Sssssnake Bites

[Traveler]

The old time cut 'n suck method of snake bite treatment came about before it was understood that not all bites carried venom and how quickly venom can be absorbed by surrounding tissue. Secondary infections caused by cutting open of the wound area and/or bacteria from hands or saliva of the one administering first aid often became more serious.

There are sites that caution against using the suction cup type of first aid, along with the cut 'n suck method made famous in old westerns. I have tried to link a couple of them (see below the quote) but I am not sure if the link will work (let me know if they don't). I am not sure there is any definitive word on this device though most sites I looked through have language similar to what NCCE says below, there are no measurable advantages in its use.

From the NC Cooperative Extension - Snake Bite First Aid publication

ACTIONS TO AVOID:
DO NOT cut the bite. The additional tissue damage may actually increase the diffusion of the toxins throughout the body.
DO NOT apply a tourniquet. Such action can result in the loss of the limb.
NEVER try to suck out the venom by mouth. You can try the suction cup in a snakebite kit if it doesn't delay other needed treatment. Suctioning seldom provides any measurable advantages, however.
Do not apply cold and/or ice packs. Recent studies indicate that application of cold or ice makes the injury much worse.
The recommended treatments presented are those published in the current edition of Brady's Emergency Care for the Sick and Injured, the standard training and procedures manual for Emergency Medical Technicians.

http://Snake bite First Aid - What do you do?

http://Treat a Snakebite - Backpacker

[ocourse]

The old time cut 'n suck method of snake bite treatment came about before it was understood that not all bites carried venom and how quickly venom can be absorbed by surrounding tissue. Secondary infections caused by cutting open of the wound area and/or bacteria from hands or saliva of the one administering first aid often became more serious.

There are sites that caution against using the suction cup type of first aid, along with the cut 'n suck method made famous in old westerns. I have tried to link a couple of them (see below the quote) but I am not sure if the link will work (let me know if they don't). I am not sure there is any definitive word on this device though most sites I looked through have language similar to what NCCE says below, there are no measurable advantages in its use.

From the NC Cooperative Extension - Snake Bite First Aid publication

ACTIONS TO AVOID:
DO NOT cut the bite. The additional tissue damage may actually increase the diffusion of the toxins throughout the body.
DO NOT apply a tourniquet. Such action can result in the loss of the limb.
NEVER try to suck out the venom by mouth. You can try the suction cup in a snakebite kit if it doesn't delay other needed treatment. Suctioning seldom provides any measurable advantages, however.
Do not apply cold and/or ice packs. Recent studies indicate that application of cold or ice makes the injury much worse.
The recommended treatments presented are those published in the current edition of Brady's Emergency Care for the Sick and Injured, the standard training and procedures manual for Emergency Medical Technicians.

http://Snake bite First Aid - What do you do?

http://Treat a Snakebite - Backpacker

Pretty good info, I think. For those who don't like the Extractor (yes I'm still waiting for reasons or statistics), why not? The Actions To Avoid above are good advice, and have nothing to do with this device. There is no cutting, sucking via mouth, tourniquet or cold packs.

[Fredt4]

Several websites state that the Sawyer Extractor has not been evaluated scientifically and there is no medical or scientific support for the advertising claims of their manufacturers. Extractors thus remain an unproved therapy. Therefore using The Extractor is akin to casting a antivenom spell or saying a chant in the event of a snake bite, also an unproven therapies.

http://www.ncbi.nlm.nih.gov/pubmed/14747805
Studies have shown that using an Extractor kit at best removes 2% of the venom. But note that the 2% was achieved by persons familiar with how to use the device. In the field you'll most likely not even reach this level.

One study indicates that the suction could actually increase local tissue damage and possibly interfere with the ability of the body to recover from the snake bite. This is especially problematical if the bite didn't involve injection of venom, as one would be doing harm with no possible benefit.

