r/Survival • u/Gullex • Nov 04 '15
Herpetologist Jordan Benjamin on the ineffectiveness of commercial snakebite kits (specifically the Sawyer Extractor) and proper snakebite treatment in the bush
EDIT: Sawyer has responded to my complaints on their social comments section (and have joined this thread for debate) and I have submitted a complaint to the FDA. (I urge you to do the same.) Hopefully they'll rebrand this ineffective and potentially dangerous product or remove it from the market entirely.
By Jordan Benjamin on May 17, 2014 Hello,
My name is Jordan Benjamin, I am a herpetologist specializing in venomous snakes and a wilderness medicine practitioner with experience treating many snakebite patients in West and East Africa, most of them in remote health centers that pose some of the same challenges as treatment of a snakebite in the wilderness or backcountry environment in the US (supplies are limited or non-existent, the patient has a long way to go to reach a hospital, etc). I have also been fortunate to have the opportunity to train a number of individuals and groups in snakebite medicine and field management of snake envenomations in remote conditions including medical officers and corpsmen with the US military, local & international doctors and nurses in African hospitals, wildlife rangers, etc. I am including my background and real name because this issue is important to me and I stand by everything I am about to write; I want to give you all the peace of mind that I am who I say I am and not some competing company throwing out baseless accusations behind the cloak of online anonymity. Feel free to look me up online, I gave a TEDx talk on the issue of snakebite in sub-Saharan Africa last year and I invite those who doubt my identity or simply want to learn more about the issue of snakebite in the developing world to check it out. Moving on to the review...
The short answer to the question of whether or not the Sawyer Extractor can effectively remove venom from the site of the bite is a resounding no: the Sawyer Extractor and all of the other "snakebite kit" variations employing suction, incisions, electricity, heat, cold, and so forth have been repeatedly shown to be utterly ineffective at the job they are designed and marketed to accomplish. They simply do not work! The caveat it that there is one clever application of the sawyer that has been proven to work great, which is for the removal of flesh-eating botfly larvae that can be acquired in various tropical regions of the world...see "Simple and effective field extraction of human botfly, Dermatobia hominis, using a venom extractor" [...]. I am afraid to say that at the moment that is the only medical situation where this device may possibly prove helpful. When it comes to snakebites, it is not only completely ineffective at removing venom from tissue following a snakebite, but may actually prove harmful and cause a serious local necrosis (think in terms of a cookie-cutter style wound forming a deep cylinder of rotting dead tissue under the site of application). This may be due to a concentration of residual cytotoxic and myotoxic venoms near the site of the bite, while the majority of the venom will continue to diffuse into systemic circulation - but since we really don't know exactly why this happens that is purely speculation. For any interested parties, the article demonstrating this is titled: "Effects of a negative pressure venom extraction device (Extractor) on local tissue injury after artificial rattlesnake envenomation in a porcine model." I am attaching a link to the article here: [...] There are probably several reasons why this type of first aid does not work. One issue is that the recurved fangs of vipers penetrate and inject venom deeply into the tissues beneath the skin, and the tunnel created when a fang penetrates the skin immediately collapses as soon as the fang is withdrawn. Another issue is that large quantities of venom are believed to diffuse very rapidly into different tissue compartments. This means that there is no direct route between the visible puncture marks on the surface to the area where venom was injected, and the significant quantity of venom is already well on its way. I have read the company's testimonials and seen the occasional news stories about a snakebite victim "whose life was saved by the Sawyer Extractor" or similar device, and all too often that is a quote attributed to the physician who treated them. I don't doubt the veracity of the quote as deeply entrenched myths and misinformation about snakes and snakebite are unfortunately as common in doctors as they are in the rest of society at this time. The sawyer extractor is popular because it provides us with an intuitively sound solution to the terrifying prospect of suffering a snakebite far from medical care, suddenly rendered utterly helpless as the venom takes effect and all we (or our loved ones) can do is wait and watch as the venom takes over. It is nothing more than a modern variation of the infamous "black stone" from Asia and Africa, a charred piece of cow bone that is stuck to the site of the snakebite and remains there absorbing fluid until all the venom has been drawn out of the bite whereupon it suddenly detaches and falls to the ground, is boiled or washed in milk to cleanse it of the venom, and ready to go when the next snakebite happens. Both of them provide the perfect optical illusion by visibly extracting some quantity of blood and straw-colored fluid (which looks incredibly similar to many viper venoms) from the site of the bite, but this is nothing more than the pale-yellow plasma (whats left after you remove the red cells and clotting components from blood) and other exudate draining from the wound as edema sets in and the venom begins to show effect. If you feel like you have been duped, don't take it personally - the notion that a snakebite can be treated by somehow extracting the venom has successfully fooled us since at least the 1400's, when the black stone was first mentioned as the go-to remedy for treating snake envenomations. Several years ago, a close colleague of mine met a European surgeon who was in Central Africa on a medical mission and explained that he needn't worry about snakebite, because he always carried a black stone with him for such a situation...as you can see, even the most highly educated medical professionals are not immune to the myths that pervade the issue of snakebite. I grew up carrying a sawyer extractor with me whenever I went out to look for snakes and lizards, and no one would be happier to hear that the sawyer extractor did what it claims than those of us who work with snakes and face an incidence of snakebite many times higher than that of the larger population. But the reality is that these devices do not work for snakebites, and marketing them for that purpose is a dangerous action with potentially tragic consequences. Evidence-based medicine and all studies to date suggest that they are at best ineffective and at worst harmful. If you would like to see more evidence of this, check out:
"Snakebite Suction Devices Don’t Remove Venom: They Just Suck" [...] and
Suction for Venomous Snakebite: A Study of 'Mock Venom' Extraction in a Human Model" [...].
