Sawyer Extractor Snake Bite Kit – Still Relevant?

"Again, my thinking is that if the venom goes into your calf muscle, it's staying there. But if it goes under the skin at your ankle, then significant venom may come out."

Delmar, if we go back to the old, old days, maybe 35 years ago, the snakebite treatment was a lot different. Of course it now contradicts the current treatment. If you study the way a rattlesnake's fangs are constructed and the way that it envenomates a victim, the venom is not normally left deep within some muscle. I suppose that is possible, but the thinking (at the time) was that most of the venom will be left relatively close to the skin surface, so there is a short distance that the incision would have to go to provide a vent for the venom. So, back then at least, we were taught to make two very limited incisions on top of the fang holes. Those were supposed to be only 1/4 inch long and 1/8 inch deep… and this is important… the incisions were to be parallel to the axis of the limb. The reason was that you are less likely to sever some critical structure in the limb by cutting that way. If you cut across the axis, then you stand to do major damage to all sorts of structures in there. Then, by applying the suction from a rubber cup (part of the old snakebite kits), you would get at least part of the venom to exit quickly. If you fooled around too long, the venom would congeal and then it could not be extracted. The critical time to extract it was from 5 minutes until about 20 minutes. Anyway, that was the conventional wisdom about 35 years ago, and I can't tell you exactly when all of that was abandoned for the modern techniques. Or, maybe they just have more statistics now. Maybe they decided that too many people were doing too much damage by cutting. I don't know. I'm an engineer, not a doctor!

–B.G.–

LOL, Bob G!!!!

Get yer nerd on with a veiled Star Trek reference – I love it!

> Delmar, if we go back to the old, old days, maybe 35 years ago…

Well Junior, if you don't mind me calling you that, I hail from the even earlier time, when I was originally taught to cut an X over each fang mark, and yes, that did mess a lot of people up, cutting across muscle tissue. Such was medical science at the time.

> the venom is not normally left deep within some muscle…

Depends on how we define "deep." From my reading of the med lit, they define "deep" as "deep enough to make it into a muscle and get absorbed readily into the blood." Is that 1/8, 1/4, 1/2 inch? Don't know. I've gotten inoculations with needles a lot shorter than snake fangs.

The difference as I read it, is whether the venom gets absorbed, or pools. As far as I can tell, the tests of the Extractor are done on absorbant tissue. Which would result in the Extractor appearing less effective than it might be in the real world, where a snake occasionally bits in a non-absorbant area. I've not seen any tests of the Extractor with the envenomed site being a non-muscled area like a hand, wrist, ankle, foot, tendon, knee, elbow….

My quibble is actually with the physicians testing this. I have done much research work with physicians and can attest to how they generally have little to no training in research methodology. But what bothers me about the research in this area, is there's so little of it. So a handful of papers cause the recommendations to change.

Given how frequently the medical establishment revises itself, how long before the current recommendations are reversed?

Not sure one could do ethical medical research on rattler bites on humans. The best way may be an analysis of snake bite victims who used the Extractor — plus there's various heads for other types of bites and stings, so the Extractor is still being sold – I use my for insect stings that puff up myself.

> Not sure one could do ethical medical research on rattler bites on humans

Great Zot, who is suggesting *that*?

>The best way may be an analysis of snake bite victims who used the Extractor

This is the classic "low-N" problem that bedevils medical research. How many decades before you could get 100 Ss in the experimental group? If you read the articles you'll see they test on animal models. Cue off-topic ethics discussion…now.

Delmar, I remember the old, old days, maybe 35 years ago. It was your retirement party, I believe.

