Key Messages for Prevention and Control of Snakebites

Prevention of snakebites

General precautions

• If you see a snake, do not try to pick it up or kill it; give it a clear path to leave the area, maintain a safe distance and gently move away. Snakes do not confront humans and do not attack from a distance.
• People should be aware of their local snakes, toxicity status (venomous and non – venomous), activities, activity cycles, and habitats, dwelling spots and hideouts.
• Always maintain a safe distance from snakes, including from those that enter human habitation.
• Wear sturdy closed-toe footwear and exercise vigilant caution while navigating through the bush.
• Be vigilant of snakes, especially during the rainy season. Hatchlings of several species, including cobras, emerge out during the monsoon. Additionally, snakes in flood-inundated areas may be forced out of their burrows, which may then wander in search of warmer, drier terrain, including houses, roads, fields, etc.
• Snakes do not attack unless they are handled, threatened, trapped, cornered, or stepped on.
• When walking through a forest, wearing a hat or cap offers protection from bites of treedwelling snakes.
• Do not pick up a snake that is either dead or appears dead. Even accidental scratching from the fangs of a snake’s severed head can deliver venom.
• Even a juvenile venomous snake has fangs and venom, so do not ignore bites by a small snake.
• Chemical or natural repellents are ineffective in repelling snakes. While bleaching powder or gammaxene application may not deter snakes, they may repel small creatures like rats and frogs, thereby, avoiding snakes that may come in search of prey.
• In case of snake bite, get to the nearest health facility that stocks and administers antisnake venom.

Home/environment

• Use a torch light or lamp while walking outside at night. Do not step or walk in areas where the ground is not visible.
• Always check shoes/footwear before wearing them.
• Do NOT put hands, fingers, or feet into holes, nests, or hidden places, where snakes may live.
• Carefully prod and examine any material for hidden snakes that have been on the ground before picking it up.
• Try to avoid sleeping on the ground. If unavoidable, use a mosquito net that is well tucked in under the mattress or sleeping mat.
• Avoid open-air defecation, especially in the dark. If unavoidable, carry a torch or lamp.
• Constructing indoor toilets while constructing a new house would be an ideal practice.
• Clear heaps of rubbish, building materials, and termite mounds in and around human habitation.
• Regularly trim ornamental plants, grass, and undergrowth, especially around the buildings. This practice would remove any hideouts for snakes or their prey.
• Where ever possible, apply smooth plastering on the outer side of the boundary wall to discourage snakes from climbing over and entering human dwellings.
• Cut tree branches that enter your boundary. Snakes may scale vegetation to enter human spaces.
• Discard garbage responsibly. Rodent control should be top priority to keep snakes away.
• Store firewood at a distance from the house, to prevent snakes from hiding in it and coming into the house.
• Avoid housing livestock and poultry indoors, as this may attract snakes seeking to prey on them. Additionally, store animal feed away from the house or inside a close space, as it can attract rodents, and in turn attract snakes.
• Seal the holes in the house/around the premises to prevent snakes from entering.
• Keep plants away from doors and windows as snakes like cover and climb on them into the windows. Trim branches of creepers and trees so that they are not too near your window.
• The mouth of rain-water overflow may be covered with a mesh to avoid entry of snakes.
• Inspect mud-made chulhas first before cleaning them.
• Examine beddings for snakes before using it in areas where snakebites are common.

Farmers/Agricultural workers

• Wear protective gloves and shoes (gumboots) while working in fields.
• Complete farm work early and avoid walking in late evenings to minimize the risk of snake bites, as most incidents occur during this time.
• Use a stick while cutting/collecting grass or picking fruits or vegetables or clearing the base of trees. With the stick move the grass or leaves first, which gives a chance for the snake to move away
• While harvesting crops like millets which are cut at head height, keep checking the ground ahead

Trekkers/Adventurers

• During trekking through forests or mountains it is advised to stay on clearly marked tracks. Step on to rocks or logs rather that straight over them so that snakes if present on either side can slither away
• Rock climbers and trekkers often seek support in rocky crevices as they climb. While doing this ensure that no creature is lurking within

Fishermen

• Fishermen should not touch sea snakes caught in their nets
• Sea snakes are often seen lying immobile in marshy and sandy areas. Avoid the temptation to touch and prod them.

