Dispelling the Snakebite Myth

- John C. Jones, MD, AWLS
Over the years there have been many in-the-field remedies for snakebites. Most of these therapies are as strange as our fear of snakes, and none of them work. Mostly, they increase the harm that is already being done.
Mojave rattlesnake
© Rich Gassaway

Within roughly 30 to 60 minutes you might notice swelling, redness, and bruising around the immediate bite site. The victim may also complain of burning pain.

Do Not:
  • Cut the bite with a knife
  • Attempt to suck out the venom
  • Use electricity to shock the wound
  • Apply ice to the wound
  • Use a tourniquet
  • Allow the victim to drink alcohol

Snakes are exceptionally fascinating, although I don't find them fascinating enough to own one. If you ever happen to be walking along a trail and come nose-to-nose with one of these suckers, I bet you'll find you are fascinated enough to stop and watch.

Over the years, I've had a few exciting encounters with snakes. The most relevant example occurred while foolishly hopping down some rock ledges in a ponderosa-pine forest on a warm summer day. Luckily, some smaller rocks had fallen preceding my leap, scaring a timber rattler just in time to prevent me from making him into a welcome mat. As he slithered away, I stood there stunned with the sound of his rattled tail still in my mind. For some time afterwards, I fooled myself into thinking that I would hear a warning rattle if I were ever approaching snake territory. The truth is many snakebites occur without a warning. Still, I make a habit of kicking loose rocks and scree over ledges before I step.

Our fear of snakes is disproportional to the likelihood of being bitten by them. Their creepy nature only serves to enhance our fear. Looking at some of the statistics helps put this risk in its proper place. Native, venomous snakes are found in every state except for Alaska, Maine, and Hawaii. Each year in the U.S. approximately 45,000 snakebites are reported. Of these, only 8,000 are deemed to be from poisonous species. One retrospective study in Utah identified only 9 poisonous snakebites per year that resulted in actual signs of envenomation. Even then, only five or six people die each year from envenomations, nationwide! Now that doesn't mean you can be free from worry. Those 5 or 6 people are the ones that didn't get to the hospital, didn't receive enough treatment, or are the very young and elderly who are more susceptible to the damaging effects of the venomous toxins.

Does it strike you as interesting that the typical victim profile is men between ages 17 and 27? How about that alcohol intoxication is a risk factor for being bitten? Or, that the most bites occur during the peak summer months? I'm having a clear picture of a drunken young male pestering an angry snake on a warm day. In this case who is more intelligent? I'd bite him, too. Most outdoor places, people want to throw little rocks at a snake or poke it with a stick to see what it does. I've been guilty of this, too. However, trying to upset a snake is a stupid thing to do. Just walk away. Take a picture if you need to, but keep it from a safe distance.

To be fair, some snakebites are just accidental. If I had landed on that snake, I would most likely have been a victim. But strangely, some snakebites are "dry", meaning no venom is injected. Some studies have demonstrated that 25% of rattlesnake bites and 50% of coral snake bites are dry. However, you don't want to take those chances for whether you’ve been struck with the poison.

I don't have room here to catalog all of the pictures and descriptions of the 25 indigenous, poisonous snake species in the U.S. If you go hiking in snake infested country, take a herpetologist. You'll can probably learn some amazing things. If your not so lucky, you can try to identify a poisonous snake by yourself. It can be challenging. Some general rules apply.

We hear most often about pit vipers (e.g. rattlesnakes, copperheads, and water moccasins). Their name comes from the heat-sensing "pit" on each side of their face that might make it look like they have four nostrils. They have heads that are more triangular than their non-venomous cousins, because of the extra room needed for venom glands. They have oblong or slit-like pupils--that is if you happen to have 20/10 vision from afar or you're looking at a dead one up close. Retractable fangs fold up into their mouths when closed. Many have rattles, but not always.

Coral snakes live in the Southern United States, but none are native to Utah. In case you travel south, here's the low down. These snakes are shy night creatures with smaller heads. They are not aggressive, so most bites here fall into the non-accidental category. They have alternating bands of race-car colors: red, yellow, and black. There are some non-poisonous snakes that try to impostor this color scheme. This gives rise to some of the rhymes used to remember who's poisonous and who's not. The simplest of these is, "Red on yellow can kill a fellow." Another is "Red on black is friend of Jack." This only holds true for the United States.