–B.G.–

At least here in Australia:

"Do NOT wash the bitten or stung area. The type of snake involved may be identified by the detection of venom on the skin."

http://www.health.qld.gov.au/poisonsinformationcentre/bites_stings/bs_pressure.asp
http://www.stjohnnsw.com.au/secure/downloadfile.asp?fileid=1004638

and with more information on medical treatment at the hospital:

"To ensure test procedures are properly followed, the SVDK (Snake Venom Detection Kit) should be used by laboratory staff wherever possible. The best specimen is a bite-site swab."

https://www.mja.com.au/journal/2013/199/11/snakebite-australia-practical-approach-diagnosis-and-treatment

Australia, yeah we have a few venomous snakes…

I carry a snakebite bandage, and PLB. But given remote areas, it could take considerable time for any rescue.

In perspective, the risk of death by snakebite is lower than death by lightning strike.
Lightning deaths 5 to 10 per year in Australia
http://spice.duit.uwa.edu.au/samples/ast0437/ast0437.pdf

Snake bite deaths 2 to 5.
http://www.burkesbackyard.com.au/factsheets/Conservation-and-the-Environment/Snake-Bites/1537

There are bigger thing to worry about.

"If you study the way a rattlesnake's fangs are constructed and the way that it envenomates a victim, the venom is not normally left deep within some muscle."

The fangs on most snakes are typically less than 1 cm long. In addition to penetrating the skin they also need to penetrate the cloths you are waring.

"So, back then at least, we were taught to make two very limited incisions on top of the fang holes. Those were supposed to be only 1/4 inch long and 1/8 inch deep… and this is important… the incisions were to be parallel to the axis of the limb. The reason was that you are less likely to sever some critical structure in the limb by cutting that way."

That is a very good point! Thanks!

"Anyway, that was the conventional wisdom about 35 years ago, and I can't tell you exactly when all of that was abandoned for the modern techniques. Or, maybe they just have more statistics now. Maybe they decided that too many people were doing too much damage by cutting. I don't know. "

I think the problem was people were not using a clean knife, cutting to deep, and then getting in a car and driving to the hospital only ten minutes away. And then the doctors find it was a dry bite with little to no venom.

This is a very interesting discussion, as my WFR classes have painted the issue as much more black and white.

However unless WMI (or WMA or SOLO) decides to favor the extractor I can't use it when leading groups, or really for that matter even if I come across a stranger on the trail. Particularly in the work setting I am required to stick with the standard of care that I have been taught and right now that doesn't include the extractor.

Peter

Chad B's response is right on the money. The only things I would include are:

1) Heat packs have been shown in research to often inhibit swelling a little and to help to slightly neutralize the venom. In any event, heat packs have not increased any adverse affects so they might be worth considering.

2) Most American snake bites will take more than 24 hours to kill you, so don't panic.

3) Under NO scenario is it advisable to use a snakebite kit, to cut across the puncture wounds, or to have someone try to suck the venom out. EVER!

4) If you are bitten by a rattle snake, the hospital will only give you anti-venom as a last resort because it can only be given once in your life. Most adults that have been bitten by a rattle snake will not require anti-venom, BUT ALL VENOMOUS SNAKE BITE VICTIMS WILL NEED HOSPITALIZATION.

5) I didn't see anyone here talk about using bee sting auto injectors (the shots for allergic reactions for bee stings) to try to treat snake bites, but I have heard people talk about it elsewhere. NEVER USE THEM FOR ANY PURPOSE OTHER THAN THEY'RE PERSCRIBED FOR.

"At least here in Australia:

"Do NOT wash the bitten or stung area. The type of snake involved may be identified by the detection of venom on the skin."

I don't live in Australia but my understanding is that most snakes there don't have hypodermic fangs. Instead most venomous snakes have the venom mixed in with the saliva. The venom then enters the body through the holes left by the teeth of the snake.

Rattle snakes and few others had hollow fangs *typically 2) that penetrate the skin and then the venom is injected under pressure into the victim.

So if the snake doesn't have fangs testing the saliva can tell you the type of snake. So in that case removing the excess saliva quickly might be a good idea. Since the venom is on the surface and mot under the skin cutting the skin could make a minor bite much worse. Suction without cutting is in this case is probably the best approach However suction should be done quickly before clotting
occurs.

