Tanzania: Snake Bite Is a Medical Emergency but Do Not Tourniquet

NAKES are found everywhere in the world except for a few islands and Antarctica.
All are carnivores, swallowing their prey whole. They smell with their tongue and have no ears. Because snakes are prey to other animals they are very quiet and secretive. They hunt at night or in the hours of early dawn or late dusk.
Their behavior often enables them to co-exist with humans in homes, gardens and farms with their presence usually unnoticed.
Of course the preference is to prevent snake bites, but that is not always possible. Snakes are responsible for an untold number of bites, many deaths as well as permanent physical disability.
If a person is bit by a snake, first aid must be started by the victim, or a person nearby. According to ten nurses who have worked in Morogoro, Dar es Salaam, Bombo, Magoto, Muheza, Tanga, Mwanza, Segerema and Haydom Hospitals. Most patients came to the hospital quickly, within a few hours. One waited for five days receiving herbal medicines, arrived very weak, and died in hospital.
Before arriving at the hospital six had applied a tourniquet, six had applied a snake stone, five had applied herbal treatment, three had applied dung, and three had washed the wound. One received no treatment. What is the best first aid for a person who has been bitten by a snake?
According to Warrell, writing in the WHO "Guidelines for the Prevention of and Clinical Management of Snake bite in Africa" (which can be downloaded for free), the first thing is to move the victim to a safe place, away from the site if he could be bitten again.
Remove the snake if it is still hanging on (but do not do this with bare hands). Reassure and calm the victim with true facts: 95% of bites are harmless and even if not, there is almost always time to get the person to the hospital. Death from snake bite rarely occurs rapidly - death will occur in hours after cobra bites, and in days after viper bites.
Since the area around the bite may swell, to prevent additional damage remove anything constricting the limb especially rings, bracelets, bands, clothing or shoes. The victim must be immobilized especially the bitten limb, using a splint or sling. The person must stay still.
Muscular contractions anywhere in the body, but especially in the bitten limb, will increase the absorption and spread of venom from the site of the bite via blood and lymph movement. All movements should be avoided as far as possible.
Transport the patient as quickly and as passively as possible to the nearest facility available for medical care (health clinic, dispensary or hospital). Victims of snake bite should be transported by stretcher, in a motor vehicle, on a bicycle (as a passenger), by boat, or by being carried. If possible the dead snake or a photo of it should be brought with the patient.
Warrell warns us about what should not be done. Suction of the wound by mouth or pumps should not be done. Ice packs should not be applied. All of those actions increase the risk of tissue death. Do not make small cuts around the wound.
This can provoke uncontrolled bleeding if the blood has become incoagulable due to the venom. As well, cutting may damage nerves, blood vessels or tendons; and introduce infection. A tight tourniquet should NEVER be used! According to Warrell: Tourniquet is one of the most popular first-aid methods in Africa and continues to cause terrible morbidity and even mortality in snakebite victims: tourniquet should not be used.
The dangers of tourniquets are ischaemia and gangrene, if they are applied for more than about 2 hours; damage to peripheral nerves (especially the lateral popliteal nerve at the neck of the fibula); increased fibrinolytic activity; congestion and swelling; increased bleeding; increased local effects of venom; and, immediately after release, shock, pulmonary embolism or rapidly-evolving life-threatening systemic envenoming.
No tourniquets! Therefore of the 12 snakebite victims reported coming to the hospital by the nurses, perhaps only one did the right thing. "Received no treatment". And if: he had also been reassured, all tight fitting things removed from his body, the limb immobilized, and then the patient carried to the hospital, that would have been the best possible first aid.