First aid: Laypeople

First-aid treatment is carried out immediately or very soon after the bite before the patient reaches a health centre or hospital. It can be performed by the snakebite victim himself/herself or by anyone else who is present and knowledgeable.

Stay calm

Reassurance will reduce fear and excitement, slow the victim’s heart rate, and reduce the spread of venom.

Immobilize the patient

Place the victim in a comfortable and safe position, ideally in the recovery position, and immobilize the bitten limb with a splint. Movement or muscular contraction, even undressing or walking, will increase absorption and spread of venom.

 CAUTION: Delay the release of tight bands, bandages, and ligatures.

If these, unfortunately still very popular methods of first aid were applied, they should not be released until the patient is under medical care, the initial antivenom dose administered and resuscitation facilities in place.

Apply pressure-immobilisation-technique (PIT) as quickly as possible.

If the bite is not on the limb, firm direct pressure on the bite site may be useful.

If resuscitation is needed it takes precedence over the PIT. However, the resuscitation team should apply PIT as soon as possible to potentially minimise further venom flow.

1. Locate and call the nearest hospital that has antivenom available.
2. Make sure that you ask specifically about antivenom availability and get confirmation.
3. Get their advice on how to tranfer the patient (they may have an ambulance or connect you to the ambulance service of the region)
4. If you have to tranport the victim on your own and the victim cannot move limbs, has "heavy" drooping eyelids or difficulties breathing you may need to stop at a health facility on the way to the hospital (with antivenom) to get support.

Transport the victim on a stretcher, "fire-man's lift" method, bicycle, motorbike, chart, horse, boat, etc.

• A stretcher can be made with materials that are available in villages or at work.
• Transporting the patient with a stretcher avoids any movement that increases systemic absorption of venom.
• The recovery positionwill allow for vomit and other secretions to drain from the mouth with less risk of airway obstruction. This is particularly important when the patient is unconscious or semiconscious.
• Fix the patient to the stretcher with straps.
• Let somebody walk alongside the patient to continuously observe him/her.

Two-wheeler transport

• Support the victim between the driver and a pillion passenger
• Protected the victim’s legs from exhaust burns
• Drive safely
• All passengers should wear helmets!!

If a service is available, call the ambulance

• Inform the responder about
• Number of mobile phone
• Name of the caller (victim, first responder)
• Nature of snakebite envenoming (Unconscious? Difficulties breathing? Cannot lift head whilct lying on the ground? Bleeding)
• Name of the incident location
• Nearest place where the ambilance can get to the victim
• Never put down the phone / mobile, wait for the call agent for any medical information / pre-arrival iinstructions

The bite may occur in such a way that the victim does not notice or misinterprets it, e.g. the victim thinks to have trodden on a sharp object, e.g. a fragment of shell, while wading. Even if the affected area of skin is inspected, the bite may still not be noticed. The venom fangs can leave behind small circular marks, but often only a superficial scratch mark. The site of the bite itself is painless and does not show any redness or swelling. Thus there is a risk that the first thing that is noticed are the symptoms caused by the systemic action of the venom. Even then, children and tourists unfamiliar with the area would not consider a sea snake bite to be the possible cause.

• the urgency of the problem.
• the expectation of signs & symptoms still to develop – very important to move quickly to a health post or hospital for assessment and observation (move preferenntially to a health post or hospital that have antivenom available!).
• a safe time interval to exclude a bite of a venomous snake or a ‘dry bite’: around 12 hours.