Western Rattlesnake (Crotalus oreganus). Never - I repeat, NEVER - use a pressure-immobilization bandage for a viper bite (this includes rattlesnakes) and never use a tourniquet for any snakebite whatsoever. Pressure-immobilization bandaging will make viper bites much worse and could cost you your limb when it could otherwise be saved!
FIRST AND FOREMOST, DO NOT MAKE IT WORSE!
DO NOT MAKE A TOURNIQUET, DO NOT CUT AND SUCK, DO NOT APPLY THE SAWYER EXTRACTOR OR OTHER COMMERCIAL “SNAKEBITE KITS”, DO NOT ELECTROCUTE YOURSELF WITH A STUN GUN, AND DO NOT FOLLOW ANY STRANGE RECOMMENDATIONS YOU RECEIVE FROM OTHER HIKERS ON THE TRAIL. NO FIRST AID IS OFTEN LESS HARMFUL THAN BAD FIRST AID WHEN IT COMES TO SNAKEBITES!
Tourniquets, pocket-knives, tasers, and commercial snakebite "venom extractors" are terrible for snakebites and are only going to worsen your odds of losing life or limb. If an idea sounds ridiculous that's because it probably is...
WHAT SHOULD YOU ACTUALLY DO IN THE EVENT OF A SNAKEBITE IN THE BACKCOUNTRY?
The following steps are what you actually should do in the event of a snakebite in the backcountry from any species of venomous snake. Ultimately you are going to need antivenom because antivenom is the only definitive treatment for a snake envenomation, but the tips below are designed to help you get to the hospital alive and leave the hospital in one piece.
1) Carefully walk backwards and find a safe space to sit down nearby before the venom drops your blood pressure and you pass out and hit your head. Many snake venoms disrupt blood clotting and the last thing you want is to cause internal bleeding on top of your snakebite.
2) Remove any rings, watches, bracelets, and anything else that could become a tourniquet if your limb swells up like a balloon. These items can be very difficult to remove once swelling has occurred, so exercise some foresight and remove them right away.
3) Circle the site of the bite with sharpie and write the time next to it. Mark the edge of the swelling and pain, make a list of your symptoms, and repeat every 30 minutes or so. Always record the time next to each mark. The vast majority of snakebites can be diagnosed and treated by your symptoms and severity of the envenomation without requiring a positive identification of the species responsible. That’s why this is so important! The photos below show this technique:
Circle the site of the bite and mark the time that it occurred…
…then mark the leading edge of the swelling and pain (separately, if needed) and repeat the process as they advance up the limb. It is particularly important to record the time that swelling reaches and/or passes the various joints on the affected limb.
4a) If you begin to experience signs of anaphylaxis (swelling of face, mouth, or throat; hives; difficulty breathing, etc) use an epinephrine autoinjector (EpiPen or generic) if you have one.
5) If you have cell phone reception call 911*, tell them where you are, when you were bitten, and the list of current symptoms you just wrote down.
*If you aren’t in the United States, look up the local emergency services number (whatever the equivalent of 911 is) and add it to your phone before you head out.
6) If you don't have reception, plot the safest and most expedient path to find it or reach a vehicle (whatever is safer/faster) and then start hiking out.
Time is tissue and it may be better to walk yourself out in an hour than to sit on your butt for 5 hours until a helicopter can show up. I think the idea that one should do everything possible to avoid speeding up circulation of venom is bad advice. You are already terrified from being bitten by a snake so your heart rate and blood pressure are already sky high. I've treated lots of bites in remote places and pretty much all of them had to hike out to reach the hospital. Figure out the fastest, safest route to find help and then make it happen.
General Advice
Should I try to kill/capture/photograph the snake so the doctor knows what bit me? Do not put yourself in danger to kill, photograph, or otherwise mess with the snake. This is how a snakebite turns into snakebites. We see this happen all the time. If you can get a picture on your phone without putting yourself at risk, it will be useful, but it is not necessary by any means because snake envenomations can be diagnosed and treated by your symptoms. That’s why it is so important to chart the progression of swelling and records the symptoms as they develop!
