As many as 10,000 people in India die every year of snakebites. That is more people than the tsunami could ever wipe out. Yet
there is not enough research in this field.
For doctors therefore, the Do it Right campaign, which has been
implemented in Rajasthan, West Bengal, Madhya Pradesh and Andhra Pradesh and soon to be launched in Tamil Nadu, is
One of the world's leading herpetologists, Dr. Ian Simpson, who is also on the Tamil Nadu Snake-bite
Task Force Council
and snake advisor to the Pakistan Medical Research, was also instrumental in designing the national
protocol, which is a step-by-step guide approved by the Government of India to treating snakebites.
Dr. Ian Simpson
has been working from Kerala and has been associated with the Little Flower Hospital, SRM Hospital and Bombay Natural History
Society in his research. His research papers have been published in the Transactions of the Royal Society of Tropical
Medicine, Wilderness and Environmental Medicine and Journal of the Indian Medical Association. Medindia
up with Dr. Ian Simpson recently. Here are some excerpts from the interview: What is the objective of the 'Do it
The Do it R.I.G.H.T. campaign is based on giving the best first aid advice to victims so that
they can get to hospital in the best possible shape. Traditional methods such as tying a tight tourniquet and cutting and
sucking the wound have been shown to be ineffective and dangerous. Tourniquets carry the risk of increasing local tissue
damage either on their own or by increasing the necrotic damage caused by the snake venom. Viper bites lowers the blood
clotting potential. Cutting the victim creates a further risk of severe bleeding, as the victim's blood is no longer able to
clot. In addition, suction, either by mouth or using the so -called 'venom extraction devices' has been shown to be
ineffective. Could you elaborate?
The Do it Right method stresses the need to - R-
the patient. 70% of snakebites come from non-venomous species. Of the remaining 30%, which are from venomous
species, half will not inject venom and are called 'dry bites'. The victim is not at risk. . This is why traditional
treatments appear to work. What this does, however, is to delay the victims who have been envenomed from reaching the
hospital. I- Immobilise
the affected limb in the same way as a fracture. Do not tie tight bandages; simply
stop the limb from moving as movement helps venom spread. GH - Get to hospital
fast. If there is nothing wrong
with you then you will be discharged after observation. If you have been envenomed, then the doctor will administer anti-
venom. A groundbreaking study just carried out in West Bengal shows that victims who do not survive are those that come late
to the hospital. Getting to hospital quickly will save the victim's life! T - Tell the doctor
of any signs
that develop on the way to the hospital such as, drooping eyelids, double vision, tasting blood in the mouth or unusual
bruising, as these all help the doctor to diagnose if the victim needs anti venom. Can u tell us of the ill
effects of tying a bandage, cutting the bite area with a knife or tying a tourniquet?
Another method of first aid
that has been recommended is the Pressure Immobilisation Method
(PIM), developed in Australia. This involves tying a
bandage in the same way as for a sprain. The idea is that the bandage and splint slow the venom moving through the lymphatic
system. However, there are major problems with this approach.
The experimental basis on which it was based was not
convincing. Further research showed that it had to be tied in a narrow range of pressure depending on whether the limb was an
upper or lower one. In addition, even if tied correctly, if the victim walked for more than 10 minutes the bandage would not
work. Prof Bob Norris carried out a great study showing that in a simulated snakebite only 13% of emergency trained doctors
could tie it correctly. This technique needs more research before being put to use. What about identification of
the dead snake, which has bitten the patient?
Most people bring a dead snake to the hospital and the doctor's
definitely not a herpetologist.
In actual fact only a small number of patients bring the dead snake. It is useful if
the doctor can see the snake but generally the snake escapes. The important point is that the doctor will use the right
symptoms to administer ASV (Anti-Snake Venom).
A great deal of ASV is wasted because doctors use criteria from
Western textbooks that are not suitable for Indian conditions.
In India the criteria for giving ASV are -
Incoagulable blood measured by a 20 minute whole blood clotting test taken in a NEW CLEAN GLASS DRY test tube. (Old or washed
bottles, plastic syringes and capilliary tubes do not give reliable readings)
2. Visible neurological signs, such as
3. Severe current swelling i.e. swelling that crosses a joint or involves half the bitten limb.
Simply local swelling at or around the bite site is not grounds for ASV administration. What are the do's and
don't for doctors if he cannot identify the snake?
The victim should be kept under observation for 24 hours to
see if any of the conditions for giving ASV arise, if not the victim can be discharged with a tetanus shot. If the criteria
for giving ASV arise then the treatment should commence. Most people react strongly to the anti-venom. So can
administration of ASV be avoided?
The only defence to venom is ASV. But doctors must know when one needs to
administer ASV. On an average 70% of bites are from non-venomous species, such as rat snakes and keelbacks. Of the remaining
30%, which are from venomous species only around 50% inject venom into the victim. The remainder are called dry bites, where
the snake bites but does not envenomate the victim. In these cases no ASV is required. Most often general
physicians take care of snake bites, how can these doctors equip themselves to deal with a snake bite more efficiently?
Doctors can best equip themselves by using the new protocol to treat snakebite. There are a number of states such as
West Bengal and Rajasthan that have adopted it. The Government has approved of the national protocol, which will be launched
Basic drugs such as anti-venom are the key, but equipments like resuscitation bags and rubber endotracheal
tubes (size 5) also help. These can be cut to size and inserted into the victim's nasal passages before transfer in cases of
neurotoxic bites. Drugs such as neostigmine and atropine
to help in neurotoxic bites and drugs such as
handle adverse reactions to ASV (anti-snake venom).