Snake catchers and charmers

• Only trained personals should be involved in catching and handing the snake
• Appropriate handling of snake to prevent inadvertent bites and injury to the snake
• Always wear protective equipment’s which handling the snake.
• Avoid exhibition and shows after catching the snake in public.
• After snakebite – Do’s The symptoms of snakebite include progressive painful swelling of limb (viper bite), neuroparalytic symptoms like ptosis (drooping of eyelids), double vision, difficulty in speaking, hoarseness of voice, difficulty in respiration and difficulty in swallowing (cobra, krait bite), vasculotoxic symptoms like bleeding, tissue necrosis, kidney injury (Russel’s viper/Saw-scaled viper), myotoxic symptoms like muscle pains (sea snake) or severe abdominal pain and vomiting (krait bite). Inform the doctor about any of these symptoms or any new symptom which has occurred
• Seek medical help immediately. If necessary walk with support (try not to run) to get help
• Take a picture of the snake on mobile phone from a distance or try to remember what it looked like to describe to the doctors. It is advised not to waste time on this if it is difficult to do.
• Arrange for transport of patient to an equipped medical care facility as quickly, safely, and passively as possible by ambulance (toll free no. 102/108, etc.), or any other suitable means of transport (bicycle, stretcher, boat or motorbike).
• Keep the patient calm. Reassure the victim that the bites can be effectively treated in an emergency room with ASVS.
• Do not apply any pressure or force, including heat and electricity at the bite site.
• Restrict the movement of the affected part by immobilizing the limb with a sling (as in a fracture), with a loose splint which should not restrict blood supply. Keep the affected area below the heart level to reduce the flow of venom.
• Rinse the venom in the eyes with running water in case of spitting snakes
• The victim should not exert themselves after a snakebite. Running or self-driving to a health facility could speed up blood flow in the body.
• Remove the shoes, belt, rings, watches, jewellery, or tight clothes from the affected area as these can act like a tourniquet when swelling occurs
• Make the patient lie in prone, on the left side, with the right leg bent and hand supporting the face so that the patient will breathe better and the chances of aspiration of vomitus are minimized
• Inform the doctor about any observable envenomation symptoms, including swelling, drooping of eyelids, slurring of speech etc.
• If the bitten area begins to swell and change colour, the snake was probably venomous
• Blisters, if any should be left undisturbed

If possible, monitor the person’s vital signs like temperature, pulse, rate of breathing, and blood pressure. If there are signs of shock (such as paleness), lay the person flat, raise the feet about a foot, and cover the person with a blanket.

After snakebite - Don’ts

• Do not waste time with traditional remedies (black stones, sacrifice) and alternative medicine/herbal therapy as they are ineffective and do harm by delaying the treatment.
• Do not allow the victim to become over-exerted or panic.
• Do not run as this will increase the speed at which the snake venom spreads through the body
• Do not wash the wound or interfere with the wound (by rubbing, vigorous cleaning, massage, cutting, suturing, suction, tattooing, application of herbs or chemicals) as this may increase the absorption of venom and increase local bleeding or infection
• Do not apply or inject anti-snake venom locally in the wound
• Do not apply a tourniquet or cold compress to the snakebite site. Application of tourniquets cannot occlude the arteries, and release of tourniquets will cause sudden release of toxins into blood circulation which can result in sudden symptoms like fall in blood pressure. Victims with ligatures tend to believe that venom flow has been stopped, thus delay in seeking medical attention and less urgency. It carries the danger of necrosis (tissue death) and loss of limb in cobra and viper bites, and inadequate blood supply if left in place more than 40 minutes. If applied, it should be removed only in presence of a doctor in a health facility
• Electrical therapy has no role in snakebite first-aid and cryotherapy may do more harm
• Do not try to suck out the venom or cut into the wound by a razor or knife; these can cause infection and venom spread
• Do not rub the eye if the snake has spit venom into the eye. Rubbing causes irritation to the eye and spreads the venom
• Do not give the person stimulants or pain medications unless prescribed by doctor
• Do not give the person anything by mouth after a snakebite
• Do not raise the site of snakebite above the level of the person’s heart
• Do not attempt to kill or catch the snake as it is dangerous and time might be  wasted hunting for the snake and there is risk of another snakebite. Even a dead snake or a severed head can bite for several hours due to reflex activity. Take a picture of snake for identification by an expert.

Source : National Action Plan for Snakebite Envenoming (NAPSE)