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One great fear for travelers in tropical or semi-tropical climates is a venomous snake bite. Though relatively rare, venomous snake bites do account for about 40,000 deaths worldwide, many of them in rural areas of underdeveloped countries. Pit vipers are the source of many bites but most have low death rates. Although all snake bites are potentially dangerous, highly venomous snakes require urgent and specific attention. I was contacted to assist with just such a snake bite right before Christmas.
A small group of adventurers in southern Colombia were on an expedition along the Amazon River when two of them ventured up a rocky hill to observe primitive rock art. Rapeling on the way down, one lost his balance and reached out to catch his balance. Unfortunately, a snake struck his hand when he grabbed a ledge. The local guide with them was able to identify the snake as a fer-de-lance (Bothrops atrox), one of the most venomous snakes in the Americas.
The key to survival is rapid treatment with the specific antivenin, care of the wound, and managing toxin effects. The problem is access to the antivenin. This group was 150 km east of where I was in the Amazon recently (see Visit The Enchanted Forest on this site) in very dense rainforest with no settlements and no place to land aircraft. Communication is very poor due to the thick canopy and the only transportation is slow on the rivers. Compounding this situation was the fact that the group had not purchased evacuation coverage as recommended. Oh, and the area was heavily infested and controlled by narco traffickers.
My close friend who had called me determined that a helicopter evacuation would cost over $50,000 which they did not have. He contacted the ambassador of the victim’s country of origin and together they contacted the Colombian military. I determined where the antivenin could be obtained and contacted top physicians to alert them and provide assistance. Fortunately, the military decided to use this as an extraction exercise. They were very concerned about being fired upon so a rapid extraction protocol was initiated. After a 3 hour flight to the site and 3 hours of searching, they were about to turn back but took one more sweep and found the party on the river. The rather harrowing transfer to the helicopter was successful and the patient was admitted to the military hospital in Bogota in relatively good condition. But had they not contacted my connected friend, they would have been stuck in the jungle without help. Truly up a creek, with a paddle maybe, but a long way from help.
This story has a happy ending. He is lucky to be alive and likely sustained a partial bite or else a dry bite, one where the snake has recently discharged its venom with little or no residual at the time of the bite. No one knows that at the time. I was able to advise them what to do on the ground (keep the arm even with the heart, do not bite or suck the wound or use a snakebite kit, remove all jewelry from the affected extremity, give pain medication, and no tourniquets) but the key is immediate evacuation and use of antivenin. The longer he survived after 12 hours, the better his chances of overall survival. Fortunately, he had few side effects from the venom which interrupts coagulation and destroys red blood cells.
Stay tuned for a column on the need for medical evacuation coverage. Please see my book Lizard Bites & Street Riots for more information on snake bites and medical evacuation.
Michael J. Manyak, MD
VP National Eagle Scout Association
Author, Lizard Bites and Street Riots, Travel Emergencies and Your Health, Safety, and Security
Twitter: @LizardBites
January 7, 2016