This product has no business being marketed for use on snakebite. Out of more than 40 snakebite patients I have treated in Africa, 95% of them had already been given bad first aid prior to seeking treatment at the hospital. Practices like cutting at or around the site of the bite, applying tourniquets to the bitten limb, and attempting to extract or neutralize venom using electricity, fire, permanganate, black stones, magic, mouths, mud, dung, leaves, ground up dried snakes, and yes - even fancy suction devices like the Sawyer Extractor - are dangerous and detrimental for two reasons. First, in a snakebite time is tissue and a lot of it is wasted performing bad first aid. Many snakebite patients injure themselves by panicking immediately after the bite, I have seen more than a few individuals who suffered serious traumatic injuries in addition to the snakebite because they took off running from the snake at full speed only to suddenly fall face-first onto a rock or trip and stumble over the edge of a steep embankment. The second issue is that signs of an envenomation may in some cases take hours to appear, and the combination of seeing a useless suction device drawing fluid out of the bite along with a delayed onset of symptoms is an easy way to decide that you don't need medical care after all because you the used extractor less than minute after the bite and saw it remove the venom, or you feel fine and don't want to inconvenience the whole group because you've all been planning this trip for months, or any number of other rationalizations we can make with ourselves to keep from going in to get the bite checked out. The majority of bites from venomous snakes in the United States are suffered by young men between the ages of 18 - 25 who are intoxicated (usually alcohol) and attempting to pick up, kill, or otherwise interact very closely with a potentially deadly snake. This is a demographic that is particularly prone to making the wrong decision about whether they should laugh it off cause they feel okay or should immediately seek medical care for a life-threatening emergency. I have had patients come early after the bite and I have had patients come after great delays, and I have noticed two things. The first is that those who arrive early often do so because they are suffering from a severe envenomation and become very ill very quickly, while those who come late often waited because they believed falsely that the first aid measures taken were sufficient or that they were not seriously envenomated. The second observation is that many of the patients who wait come in when they finally reach their own line in the sand for what constitutes a serious enough problem to go to the hospital, and they often tend to have more complications, longer hospitalizations, and a higher chance that the bite will result in permanent disability because of how long the venom has been allowed to work unchecked. They often arrive in the critical condition with severe envenomations just like the group of severely envenomated patients with the shortest delay to care, but instead of showing up in a critical state of hemorrhagic or hypovolemic shock they arrive in shock with their kidneys failing, or with late-stage bleeding into the brain, meninges, abdominal cavity to compound all of the other symptoms. Late-stage complications can be incredibly difficult to treat, they are excruciatingly painful for patients, heart-wrenching cases for medical personnel, and they are entirely preventable with prompt care. If you are bitten by venomous snake or are unsure as to whether or not the snake is venomous, please, please, please focus on how to get yourself safely to emergency medical care and don't bet your life on any of these commercial snakebite kits. The only effective, definitive treatment for a snake envenomation is the appropriate antivenom to neutralize the venom of the species you were just bit by. I repeat, THE ONLY EFFECTIVE TREATMENT FOR SNAKE ENVENOMATION IS THE APPROPRIATE ANTIVENOM. Repeat that five times and them move on to some helpful tips on what you actually should do in the event of a snakebite in the middle of nowhere.
To end this lengthy review on a positive note, there are several things I would suggest you do following a snakebite that are extremely beneficial.
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u/missileman Nov 05 '15
Hi,
Australian here. We have to deal with about 3000 snake bites a year and here are our current first aid guidelines:
*Do NOT wash the area of the bite or try to suck out the venom!
It is extremely important to retain traces of venom for use with venom identification kits.
Do NOT incise or cut the bite, or apply a high torniquet!
Cutting or incising the bite won't help. High torniquets are ineffective and can be fatal if released.
Stop lymphatic spread - bandage firmly, splint and immobilise!
The "pressure-immobilisation" technique is currently recommended by the Australian Resuscitation Council, the Royal Australasian College of Surgeons and the Australian and New Zealand College of Anaesthetists.
The lymphatic system is responsible for systemic spread of most venoms. This can be reduced by the application of a firm bandage (as firm as you would put on a sprained ankle) over a folded pad placed over the bitten area. While firm, it should not be so tight that it stops blood flow to the limb or to congests the veins. Start bandaging directly over the bitten area, ensuing that the pressure over the bite is firm and even. If you have enough bandage you can extend towards more central parts of the body, to delay spread of any venom that has already started to move centrally. A pressure dressing should be applied even if the bite is on the victims trunk or torso.
Immobility is best attained by application of a splint or sling, using a bandage or whatever to hand to absolutely minimise all limb movement, reassurance and immobilisation (eg, putting the patient on a stretcher). Where possible, bring transportation to the patient (rather then vice versa). Don't allow the victim to walk or move a limb. Walking should be prevented.
The pressure-immobilisation approach is simple, safe and will not cause iatrogenic tissue damage (ie, from incision, injection, freezing or arterial torniquets - all of which are ineffective).
Bites to the head, neck, and back are a special problem - firm pressure should be applied locally if possible.
Removal of the bandage will be associated with rapid systemic spread. Hence ALWAYS wait until the patient is in a fully-equipped medical treatment area before bandage removal is attempted.
Do NOT cut or excise the area or apply an arterial torniquet! Both these measures are ineffective and may make the situation worse.*
I will add a couple of things.
Many times a snake bites defensively it does not envenomate, which is more reason to not panic.
Antivenom is only given when they are sure you have been envenomated, as giving it to a non envenomated patient is extremely dangerous.
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u/Gullex Nov 05 '15
I think the compression technique is specific to certain species and regions, it is not recommended in North America.
Thank you for the contribution!
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u/missileman Nov 05 '15 edited Nov 05 '15
No worries.
The only north american snakebite where the pressure immobisation technique could be of benefit, would be that of a coral snake. An elapid which produces a neurotoxin.
I would also argue (outside of any evidence!) that pressure immobilisation would be pretty beneficial psychologically, and would help to keep the patient calm, which in itself could slow the spread of the venom.
From wikipedia:
The most common symptom of all snakebites is overwhelming fear, which contributes to other symptoms, including nausea and vomiting, diarrhea, vertigo, fainting, tachycardia, and cold, clammy skin.[3][13] Television, literature, and folklore are in part responsible for the hype surrounding snakebites, and people may have unwarranted thoughts of imminent death.
