Snakebite first aid in Australia

Call for help

Call 000 and ask for an ambulance; if 000 does not work on your mobile phone, try 112⁵. Send for an ambulance for anyone with a suspected snake bite, and treat every bite as potentially life-threatening, even if the person seems well^2,5. The bite may be painless and leave no visible marks². Where possible, bring help to the person rather than moving them^1,3. For advice, call the Poisons Information Centre on 13 11 26^3,5.

While you wait

• Move away from the snake⁵.
• If the person is unresponsive and not breathing normally, start CPR. There is no risk of venom passing to the rescuer².
• Keep the person lying down, still, calm and under constant watch^2,4.
• Remove rings, bracelets and anything tight from the bitten limb before bandaging, in case it swells⁴.
• Apply a pressure immobilisation bandage and splint, as described below².
• Write down the time of the bite and when the bandage went on, and mark the bite site on the bandage with a pen^4,5.
• If the person becomes unconscious, lay them on their left side in the recovery position⁴.
• Stay with them until the ambulance arrives⁵.

Sudden collapse with cardiac arrest is the most common cause of death after an Australian snake bite, and it can happen within 10 to 60 minutes².

How to apply a pressure immobilisation bandage

These are the steps in ANZCOR Guideline 9.4.8¹:

1. As soon as possible, apply a broad pressure bandage over the bite. Elasticised bandages 10–15 cm wide are better than crepe bandages; if you have neither, use clothing or other material¹.
2. Make it firm and tight: you should not be able to slide a finger easily between the bandage and the skin^1,5. AVRU describes this as at least as firm as a bandage for a sprained ankle⁴.
3. Apply a second pressure bandage, starting at the fingers or toes of the bitten limb and covering as much of the limb as possible, over clothing if you can¹. AVRU advises leaving the fingertips or toes uncovered so that you can check the circulation⁴. A single bandage, started at the fingers or toes and taken up the limb over the bite, is an accepted alternative¹.
4. Splint the limb, including the joints on either side of the bite¹. For an arm, ANZCOR advises a sling¹; AVRU instead suggests strapping the splinted arm to the body, because bending the elbow into a sling can act like a tourniquet⁴. For a leg, AVRU suggests splinting both legs together⁴.
5. Keep the person and the limb completely still, and do not remove the bandages or splints until the person is in hospital¹.

If the bite is not on a limb, firm pressure over the bite may help, but do not restrict breathing and do not press firmly on the neck or head¹. If you are alone, bandage the limb as completely as you can and keep still until help arrives; if no one can come to you, apply local pressure and go for help¹.

What not to do

• Do not wash the bite: venom left on the skin and clothing can help identify the snake^1,5.
• Do not cut the bite or try to suck the venom out¹.
• Do not use an arterial tourniquet that cuts off blood flow¹.
• Do not try to catch or kill the snake, because of the risk of more bites; many Australian snakes are protected. A photo from a safe distance may help².
• Do not let the person walk or run⁴.
• Do not apply hot or cold packs or electric shocks, and do not give alcohol, tea, stimulants, food or medicines without medical advice⁴.
• Do not remove or loosen the bandage unless medical staff tell you to⁴.

Why Australia uses a pressure bandage

The pressure immobilisation technique was introduced for Australian snake bites, and ANZCOR recommends it for all Australian venomous snakes, including sea snakes¹. It slows the flow of lymph, which carries venom from the bite into the circulation¹. Research with snake venom has shown that very little venom reaches the bloodstream if firm pressure is applied over the bite and the limb is kept still³. The evidence comes from small animal studies and tracer studies in people; field studies have not shown a clear benefit, possibly because the bandage is often applied poorly¹. The Australian Snakebite Project found no strong evidence that it improves outcomes, but concluded that it remains a safe first aid approach⁶.

How this differs from the general advice

Pressure immobilisation is not the general advice for every country. WHO’s first aid, which the general first-aid page follows, says never to use a tight arterial tourniquet and recommends the Australian bandage method only for bites by snakes that paralyse without causing local swelling⁷. In the United States, emergency-medicine guidance does not recommend pressure immobilisation for rattlesnake and other pit viper bites⁸. A pressure bandage is not a tourniquet: ANZCOR says arterial tourniquets that cut off the circulation are dangerous and not recommended for any bite or sting in Australia¹. Australian guidance also says not to wash the bite^1,5, and AVRU advises giving no medicines without medical advice⁴, whereas WHO’s general advice allows paracetamol for pain⁷.

In hospital

Antivenom is available for all venomous snakes native to Australia, and it is given under medical supervision in a properly equipped hospital². About 5 in 100 people bitten by a snake are given antivenom; the type depends on the snake, the symptoms and where the bite happened, and doctors decide with a clinical toxicologist⁵. Australia has separate antivenoms for brown snakes, tiger snakes, black snakes, taipans, death adders and sea snakes, as well as a polyvalent one⁶. The usual dose for all the major snake groups has fallen to one vial⁶.

Snakes that matter here

Australian snakes capable of lethal bites include taipans, brown snakes, tiger snakes, death adders, black snakes, rough-scaled snakes and many sea snakes². In the Australian Snakebite Project (2005–2015), brown snakes caused 41% of envenomings where the snake was identified, tiger snakes 17% and red-bellied black snakes 16%; of 23 deaths, 17 were from brown snakes and four from tiger snakes⁶.

• Eastern brown snake: its range includes some of the most populated parts of the country, and it is probably met more often than any other snake¹⁰. WHO places it in its highest category of medical importance in Australia⁹.
• Tiger snake: tiger snakes caused the second-largest share of envenomings in the project⁶, and WHO also places this species in its highest category in Australia⁹.
• Red-bellied black snake: it caused 16% of identified envenomings, but none of the project’s deaths was attributed to it⁶.
• Taipans: the coastal taipan, found along the east coast and across the north¹¹, and the inland taipan are both of secondary medical importance in WHO’s list⁹.
• Common death adder: before antivenom, about 60% of death adder bites to people were fatal¹². WHO lists it as of secondary medical importance⁹.