1. India Snake Bite Initiative…. Every life counts! SNAKE BITES Facts, First-aid & Prevention Ver. 1.0 – July 2015 Reviewed by : Dr. V V Pillay, Dr. Dilip Punde & Dr. Sadananad Raut

2. Everything you need to know about snakebites And these can be easily prevented….

3. Everything you need to know about snakebites 1.Less than 10% of total snakebites are potentially lethal, venomous snakebites. India has about 290 species of snakes. 2.Venomous snakebites can be SUCCESSFULLY treated in Hospitals ONLY with anti-snake venom / anti-venom (ASV) 3.Proper first-aid can save the life of a snakebite victim in most cases, especially in the first hour, also known as the ‘golden hour’ 4.Incorrect first-aid, quacks, tantriks, & traditional remedies prescribed by faith healers WASTES precious time and may result in the death of the patient 5.Clinical symptoms have to be recognized by the doctor to successfully treat snake bites. 6. ASV should be administered only by a qualified doctor & it is not a first-aid method.

4. The Big Four of India Common cobraCommon kraitRussell’s viper Saw-scaled viper The most common and widely spread venomous snakes of India. Together they cause more than 90% of the snakebite deaths in the country and therefore are known as “ The Big Four”. They are found in human habitations and even in the middle of urban areas. There are other venomous snakes, including banded krait, black krait, monocellate cobra & pit vipers which are equally dangerous to human lives. Their distribution is, however, limited to certain geographic locations of the country.

5. Common Cobra (Naja naja) The Big Four of India

6. Common Krait (Bungarus caeruleus) The Big Four of India

7. Russell’s viper (Daboia russelii)

8. Saw-Scaled Viper The Big Four of India Saw-scaled viper (Echis carinatus)

9. Saw-Scaled Viper How to avoid snakebites ? When you walk in the open, use protective clothing such as long pants, boots (preferably thick hiking ones), etc. During evening/night time, ensure that you always carry a flashlight with you. You wouldn’t want to accidentally trod on a snake on a dark path! Do not reach into dark corners/gaps without examining them. Remember snakes often hide in there. Piled up wood, bricks or stones are also perfect hiding places for snakes. Be cautious while cleaning/handling. Do not sleep on the floor in snake prone areas. Try to use an elevated surface to avoid being in the way of a slithering snake. If you see a snake, do NOT disturb it. Avoid it and it will not harm you. Never try to rescue a snake by imitating TV shows, especially if you’re not sure of the species! It never ends well for the human or the snake!

10. Saw-Scaled Viper Who are prone to snakebites? A high number of snakebite cases tend to happen to those who work in agricultural fields. People who work in paddy and sugarcane fields quite often get bitten on their hands. Paddy fields attract rodents and these attract snakes, who live in the fields, for whom the rodents are the perfect Happy Meal. Work on a farm or know people who work on such fields? Make sure all precautions are followed to minimise chances of a bite!

11. The ‘X’ mark shows the potential site of a snakebite Saw-Scaled Viper Common locations of snakebites

12. These images of actual bite marks by venomous snakes show that marks may or may not be clearly visible. Bite marks depend on the type and size of snake in question. Images courtesy: Dr Sadanand Raut, M. D. Saw-Scaled Viper Common locations of snakebites

13. Common envenomation signs and symptoms Puncture mark or scratches on suspected bite area. At times marks may not be visible. Bleeding at bite site, unusual pain around the bitten area and limb, swelling. Nausea, headache, vomiting, stomach ache, difficulty in swallowing or drinking. Double or blurred vision. Drooping eyelids. Difficulty in talking. Bleeding in gums. Dark or brownish urine, bloody urine. Giddiness. The following are a few of the most common symptoms of envenomation due to a snakebite. Symptoms may occur soon after the bite or take hours to appear. A minimum of twenty-four hour observation of the patient is suggested. Saw-Scaled Viper Signs and symptoms of a venomous snakebite

14. Drooping eyelids Change in color of tissue around the bite area Swelling in the limb Blisters in the bite area Images courtesy: Dr Sadanand Raut, M. D. Saw-Scaled Viper Signs and symptoms of a venomous snakebite

