You are receiving this email because you signed up for the monthly ASI Newsletter. 

If you no longer wish to receive these emails you can unsubscribe here.

February 2025 - First Aid for Snakebite

The main reason why thousands of people attend our snake awareness courses, is to get accurate and up to date information on first aid for snakebite.

This has been covered comprehensively in my books Snakes and Snakebite in Southern Africa, as well as A Complete Guide to Snakes of Southern Africa. We also have a First Aid for Snakebite booklet that is available on the free ASI app ASI Snakes.

Unfortunately, there are still many outdated and ineffective first aid measures that are shared from generation to generation and repeatedly posted on various social media platforms.

Outdated and incorrect first aid measures for snakebite include cutting around the site of the bite and trying to suck venom out, making incisions and rubbing Condy’s crystals in, applying ice or heat, injecting antibiotics like penicillin or administering anti-inflammatories. Always bear in mind that you are trying to assist the patient until hospitalization, either by delaying the rate at which venom is absorbed, relieving pain or providing rescue breaths.

Most serious damage is done by applying arterial tourniquets and in rural settings, most snakebite patients arrive at a hospital with a  belt, shoelace or a piece of fence wire tightly wrapped around a bitten arm or a leg. I have discussed the use of arterial tourniquets with a variety of snakebite experts, including the likes of Prof David Warrell (Oxford University and WHO Snakebite Expert), Dr Gerbus Muller, now retired from the Tygerberg Poison Centre and Dr Colin Tilbury, one of the most experienced snakebite doctors in Africa, and they are all in agreement – do not apply an arterial tourniquet for a snakebite. The only exception would be that you are more than 90 minutes from medical help, and on your own and you are certain that the snake responsible was a Black mamba or Cape Cobra. Should you choose to apply an arterial tourniquet in such a dire situation, use a proper arterial tourniquet designed for the purpose.
 

Mozambique Spitting Cobras frequently move around houses in search of prey and sometimes enter buildings. 

Preventing snakebites far outweighs any treatment and by applying some common sense, most snakebites can be avoided. Most snakebites happen on warm summer nights when people accidentally step onto snakes. Make use of a torch at night and wear closed shoes. There is evidence that up to half of the venom that a snake injects can be absorbed by thick trousers. Gumboots, although not foolproof, offer good protection against snakebite. Our corporate clients on mines, wind farms and solar farms make use of snake gaiters, which protect the legs from below the knee to the feet.

Sleep on an elevated bed and if you are in an area that has many snakes, sleep under a mosquito net that is carefully tucked in. The Mozambique Spitting Cobra is well-known for entering houses and biting people while asleep.

Keep your property clean and neat and remove building rubble and sheets of wood or corrugated iron. Piles of rocks and water features provide shelter for rodents and frogs and they, in turn, lure snakes closer. Never try to kill or catch a snake, no matter how small or innocent looking. Observe the snake from a safe distance (5 m or more) and call a snake remover. The ASI Snakes app has over 800 snake removers countrywide that can assist with removals.

Puff Adders account for a large number of bites. Many bites are at night when these snakes are on the move and are trodden on.

 In the unlikely event of a snakebite:

·        Move the patient away from the snake, as a second bite would complicate matters

·        Clear the area of people, especially children, and pets

·        Do not attempt to catch or kill the snake, but take a photograph of it if this can be done safely (bear in mind that some snakes spit)

·        Observe the snake from a safe distance (5 m or more)

·        Remove tight clothing and jewelry from the bite victim, especially rings and bangles

·        Keep the victim calm and reassure them

·       Call the nearest hospital with an emergency room, and an ambulance service, unless it is quicker for you to drive to hospital.

In most cases where someone is bitten by a snake, the snake is not identified. Few people have sufficient knowledge to identify snakes (there are over 170 species in southern Africa) and most bites happen at night.

