Canyoneering First Aid (Round One)

[rockgremlin]

Ok, the following scenario has ALMOST happened to several folks on this forum in the recent past. Let's play devil's advocate and say that it actually does happen.


You and two other physically fit guys are hiking down Not Mindbender in mid-June. You are approaching the final rappel, when suddenly a member of your party accidently steps on a rattlesnake, which whips around and bites him just above the ankle.


NOW WHAT?!


Please take this seriously...this COULD happen to any one of us, and who knows...maybe the discussion here could save a life.

[Iceaxe]

Since we are at the final rappel..... I would get the victim down the final rappel to a nice. cool, shady place. This also leaves a place to land a chopper nearby. I'd leave someone with the victim and have someone go for help.

Or.....

If I was with Red Bonez I'd just pull the rip-chord on his new super cool persoanal survival beacon and wait for SAR to show up with cold beer.

No matter what I'd try to get the victim to a place where you could land a chopper if required.

Some of this matters who I am with and who is bitten. To some folks a trip out of Not is just a simple stroll in the park, for others it's a major undertaking.

[Alex]

Ice is referring to this device:



I am buying one this weekend

[rockgremlin]

Interesting opinions on this issue and it seems they change their minds every year. I would tend to lean towards Ice's advice.

The BSA still recommends sucking the venom out of the wound. On their website it describes a special device for doing this (instead of your mouth).

[accadacca]

The BSA still recommends sucking the venom out of the wound. On their website it describes a special device for doing this (instead of your mouth).

I was waiting for this to be mentioned. That is what I learned in scouts and you know, I am a falcon or eagle, something rather.

[Jaxx]

I carry a little snake bite kit. So I would get as much venom out as possible and then do Ice's idea.

[mtreker]

First tie a piece of webbing two to four inches above the bite, to help slow the venom. Get the person down the last rap. Once down keep the ankle below the heart. Then send someone for help. If you're smart you have a first ad kit with a snake bit kit. Keep the person cool and comfortable tell help arrives. If you don't have a snake bit kit you can use a water bottle. Just squeeze the bottle and put if over the bite and let go. Doesn't do as good of job but it just might slow the venom down tell help arrives. then after there all better you laugh at them and make fun of them every time you go canyoneering with them.

[Iceaxe]

here is more info:

SPOT Satellite Messenger

My mom told me she would pay for the thing if I'd wear it... ain't mom's wonderful.

[trackrunner]

I carry a little snake bite kit. So I would get as much venom out as possible and then do Ice's idea.

I would apply a tourniquet first, keep bite as low as possible gravity wise, move to a better place, go for help, wait for chopper, and while waiting then pull out the snake bit kit. I've been told by a doctor that deals in venom bites that if you are close to medical help it is better to go towards the help then suck out the venom. Example if you were bit hiking along the Wasatch Front it would be better to go to the hospital receiving treatment then in comparable time waste 30 minutes to suck out the venom.

[accadacca]

Don't suck out the venom? Pay for the chopper?

[trackrunner]

Don't suck out the venom? Pay for the chopper?

You'll still need medical attention and you most likely not are able to suck all the venom out. Why not get there sooner? I say you should be trying to get medical help ASAP that is why move to a safer/better location first. But if you could suck out the venom waiting for medical help to arrive even better.

Of course I never thought about it, if you

[Iceaxe]

Something to hope for.... 25% of all Rattlesnake bits are dry strikes (no venom injected).

[shaggy125]

You'll still need medical attention and you most likely not are able to suck all the venom out. Why not get there sooner? I say you should be trying to get medical help ASAP that is why move to a safer/better location first. But if you could suck out the venom waiting for medical help to arrive even better.

Makes sense, just like if an adult has a heart attack, what is going to save their life is a defibrillator (their heart is fibrillating at such a fast rate, no blood is being pumped, they need to be shocked to put them back into a normal rhythm) Don't even start CPR until you have called for help, every second wasted is a second longer you wait for the defibrillator to arrive. Even the most effective CPR in the world where you are busting ribs left and right will only pump something like 25% of what the heart can do on its own, plus mouth to mouth only gives about 15% oxygen compared to 21% in air, and 100% given through bag and mask by the paramedics. I'm sure the same goes for venom, getting them the anti-venom is what will save them, sucking venom out will slow things down but getting to a hospital or getting anti-venom to them is number 1 priority.