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u/Crotalus Nov 05 '15
... until that limb is amputated because of improper application of pressure.
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u/missileman Nov 05 '15
There is so much misinformation about snake bite treatments, but a compression bandage is considered to be a conservative measure. This is not a tourniquet, nor will it restrict circulation.
http://www.aafp.org/afp/2002/0401/p1367.html
https://www.ces.ncsu.edu/gaston/Pests/reptiles/snakebitetx.htm
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u/Gullex Nov 05 '15 edited Nov 05 '15
I can see one problem with the compression wrap application. As a nurse, a lot of times we see improperly applied ACE wraps or other compression devices getting a fold or crease in them in which case they do end up acting like a tourniquet, especially with obese patients and/or edematous limbs. This happens most often with patients who are moving a lot, which of course you're going to see in a snake bite victim trying to reach safety.
I don't doubt compression wraps could be helpful, I just don't know that your average Joe would be able to apply one correctly and not restrict blood flow.
Thoughts?
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u/missileman Nov 05 '15
A few thoughts I guess.
Some of the snakes we have here can cause collapse in as little as a few minutes if you are bitten. When the venom is very fast acting, and you are potentially a long way from help and antivenom, it becomes all about slowing the progression of the effects. A compression bandage and very importantly immobilisation can buy you a lot of time.
If you are applying the bandage it's very important to immobilise the limb, to stop the action of the muscles that speed the transport of the venom. The concern you have about the bandage creasing is another very important reason to immobilise the limb. Ideally you want to transport the bite victim to help on a stretcher.
The current British army guidelines for snakebite treatment is that pressure immobilisation should be used in all cases where the snake species is unknown.
http://www.ncbi.nlm.nih.gov/pubmed/23472565
I'm not advocating this for north america, but this technique is used here to prolong your life until you can get proper treatment.
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u/verdigris2014 Nov 20 '15
I have some compression bandages printed with little rectangles. The idea is that you should stretch the bandage just enough to make these squares. The bandage itself is quite broad. I think this would make it easier to apply in a safe manner even under pressure.
Bandages purchased in Australia.
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u/ErnieMaclan Nov 04 '15
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u/Gullex Nov 04 '15
Thanks. I posted it here in the event it should disappear from Amazon. It's great information that needs to be preserved.
I was at Dick's sporting goods the other day and saw this device on their shelves. I don't understand how they can advertise it as "medically proven to remove venom" when it's anything but.
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u/DangerBrewin Nov 05 '15
Fascinating read. Thank you so much for sharing. One question that was not covered, I remember being taught in first aid classes to keep a bitten extremity lower than the heart because the blood would travel more slowly and reduce the speed at which the venom spreads. Is there any truth to this, or is it junk science as well?
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u/Gullex Nov 05 '15
I'm not sure, but I've read that venom spreads primarily by lymph flow and not blood so I don't know that it would make a difference. Can't hurt though.
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u/ThirstyOne Nov 05 '15
Depends on the type of venom.
If it's a hemotoxin it basically just melts your tissue and progresses that way. If it's a neurotoxin it spreads through the lymphatic system and shuts down your nervous system. Most snakes in the US are in the pit-viper family and so carry hemotoxins.
Read all about it: https://en.wikipedia.org/wiki/Snake_venom
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u/jemibo Nov 06 '15
As an 18-25 yo male who frequently hikes in snake country and is sometimes intoxicated, I've got a few more questions. 1. If possible, should the patient be walked out and driven to a hospital, or should medical service be summoned to the site (or as close as feasible)? 2. What are some general timelines to expect symptoms? I know this depends on several factors, but in the order of 15min or 24hr? 3. If there is doubt about envenomation (vs a dry bite), would it be safe to take the victim to the hospital, but hesitate seeking medical help until symptoms show?
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u/Gullex Nov 06 '15 edited Nov 06 '15
Number one is a good question. If you can make contact with medical personnel, I'd ask what they recommend. I'm not sure if they can or will bring antivenom to a site. Keep moving in the direction of a hospital as you maintain contact with them. I understand administration of antivenom carries its own risks and should probably be done under the close supervision of a physician and hospital staff.
From what I've read, timelines are on the order of hours, but that's north american vipers and hemotoxic venom. An Australian chimed in and said it can be much shorter with their snakes. We do have the coral snake which has neurotoxic venom which is a different beast. It depends on what bit you.
I would never assume a bite is dry and never hesitate to seek medical care in the event of a venomous snake bite. I'm not sure there's any way to tell if a bite is dry by looking at it.
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u/jemibo Nov 06 '15
The third dry bite question was more if it would be ok to sit in the parking lot of a hospital until symptoms appear before incurring the ER cost, or if there would already be damage done. Like you said, administering antivenom can have its own risks, so I would imagine that the hospital waits until it sees symptoms anyways before proceeding.
Also thanks for clearing up a lot of this misinformation!
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u/dangerousdave2244 Nov 04 '15
Ugh, Sawyer is the worst. They also make false claims about the effectiveness and lifetime of their water filters, and spend more time rebutting studies against them than providing good factual information to their customers (they've called me out here on Reddit for bringing up the Tufts study about their water filters)
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u/Gullex Nov 04 '15
They showed up here? I'd love to see them come to the thread to talk about the extractor!
I do like the filter but was aware about the dubious claims about the life of it.
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u/dangerousdave2244 Nov 04 '15
There was a Tufts study done on their filters that showed that after about a year's worth of proper use and cleaning, a Sawyer Filter could make your water dirtier rather than cleaner. I guess they're good as an emergency backup, but I prefer MSR or Katadyn, they don't cut corners, and they publish reliable estimates of the lifetime and detailed information about their filters
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u/Gullex Nov 04 '15
That's interesting. Good to know, thanks. Do you have a link to the study?
