Snake bites

There is a great deal of folk wisdom about snake bites, and almost all of it is wrong. Suck out the venom, cut the wound open, strap a tourniquet round the leg, cauterise it, pack it in ice, give the casualty a drink of spirits — every one of those pieces of advice once sounded sensible, and every one now sits on the list of things that maim people. Real first aid looks dull: move away from the snake, call an ambulance, take off your rings, keep the bitten limb still and get to hospital as fast as you can. This page is built around that split between what to do and what not to do, and the second list matters more.

The first few minutes: what to do

• Move away from the snake by several metres and take everyone else away too. Snakes bite a second time if they keep being disturbed.
• Call an ambulance — in European countries on the single number 112 — or ask to be driven to the nearest hospital. It is better not to drive yourself.
• Take off rings, watch, bracelets, tight footwear and anything constricting above the bite. Swelling comes on fast, and a ring that will not come off later will strangle the finger.
• Keep the bitten arm or leg still and, if you can, at about the level of the heart. A sling or an improvised splint will do; the point is to move the limb as little as possible, because movement spreads the venom.
• Sit or lie down and try to settle. Rapid breathing and panic make you feel worse in their own right.
• Take note of the snake: colour, markings, head shape, length. If you can, photograph it from a distance, from somewhere safe, and never move closer for the sake of the picture.
• Write down the time of the bite and, if you have a pen, draw a line on the skin at the edge of the swelling with the time beside it. That shows the doctor how fast it is advancing.
• Wash the bite with soap and water if you can, and cover it with a clean dry dressing. Do not scrub it or squeeze it.
• For pain, paracetamol. Taking a painkiller does not replace the trip to hospital.

What you must not do

This list is worth reading before you need it. In Europe, almost all of the harm from a snake bite comes not from the venom but from the first aid.

• Do not suck the venom out, neither with your mouth nor with one of the suction pumps sold in kits. The venom is already in the tissues, it cannot be drawn back out, and the wound ends up dirty and damaged.
• Do not cut or score the wound. After an adder bite the bleeding is already increased, because the venom stops blood clotting properly. A cut adds blood loss and infection to the poisoning.
• Do not apply a tourniquet or tighten a belt, cord or cable round the limb. A tourniquet does not hold the venom back, but it does cut off the blood supply; limbs are lost far more often to that piece of first aid than to the bite itself. A tight pressure bandage is not advised for European adder bites either: it concentrates the venom in the tissues and worsens the local damage.
• Do not cauterise the wound with matches, embers, a cigarette, acid or anything else. That simply adds a burn to the poisoning.
• Do not apply ice or cool the bite. Cold does not neutralise venom; it narrows the vessels in tissue that is already suffering and helps it die.
• Do not give alcohol, either to the casualty or to the companions "for the shock". It speeds up the circulation and makes the doctor's assessment harder.
• Do not take aspirin or anti-inflammatory painkillers, as they increase bleeding. Paracetamol is the one to use for pain.
• Do not try to catch, kill or bring in the snake. That is how people get a second bite, including from a snake that has just been killed, whose biting reflex persists for a while. A description or a photograph is enough for the medical team.
• Do not wait at home "to see how it goes". Waiting is the commonest mistake and the costliest.

How a bite unfolds

After a venomous bite there are usually one or two puncture marks on the skin, with pain, redness and swelling appearing rapidly around them. Swelling is the main thing to watch: it can keep growing for several hours and climb from the hand to the forearm and shoulder, or from the foot to the calf and thigh. There may be bruising and blisters, and the glands in the armpit or groin may enlarge.

Whole-body symptoms do not happen to everyone, but they are what makes a bite dangerous: nausea and vomiting, abdominal pain, diarrhoea, weakness, dizziness, a drop in blood pressure to the point of fainting, palpitations. Less often there is swelling of the lips and tongue, a rash and difficulty breathing — that is an allergic reaction to the venom, and it develops fast.

A separate word about the dry bite. A snake does not always inject venom: some bites go without it, and then there is nothing beyond two small marks and mild soreness. The difficulty is that in the first hours a dry bite cannot be told apart from a genuine envenoming, because real poisoning sometimes declares itself late as well. So every bite means a trip to hospital, even if you feel completely fine half an hour later.

Bites are tolerated worse by children, by older people, by anyone with heart disease and by anyone taking blood-thinning medication. Bites to the face, neck and trunk are more dangerous, as are multiple bites.

What happens in hospital

The main reason for going is observation. Swelling and general symptoms can appear late, so the patient is kept under watch for several hours and, if there are signs of envenoming, for a day or longer. The circumference of the limb is measured, blood pressure is monitored and blood tests are taken, clotting included.

The wound is cleaned and the tetanus vaccination is topped up if it is due. Antibiotics are not given just in case: infection after a snake bite is uncommon.

Antivenom exists, and European countries hold antiserum against the bites of their native adders. It is not given to everybody and not simply because a bite happened, but when there are signs of serious envenoming: swelling advancing quickly, disturbed blood clotting, falling blood pressure, severe general symptoms. The hospital makes that decision, often after consulting a poisons centre. It is given into a vein and under supervision, because the antiserum itself can cause reactions. There is no home remedy "against venom", and there is nothing to buy in advance.

Snakes in Europe: what to expect

In Europe the dangerous bites come mainly from adders, which are found from the Iberian peninsula to Scandinavia and Ukraine. Severe envenoming is rare, deaths are exceptional, and most people who are bitten go home after a day or two.

None of that means a bite can be sat out at home. Adder venom acts first and foremost where it lands: the swelling grows over hours and can squeeze the tissues of the limb, and clotting problems do not show themselves straight away. That is exactly why everyone needs observing, not only those who obviously feel unwell.

Grass snakes and smooth snakes, which are by far the most likely thing to meet on a walk, are harmless to people — but nobody without training can identify a species from a fresh set of tooth marks. So the approach is simple: any snake bite is a reason to be seen by a doctor.

How to avoid being in this position at all: in grass, among rocks and in boggy ground, wear closed shoes and long trousers; watch where you put your feet and your hands; do not turn over stones and logs by hand; do not touch a snake or photograph it from close up. If you hear a hiss, stand still and back away slowly — almost every bite happens while somebody is trying to catch or shoo the animal.

If the snake is not a native species

Bites from exotic snakes, in people who keep them at home or handle them at work, are a separate story. Cobras, mambas, rattlesnakes and moccasins produce a picture nothing like an adder bite: with some the venom strikes the nervous system, with drooping eyelids, double vision and trouble swallowing and breathing; with others it causes massive bleeding. Ordinary adder antiserum is useless in those cases.

The species must be given to the medical team immediately, precisely, and by its scientific name if that is known. It determines which antivenom has to be found, and sometimes it has to be brought from another city or another country. Say it in the very first conversation with the emergency call handler, so the search can start before you arrive.

If you keep venomous snakes, keep a written card ready too: the list of species, the number of the poisons centre and of the nearest hospital that knows about your collection. Never handling them alone is part of the same preparation.

Online consultation

The bite itself is not something to deal with online: it is an emergency that calls for the ambulance number, not an app. A remote appointment is useful around the event, though. Before a trip: if you are planning a hike and want to know in advance which snakes live there, what belongs in the first aid kit and what definitely does not. After hospital: going through the discharge letter, understanding what the blood test changes meant, how to care for the healing wound, how long the swelling will last and when you can go back to physical activity. Online is also the place to check where your tetanus vaccination stands and what to do about your regular medicines if any of them thin the blood. And separately, there is the question asked by someone bitten by a harmless grass snake who does not know whether anything more needs doing.

This material is for information only and does not replace medical advice.