15. DO NOT PANIC! Do it R I G H T R = Reassure I = Immobilize G & H = Go to Hospital T = Tell the Doctor. 1.Remember that only 15 out of 290+ known species of snakes can cause a serious health problem. 2.Not all of them are common and found across the county. So your chances of getting bitten by a venomous snake are very low. 3.In case of a snake bite, ensure that the patient remains clam, and take control of the situation at the earliest. A patient who is calm has much higher chances of surviving a venomous snakebite. 4.Even if you know that the snake in question is a venomous snake, you should not announce that to the patient. Provide the proper first-aid and move the patient to the hospital at the earliest, preferably within the ‘golden hour’. Reassure him and say that you are just taking him to the hospital for observation. Saw-Scaled Viper Dos and Don’ts in the case of a snakebite

16. 1.Remove rings, bangles, etc., from the bitten limb. There may be swelling later and it may force ornaments to act as a tight tourniquet. 2.Remove dirt from the bite location (if there is any visible dirt). 3.DO NOT wash and clean the wound! Massaging during the wash, or cleaning the bitten area will help the venom to spread faster through the circulatory system. Saw-Scaled Viper Dos and Don’ts in the case of a snakebite

17. Cut the wound open and drain blood Attempt to suck venom out from the bitten area Give alcohol, coffee, tea, etc. If the patient is thirsty, give some water Walk or run if you are the patient. The lesser the body movement, the better it is Apply traditional remedies or go to local faith healer Attempt to find the snake which bit the patient Saw-Scaled Viper Dos and Don’ts in the case of a snakebite DO NOT

18. The trusted snakebite first-aid which could save hundreds of snake bite victims across India in the golden hour. Everything you need to know about managing snakebites

19. Use the pressure bandage and start wrapping the finger from the bite location. If you don’t have a pressure bandage handy, use a clean cloth which is about 4 inches wide and minimum a meter in length. Saw-Scaled Viper How to correctly bandage the snakebite area DO

20. Tie the bandage too tight or too loose We are NOT trying to cut off the blood circulation. We are slowing the blood circulation down, by immobilising the limb and also choking the lymphatic vessels to slow down lymph fluid too. Saw-Scaled Viper DO NOT How to correctly bandage the snakebite area

21. Keep the bitten portion / limb below the heart level

22. You may not always have a pressure bandage handy, in which case use a clean cloth about 4” inch wide and 1 metre long How to correctly bandage the snake bite area

23. Saw-Scaled Viper Keep the bitten portion/limb below heart level How to correctly bandage the snakebite area

24. Saw-Scaled Viper Frequently Asked Questions Q.1 Some people suggest that a pressure bandage is NOT a good option as a first aid to snakebites. Is this true? Applying a pressure bandage or cloth in the right way slows the spread of venom to the vital organs of the body. It is very effective in case of neurotoxic snakes such as the common krait and common cobra. If the bitten snake is a viper then a prolonged pressure bandage application may cause severe local tissue damage. At the same time, applying a first-aid like this can help in calming the patient down too. Q.2 Do we need to catch the snake to help with the treatment? No. There is no need to identify the snake to decide the treatment. A doctor will look at the clinical symptoms to verify whether the snakebite caused envenomation or not. Once the envenomation is confirmed, then the doctor will start medication accordingly. Q.3 So, If there is a dead snake/photo of the snake, then it’s not helpful? If there is a photo of the dead snake/live snake, then share it with the experts who could help you identify the snake in question. However that is not needed to decide the course of treatment, and time should not be wasted in trying to determine identity, and the patient should be rushed to the nearest hospital stocking anti-venom as soon as possible.

25. Need to identify the suspected snake? Saw-Scaled Viper Contact us! 1.You can send the image of the snake for identification through WhatsApp. Send an image + location to any of the following numbers: 09745003075, 09479954887, 0944892736, 09993116007, 09742921801, 09818062986, 09432917690 2.You can also email the image to snakeid@indiansnakes.org Wait for maximum five minutes for a response 3. If none of the above get you a response in five minutes, then call 09745003075 even if it is the middle of the night.

26. Is there an anti-venom shortage in the health-care centres of your area ? In case of shortage of anti venom in your area, please write to us at savelives@indiansnakes.org savelives@indiansnakes.org We will help you procure ASV directly from the company to your doorstep at a subsidized cost. Saw-Scaled Viper Contact us!

27. Reviewed by : Dr. V V Pillay, Dr. Dilip Punde & Dr. Sadanand Raut THANK YOU www.indiansnakes.org India Snake Bite Initiative…. Every life counts! ASV supported by Send your feedback & suggestions : Jose@indiansnakes.org