Snakes | Spiders | Jellyfish | Other

I am planning a trip to the outback, including remote areas, and I am wondering whether I should take antivenom with me in case of snakebite?

AVRU strongly advises against this. Below is an itemised explanation

• The chances of getting seriously bitten when hiking are actually very low. Snakes invariably remove themselves from the vicinity long before you have a chance to step on them. They usually will not threaten unless they perceive that they're cornered.
  
  
• A snake which is accidentally cornered will often threaten before it strikes, which is the ideal opportunity for the person to back away. The snake will then feel less threatened and is unlikely to strike.
  
  
• Appropriate clothing (sturdy boots, gaiters, long pants) is very good protection against a snake being able to pierce the skin.
  
  
• If a snake actually does bite AND the bite penetrates the clothing AND pierces the skin, it is often what is known as a dry bite, where no venom is injected. Also, victims often experience some illness but not critical illness (possibly because the snake did not inject much venom), in which case antivenom would not be appropriate, but in fact dangerous (see below).
  
  
• If a snake actually does bite (and it is a dangerously venomous snake), correctly applied first aid should buy you several hours of time. There is one case we know of where the victim of a venomous bite waited two days before being retrieved, the correctly applied first aid preventing any serious symptoms.
  
  
• Antivenom must be administered intravenously. To administer intravenous drugs one requires training. Ambulance officers, nurses and physicians all undergo years of training before they are able to safely give IV medications.
  
  
• A serious consideration when we cannulate someone in order to give IV drugs is that an opening is being made directly into the bloodstream - a condition which makes the body susceptible to elevated danger of infection. Such a consideration is not taken lightly even in a hospital environment. It would certainly weigh heavily against the decision to cannulate in a bush or outback setting.
  
  
• Antivenom is itself a dangerous drug. Much of it is protein, which has a low but very significant chance of causing an adverse reaction in the patient. Such a reaction, if serious, would require the facilities of an intensive care unit or emergency department.
  
  
• Antivenom comes in different immunotypes. That is, different types for the five clinically different kinds of snakes, so its important to know the type of snake. Snake identification is often difficult, even for experts, unless one has the snake and a guide book handy. Most cases of snakebite are quick, and the snake is gone in seconds. Many people bitten don't even see the culprit, let alone get a really good look at it. The chances of catching a frightened snake are slim, and chasing a snake after being bitten by it is the surest way of making the venom act fast. This means that identifying the type of snake is unlikely. Hospital staff decide which type of antivenom to administer based on two main considerations. The first is the location; some areas only have one or two types that occur there, but most have more. The second, which is more informative and far more reliable, is the snake venom detection kit made by CSL Ltd. The kit is easy to use in the lab, but would be difficult to use in the field. The alternative to knowing the right type is to resort to polyvalent antivenom, which works against all five types. The problem with polyvalent, which makes hospital staff avoid using it except as a last resort, is that it has a very high protein content, making it the most likely to produce an adverse reaction.
  
  
• Antivenom alone can sometimes fix the problem of critical envenomation, but often there are complications arising from the action of the venom which require additional support or therapy. Antivenom is useless against such complications.
  
  
• Some level of neurotoxicity is almost always present in serious cases of snake envenomation (i.e., the ones which might require antivenom). The best trained doctor, in the best-equipped intesive care unit, is unable to effectively self-administer antivenom if he or she is delirious, drowsy, confused or unconscious (all of which are common manifestations of neurotoxicity).

Alternative Recommendations

• Try to be aware of the danger of snake bite and avoid activities which highten that danger. This is mainly based on common sense. For example, when moving through thick undergrowth, try not to move quickly and observe the ground where you’re about to tread. Snakes love to hide in cool and dark places, so try to avoid disturbing such places or any material under which a snake might hide. Only go alone when it's impractical or impossible to do otherwise and try to keep the time alone as short as possible.
  
  
• When alone, try to be extra careful (not just because of snakes - a broken ankle in a remote area is probably a greater threat). Always tell someone, in writing, where you’re going as accurately as possible, how long you expect to take for each part of the trip, where you'll camp, etc. Don't stray from the plan unless you really have to.
  
  
• Finally, as an alternative to personal antivenom and all its inherent risks, consider a satellite phone. This would ensure better safety for all kinds of ailments and injuries, rather than just snakebite.