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Snakes are amazing creatures! Though their depiction in Raiders of the Lost Ark and ability to inflict deadly bites creep some people out, these fascinating reptiles occupy an important place in their ecosystems. Like landing gear on a plane, pit vipers, such as rattlesnakes and copperheads, have fangs that retract into the roof of their mouths when not in use. A snake’s forked tongue serves as its olfactory organ. As a snake grows, it sheds its skin multiple times each year; finding a snakeskin is a cool opportunity to observe a snake’s intricate scale pattern and marvel at this unique way of growing.
In order to avoid snakebites and better understand these fellow residents of our planet, it’s helpful to consider why a snake might bite. Wilderness medicine educator Tod Schimelpfenig gives perspective: “Imagine yourself trying to catch a small mammal for dinner, equipped only with a long, limbless body. You might develop the ability to leap quickly to your victim. You might also develop a venom to immobilize the victim. This is how a rattlesnake makes its living: striking quickly and accurately and immobilizing or killing its victims with venom.” These long, limbless bodies aren’t out for human blood, they simply want to eat dinner. If a snake bites a human, it is because the human has frightened or bothered the snake.
In North America, we have two families of venomous snakes, Elapidae and Crotalidae. Our only Elapid is the coral snake, the beautiful creature with red, black, and yellow bands. Coral snakes are distinguishable from their non-venomous lookalikes, the king snakes, using the phrase “Red on yellow, kill a fellow; red on black, venom lack.” Our Crotalids include rattlesnakes, copperheads, and cottonmouths. In the U.S., 95-99% of all poisonous snakebites are from Crotalids, or pit vipers. They have triangular heads, catlike pupils, thick bodies relative to head and tail diameter, and pits between the eyes and nostrils.
The effects of a bite from a venomous snake vary widely. Firstly, a snake can control the concentration of venom it injects, and venomous snakes do not envenomate at all in 20-30% of bites. In addition to the variable amount of venom, many human factors influence a snakebite’s effects: the human’s age, size, health, emotional state, and allergies, along with the bite’s location and the first aid the patient receives. Effects also depend greatly on the size and species of the snake. For example, a Mojave rattlesnake’s venom is approximately forty-four times more potent than that of a southern copperhead.
What to make of all these variables? A calm patient fares much better than a panicky one, a snakebite isn’t a death sentence, and it is difficult to immediately know how much envenomation occurred, so treat all snakebites seriously.
Thankfully, though accidents happen, it is fairly simple to avoid frightening or bothering snakes. In a sentence, preventing snakebite boils down to paying attention to your surroundings. Snakes, like all reptiles, are cold-blooded, meaning they rely on external sources of heat to manage their body temperature. Because of their cold-bloodedness, snakes tend to seek shade in the heat of the day, and conversely sun themselves, often on warm rocks. Before sitting down under a shady overhang on a hot, sunny day, look! Keep your eyes out on the trail; it’s common to see a snake slither across a sunny trail.
Remember, the snake does not want to encounter you, so by keeping your eyes out you can notice snakes and avoid surprising one. Also listen. Rattlesnakes often use their rattles to warn humans and large animals before they strike in self-defense. Never put your hands anywhere you can’t see, like an overhead rock ledge when scrambling. And leave snakes alone. Imagine a creature twenty times your size removing the roof of your house and closely inspecting you; now imagine your reaction if you had fangs. As with all wildlife, admire these creatures from a respectful distance. Do not pick up a snake.
If, in your vigilance, you see a snake from a distance, enjoy observing it. Give it time and space to slither away. If it is in the trail and doesn’t want to move after some time, detour around it, giving it a wide berth. Do so while practicing leave no trace principles. Walking on rocks is great; walking across cryptobiotic soil crust is not. If you notice a snake at a much closer distance, freeze, let it slither away, then proceed. If you hear the sound of a rattle, freeze, locate the snake with your eyes without moving your head. Wait for the snake to relax from the strike position, then back away slowly. Remember, a snake’s striking range is about half to two thirds its length.
Even when taking precautions, snakebites occasionally occur.
First, make sure the scene is safe; ensure that no patient or rescuers are in the snake’s proximity. Do not create another patient by attempting to pick up, capture or kill the snake. If you can do so safely take a picture of the snake for identification. This can help expedite the treatment when you do arrive at the emergency room.
If the patient is in a frontcountry setting, generally defined as within an hour of definitive care (an emergency department or ambulance access), call 911 and get the patient to a hospital. As the Poison and Drug Information Center in Arizona, the most likely state in which to die of snakebite, puts it, “The best first aid kit for snakebite includes your car keys and cell phone. Get help quickly if you are bitten.” But often while adventuring, we’re much more than an hour from definitive care. Buck Tilton, MS, WEMT, and author of Wilderness First Responder offers these steps for treating snakebite in a wilderness setting in North America.
