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Wheels
AH ambassador
Tragic news. Thoughts and prayers for the family.
Regarding antivenom, a hospital administrator in rural Tanzania told me about five years ago that antivenom costs about $6,000, has a short shelf life and must be kept refrigerated. Two different kinds must be kept, one for hemotoxic and one for neurotoxic bites. Most African countries have poor electrical service in rural areas so a backup generator is needed. Most antivenom is thrown away due to the shelf life or due to loss of refrigeration. Money is always short and antivenom isn't the best use of funds.
This doesn't make the loss of a family member or friend any easier. Just wanted to explain my understanding of the situation surrounding antivenom. Especially in rural areas.
Regarding antivenom, a hospital administrator in rural Tanzania told me about five years ago that antivenom costs about $6,000, has a short shelf life and must be kept refrigerated. Two different kinds must be kept, one for hemotoxic and one for neurotoxic bites. Most African countries have poor electrical service in rural areas so a backup generator is needed. Most antivenom is thrown away due to the shelf life or due to loss of refrigeration. Money is always short and antivenom isn't the best use of funds.
This doesn't make the loss of a family member or friend any easier. Just wanted to explain my understanding of the situation surrounding antivenom. Especially in rural areas.
Last edited:
Randy Bo
AH veteran
Typical African thing. Expired anti-venom which they apparently would not give him. Called a medivac for Beira, and it took too long to get him there.
Randy Bo
AH veteran
If this had been a client with @Global Rescue do you guys think it would have been handled differently?
YancyW
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I believe now they have a single dose that covers both types. That wouldn't elevate the other issues though.
rinehart0050
AH legend
Very sad to hear. Condolences to you for the loss of a friend and to his family.
Zambezi
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South African Vaccine Producers (SAVP) manufacture three types of antivenoms.
Polyvalent: as the name suggests it is effective across a variety of snakes venoms (both cyto and neuro toxic).
Monovalent: Specific to the Boomslang
Monovalent: Specific to the Saw Scale Viper
Refrigeration is required and it is expensive. I think the shelf life is around 1-3 years and it costs around $700 a vial last I heard. For a severe envenomation it can take 10-15 vials for effective treatment. For a hospital to store sufficient and "in date" AV is a very costly exercise. It is usually the bigger hospitals that SOMETIMES store the AV and it is flown to where needed in the smaller admitting hospital.
It is only administered in hospitals due to some patients experiencing severe adverse reactions/anaphylactic shock and they then require high medical care.
It is a pity that it is sooo expensive'
Polyvalent: as the name suggests it is effective across a variety of snakes venoms (both cyto and neuro toxic).
Monovalent: Specific to the Boomslang
Monovalent: Specific to the Saw Scale Viper
Refrigeration is required and it is expensive. I think the shelf life is around 1-3 years and it costs around $700 a vial last I heard. For a severe envenomation it can take 10-15 vials for effective treatment. For a hospital to store sufficient and "in date" AV is a very costly exercise. It is usually the bigger hospitals that SOMETIMES store the AV and it is flown to where needed in the smaller admitting hospital.
It is only administered in hospitals due to some patients experiencing severe adverse reactions/anaphylactic shock and they then require high medical care.
It is a pity that it is sooo expensive'
Desperatezulu
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I hope I am allowed to do this - post below from Dr Willie Barnard, a very knowledgeable medical doctor when it comes to snakebites in SA!!
Post from another forum
_____________________________________________________________
I had an interesting case of mamba bite this past weekend.
I believe certain lessons can be learned by hunters, outdoorsmen and gunsiters in general.
The case:
58 year old farmer bitten on left ankle (twice), by what he described as "a 12 feet mamba". This happened at exactly 15h02 while he was alone in the bush, checking on the solar panels of a water pump. The grass was very dense and about knee height. The mamba slithered away.
At the time his farmhands were in the vicinity looking for cattle. He was about 10 km from the farmstead, cellphone reception patchy.