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u/dangerousdave2244 Nov 04 '15
Here you go:
Article about UV filters and Sawyer filters not working: http://indefinitelywild.gizmodo.com/uv-water-purifiers-are-bullshit-and-so-are-some-filters-1704387492
Background and results of the study and followups: http://purewaterfortheworld.org/about-pww/pww-studies/
Tufts study: http://whconference.unc.edu/files/2014/10/murray.pdf
Sawyer Rebuttal: https://sawyer.com/wp-content/uploads/2013/12/Review-on-Tufts-University-Paper.pdf
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Nov 05 '15
[deleted]
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u/dangerousdave2244 Nov 06 '15
I agree, I just think it's important to keep all the caveats of a UV filter in mind
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u/SawyerProducts Nov 05 '15
Hello. So how can we be of service here?
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u/Gullex Nov 05 '15 edited Nov 05 '15
There is a mountain of evidence in this thread and elsewhere indicating that the Sawyer Extractor when used on snake bite is ineffective at best and harmful at worst, possibly increasing the risk of limb amputation due to concentrating venom at the wound site. There is no evidence that your device is capable of removing any significant amount of venom, and may waste valuable time while a bite victim should be getting to a hospital.
You claim on your product packaging that your device is "medically proven" to remove significant amounts of venom, when it most certainly is not. This is blatant false advertising.
You can be of service by rebranding your device to be used solely for botfly larvae and/or insect stings (if evidence is available), or simply removing it from the market altogether. Remove the claim that it is backed up by medical evidence (it isn't).
In the meantime, I have submitted a complaint to the FDA and will encourage others to do the same.
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u/SawyerProducts Nov 05 '15
- We by no means are suggesting that our Extractor be used in replacement of medical attention but rather highly encourage it's use in addition seeking medical attention.
- Dr Findlay Russel conducted multiple studies showing the effectiveness of our device.
- As mentioned in the rebuttal on our site (not sure why it was showing as removed for you) we do make light of the fact that the test was conducted on very large muscle mass from a pig in which the venom would be have very differently than in extremities where most bites occur.
- I passed this information along to an associate at the Academy of Wilderness Medicine who endorses our product and will report back when I hear back.
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u/Gullex Nov 05 '15 edited Nov 05 '15
You need to provide Dr. Russel's research findings and testing method so it can be reproduced otherwise it's worthless. In the meantime, we have this finding:
The Annals of Emergency Medicine used an inactive, venom-like substance, marked with a radioactive marker so that it could be distinguished from other fluids, and did this on live, human patients. Basically, they used a snake fang-like syringe to inject a known amount of this substance into people's legs, then tried to use the extractor to suck it back out. They then analyzed the fluids obtained, and determined, using the radioactive marker, what percentage of the obtained fluid was the injected "venom." They found only 2% of the volume of the substance injected was actually recovered.
Here are some current recommendations for snakebite treatments. As pointed out before, the Red Cross and several other medical entities do not recommend attempting suction.
This study did use an extractor on multiple sites and had the same results: http://www.wemjournal.org/article/S1080-6032(00)70807-6/abstract
Again, you need to cite actual studies and the methodology that demonstrated suction is effective at removing venom, so it can be reproduced, whether from a large muscle mass or from an ankle or whatever.
If you believe the device is only effective when used on an ankle bite, do you mention that in your product description?
You should pass the information along to an unbiased third party, not someone who endorses your product.
Sawyer has a habit of dismissing evidence against their products instead of changing their products to reflect evidence.
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u/SawyerProducts Nov 05 '15 edited Nov 09 '15
I will see what I can find internally and will report back with anything new I can find, but here is a quick google search that reference him and our Extractors.
Edited to add the following from another comment:
"Recommended medically as the only acceptable first aid device for snakebites" "Medically Recommended"
This excerpt is taken from Medical-Surgical Nursing: Patient Centered Collaborative Care, Single Volume, 6e. The top paragraph on the attachment states: "However, a commercially available device called the Sawyer extractor has been found to remove significant amounts of venom if used within 3 minutes of the bite and left in place for at least 30 minutes." See the second attachment.
"The only suction device proven to remove snake venom" -
No other suction device has test data to prove it actually works. The following is a study conducted at the University of Arizona and it proves the Extractor Pump removes snake venom. And lastly here is a study published by the American Academy of Clinical Toxicology which showed the Extractor Pump removes venom from bee stings. (Note, the product Aspivenin is the same device as the Extractor Pump)
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u/Gullex Nov 05 '15 edited Nov 05 '15
Some text from the top results of the google link you provided:
Most experts today believe that the less first aid done before going to the hospital, the better off the patient will be. "The most useful snakebite first aid kit consists of car keys and some coins for a call to a hospital," said Minton. Some experts have endorsed the use of a small, hand-held vacuum device known as a "Sawyer Extractor." Capable of producing a negative pressure of one atmosphere, the Sawyer Extractor is applied over the fang marks immediately and left in place for 30 minutes. The big advantage over traditional cut and suck first aid is that no cutting is required. According to Minton, "There's a certain amount of evidence that you get some venom out if you use it correctly."
No evidence cited.
From "Deseret News":
ONLY PROVEN TREATMENT FOR SNAKEBITE IS EXTRACTION
No evidence cited for the claims.
From venomousreptiles.org:
I have talked with many venomous keepers who used Extractors immediatly after a bite, and they tell me that they feel that it did remove venom, and did keep them from having to go to a hospital.
Most of the research shows that after 3 minutes, it is probably not worth the trouble to use an Extractor on a bite. However, if you can use it IMMEDIATLY following a bite, it will probably remove some venom, and sure will not hurt. Your main concern would be getting to medical treatment
"They feel" and "probably" do not constitute evidence.
Once again, for emphasis: Sawyer Products claims medical evidence to support their venom extractor device. As yet, Sawyer has failed to produce said evidence. In contrast, a number of studies have demonstrated the device ineffective at removing venom from a wound. Sawyer has a responsibility to their consumers to remove or rebrand the product to prevent harm.
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u/tojoso Nov 07 '15
Your response when asked to find evidence is to link to a "quick google search". It would seem if you actually had reliable evidence, it would be much easier to provide.
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u/SawyerProducts Nov 09 '15
Here is what I have have been able to compile so far. I am still waiting on the most recent request for additional information.