As important as what to do is what not to do. Terrible advice for treating snakebites abounds. Per Tilton’s instructions:
Anyone with a snakebite should be evacuated to definitive medical care, and any patient showing signs or symptoms of envenomation should be evacuated rapidly. For Crotalid bites, these signs and symptoms include fang marks, swelling, pain, bruising and/or blister formation (over 6-36 hours), weakness, sweating, chills, nausea, vomiting, numbness, and swollen lymph nodes. For Elapid bites, signs and symptoms of envenomation include local swelling, nausea, vomiting, dizziness, weakness, and respiratory difficulty (up to 12 hours after bite).
One final treatment note: only if a bite can be positively identified as a coral snake bite, apply a pressure bandage, such as an ACE wrap, around the limb with uniform pressure as tight as an ankle wrap. A pressure bandage is also recommended for Australian Elapid bites. A pressure bandage is not a tourniquet; as noted above, do not treat a snakebite with a tourniquet. Monitor the patient’s pulse in the extremity distal to the bandage to be sure it’s not too tight.
The easiest way for any medical patient to evacuate the wilderness is to walk out under their own power. Ideally, however, any snakebitten patient should remain immobilized. This conundrum inevitably leads to tough decision making in the backcountry. If a patient is mentally and physically able to walk out, help them do so. In Tilton’s words, the patient must be stable, meaning their vital signs remain within normal range over time. You do not need a medical background to note vital signs — if the person that was bit is acting normal then vital signs are “normal”. If physical or mental capacities become erratic or abnormal the patient is no longer considered “normal” or stable.
Keep the pace easy to avoid additional strain on the patient. Sometimes, a moderate to severe envenomation results in physical and mental distress that prevents a patient from walking out under their own power. Also, often keeping the bite at heart level and walking out are mutually exclusive, as in the case of a bite on the leg or foot. In these cases evacuating a patient on a litter (often improvised) may be the best option, but doing so requires a group of people and is extremely difficult over long distances. Walking out may be the bite victim’s only option. Also, consider the importance of promptly receiving antivenin; if someone is available, send a runner ahead of the evacuee to call for help.
If snakebitten on a solo adventure, all the above treatment principles apply. Unfortunately, a solo snakebite victim has fewer options. It’s likely that regardless of the severity of the envenomation and the patient’s state, a self-evacuation will be the only option. To prepare for such situations, consider carrying a device like a Garmin inReach GPS or SPOT X 2-Way Satellite Messenger to mobilize search and rescue, a wise move for group adventures, too.
To be prepared for treating snakebites on your adventures, be sure your first aid kit contains ample wound cleaning supplies and bandages. The bare minimum treatment for any snakebite is to treat the wound, so have the proper essentials for to clean and bandage a wound.
Proper treatment of any medical emergency, especially over the prolonged period of time common to treating backcountry emergencies, requires extensive note taking. Be sure your kit includes a pen and paper, ideally something waterproof like a Rite in the Rain notebook. A permanent marker is also a great option in snake country. You can use this marker to mark the skin or swelling changes by writing the time on the patients body.
Should you need to carry out a snakebite patient, a litter may be required; consider adding a 20-foot length of webbing to your kit for improvising a litter, as in this video.
DO NOT buy, pack, or use the Sawyer extractor snakebite kit. This is because “…the Sawyer extractor not only fails to suck fluid out of the wounds but actually collapses the wound tracts near the surface by drawing the skin up into the suction cup and may actually force that venom even deeper into the tissues.”
As with many medical emergencies on outdoor adventures, avoiding snakebite is fairly simple with a bit of vigilance. Keep your eyes and ears open as you travel through snakes’ homes. If a snakebite occurs, do your best to remain calm and follow the above guidelines for treating yourself or others. Remember, any animal bite is cause to get a patient to definitive medical care. Here’s to many great adventures in snake country, and may your vigilance be rewarded with many sightings of these impressive creatures from a safe distance.
Foot Notes / Source Credit:
Buck Tilton, Wilderness First Responder (Morris Book Publishing, 2010).
Peter Alden and Peter Friederici, National Audubon Society Field Guide to the Southwestern States (New York: Knopf, 1999).
“Rattlesnakes,” Arizona Poison and Drug Information Center, May 21, 2019, https://azpoison.com/venom/rattlesnakes
Shana Tarter and Gates Richards and Tod Schimelpfenig, Wilderness Medicine Handbook (Lander: NOLS Wilderness Medicine, 2019).
Tod Schimelpfenig, Wilderness Medicine (Mechanicsburg: Stackpole Books, 2008).