In the event of a bite from an unknown snake, it is important to get the victim to the nearest hospital quickly and safely. In rural environments where it often takes more than an hour to get to the nearest hospital, we recommend applying a pressure pad.

A pressure pad may consist of some cotton wool, bandage or other material that measures roughly 6 x 6 x 3 cm. It is placed over the site of the bite and that area is bandaged up as you would for a sprained ankle. Pressure on veins and lymphatics at the drainage site may delay the rate at which venom spreads. Place the victim in the recovery position and get to a hospital.

Pressure pads are ideal for most snakebites and slow the movement of venom through the body.

If the identity of the snake responsible for the bite is known and it is a Puff Adder, Common Night Adder, Mozambique Spitting Cobra or Bibron’s Stiletto Snake, there is no effective first aid. Transport the victim to hospital. If the bite is on a hand or foot, slight elevation (just above the heart) will reduce pain. In cytotoxic bites avoid all bandages.

In a confirmed Black Mamba or Cape Cobra bite, it is vital to get the victim to the nearest hospital as the fast-acting neurotoxic venom of these snakes may compromise breathing. Patients die within minutes once breathing stops. Black Mamba and Cape Cobra bites may be fatal in 1-8 hours although in extreme bites, death has occurred in under 30 minutes.

Stiletto Snakes account for a large percentage of bites in Africa. There is no effective first aid for these bites. Transport the victim to hospital or a clinic.

Pressure immobilization

Most fatal snakebites in southern Africa are from neurotoxic bites, and the Black Mamba and Cape Cobra account for most of these bites. In a confirmed Cape Cobra or Black Mamba bite, the victim needs to be transported to a hospital urgently and a pressure bandage applied. The concept of pressure immobilization was developed in Australia in the 1980s by Dr Sutherland, who found that if a bitten limb was wrapped with a pressure bandage at a specific pressure, the absorption of venom via the lymphatic system was slowed down, providing more time to get to a hospital before the onset of severe symptoms. How much time one buys by applying a pressure bandage is unknown and depends on various factors, but in tests on animals, those with pressure bandages survived far longer than those without. Pressure bandages should only be used in Cape Cobra and Black Mamba bites but may also be used in non-spitting cobra bites. Never use a pressure bandage for a cytotoxic bite.

Pressure bandages should only be used for neurotoxic snakes like this young Black Mamba.

Should you apply a pressure bandage it is advisable to make use of a Smart bandage. The ideal pressure is 50-70 mm Hg, and this is not easily achieved with a crepe bandage. Smart bandages have rectangles printed at intervals and the bandage must be stretched until the rectangles form squares, resulting in the ideal pressure as recommended. 

The pressure bandage must remain in place until the victim is hospitalised. It can be used in conjunction with a splint which will prevent the limb from moving and reduce muscle contractions which will spread venom quicker.

Non-spitting cobras like the Snouted Cobra and Forest Cobra and the Green Mamba have predominantly neurotoxic venom, but their venom also contains cytotoxins that may cause swelling. A pressure bandage can also be used in confirmed bites from the above snakes.

Pressure bandages must be wrapped from the approximate area of the bite towards the heart, stretching the rectangle patterns into a square to apply the correct pressure. 

Mouth-to-mouth resuscitation

If the victim stops breathing, mouth-to-mouth resuscitation can be lifesaving.  It is advisable to use a barrier device, either a face mask or a pocket mask, to prevent bodily fluids entering your mouth. Many victims may throw up from shock. CPR or chest compressions are not required for snakebite, as the heart is not affected by snakebite and functions normally. The most important aspect is to gently force oxygenated air into the lungs so the heart can circulate the oxygen.

Tilt the patient’s head back to open the airway, get a good seal over the mouth and in adults deliver one gentle breath every six second. Look for a chest rise and allow the patient to exhale after each rescue breath. In children we deliver one recue breath every three seconds and in babies one breath every two seconds.