[Brian in SLC]

This is kinda it in a nutshell (from emedicine or some such site):

************
Prehospital Care

Do nothing to injure the patient or impede travel to the ED.

Support the airway, breathing, and circulation per advanced cardiac life support (ACLS) protocol with oxygen, monitors, large-bore intravenous lines, and fluid challenge. Minimize activity (if possible), remove jewelry or tight-fitting clothes in anticipation of swelling, and transport the patient to the ED as quickly and as safely as possible. Every 15 minutes, use a pen to mark and time the border of advancing edema.

In recent studies, no benefit was demonstrated when a negative pressure venom extraction device (eg, The Extractor from Sawyer Products) was evaluated; additional injury can result. Incision across fang marks is not recommended. Mouth suction is contraindicated.

Lymphatic constriction bands and pressure immobilization techniques may inhibit the spread of venom, but whether they improve outcome is not clear. These techniques may actually be deleterious for pit viper envenomation if they increase local necrosis or compartment pressure.

Tourniquets are not recommended.

Maintain the limb in a neutral position.

First aid that lacks therapeutic value or is potentially more harmful than the snakebite includes electric shock, alcohol, stimulants, aspirin, ice application, and various folk and herbal remedies.

Cost and risk of acute adverse reactions generally preclude field use of antivenom.

Attempts to capture or kill the snake are not recommended because of the risk of additional injury.

In the United States, all pit viper (rattlesnake, pygmy rattlesnake, and moccasin) envenomations are treated similarly, based on the severity of presenting signs and symptoms. Therefore, if the patient shows signs of envenomation (eg, pain, swelling), then species identification is not necessary. The exception to this rule is Mohave rattlesnakes, whose neurotoxic venom requires special consideration. However, because there is little overlap between the natural range of Mohave rattlesnakes and that of the moccasins (except for the Trans-Pecos region of Texas), this is rarely a clinical dilemma.

If the venomousness of a particular snake is uncertain, consider taking photographs of the snake from a safe distance of at least 6 feet away using a digital or Polaroid camera.
******************

This has been discussed a bunch over the 'net in recent years. I believe EMT's WEMT's, WFR, NOLS, all are NOT recommending the use of a Sawyer Extractor. There has been a ton of research on the effectiveness of the extractor to remove venom and it just isn't. Neither is cutting and sucking (highly not recommended). You can surf a bunch of medical journals as there's been a ton of reasearch on this. The consensus is that extractors don't work. Getting to a hospital and getting anti-venom is really the ultimate treatment.

I had a reasonably close call in Arizona (Cochise Stronghold, base of the climb, "What's My Line") with a fairly rare type of rattle snake which had been showing up with a touch of neurotoxic type venom. Flip side is, that its a fairly docile snake, which, had is been a western diamondbake, probably would have bit me. We went to the Sonoran Desert Museum in Tucson afterwards, and saw the rattle snake demonstation there, and I asked specifically about protocol for snake bite in remote areas. Was the same as posted above. Even asked the snake handler, "what if YOU got bit, what would you do". Well, he had been bit, and, tryed to stay calm and got to a ER where he got anti-venom treatment. No suckin'. Doesn't work.

Anyhoo, some folks will do what they think is reasonable and carry an extractor anyhow. Hey, if that makes you more calm, then, what the heck. Probably better than stressin' out a bunch over it.

-Brian in SLC

[Iceaxe]

My big dilemma has always been.

1. Sit tight and wait/send for help?

2. Walk out and get help ASAP?

At what point do you draw the line?

[trackrunner]

You'll still need medical attention and you most likely not are able to suck all the venom out. Why not get there sooner? I say you should be trying to get medical help ASAP that is why move to a safer/better location first. But if you could suck out the venom waiting for medical help to arrive even better.