To splint, or not to splint? Some experts advocate splinting or otherwise immobilizing the bitten limb, but there are no compelling studies showing any benefit at this time. What we do know is that extreme positioning (immobilizing the limb and keeping it either way above or way below the heart) does not appear to be helpful and may even increase the odds of developing a dangerous compartment syndrome. As with anything else moderation seems to be everything here. If you want to immobilize the limb with a sling or swath in a relatively neutral position of comfort that reduces pain, that is probably a fine idea. If you do choose to splint it, be very careful not to wrap the limb tightly because you want to give the tissues room to swell on their own.
Pain relievers: Be very careful to avoid taking any sort of NSAID analgesics for pain control after the bite. This includes things like aspirin, ibuprofen (Motrin), aleve and a few other less common drugs. All of these medications interfere with normal blood clotting and when you combine this with the nasty effects many snake venoms have on blood vessels and blood clotting it can lead to very severe internal bleeding.
Ice: Do not use ice for snakebites! Ice causes the smaller blood vessels to constrict and when combined with viper venoms it can produce dramatic tissue damage. Again, better to let the swelling happen and focus on getting to a hospital.
SPECIAL CONSIDERATIONS NEUROTOXIC ELAPID BITES
The following technique is only to be performed in the event of a known bite from a neurotoxic elapid species and should never be performed on viper bites such as the rattlesnake shown at the top of the page. This technique would take place during step 4b. Read on for more information about this technique. Don't use it if you don't understand everything written below, as it could cost you your limb if done incorrectly. If you are wondering what snakes you can use a pressure-immobilization bandage for, it is indicated for bites from elapid snakes which possess potent neurotoxins that can lead to death much quicker than a typical viper bite. A pressure-immobilization bandage can delay the spread of neurotoxic venoms and buy you enough time to make it to a hospital if applied correctly and under the right circumstances. Some snakes that pressure-immobilization could be considered for include the following: non-spitting cobras, mambas, kraits, coral snakes, sea snakes, and everything in Australia.
4b) If you are positive that you have been bitten by a neurotoxic snake, apply a pressure-immobilization bandage as shown in the diagram below, but DO NOT USE THIS FOR VIPER BITES! Special considerations for using this technique are as follows:
A pressure-immobilization bandage is not a tourniquet, and a tourniquet is not a substitute for a pressure-immobilization bandage. A tourniquet is never appropriate for a snakebite!
Once you have applied a pressure-immobilization bandage, you cannot take it off until you reach a hospital that has antivenom ready. Once removed, the massive surge of venom into the blood stream can cause a rapid decline in the patient and this must be done carefully in a hospital.
Once the bandage is applied, you most immobilize the entire limb (splint it) to prevent any movement. Movement of the limb will cancel out the benefits of the bandage, but it can't be removed once it is on outside of a hospital so now you have a painful and ineffective bandage you can't take off stuck on your limb until you get to the hospital.
A pressure-immobilization bandage to the leg will effectively engage your ability to walk out so choose wisely.
Once again, for a viper bite such as the rattlesnake pictured at the top of this post a pressure-immobilization bandage will trap tissue destructive venoms in the limb and dramatically worsen the local tissue damage. This could cost you your limb for no benefit and should not be used for a viper bite, ever!
See the diagram below for a walkthrough on how to apply a pressure-immobilization bandage to a patient with a neurotoxic snakebite:
How to apply a pressure-immobilization bandage to a patient with a neurotoxic snakebite. This great figure comes from the following paper: Warrell, D. A. (2005). Treatment of bites by adders and exotic venomous snakes. Bmj, 331(7527), 1244–1247. http://doi.org/10.1136/bmj.331.7527.1244.
Feel free to ask questions or leave comments below and we will get to them when we can!
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