Bag Valve Mask Reserve – BVM (or Adult resuscitator)

A more effective method of providing rescue breaths is the use of Bag Valve Mask Reserve (BVM). The use of a BVM requires proper training – attend a Basic Life Support course (check out www.resus.co.za). Correctly using a BVM requires two people – one to tilt the head back and get a good seal over the mouth and nose, and the second person to provide the rescue breath by squeezing the bag. A BVM can be linked to an oxygen tank to provide more oxygenated air, but this is not essential.

The best thing to do in snakebite emergencies is stay calm and keep the victim still. If you are further than 30 minutes to an hour from a hospital, it may be advisable to call an ambulance service, as paramedics are far better equipped to deal with such emergencies than first aiders.  

If you are close to a hospital, you can transport the victim yourself and in a safe manner. It is advisable to call the hospital ahead to notify them that you are coming in with a snakebite victim.

If you are working in rural areas, especially outside of South Africa it is a good idea to obtain medical insurance that will cover emergency flights to a major hospital.

Bag Valve Masks are an effective way of providing oxygen after a neurotoxic snake bite. It is preferable to have two people to opperate the mask efficiently. 

Spitting Snakes - First Aid

There are five spitting snakes in southern Africa – the Rinkhals, Mozambique Spitting Cobra, Black Spitting Cobra, Zebra Cobra and the Black-necked Spitting cobra, with the Mozambique Spitting Cobra, Zebra Cobra and the Rinkhals being the three most commonly-encountered species. These snakes can spit or eject their venom over two meters in distance and do so very effectively – they aim for the eyes. The idea is to get some venom into the eyes of the attacker, which causes intense pain and temporary blindness, giving the snake time to escape. The venom may land on your head, face, arms and chest but only does damage in the eyes – the rest can be rinsed off easily. Venom in the eyes causes immediate pain – not unlike getting pepper spray in your eyes.  

For venom in the eyes, immediately flush the venom out with water. Get the victim’s head under a running tap and keep it there for several minutes holding the eyes open and flushing as much of the excess venom out as possible. Then consult a doctor who will examine the eyes for corneal damage and prescribe antibiotic drops to prevent further infection. In most instances the eyes recover fully within a few days, and cases where permanent damage is done to the eyes are rare. There is no reason to flush the eyes with milk, beer, cold drink or even urine, as water works best.

Mozambique Spitting Cobras are quick to spray venom at a potential threat. Eye protection must be used for removals of all spitting snakes. 

Snakebite fatalities are rare in South Africa and often avoidable. As for antivenom, nine out of ten snakebite victims that are hospitalised after a bite, do not receive antivenom as it is not necessary – venomous snakes can give dry bites or inject very little venom. Doctors therefor treat snakebite symptoms, not snakebites.

We’re fanatical about spreading snake awareness, and we have a number of FREE resources for the public to use. One such resource is the over 400 snake posters on our website. From local cities, provinces and nature reserves to neighbouring countries, first aid posters, scorpion spiders and even a kid’s poster. All are vital tools to help spread snake awareness and education as far as possible. You can view and download all these posters here, for free.

FIND US ON SOCIAL MEDIA 
 

Johan Marais
African Snakebite Institute | +27 82 494 2039
E-mail johan@asiorg.co.za 
Find out more at www.africansnakebiteinstitute.com

Johan Marais is the author of various books on reptiles including the best-seller - A Complete Guide to Snakes of Southern Africa. He is a popular public speaker and CEO of the African Snakebite Institute. The African Snakebite Institute (ASI) offers a variety of courses including Snake Awareness, Scorpion Awareness and Venomous Snake Handling. ASI is accredited by the International Society of Zoological Sciences (ISZS) and is a Travel Doctor-approved service provider. The courses are also accredited by the Health Professions Council of South Africa (HPCSA). ASI is the largest provider of quality snake handling and safety equipment in Africa!

Copyright © 2025 African Snakebite Institute, All rights reserved.

Our mailing address is:
admin@asiorg.co.za
unsubscribe from this list