Snake Bites in Austere Settings

Off the grid, you will find yourself outdoors a lot, with activities like gathering wood for fuel, foraging, and hunting required to keep body and soul together. In warm weather, you just might find yourself face-to-face (or maybe face-to-ankle) with a snake.

Most snakes aren’t poisonous, but a few are, including some species common in North America. The term “poisonous snake” is probably incorrect, as venoms and poisons are not the same thing. Poisons are absorbed in the gut or through the skin, but venom must be injected into tissues or blood via fangs or a stinger. Interestingly, it’s usually not dangerous to drink snake venom unless you have a cut or sore in your mouth. Having said that, please don’t test this out at home.

Venomous snake bites have a distinct appearance due to the hollow fangs at the front of the mouth. This differs from non-venomous snakes, which have a more uniform appearance.

Since snakes are most active during the summer, most bite injuries occur then. Not every bite from a venomous snake transmits toxins to the victim, however; indeed, 25-30% of these bites will be “dry” and show little or no ill effects.  This could be due to the short duration of time the snake has its fangs in its victim or whether the snake had bitten another animal shortly beforehand. Many other snake bites are only slight “envenomations” and resolve without major intervention.

In most cases, it’s not hard to tell whether there’s venom in the bite. Snake bites containing venom tend to cause a painful burning sensation almost immediately. Swelling at the site may begin as soon as five minutes afterwards, and may travel up the affected area towards the body core.

Venomous Snakes in North America: Pit Vipers and Elapids

The two to worry about in North America are the pit vipers and the elapids. Of these, the pit vipers are responsible for the grand majority of venomous bites in the United States.

Pit vipers like rattlesnakes and water moccasins are identified by the presence of a heat-sensing “pit” organ between the eye and nostril on both sides of the head. They are, perhaps, more easily recognized by their triangular-shaped heads and slit-like eyes.  Rattlesnakes will, of course, have rattles that make noise when they’re threatened.

Pit viper bites tend to cause bruising and blisters at the site of the wound.  Numbness may be noted in the area bitten, or perhaps on the lips or face.  Some victims describe a metallic or other strange taste in their mouths. Serious bites might cause spontaneous bleeding from the nose or gums, irregular heart rhythms, or difficulty breathing.

The elapids include cobras and mambas, but the main North American representative is the colorful coral snake. Coral snakes appear very similar to their look-alike, the non-venomous king snake.  They both have red, yellow, and black bands and are commonly confused with each other. The old saying goes: “red touches yellow, kill a fellow; red touches black, venom it lacks”.  In other words, if the red band is next to the yellow band, it’s a deadly coral snake. If the red band touches the black band, it’s a non-venomous king snake. It should be noted that this old saying only applies to coral snakes in North America.

Coral snake bites are “neurotoxic” and will cause mental and nerve issues such as twitching, confusion, and slurred speech.  Later, nerve damage may cause difficulty with swallowing and breathing, followed by total paralysis.  Luckily, only 73 coral snake bites were reported in the U.S. in 2013.

Preventing Snake Bites

An ounce of prevention, they say, is worth a pound of cure.  High-top boots and long pants are always a sound strategy when hiking in the wilderness. It’s important to be aware of where you’re putting your hands and feet.  Be especially careful around areas where snakes might like to hide, such as hollow logs, under rocks, or in old shelters. Wearing sturdy work gloves would be a wise precaution if you can’t avoid these places.

If you let snakes know you’re near, they tend to leave the area. Snakes have no outer ear, so treading heavily creates ground vibrations much more easily “heard” by them than, say, shouting.

In warm weather, many snakes like to be active at night. This means that nocturnal outdoor activities are inadvisable without a good light source.

Treating a Snake Bite in Austere Settings

The standard treatment for a venomous snake bite is “anti-venin”, also called “anti-venom”. Anti-venin is an animal or human serum with antibodies capable of neutralizing a specific biological toxin. Any hospital will have it, but in survival scenarios, this product will be a scarce commodity. If there’s no help coming, consider these steps:

• Keep the victim calm. Stress increases blood flow, thereby endangering the patient by speeding the venom into the system.
• Stop all movement of the injured extremity. Movement transports the venom into the circulation faster, so do your best to keep the limb still.
• Clean the wound thoroughly to remove any venom that isn’t deep in the wound.
• Remove rings and bracelets from an affected extremity. Swelling is likely to occur.
• Position the extremity slightly below the level of the heart; this slows the transport of venom.
• Wrap with clean, loose bandages further up the limb than usual. Pressure bandaging is thought to be helpful for elapid bites, but may be risky for pit viper bites, as it may cause tissue damage.In any case, keep the wrapping somewhat less tight than when dressing a sprained ankle. If it is too tight, the patient will reflexively move the limb, and spread the venom around.
• Avoid tourniquets, which do more harm than good.
• Draw a circle around the affected area. As time progresses, you will see the area shrink if it improves or grow if it worsens. By the way, this is a good strategy to follow for any local reaction, infection, abscess, or hematoma.

The limb should then be rested and, perhaps, immobilized with a splint or sling.  The less movement there is, the better. Keep the patient on bed rest, with the bite site lower than the heart, for 24-48 hours. This strategy also works for bites from venomous lizards, like Gila monsters.

It is no longer recommended to make an incision and try to suck out the venom with your mouth.  The amount of venom removed is thought to be very little and oral bacteria could introduce an infection. Snake bite kits are available for your backpack, but are out of favor with most wilderness medical professionals. The Sawyer Extractor (a syringe with a suction cup) is modern and compact, but ineffective in eliminating more than a fraction of the venom. These methods fail, mostly, due to the speed at which the venom is absorbed by the body.

You may wonder why I haven’t suggested antibiotics as a treatment for snake bite. Interestingly, snake bites don’t cause infections as frequently as bites from cats, dogs, or humans.  As such, antibiotics are used less often.

Parting Thoughts on Snake Bite

A snake doesn’t always slither away after it bites you.  It’s likely that it still has more venom that it can inject, so move out of its territory or abolish the threat in any way you can. To many, this entails killing the snake. Even severing the head from the body may not render it harmless, however: it can reflexively bite for a period of time.

Elapids and pit vipers may respond differently to an encounter with a human. Coral snakes are not as aggressive as pit vipers and prefer fleeing to attacking.  Once they bite you, however, they tend to hold on. Rattlesnakes prefer to bite and let go quickly. Unlike elapids, though, pit vipers may be reluctant to relinquish their territory to you, so leave the area as soon as possible.

Snakes can be dangerous, but they want to avoid you as much as you want to avoid them. Keep an eye out, wear decent gear, and both you and the snake will be the happier for it.

Joe Alton MD

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