For Rattle snakes the venom is almost never on the surface of the skin. Instead it is under it. In the western US rattle snakes are the only venomous snakes we have to deal with.

We do have one venomous lizard the Gila Monster which doesn't have fangs. The Gila monster doesn't let go once it bites. The movement of the had and victim then give the saliva time to penetrate the victim. In the east we do have the coral snake which apparently has small fangs but the venom is much slower acting, taking up 4 to 6 hours for symptoms to appear and apparently about 48 hours for maximum effect.

I live in the west and have only seen rattle snakes.

A quick google search for rattlesnake bite treatment finds:

"Cleanse the wound, but don't flush it with water, and cover it with a clean, dry dressing."

http://www.mayoclinic.org/first-aid/first-aid-snake-bites/basics/art-20056681

Others don't say anything about cleaning, but:

"First aid techniques that lack therapeutic value or are potentially more harmful than the snakebite include electric shock, alcohol, stimulants, aspirin, placing ice on the wound, and various folk and herbal remedies."

http://emedicine.medscape.com/article/771455-treatment

Yet other sites say

"Wash the bite with soap and water (if available)."
http://www.ces.ncsu.edu/gaston/Pests/reptiles/snakebitetx.htm

"According to the American Red Cross, these steps should be taken:
Wash the bite with clean water and soap.
Immobilize the bitten area and keep it lower than the heart.
If the bite is on the hand or arm remove any rings, watches or tight clothing.
Get medical help immediately."

http://www.desertusa.com/reptiles/rattlesnake-bites.html

"Wash the bite area with soap and water."
http://wdfw.wa.gov/living/snakes.html

So check the information for treatment for your country.
Australia: do not wash
USA: wash

In spite of the OP's disclaimer, it's disturbing to see such fascination with "treating" such an absurdly unlikely event. The issue (as I see it) isn't whether or not a 1.5 oz weight penalty is worth it; it's the attitude that wilderness is a malevolent force from which we need constant protection (usually involving the latest technology).

Great thread, Delmar. It is indeed a confusing topic.

IMO too many people look at the snakebite risk as binary: 0 = no bite, 1 = death from bite. They look at the stats on fatal bites and say "not worth worrying about". The middle ground is that you can get bitten and live, but have horrific tissue damage and lifelong disability. Do a Google image search on the keywords "rattlesnake bite".

This is similar to many people's risk analysis regarding personal assault. They think the two scenarios are (0 = nobody will try to hurt me) or (1 = someone will kill me). But the dark reality is that plenty of people are assaulted, live through it, then carry physical and emotional trauma for the rest of their lives. I've dealt with them in field settings and it is not pretty. But they lived, so they didn't add to the stats for death from assault.

I think one factor in the medical community's advice for treatment is the LCD (lowest common denominator) issue. I strongly suspect that a carefully executed regimen of incision plus vacuum could have real benefit. It would take education, judgment, and careful action. But the worry is that Bubba will cut into a blood vessel, cut a tendon in half, use a garden hoe to make the cut, etc etc so the boilerplate is "just get to the ER". Meanwhile in the ER context, the best treatment really is antivenin. So that's what the docs do. Being in a truly remote location, with no hospital support, is a special case that WebMD simply isn't going to address. And they're not going to take the legal risk of looking into a viable field surgery solution.

Good post, Hamish. I'm inclined to agree on all points.

> it's disturbing to see such fascination with "treating" such an absurdly unlikely event…it's the attitude that wilderness is a malevolent force…

This is an odd reframe. What you call "fascination," I call "education." Snake encounters are not rare or theoretical events for me, I encounter rattlers frequently (and have been struck at, twice; both times a miss). I don't consider the natural world malevolent, I consider it dispassionate. I do consider it my responsibility to be reasonably prepared and knowledgable about the risks I choose to take.

What makes the discussion difficult to resolve, is the difference of opinion offered by the medical establishment.