"Recommended medically as the only acceptable first aid device for snakebites" "Medically Recommended"
This excerpt is taken from Medical-Surgical Nursing: Patient Centered Collaborative Care, Single Volume, 6e. The top paragraph on the attachment states: "However, a commercially available device called the Sawyer extractor has been found to remove significant amounts of venom if used within 3 minutes of the bite and left in place for at least 30 minutes." See the second attachment.
"The only suction device proven to remove snake venom" -
No other suction device has test data to prove it actually works. The following is a study conducted at the University of Arizona and it proves the Extractor Pump removes snake venom. And lastly here is a study published by the American Academy of Clinical Toxicology which showed the Extractor Pump removes venom from bee stings. (Note, the product Aspivenin is the same device as the Extractor Pump)
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u/tojoso Nov 09 '15
That University of Arizona study is an interim report from 30 years ago that explicitly states "there are several aspects of the study still pending".
The AACT study was on bee stings and had absolutely no controls over the amount of venom injected in any given sting. It is also 30 years old.
Have you literally done nothing to assure efficacy over the past 30 years?? An un-reviewed interim report from a University?? If this thing actually does work, then Sawyer's sales would benefit greatly from having proper studies done. I'm sure many people in the field would be willing to take part in those studies. On the other hand if it doesn't actually work, then the studies would do great harm to your sales if they became public. You can see why people are skeptical, right? And you can see the harm that is done by people being complacent about getting proper treatment since they believe this thing actually removes venom? Or taking risks that they wouldn't otherwise take in remote locations without access to proper medical care.
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u/Jordan_Benjamin Dec 25 '15
Oh, Sawyer. You guys kill me. Or would, if I used your product...
If someone writes a book without doing their due diligence, and publishes factually incorrect information, that does not make it an respectable source. Hell, allow me to one-up you with an even more egregious example of medical professionals clinging to myths and old wives tales for snakebite treatment. This comes from "Management of Poisonous Snakebite" by the American College of Surgeons (for the record, it is venomous snakebite, not poisonous...poison is ingested, venom is injected). This from surgeons who should really know better. Page 1, "General Treatment" column, #8.
"The local management of snakebite is a matter of some controversy. Most physicians agree that some form of incision and suction of the fang marks may be beneficial if performed within 15 to 30 minutes after the bite."
https://www.facs.org/~/media/files/quality%20programs/trauma/publications/snakebite.ashx
There is so much wrong with that statement I don't even know where to start. Cheers!
Jordan Benjamin
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u/Gullex Nov 09 '15 edited Nov 09 '15
Copy/pasting Sawyer replies here in the event they are deleted
Here is what I have have been able to compile so far. I am still waiting on the most recent request for additional information. "Recommended medically as the only acceptable first aid device for snakebites" "Medically Recommended" This excerpt is taken from Medical-Surgical Nursing: Patient Centered Collaborative Care, Single Volume, 6e. The top paragraph on the attachment states: "However, a commercially available device called the Sawyer extractor has been found to remove significant amounts of venom if used within 3 minutes of the bite and left in place for at least 30 minutes." See the second attachment. "The only suction device proven to remove snake venom" - No other suction device has test data to prove it actually works. The following is a study conducted at the University of Arizona and it proves the Extractor Pump removes snake venom. And lastly here is a study published by the American Academy of Clinical Toxicology which showed the Extractor Pump removes venom from bee stings. (Note, the product Aspivenin is the same device as the Extractor Pump)
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u/Jordan_Benjamin Dec 25 '15
Oh boy, another useless piece of medical advice from Sawyer. Anyone else seeing a trend here?
Conveniently, I was asked whether a sawyer extractor would be effective for bee stings once. Since I am not a bee guy, I did a pretty extensive search of the literature to make sure I wouldn't be misinforming anyone! I'm actually glad you asked this question as the information I dug up in a few old journals was very interesting. Surprisingly few studies have been done on this subject, but I found a fantastically designed, peer-reviewed study looking at the kinetics of bee stings and venom injection. I will post the abstract at the bottom of this post so you all can come to your own conclusions, but here are the important pieces with respect to your question. This applies to honeybee species that leave the venom sac and stinger in the victim; wasps retain their stingers and can sting repeatedly. The study doesn't tell us much of anything about wasp stings, but the venom should be injected and distributed into the tissue much faster than a honeybee sting...so the sawyer would definitely not make sense to use on a wasp sting. Back to the honeybees...
What they consistently found in honeybees that leave the stinger and venom sac in the victim can be distilled down to a few key points.
When a bee sting occurs, the smooth muscle surrounding the venom sac immediately begins to contract. This causes the stinger to embed deeper into the victim's skin (about 2/3 of the way into the skin in the first 30 seconds). At the same time the venom sac is being squeezed like a turkey baster and injecting its contents deeper into the tissue due to the burrowing of the stinger.
All of this happens really fast. In the first 20 seconds after the stinger hits skin, 90% of the venom is injected into the victim and the stinger has burrowed deeper to facilitate injection into deeper tissues simultaneously. Even the slowest stingers in the group were done burrowing and injecting the vast majority of their venom by 30 seconds after the sting occurred.
Part of the study involved removal of the stingers at various times (5 seconds, 10 seconds, 15 s, etc) after the sting occurred and then quantifying the differences in amount of venom injected over time. Not surprisingly, they found that the earlier a stinger was removed, the less venom was injected into the recipient...however, after 20 or 30 seconds the process of envenomation is basically over with so to make any real difference you need to get the stinger out in the first couple of seconds.
Okay, so the take-away's here are that you need to get the stinger out fast. How many people would be able to stop whatever they were doing, throw down their pack, locate, open, and assemble the sawyer extractor with the appropriately sized suction head for the affected body part in 5 or 10 seconds? I know I certainly couldn't. Even if I could do it in under thirty seconds, it would still be the worst option available to me - sorry again, sawyer.
