Snakebite first aid in India

Call for help

Call the toll-free ambulance number 108; India’s guideline also lists 102^1,2. The single emergency number 112 reaches ambulance, fire and police³. Take the bitten person straight to the nearest health facility where anti-snake venom (ASV) is available, as quickly, safely and passively as possible¹. If no ambulance can come, the guideline accepts a boat, bicycle, motorbike or stretcher; on a motorbike, a third person must sit behind the bitten person¹. The bitten person must not run, or drive themselves¹.

While you wait

These are the first-aid steps in India’s national guideline¹:

• Reassure the person: around 70% of snakebites are from non-venomous snakes¹.
• Look for signs of a bite, such as fang marks, bleeding or swelling. A krait bite may leave no visible mark¹.
• Keep the bitten limb still, as you would a broken one: use a splint along its whole length so that every joint is held still. Any rigid object will do, such as a piece of wood, a branch, a spade or rolled-up newspaper. Do not block the blood supply or apply pressure¹.
• Lay the person on their left side in the recovery position, with the airway protected in case they vomit¹.
• Give nothing by mouth until the person reaches a health facility¹.
• Remove shoes, rings, watches, jewellery and tight clothing from the bitten area, because they can act like a tourniquet when it swells¹.
• Leave any blisters alone¹.
• Watch for new symptoms on the way, such as spreading swelling or drooping eyelids, and tell the doctor¹.

What not to do

• Do not tie a tourniquet: it can cause gangrene of the limb¹. If one is already tied, WHO advises leaving it until the person is in hospital, with staff, resuscitation equipment and antivenom treatment under way².
• Do not wash, cut, suck, rub, tattoo, massage, burn or chill the bite, or put herbs or chemicals on it. These can cause infection, increase venom absorption and increase bleeding¹.
• Do not use black stones, scarification or herbal treatments. Traditional remedies have no proven benefit and delay treatment¹.
• Do not try to kill or catch the snake¹.
• Do not put anti-snake venom on or into the bite¹.
• Do not try a pressure bandage yourself. The guideline allows a crepe bandage over the bite and the whole limb only when trained medical staff are present and the trip to hospital will take between 30 minutes and 3 hours¹.

How this differs from the general advice

India’s guideline differs from the general first-aid page in two places. The general page, following WHO, says paracetamol may be given for pain⁴, but India’s guideline says to give nothing by mouth until the person reaches a health facility¹. WHO’s South-East Asia guideline suggests a pressure pad over the bite unless a bite by an elapid snake, such as a cobra or krait, can be ruled out², while India’s guideline says not to apply pressure and leaves any bandaging to trained staff¹. This page follows the Indian guideline. It also says not to wash the bite, a point the general page does not cover¹.

In hospital

India’s guideline asks hospitals to admit everyone with a confirmed or suspected snakebite and observe them for 24 hours¹. Anti-snake venom is the only specific treatment, and doctors give a full dose as soon as there are signs of envenoming, without waiting for test results¹. India uses polyvalent antivenom, made against the venoms of the Indian cobra, common krait, Russell’s viper and saw-scaled viper². It contains no antibodies against sea snakes or green pit vipers, and hump-nosed viper envenoming does not respond to it^1,2.

Snakes that matter here

Four species, the “big four”, have long been treated as India’s most important, but other snakes matter in some regions². WHO places these in its highest category of medical importance in India²:

• Indian cobra, found throughout the country².
• Common krait, which is active at night and often bites people sleeping on the floor^1,2.
• Russell’s viper².
• Saw-scaled viper².
• Monocled cobra, in the east².
• Hump-nosed viper, on the south-west coast and in the Western Ghats².

The king cobra and the banded krait are also highly venomous, but WHO ranks them of secondary importance in India².