"In a study with pigs, suction not only caused no improvement but led to necrosis in the suctioned area. [cite: Bush SP, Hegewald KG, Green SM, Cardwell MD, Hayes WK (2000)." [cite: Effects of a negative pressure venom extraction device (Extractor) on local tissue injury after artificial rattlesnake envenomation in a porcine model". Wilderness & environmental medicine 11 (3): 180–8.]" https://en.m.wikipedia.org/wiki/Snakebite ]

Sawyer also previously claimed the device to be scientifically validated:
"The Sawyer Extractor Pump is the only kit proven scientifically to remove significant quantities of venom from Snake Bites. Scientific research also proves the Sawyer Extractor Pump removes poison when treating bee stings. It also removes saliva and anticoagulants from mosquito and tick bites." However they appeared to have backed off this claim.

Their site doesn't currently make this claim. It does state, "The Sawyer ExtractorTM Pump vacuum was specifically designed to provide the most powerful suction available for the safe extraction of venoms and poisons, eliminating the need to use dangerous scalpel blades or knives associated with less effective bite kits." It is further stated, "Effectiveness of the Extractor varies with the location of the bite; the Extractor most effectively retrieves venom from extremities and areas of the body outside muscle areas".
https://sawyer.com/products/extractor-pump-kit/

Aside: At least people using the Extractor will not be cutting each other if they follow the instructions, perhaps that's an improvement.

I've found no scientfic or medical evidence that the Sawyer Extractor is effective for snake bites (or even for bee stings). Yes, many organizations have previously recommended use of the Sawyer Extractor but the reputable sites no longer do. So will say, It's worth a try. No it's not, it's potentially harmful and to insist on using it is to casually disregard recent scientific and medical research and rely on marketing claims, anectdotal evidence and heresay is contrary to common sense and dangerous. In my opinion Sawyer is intentionally and knowingly making a false claim regarding it's effectiveness for snake bites. What's especially egregious is that it's possibly also causing harm.

First Do No Harm!

"No first aid is much better than performing bad first aid. Don’t cut at or around the site of the bite, don’t compress the bitten limb with a cord or tight bandage, don’t attempt to extract or neutralize venom using electricity, fire, permanganate, salt, black stones, mouths, mud, leaves, etc.", from Wikipedia.

So, if you're bitten by a rattlesnake why would you use a device that most likely will provide no significant benefit, even if venom was injected, and will possibly (probably) do damage to the local tissue and interfere with the body's ability to manage the bite and to heal itself. Spells, chants and incantations most likely provide no benefit, but at least they will do no harm.

As a hiker it is better to put that 4 ounces of weight and the $17 toward a pair of gaiters to protect your ankles, as that's where your likely to be bitten by a snake if you're a hiker. As for it's effectiveness for stings and ticks, I'll just say that I didn't find any study showing it's effectiveness (didn't look very hard, I'll leave that for another day), and given their audacious and totally unsupported claims of effectiveness for snake bites, I'll assume it's also ineffective for stings and ticks and probably also harmful.

As they say;
fool me once, shame on you,
fool me twice, shame on me.

Therefore Sawyer's Extractor kits are Verboten!

[Traveler]

Pretty good info, I think. For those who don't like the Extractor (yes I'm still waiting for reasons or statistics), why not? The Actions To Avoid above are good advice, and have nothing to do with this device. There is no cutting, sucking via mouth, tourniquet or cold packs.

I don't have much issue with this device outside of doing some light poking around the internet per your request of finding information on why not to use it. I doubt there will be any medical studies on this device, manufacturers usually fund such things to provide empirical data demonstrating their products are safe and/or effective.

As pointed out by a lot of responsible medical first aid sites, similar to what I quoted, there is nothing that shows it provides any measurable advantage. Most sites say if you want to use the device go ahead IF it does not interfere with other first aid processes that are known to be more effective. That would include moving the victim out of the area to medical treatment (difficult to do using little suction cups at the same time). Fangs are curved, so IF there is venom in the bite it will not be at or under the site of the wounds, tissue will close around the puncture wounds instantly, closing the open path to remove venom even if it did pool at the bottom of the wound for a while. Exposure to tissue not initially contacted by the venom via suction has been seen (through animal testing) to cause other problems that compound the initial site injury.