I think if you hiked where I hike, you’d consider the discussion very relevant.

"…it's disturbing to see such fascination with "treating" such an absurdly unlikely event"

Tell that to this kid: http://caseysorrow.com/tag/rattlesnake

"I think if you hiked where I hike, you’d consider the discussion very relevant."

Yea, after looking into this (mentioned above) I was told I very easily came within 50 yards of hundreds of rattlesnakes in that area – so the 5 I ran into was statistically small.

I agree that it shouldn't be a primary concern, but do not think it should be dismissed due to stats, either.

For example, I hike in loose fitting long pants & long sleeve shirts as an ounce of prevention, following the advice I received. No, these materials are not impenetrable, but make it less likely for a bite to land. & there are other reasons for wearing clothing like that in high heat/low humidity.

Also, I've noticed an "experience gradient" that seems like a bell curve. Least experience, lower concern; some experience, higher concern (me); most experience, lower concern (herpetologist). Maybe too glossy to account for everyone, but seems to be a trend I've noticed.

Another poster had a risk assessment given magnitude of consequences & likelihood of occurrence somewhere on here that I though was a good way to view things.

Honestly, I'm still not sold on the bite kit/extractor. I think it's worth the discussion, but hard for me to lean toward controversial treatment.

"I think if you hiked where I hike, you’d consider the discussion very relevant."

Ditto, from Southern Arizona! When I lived in the NE and hiked the Adirondacks, I never thought about snakes, much less poisonous ones.

In a hiking-related context, it comes down to (bad) luck — apparently TKB (aka Snakebait) and I are rattlesnake magnets. One gal I hike/backpack with often has never been buzzed, and has never seen a rattlesnake when hiking — and she BUSHWHACKS, too! I can't believe her enviable luck. I've been buzzed by a rattlesnake in the Sierras fergawdsakes! Who gets buzzed there??? (Rae Lakes loop, FYI)

My rattlesnake sightings are nearly always under the same circumstances (unavoidable unless I quit hiking): the snake is totally hidden under a plant by the side of the trail. Because it is so well camouflaged and HIDDEN on top of that — there is no earthly way to see it until you're within striking distance.

So, depending on your circumstances, this may be a very relevant discussion, indeed.

"I've been buzzed by a rattlesnake in the Sierras fergawdsakes! Who gets buzzed there??? (Rae Lakes loop, FYI)"

I have, for one. The darn thing was above 9000 feet elevation near Vidette Meadow, and that is awfully high for a rattlesnake.

–B.G.–

On a river in the Sierras we discovered several rattle snakes in the bush/tree that we were walking under to get from the campsite to the water. It was kinda creepy and no one got bit. Even though one of my camping buddies caught one! I thought we was nuts and did my best to talk him out of trying again.

When I was a kid camping on the bear river we had to be careful to avoid the rattle snakes when tubing down the river. Several times I had them swim across the river in front of me! I also "stumbled" upon one at arms length "all coiled up and hissing….". It was buzzing like crazy. There was another one in a den a few feet away. The ranges took care of that one. No bites or strikes. They closed that site right after we left.

I easily believe testosterone and alcohol are the cause of most rattle snake bites. ;^)

In the Spring I call the trail from the top of Nevada Falls all the way to Lake Merced "rattlesnake alley". Big suckers too. Do not like them.

Which river and at what elevation, if I might ask?

The North Fork of the North Fork of the American River at about 3600 feet.

It was a long time ago (20 years?). The area saw a lot more use back then. It is quite possible that the greater number of people left a greater amount of food behind increasing the mouse population in the area. Thus increasing the rattle snake population. I haven't seen one around there in many, many years.

Just got my WFR manual the mail for an upcoming course. I went straight to snakebites and they just said evacuate as soon as possible, along with very gruesome time lapse pictures of the effects of a snakebite on a finger, all the way up to amputation. I do NOT want what that poor guy had!