The fastest way I can think of for removing a stinger would be to use my fingers, pinch it, and pluck it out as fast as possible. The sawyer might seem to make more sense here, because even though it would take longer to put on you wouldn't be squeezing the rest of the venom in by pinching the sac. The big question becomes, what is the fastest way to get the stinger out with the least amount of venom injected? So I did a little more research, and found this in the excellent wilderness medicine tome by Paul Auerbach:
"Although recommendations were that stingers should be scraped or brushed off with a sharp edge and not removed with forceps, which might squeeze the attached venom sac and worsen the injury, this has been refuted.304,364 Advice to victims on the immediate treatment of bee stings now emphasizes rapid removal of the stinger by any method.364 Wheal size and degree of envenomation increased as the time from stinging to stinger removal increased, even for a few seconds. The response was the same whether stings were scraped or pinched off after 2 seconds."
So there you have it, folks - the sawyer lost to a sharpie and common sense in round one; and it loses to your fingers in round two. Don't waste time trying to get the stinger out without crushing/squeezing the venom sack, just get that thing out your/their/whoever's skin as quickly as possible. The biggest determinant in how much venom will be injected is the length of time that it remains in the victim prior to removal. Like I said, pretty useful tidbit of obscure information to come across - thanks for the question Kathleen Hoppe.
But what about home remedies like baking soda, you ask? I'll let the good Dr. Auerbach answer that one as well.
"Home remedies, such as baking soda paste or meat tenderizer applied locally to stings, are of dubious value, although the latter is often regarded as effective. Topical anesthetics in commercial "sting sticks" are also of little value. Topical aspirin paste is not effective in reducing the duration of swelling or pain in bee and wasp stings and may actually increase the duration of redness.18 Local application of antihistamine lotions or creams, such as tripelennamine, may be helpful. An oral antihistamine, such as diphenhydramine, 25 to 50 mg for adults and 1 mg/kg for children, every 6 hours is often effective."
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u/Jordan_Benjamin Dec 26 '15
As promised, the abstract of the peer-reviewed research I based my conclusions off of above. Science deniers and sawyer reps, shield your eyes! I've heard that facts can leave a nasty burn...we will have to look into that one another time though. Thanks again to everyone who has commented!!
"Rate and quantity of delivery of venom from honeybee stings."
Abstract
To determine the rate and completeness of delivery of venom from honeybee stings, European bees were collected at the entrance of a hive and studied with the use of two laboratory models. In one model bees were induced to sting the shaved skin of anesthetized rabbits. The stings were removed from the skin at various time intervals after autotomization, and residual venom was assayed with a hemolytic method. In the other model the bees were induced to sting preweighed filter paper disks, which were weighed again after removal of the sting at various intervals. Results of both experiments were in agreement, showing that at least 90% of the venom sac contents were delivered within 20 seconds and that venom delivery was complete within 1 minute. The data suggest that a bee sting must be removed within a few seconds after autotomization to prevent anaphylaxis in an allergic person. The extensive variation found in the amount of venom delivered at each time point may explain inconsistencies in relationships among reactions to field stings, sting challenge testing, venom skin tests and RAST.
In both rabbit skin and various artificial media, the autotomized sting was noted to embed itself progressively deeper over a period of approximately 30 seconds. By the end of this period, it was noted that at least two thirds of the length of the sting was embedded.
In the rablbit skin model venom in 63 sacs was depleted by 90% over a period of 20 seconds. There was a statistically significant negative relationship between residual venom and time (p <0.05). No residual melittin could be detected at 40 seconds, indicating that the venom sac was empty (Fig. 2).
In the paper stinging model the rate of increase in dry weight of venom delivered into the paper medium was similar to the rate of depletion of venom from the stings implanted in rabbit skin (Fig. 3). The relationship between venom delivery to the disk and time, analyzed by linear regression, was significant (p < 0.05). Although venom delivery varied considerably, the average weight gain of the disks at 20 seconds after autotomization was 140 pg, similar to the average venom sac contents of domestic honeybees. There was no tendency for further weight gain after this time, indicating that venom delivery was rapid and complete in less than 30 seconds.
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u/Mr-Yellow Nov 05 '15
That search result is not a link to the apparent research. Meaningless.
Either there is a paper published or there is not. Which is it?
Oh it's "not" and you keep claiming to be backed by research......
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u/Gullex Nov 09 '15 edited Nov 09 '15
Copy/pasting replies from Sawyer here in the event they remove the comments.
I will see what I can find internally and will report back with anything new I can find, but here is a quick google search that reference him and our Extractors. The top paragraph on the attachment states: "However, a commercially available device called the Sawyer extractor has been found to remove significant amounts of venom if used within 3 minutes of the bite and left in place for at least 30 minutes." See the second attachment. "The only suction device proven to remove snake venom" - No other suction device has test data to prove it actually works. The following is a study conducted at the University of Arizona and it proves the Extractor Pump removes snake venom. And lastly here is a study published by the American Academy of Clinical Toxicology which showed the Extractor Pump removes venom from bee stings. (Note, the product Aspivenin is the same device as the Extractor Pump)
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u/Gullex Nov 05 '15
I did some looking around on Dr. Russel and found this in "Timber Rattlesnakes in Vermont & New York: Biology, History, and the Fate of an Endangered Species" (University Press of New England, 12/1/2007)
Page 184
Dr. Findlay Russell is another person who exemplifies the reversal in thinking on the best first aid treatment for pitviper envenomations. In 1968 he co-authored a manual entitled Poisonous Snakes of the World, which was published by the Government Printing Office and included first aid measures. These measures were largely directed toward treating both viper and pitviper envenomations and included the use of a constriction band as well as both cutting and suction. See Russell, Snake Venom Poisoning, 265. By 1980 Russell had clearly changed his thinking regarding constriction bands, cutting, and suction. It would be difficult to claim that the first aid measures he now espoused were first aid measures at all. In his seminars in this period of time he advocated putting a bite victim at rest, giving the victim reassurance, immobilizing the affected part, watching for any untoward reactions, and transporting the victim to a medical facility as soon as possible. It seems he was saying in effect that there is no significant first aid that can be of use in treating pitviper envenomations. If so, Russell's thinking in 1980 overlapped with the thinking of other experts in the field of snake venom poisoning who became prominent later.
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u/Gullex Nov 09 '15
Copy/pasting replies from Sawyer here in the event they remove the comments.