Since you're reading this article, the next time you're out and see a snake, hopefully, you'll know what to do. However, your friend may not be as knowledgeable as you. Let's say he's gets a bite of the bad medicine on his hand. Now what? Hopefully you were able to get a good description of the criminal before he ran away. Some people recommend killing the snake to have the body for identification. Unless you have a really good way of doing this, I recommend you let it go. A word of caution: snakes can still strike by reflex even after they are dead for a few minutes. Even a severed head can still inject poison from its fangs for up to an hour after it's death. Furthermore, having the snake’s dead body will not alter how much venom has or has not been injected into the victim. This is when you might wish you had that herpetologist friend for snake identification. Since you probably don't, you must now move on and assume you have a medical problem on your hands.

You'll have to rely on the snakebite victim's signs and symptoms; and, it can be tricky. The initial anxiety response to most snakebites is a feeling of utter doom or panic. Even without any actual envenomation, people can get emotionally unstable or, conversely, think they are about to die. Fear itself may make the victim become pale, clammy, and lightheaded. He might even become nauseated and vomit. A fast heart rate and confusion could also occur from stress and fear alone. The best thing you can do is put on your cool, calm demeanor that exudes confidence and skill and help him hurry to the nearest medical facility. Current science shows there is little else you are going to do that will save the day.

Since we see that some signs and behavior may not be reliable measurements of poisoning, here are some more objective signs you might notice as you hike out. Within roughly 5 to 60 minutes you might notice swelling, redness, and bruising around the immediate bite site. The person may also complain of burning pain, but not always. The initial phase of the reaction is very localized, but depending on the severity of envenomation it can progress to affect all systems of the body. The effects most commonly seen are nausea, vomiting, numbness or tingling around the face/mouth, muscle twitching, tiredness, and weakness. Sometimes it causes a change of taste in the mouth described as metallic. In the worst cases the victim may have difficulty breathing properly, develop a blood pressure that is too low for the vital organs, and may even develop spontaneous bleeding.

Diamondback rattlesnake
© Rich Gassaway

An exception to this presentation is coral snake venom or with certain desert rattlesnakes. It may not produce any local effects until systemwide signs and symptoms occur. At that point the person may need mechanical ventilation to save his life.

With this confusing array of effects and the difficulty of knowing if, when, or how bad things will get: the answer is to promptly evacuate. Poisonous snakebites are a true medical emergency.

Over the years, there have been many in-the-field remedies for snakebites. Most of these therapies are as strange as our fear of snakes, and none of them work. Mostly, they increase the harm that is already being done. Even if you were told to do these in the past, DO NOT use: tourniquets, incision and suction, ice, or electric shock. Things you SHOULD DO include: step away from the snake, remove any jewelry or constrictive bands/clothing, reassure the victim, note the time the bite happened, and get moving to the hospital.

At some hospitals, there are anti-venom medicines to stop and possibly reverse the progression of the effects of envenomation. These are serious medications that play tricks on the immune system. Their use needs to be monitored at the hospital. Time to administration is of the essence--they work best if given within the first 4 hours, but you probably shouldn't be making the victim run to get there. There is some debate about whether the victim should be using the bitten body part during evacuation. Theoretically, a large increase in blood flow could shorten the time until systemwide effects occur. Your situation may vary, but the best advice may be to just walk out.

Avoiding the snakebite from the start seems to be the best approach. Follow these general tips: Leave snakes alone. Don't try to kill snakes. Stay on trails. Stay out of high grasses; they hide snakes really well. Wearing boots and/or pants might prevent a few bites. Don't put your arms and legs where you can't visually keep track of them. Some experts say a snake can strike half its length. Double or triple that distance for a margin of safety.

So, what are the most important lessons? All snakebites should be treated as serious medical emergencies. Forget what your scoutmaster taught you about treating the bite and get to a hospital. And, strongly consider not playing with snakes.

Hopefully, you've learned a little about confronting snakes in the outdoors. If you haven't already, sooner or later you'll see one of these critters on one of your adventures, but now you'll know better what to do.