By sheer luck, he managed to get hold of a friend on the phone, told her about the incident, and asked her to call the ambulance.
He pressed the hooter of the bakkie, to summon the farmhands, one of whom knew how to drive. They eventually came, and they started off for the farmstead. From the farmstead the farmers wife took over the driving.
The victim felt anxious, and had an inability to swallow, and he felt short of breath. (Within minutes of the bite.)
About 50 minutes after the incident the victim was taken on board the ambulance on the tar road towards Lephalale. In the ambulance he was given medical oxygen, but was still able to breathe. An (ineffective) tourniquet (leather belt) was also applied.
At 17h00 - 2 hours after bite arrived at hospital where anti-allergic (prophylactic against antiserum allergy) was administered, followed by 2 ampules of polyvalent antivenom. All intravenous . Tourniquet was removed. 18h00 -doctor administered another 2 ampoules of antivenom slowly IVI.
18h30 allergic reaction to antivenom noted, and successfully treated with IVI adrenalin.
Patient extremely restless with dysarthria (inability to articulate words),
dysphagia (inability to swallow) and ptosis (drooping eyelids).
However he never needed artificial ventilation - managed an oxygen saturation of 96% on oxygen mask only.
The site of the bite where two pairs of puncture marks were clearly visible, was on the left ankle. There were blood drops on the socks that were penetrated by the fangs. The leg developed severe swelling and pain, similar to cytotoxic venoms such as Mozambique cobra.
Kept in hospital for three days and discharged on antibiotics.
(For the cellulitis of the leg.)
The questions: (often asked by hunters):
1-Which SA snakes are the most life-threatening?
2-How much antivenom must I keep in stock, and how should it be administered?
3-What is the place of a tourniquet in treatment of snake bite?
4-What other steps can the hunter practically take?
5-How long after a mamba bite before I die?
6-Where do we take the patient?
I do think this case study give some answers.
1 There is little doubt that the black mamba is the most life threatening of SA snakes. All snake bites are unique though. In this case, the single lifesaving factor was probably the sock that prevented a deep-penetrating full dose of venom.
2 I very seldom recommend hunters and farmers to keep the antivenom at home. The exception would be a hunting camp very remote : 6 hours + from hospital, and a hunter willing and able to get some training in the use of the different medications. (Not only antivenom, adrenalin as well.)
In this case the availability of antivenom at the farmstead would have had the following consequences: i) It would have robbed them of valuable evacuation time. ii) It would have increased the level of anxiety in everybody with inexperienced people trying to administer it. iii) It might have caused the allergic reaction before reaching the hospital.
3 The tourniquet's value is ONLY in the case of a life threatening bite (Mamba and maybe cape and snouted cobra), where the victim have no access to artificial ventilation and speedy evacuation, and makes a conscious decision to sacrifice a limb. Only a rubber tourniquet will do.
In this case the use of a leather belt was fortuitous, because it did not cut off the blood supply, and therefore serious complications was inadvertantly avoided. It also demonstrated the uselessness of non-rubber tourniquets.
4 A means of communication as a medical precaution is often overlooked, yet this probably saved this farmers life. (summoning the ambulance.)
The second most important precaution would be the availability of equipment and skills to provide artificial respiration. This can be as simple as a small one-way hygienic mask, or a full ambubag with mask. Oxygen cylinders are not necessary, very heavy, and expensive.
5 With a full blown mamba bite, this patient would probably have full respiratory paralysis 30 minutes after the bite, and be dead 5 minutes later. (Untreated) With an ambubag, and a skilled user at the farmstead, death could be avoided.
6 Where you take the patient, depends on the facilities in your area. But find out, and have your plans in place long before the incident.
PRACTICAL WAYS TO AVOID DEATH BY SNAKE BITE:
1 Try to avoid being bitten.
2 Dont hunt alone, groups of three are preferrable: No1 to be victim, No2 to be first-aider, no3 to be driver. As you cannot choose No1, everyone should be able to use ambubag, and to drive.