I think there is some clever marketing that associates the a new improved no cut but suck method as opposed to the old cut 'n suck at work here. It would not be the first time a product has been made for profit that doesn't provide any "measurable advantage" (look at the myriad weight loss pills that have come and gone) but feels good to have with you. I am not saying don't use it, but given the information I would ask why when that time could be better used to evacuate, find help, or deal with shock.

As an addition concern in our litigious society, I don't know if this rises to a level where legal trouble may result, the "Good Samaritan" laws cover those who have demonstrated training of first aid for example, but only if they operate inside of their training. If someone with demonstrated training used a device like this and the victim dies, I can see a trial lawyer asking them what area of the first aid training or medical publication did they reference to use the product, how they were specifically trained in this product use, and what parameters was it to be used under. If there is no documented training, it would likely move downhill from there.

[ocourse]

I don't disagree with the bulk of this information but it does not represent definitive medical research. A similar Google search will also return lots of thumbs up for the device. There is no downside and it does no harm, and it will definitely extract venom. Weight is an issue for us all - I could question why some hikers carry camp shoes while I think it's a ridiculous, unnecessary weight. Years ago I tossed the case the device comes in, along with the razor (I carry one for my normal hygiene) and some other minor stuff in the kit. It is a very small package with little weight. For hikers who are alone I think it's the best you can do for yourself. I am extremely independent and always try to rely on myself. Snakebite, no cell service, nobody around, what would you do? You can either get some help or try to help yourself.

[Fredt4]

I don't disagree with the bulk of this information but it does not represent definitive medical research. - Yes it does, you're in denial.

A similar Google search will also return lots of thumbs up for the device. - There's also lots of sightings of Yeti, or what not.

There is no downside and it does no harm, - That's a blatant lie, yes it can do harm. Read the cited article.

and it will definitely extract venom. - No it won't, at least any amount that's significant. To claim that it "will definitely extract venom" is willful disregard of the evidence and simply shows you refuse to acknowledge the evidence.

For hikers who are alone I think it's the best you can do for yourself. - NO, it's close to the worst as it starts you on the path of doing stupid stuff.

Snakebite, no cell service, nobody around, what would you do? - Evaluate your situation, determine if it's a serious (severe level of venom was injected) bite or a less serious situation. If it's less serious then get to an E.R. if necessary for proper wound care & hepatitis shot, but don't risk life & limb doing so. If it is a sever level of venom, then you'll want to get to an E.R. for antivenim ASAP, that's when you'll want to use someone's SPOT device, cellphone, or whatever to get a medical evacuation.

Knowing how to evaluate the level of venom injected (if any) by the venomous snake (try to identify the try of snake) is one of the first things to do, after you move to safety.

Next is evaluating if you're suffering from systemic symptoms such as shock that could be life threatening. If shock is a factor then a stressful and strenuous hike out might not be a good move.

If you determine the bite is sever (involves a high level of venom) then you don't want to downplay the seriousness as it could result in loss of life & limb.

No doctor will use an Extractor, so why would you. Perhaps you're privileged to secret information that's not available to the medical community? No, I think not.

Perhaps I sound stringent in opposition to the continued use of The Extractor and other snake bite kits, but the evidence is clear, There's no justification for its continued use. Even on the theory that it can't do harm.

[Cobble]

Harsh, but true. Those minutes fumbling with a kit clearly should be used getting closer to help and/or staying calm.

[ocourse]

Harsh, but true. Those minutes fumbling with a kit clearly should be used getting closer to help and/or staying calm.