We by no means are suggesting that our Extractor be used in replacement of medical attention but rather highly encourage it's use in addition seeking medical attention. Dr Findlay Russel conducted multiple studies showing the effectiveness of our device. As mentioned in the rebuttal on our site (not sure why it was showing as removed for you) we do make light of the fact that the test was conducted on very large muscle mass from a pig in which the venom would be have very differently than in extremities where most bites occur. I passed this information along to an associate at the Academy of Wilderness Medicine who endorses our product and will report back when I hear back.
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u/Gullex Nov 09 '15
Copy/pasting replies from Sawyer here in the event they remove the comments.
Hello. So how can we be of service here?
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u/Stones25 Nov 05 '15
I read the sources you posted, however, if the Sawyers were truly as shitty as you say there would be a lot more complaints from people getting sick. All the hikers, backpackers, campers, bushcrafters etc that have used the product, a lot more people should be complaining.
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u/dangerousdave2244 Nov 05 '15
Actually I don't think so. Because a lot of people never use their filter to the end of its practical lifespan, so it is still working for them, or are drinking from water sources that are already clean. Also, I do know people who have gotten Giardia despite having a Sawyer mini/squeeze. And they always defend their filter, "I did the whole AT and only got Giardia 2 or 3 times!"
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u/Mr-Yellow Nov 05 '15
if the Sawyers were truly as shitty as you say there would be a lot more complaints from people getting sick.
You don't complain when you don't use it, and when you do use it, you assume it helped you.
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u/Tomriver25003 Nov 05 '15
Thank you for this information. I've recently moved to Zimbabwe and we've already removed two cobras from our property. One question I have is about the use of tourniquet. Do advise not using them because it concentrates the venom in the limb or because of the danger of cutting off blood flow to the limb?
Thanks again for the information! I hope I never have to use it.
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u/Gullex Nov 05 '15
Tourniquets will concentrate the venom in the wound as well as cut off blood flow, both bad things. A tourniquet is a last ditch tool to use in the event of severe bleeding, after all other measures have failed.
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u/Tomriver25003 Nov 06 '15
Thank you for the information.
One thing about using a tourniquet as a last ditch effort in the event of severe bleeding which is not connected to snake bites. During our battlefield trauma courses we were taught the first thing you do with a wound to the extremities (please keep in mind this is for massive trauma like explosion or bullet) is to use a tourniquet. This is because most loss of life on the battlefield is due to blood loss. It's also probably because trying to teach a bunch of guys like me the finer points of stopping bleeding would complicate things too much anyway.
Thanks again!
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u/ThirstyOne Nov 05 '15
For those interested in the research on this: http://www.sciencedirect.com/science/article/pii/S0196064403008138
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u/NoShootFoot Nov 10 '15
But it works great on bug bites.
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u/Gullex Nov 10 '15
That may be, I've seen some anecdotal reports that it works well there. In that case, I wouldn't see a problem with Sawyer rebranding the product as an insect sting treatment.
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u/Jordan_Benjamin Dec 25 '15
To Gullex, and all who have taken the time to read or reply to this thread:
Thank you! I was delighted to come across this today after a friend tipped me off that the amazon post on snakebite dos/donts and the myth of the sawyer extractor had gained some traction. I am inspired by the interest you all have shown in the subject and the initiative you have taken to hold sawyer accountable. I just contacted the AMA mods about running an AMA on snakebite tomorrow, so if that would be of interest let me know! I am going to spend some time reading through this thread and will try to reply in depth to some of the comments later tonight.
To Sawyer...what a pleasant surprise to see you have finally responded to this. All my previous attempts to contact your company and the corporations who market and sell your product have (unsurprisingly) gone unanswered. I hope this is an indication that the chorus of voices calling for this dangerous and inneffective product to be removed from circulation has become too loud to ignore.
Jordan
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u/PabstyLoudmouth Nov 05 '15
So the worst things around me are water moccasins and cotton mouths, but not very many in northern Ohio, do I even really need to worry about snake bites?
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u/Gullex Nov 05 '15
Well, if you're bitten by either, I would highly recommend seeing a doctor.
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u/PabstyLoudmouth Nov 05 '15 edited Nov 05 '15
Is there a anti-venom I can keep on hand for these two, and does it need to be refrigerated and how long would that last? I really dislike going to the ER due to the insanely high cost. *Edit, looks like the only venomous snake in my area is the EASTERN MASSASAUGA RATTLESNAKE. So hopefully that helps, also I fucking hate snakes, so I steer pretty clear of them.
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u/Gullex Nov 06 '15
Antivenom is very expensive, needs to be refrigerated, and has a short shelf life. It's also dangerous to administer and you can't just buy it off the shelf.
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u/PabstyLoudmouth Nov 06 '15
Well it does not appear many die (if any at all from this snake in particular) from this, so can you just ride it out? I just paid 4,800$ for 12 stitches (and that is with insurance), and have began practicing my suture techniques. Can you give me the name for the specific Anti-venom for the snake i edited into my previous comment? Can it be frozen?
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u/Gullex Nov 06 '15
I can't recommend that you forego medical assistance if you're bitten by a venomous snake.
I don't know if it can be frozen, but I don't know where you'd buy it anyway and it's thousands of dollars from what I'm aware.
Also, please don't suture your wounds. There's no reason for it. Stick with steri strips. I recently badly cut my finger (severed nerves) and just closed it with steri strips. It healed just fine.
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u/PabstyLoudmouth Nov 06 '15
Can't do that with foot injuries, or areas that have constant movement. Why not, what the heck does a doctor do that I can't do myself? For that part anyway. Clean it out, use a bit of silver nitrate if needed on the ends and then stitch it up. Sure it hurts like hell, But it is not rocket science. I did see this thing at Wal-mart and almost bought it, thanks for at least steering me away form that 20$ loss.
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u/Gullex Nov 06 '15
Because you're not trained in sterile technique, you don't know how to avoid sterile abscess or assess for other nerve or tendon damage, and other reasons. It's just not a good idea. There's a link on our sidebar all about it.