3. If you hunt alone, carry a rubber tourniquet, and be mentally prepared to use it and know the consequences. (That is the price you pay for the euphoria of hunting alone.)
4. Have a means of communication at hand.
5. Have an evacuation plan and destination planned.
I hope this post could maybe help some hunters out there.
---------------------------------------------------------------------------
Post from another forum
_____________________________________________________________
I had an interesting case of mamba bite this past weekend.
I believe certain lessons can be learned by hunters, outdoorsmen and gunsiters in general.
The case:
58 year old farmer bitten on left ankle (twice), by what he described as "a 12 feet mamba". This happened at exactly 15h02 while he was alone in the bush, checking on the solar panels of a water pump. The grass was very dense and about knee height. The mamba slithered away.
At the time his farmhands were in the vicinity looking for cattle. He was about 10 km from the farmstead, cellphone reception patchy.
By sheer luck, he managed to get hold of a friend on the phone, told her about the incident, and asked her to call the ambulance.
He pressed the hooter of the bakkie, to summon the farmhands, one of whom knew how to drive. They eventually came, and they started off for the farmstead. From the farmstead the farmers wife took over the driving.
The victim felt anxious, and had an inability to swallow, and he felt short of breath. (Within minutes of the bite.)
About 50 minutes after the incident the victim was taken on board the ambulance on the tar road towards Lephalale. In the ambulance he was given medical oxygen, but was still able to breathe. An (ineffective) tourniquet (leather belt) was also applied.
At 17h00 - 2 hours after bite arrived at hospital where anti-allergic (prophylactic against antiserum allergy) was administered, followed by 2 ampules of polyvalent antivenom. All intravenous . Tourniquet was removed. 18h00 -doctor administered another 2 ampoules of antivenom slowly IVI.
18h30 allergic reaction to antivenom noted, and successfully treated with IVI adrenalin.
Patient extremely restless with dysarthria (inability to articulate words),
dysphagia (inability to swallow) and ptosis (drooping eyelids).
However he never needed artificial ventilation - managed an oxygen saturation of 96% on oxygen mask only.
The site of the bite where two pairs of puncture marks were clearly visible, was on the left ankle. There were blood drops on the socks that were penetrated by the fangs. The leg developed severe swelling and pain, similar to cytotoxic venoms such as Mozambique cobra.
Kept in hospital for three days and discharged on antibiotics.
(For the cellulitis of the leg.)
The questions: (often asked by hunters):
1-Which SA snakes are the most life-threatening?
2-How much antivenom must I keep in stock, and how should it be administered?
3-What is the place of a tourniquet in treatment of snake bite?
4-What other steps can the hunter practically take?
5-How long after a mamba bite before I die?
6-Where do we take the patient?
I do think this case study give some answers.
1 There is little doubt that the black mamba is the most life threatening of SA snakes. All snake bites are unique though. In this case, the single lifesaving factor was probably the sock that prevented a deep-penetrating full dose of venom.
2 I very seldom recommend hunters and farmers to keep the antivenom at home. The exception would be a hunting camp very remote : 6 hours + from hospital, and a hunter willing and able to get some training in the use of the different medications. (Not only antivenom, adrenalin as well.)
In this case the availability of antivenom at the farmstead would have had the following consequences: i) It would have robbed them of valuable evacuation time. ii) It would have increased the level of anxiety in everybody with inexperienced people trying to administer it. iii) It might have caused the allergic reaction before reaching the hospital.
3 The tourniquet's value is ONLY in the case of a life threatening bite (Mamba and maybe cape and snouted cobra), where the victim have no access to artificial ventilation and speedy evacuation, and makes a conscious decision to sacrifice a limb. Only a rubber tourniquet will do.
In this case the use of a leather belt was fortuitous, because it did not cut off the blood supply, and therefore serious complications was inadvertantly avoided. It also demonstrated the uselessness of non-rubber tourniquets.
4 A means of communication as a medical precaution is often overlooked, yet this probably saved this farmers life. (summoning the ambulance.)