Makes sense, just like if an adult has a heart attack, what is going to save their life is a defibrillator (their heart is fibrillating at such a fast rate, no blood is being pumped, they need to be shocked to put them back into a normal rhythm) Don't even start CPR until you have called for help, every second wasted is a second longer you wait for the defibrillator to arrive. Even the most effective CPR in the world where you are busting ribs left and right will only pump something like 25% of what the heart can do on its own, plus mouth to mouth only gives about 15% oxygen compared to 21% in air, and 100% given through bag and mask by the paramedics. I'm sure the same goes for venom, getting them the anti-venom is what will save them, sucking venom out will slow things down but getting to a hospital or getting anti-venom to them is number 1 priority.

Clearly you did not read my ealier post about team work. If you can do both, move to get medical and extract venom, better. That was what I was trying to explain. Brian's advice was the best, even better than mine.

The chance of death from venom (from most snakes in this country) can take hours to set in, a patient can make it to the hospital and live. The chance of death from a heart attack doesn't take hours, it's right now. You can't even compare the two.

I would apply a tourniquet first, keep bite as low as possible gravity wise, move to a better place, go for help, wait for chopper, and while waiting then pull out the snake bit kit. I've been told by a doctor that deals in venom bites that if you are close to medical help it is better to go towards the help then suck out the venom. Example if you were bit hiking along the Wasatch Front it would be better to go to the hospital receiving treatment then in comparable time waste 30 minutes to suck out the venom.

[trackrunner]

My big dilemma has always been.

1. Sit tight and wait/send for help?

2. Walk out and get help ASAP?

At what point do you draw the line?

For me if I was alone, I'd go for help ASAP.

[Brian in SLC]

My big dilemma has always been.
1. Sit tight and wait/send for help?
2. Walk out and get help ASAP?

Probably depends on a bunch of things. Solo? That'd be easy.

Party of two? Depends on the terrain and how far out the hike was, but, I'd probably want to keep an eye on my partner so walking out would have to do. Until they couldn't safely.

Party of three? Easier to send one person out for help (depending on the terrain), while the other stands by to do the ABC thing if needed.

If it were me, I'd probably opt to hike out but would depend on how bad the swelling was, and where the bit was located. For most of us, will probably be in a foot, which, makes the hiking out thing tougher.

Was running a trail in, of all places, New Jersey. Near the Delaware Water Gap. Almost dark, coming down off the summit, on a good trail, and I'm joggin' along when I see movement. Managed to bunny hop a HUGE copperhead right in the dead center of the trail. Biggest one I've ever seen, alive or dead, in the wild or a zoo. And, the bugger was aggresive. Struck at me a bunch of times. Of course, initially, I probably jumped 30 or 40 feet in the air so no problemo. Went back and got some good pictures of it. Angry bugger. Anyhoo, what went through my mind then was that I'd have to walk or jog out. Then, drive or call 911 and meet wherever.

-Brian in SLC

[shaggy125]

Clearly you did not read my ealier post about team work. If you can do both, move to get medical and extract venom, better. That was what I was trying to explain. Brian's advice was the best, even better than mine.

Yea and I was agreeing with you, I was basically saying you have a good point trackrunner, not saying you where wrong? The CPR thing was an analogy not a comparison, maybe it was a bad one (maybe I just suck at typing on this Internet thing). Brian's is sound advise and lets all just love each other and get along

[trackrunner]

Clearly you did not read my ealier post about team work. If you can do both, move to get medical and extract venom, better. That was what I was trying to explain. Brian's advice was the best, even better than mine.

Yea and I was agreeing with you, I was basically saying you have a good point trackrunner, not saying you where wrong? The CPR thing was an analogy not a comparison, maybe it was a bad one (maybe I just suck at typing on this Internet thing). Brian's is sound advise and lets all just love each other and get along

When I first read your post I thought you wrote "do not even do CPR, it would be a waste of time." Afterwards I went back and read that you said "call for help first then CPR." BIG difference. My bad. Misreading only a few words completely changes the meaning. Boy I feel stupid now.