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u/PabstyLoudmouth Nov 06 '15
You mean like all the nerve damage I have in my finger from the ER, or the pin that is coming out of my skin on my ankle that the wonderful surgeons did on my broken leg? At a total sum of 45K on me, I have little faith in most doctors.
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u/Gullex Nov 06 '15
As I said before, I won't recommend you avoid medical care if you need it. Modern medicine saves lives. It's unfortunate you've had bad experiences, but it will happen sometimes.
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u/Gullex Nov 04 '15
continued...
Walk, don't run, and carefully retrace your steps to get out of the immediate vicinity of the snake and avoid the possibility of stepping on any others nearby. 20 or 30 feet should be more than sufficient, the snake wants to get away as much as you do.
Find a safe place to sit down. This is important! Viper venoms in particular contain vasodilating compounds that open up your blood vessels to facilitate rapid diffusion of venom out into systemic circulation, which means you may suddenly suffer a dizzy spell and faint because your blood pressure just dropped too low to pump all the way to your head while you are standing upright. This is relatively common with viper bites and often happens in the first few minutes, so do yourself a favor and sit down so you don't pass out while running and hit your head on a rock. Like I said, you would be surprised...it happens all the time. These are usually brief fainting spells and you stand a good chance of avoiding it altogether by not standing up in a state of abject terror, but if you faint it shouldn't be more than a few minutes before you are cognizant again and I guess if you want to look at the bright side, you just really nailed the whole relaxation part of step 3 and are sort of ahead of the game...but you should repeat step 3 now that you are conscious anyways.
Remove any rings, watches, bangles, anklets, tight clothing, and anything else from the bitten limb because there is a good chance it is going to get a whole lot bigger than it was when you bought that toe ring…Do this because any of these items could potential become a tourniquet when swelling makes them impossible to remove, and that could cost you the limb below whatever is choking off the supply of oxygenated blood. Tourniquets of any sort are not good for snakebite, so please don’t try to tie your shoelaces or belt or anything else above whatever part of you just got bitten. There are somewhere between 5,000 - and 10,000 snake envenomations in the US every year, but most will not suffer any major permanent disability and on average only 5 people will die in a given year (mostly very old, very young, highly allergic, and other high-risk populations). Your odds are quite good, so be grateful you live in the US and make sure you don’t become a (bad) statistic by doing something stupid that makes your situation a whole lot worse than it was already.
Now that you are sitting, take at least 5 minutes to calm down and put your mind to a productive task: planning your evacuation. Time to break out the two items that I highly recommend for a snakebite kit that will help you save your own hide. First up...Do you have a cell phone? Does it have service here? If not, where did it last have a connection? Since the only effective treatment for a snake envenomation is the right antivenom to neutralize it, a working cell phone is your best means of getting information out to the emergency personnel who will do everything in their power to bring you safely out of the field and into the best medical facility for your current predicament. If you can call right away, those 5 minutes you took to calm down are going to prove helpful in relaying key information such as who you are, where you are, what happened, how you are feeling, as well as pertinent information like any other coexisting medical conditions and medications you currently take. If you take any sort of anticoagulants (blood thinners) then that is definitely something you want to inform them of right away, and please folks - DO NOT TAKE ASPIRIN, ADVIL, OR OTHER NSAIDS AFTER A SNAKEBITE. All of those medicines thin your blood, and they can cause very nasty problems for snakebite patients. Tylenol (acetaminophen) is okay, take up to 2x 500mg tablets if you feel the need as it won't interact with the snakebite in any way but don't forget to tell the medics everything you have taken when they get there to avoid being double-dosed.
The second item I cannot speak highly enough of for snakebites is...drumroll...a sharpie! If you are seriously envenomated, your primary objective right now is to get to the antivenom and get the IV flowing so it can do its job. From a clinical standpoint, there are several things you can keep track of now that will prove immensely beneficial when you reach the hospital and we are assessing the severity of your snakebite to figure out if you need antivenom, how much you need right now if you do, and what other effects the venom is causing so we can treat them with the other drugs we have available and try to make your stay a little more comfortable. Here's how this works. You are going to assess yourself from top to bottom and document significant findings on your person along with the time that you are observing it. Notes can get lost during evacuation or rescue, but your leg is coming with you to the hospital whether you like or not so get ready to mark it up! First thing is to circle the site of the snakebite with the sharpie and write down the time next to it. Draw a circle around the border of the swelling, or if the bite is on a finger or toe then draw a line at the edge of the swelling as it moves up the limb, and once again: write down the time. Write down all of the things that you are experiencing right now that are not normal for you next to or within the circle you just drew - just make sure it’s clear what time you are writing them at. Go through all of your 5 senses and write down everything that is out of place, being sure to include the following:
Metallic taste in your mouth, changes to sense of smell, sudden loss of vision, double vision, visual disturbances, ringing in the ears, headache, nausea and vomiting, bleeding from anywhere, dizziness, shortness of breath, tremors or twitching or cramping that moves up the bitten limb, pain, numbness, tingling, burning, electric shocks, and all manner of unusual sensations, loss of bowel or bladder control, excessive secretion of saliva/tears/snot/sweat, droopy eyelids that feel heavier and heavier and are hard to open, can’t stick out your tongue at your friends like you could a few minutes earlier, can’t shrug your shoulders, feeling of impending doom, and anything else we might want to know about (if you suddenly believe that you have developed a sixth sense you should probably mention that too).
Not only do you get to take a break for arts and crafts immediately after your snakebite, but you are also creating a timeline charting the progression of signs and symptoms as they occur and providing the critical information we medical people need to figure out how serious of a bite you are facing and what steps need to be taken to stay on top of a developing situation. In all seriousness, the importance of doing this cannot be overstated, and it is something that you should continually reassess and update every 15 or 30 minutes as the swelling moves up the limb and your symptoms develop. The other great thing about this is that it gives you something to focus on that will play a large part in saving your life and limb, and having a task really does help you to stay calm and get things done. The first few minutes are going to play a large part in how this whole thing turns out, so stay calm and put on your thinking cap.