The second most important precaution would be the availability of equipment and skills to provide artificial respiration. This can be as simple as a small one-way hygienic mask, or a full ambubag with mask. Oxygen cylinders are not necessary, very heavy, and expensive.
5 With a full blown mamba bite, this patient would probably have full respiratory paralysis 30 minutes after the bite, and be dead 5 minutes later. (Untreated) With an ambubag, and a skilled user at the farmstead, death could be avoided.
6 Where you take the patient, depends on the facilities in your area. But find out, and have your plans in place long before the incident.
PRACTICAL WAYS TO AVOID DEATH BY SNAKE BITE:
1 Try to avoid being bitten.
2 Dont hunt alone, groups of three are preferrable: No1 to be victim, No2 to be first-aider, no3 to be driver. As you cannot choose No1, everyone should be able to use ambubag, and to drive.
3. If you hunt alone, carry a rubber tourniquet, and be mentally prepared to use it and know the consequences. (That is the price you pay for the euphoria of hunting alone.)
4. Have a means of communication at hand.
5. Have an evacuation plan and destination planned.
I hope this post could maybe help some hunters out there.
---------------------------------------------------------------------------
Last edited by a moderator:
Zambezi
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Agree with most of the above with the exception of the tourniquet. They generally cause more harm than good as and make matters worse in the case of a cytotoxic bite. Plus there is the risk of loss of limb.
Apply a pressure bandage/wad to the bite site and a pressure bandage to the limb starting from the bite site working upwards. The pressure should be the same as if you're strapping a sprained ankle etc. There should still be good capillary refill at the fingers/toes.
Apply a pressure bandage/wad to the bite site and a pressure bandage to the limb starting from the bite site working upwards. The pressure should be the same as if you're strapping a sprained ankle etc. There should still be good capillary refill at the fingers/toes.
Zambezi
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If you are in any snake environment DOWNLOAD THE ASI (African Snakebite Institute) APP ON YOUR PHONE!
Do it NOW!
Do it NOW!
Randy Bo
AH veteran
Scott CWO
AH legend
Must not be available in the USA. Couldn’t find it on AppStore
Scott CWO
AH legend
Wow, what a tragedy. Sorry to hear this and it affects so many people that were close to him. Prayers sent.
Hunt anything
AH legend
If I remember my training on snake bites, if you apply a tourniquet to a cytotoxic bite you concentrate the venom and with that type of venom you will loose flesh right down to the bone, it’s basically digested right before your eyes. If a tuniquet is applied you will most likely loose the limb but that beets the alternative. You see a lot of this deteriation with many of our North American rattlesnakes.
Wheels
AH ambassador
I can remember when hospitals in Wichita Kansas would ship their expiring/expired drugs that still had efficacy, to Tanzania and the drugs would save hundreds if not thousands of lives.
Now in Tanzania, a medical professional may or will be arrested for administering a drug that is one day out of date. The government has put fear into the medical community to the point that a drug won't be administered even if it would do no harm. ie: aspirin. The doctor's decision making has been taken from him.
I wouldn't be surprised if Mozambique doesn't have similar rules/laws. It's unfortunate that your friend wasn't afforded "Right to Try", if the dated anti-venom was available.
WAB
AH ambassador
I got a full dose from a very large copperhead. It feels like someone has injected fire into your veins. This poor man had a very painful end.
Novice Huntress
AH veteran
Terrible news, yet again another PH losses his life while out in the hunting field! Obviously condolences to his family and prayers for them and friends
RIP Sebastian
Let's hope there is some support for the young family at this very difficult time.
RIP Sebastian
Let's hope there is some support for the young family at this very difficult time.
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Nick BOWKER HUNTING SOUTH AFRICA wrote on EGS-HQ's profile.
Hi EGS
I read your thread with interest. Would you mind sending me that PDF? May I put it on my website?
Rob
I read your thread with interest. Would you mind sending me that PDF? May I put it on my website?
Rob