What you are saying is that if you get bitten, just hike out - that isn't a good idea. Or just assume that there will be somebody to help. Or carry Spot, which most hikers do not, and I doubt most of the posters here carry one. I'm saying most hikers stand a good chance of being alone and with a very uncertain timeframe of somebody coming along who is able and willing to carry you out, or who has a means of summoning help like a local rescue team or a helicopter. One thing I see over and over is the mistake of relying on someone else.

[Traveler]

What you are saying is that if you get bitten, just hike out - that isn't a good idea. Or just assume that there will be somebody to help. Or carry Spot, which most hikers do not, and I doubt most of the posters here carry one. I'm saying most hikers stand a good chance of being alone and with a very uncertain timeframe of somebody coming along who is able and willing to carry you out, or who has a means of summoning help like a local rescue team or a helicopter. One thing I see over and over is the mistake of relying on someone else.

Thats pretty much what most first aid sources say if you are hiking alone and can't get a cell signal or the attention of anyone nearby. You need to get yourself out somehow and seek medical attention. Keeping calm and walking slowly would be difficult, but not impossible. Having a SPOT device is a good idea if you know or suspect you will be out of cell phone range.

Self rescue is sometimes all you have between death and survival. Breaking your leg presents an equally dangerous situation if not more so, depending on the type of break. There are a lot of dangerous elements to this activity, some of us choose to be alone a lot, which brings with it a higher risk factor and can have a much higher consequence if one does it without means to self rescue.

[Another Kevin]

What you are saying is that if you get bitten, just hike out - that isn't a good idea. Or just assume that there will be somebody to help. Or carry Spot, which most hikers do not, and I doubt most of the posters here carry one. I'm saying most hikers stand a good chance of being alone and with a very uncertain timeframe of somebody coming along who is able and willing to carry you out, or who has a means of summoning help like a local rescue team or a helicopter. One thing I see over and over is the mistake of relying on someone else.

Of the North American snakes, only the coral snake (vanishingly rare), and perhaps a maximum envenomation from a timber rattler, have any really significant probability of being lethal to a healthy adult.

"Walk slowly to somewhere you can get help" is indeed probably the best advice for a crotalid bite. Well, put Neosporin and a bandage on it, the way you would for any animal bite, because it is an animal bite at the very least. If there are signs of envenomation, it might also be wise to immobilize the affected limb. You can hobble quite a long way with a splinted leg and trekking poles. I made it fifteen miles that way on a sprained knee early this summer, followed by driving myself to the emergency clinic. The injury knocked me off trail for six weeks afterward.

I don't carry SPOT (usually; I rented one last fall on a longer section hike at my wife's insistence), but I do carry a real PLB, so I have means of summoning help in a life-threatening emergency. Most crotalid bites are not immediately life-threatening, just as most sprains are not. Broken long bones may be, and only an X ray can tell for sure. If you try to hobble out on a broken leg with questionable immobilization and reduction, you're risking having a bone fragment migrate into an artery. So I wouldn't try to move anyone on a suspected broken leg. That's worth a PLB activation. A sprained knee, or a snakebite that isn't presenting signs of severe envenomation, is not.

If you want to get more advanced than this, the next really practical step you can take is use a pen to mark the border of the swelling so that you can gauge progression. That's the most significant indicator of severity of envenomation. Get a picture of the snake if you can, unless you are confident in the species identification.

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

Don't indulge in quackery just because you're in the field without access to ideal treatment. Suction does more harm than good in several controlled studies. Light compression, rather than a full torniquet, also appears to do more harm than good by keeping local venom concentrations high enough to induce necrosis (tissue death) and by risking compartment syndrome (increased pressure in the tissues leading to damage). And a full torniquet simply risks loss of the affected limb.

By far the greater number of snakebites occur on the hands. Your best preventative is not to handle snakes. I know, this sounds stupid and obvious, but the fact remains that most people who get bitten were doing just that. I suspect that the last words before the bite were most often, "Hey, hold my beer for me..."