Health Crisis Line
• science0861 554 911Poisons Information Helpline

South African snakes cause broadly three patterns, and knowing them helps you describe what is happening rather than diagnose it. Many bites are also dry, with no venom injected at all — but that can only be established by observation in hospital.

• Cytotoxic — immediate severe pain, then swelling and blistering spreading up the limb over hours. Puff adders and most spitting cobras. The tissue damage is what causes lasting harm.
• Neurotoxic — often little pain or swelling, then drooping eyelids, difficulty swallowing or speaking, blurred vision and progressive weakness of breathing. Mambas and non-spitting cobras. This is the most immediately life-threatening pattern and can develop fast.
• Haemotoxic — bleeding from the bite site, gums or elsewhere, and bruising, developing over many hours. Boomslang and vine snakes. It can be deceptively mild at first and needs a specific antivenom.

• Use a torch when walking outside at night. A large share of bites are on feet and ankles in the dark.
• Wear closed shoes and long trousers in long grass and bush.
• Do not put hands into holes, under rocks, into woodpiles or behind stacked material you cannot see into.
• Keep rubble, wood and long grass away from the house, and control rodents — rats attract snakes.
• Leave a snake alone. Most bites happen to people who were trying to kill or move one. Call a local snake remover instead.