First Aid and Emergency Information

1 Fundamental Criteria for First Aid
2 Basic Measures for First Aid
3 First Aid for Special Wounds
4 First Aid for Fractures
5 First Aid for Climatic Injuries
6 First Aid for Bites and Stings
7 First Aid in Toxic Environments
8 First Aid for Psychological Reactions

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Chapter 6 - First Aid for Bites and Stings

Introduction
Snakebites, insect bites, or stings can cause intense pain and/or swelling. If not treated promptly and correctly, they can cause serious illness or death. The severity of a snakebite depends upon: whether the snake is poisonous or nonpoisonous, the type of snake, the location of the bite, and the amount of venom injected. Bites from humans and other animals, such as dogs, cats, bats, raccoons, and rats can cause severe bruises and infection, and tears or lacerations of tissue. Awareness of the potential sources of injuries can reduce or prevent them from occurring. Knowledge and prompt application of first aid measures can lessen the severity of injuries from bites and stings and keep the soldier from becoming a serious casualty.

6-1. Types of Snakes
a. Nonpoisonous Snakes. There are approximately 130 different varieties of nonpoisonous snakes in the United States. They have oval-shaped heads and round eyes. Unlike poisonous snakes, discussed below, nonpoisonous snakes do not have fangs with which to inject venom. See Figure 6-1 for characteristics of a nonpoisonous snake.
Figure 6-1
b. Poisonous Snakes. Poisonous snakes are found throughout the world, primarily in tropical to moderate climates. Within the United States, there are four kinds: rattlesnakes, copperheads, water moccasins (cottonmouth), and coral snakes. Poisonous snakes in other parts of the world include sea snakes, the fer-de-lance, the bushmaster, and the tropical rattlesnake in tropical Central America; the Malayan pit viper in the tropical Far East; the cobra in Africa and Asia; the mamba (or black mamba) in Central and Southern Africa; and the krait in India and Southeast Asia. See Figure 6-2 for characteristics of a poisonous pit viper.
Figure 6-2
c. Pit Vipers (Poisonous). See Figure 6-3 for illustrations.
Figure 6-3
(1) Rattlesnakes, bushmasters, copperheads, fer-de-lance, Malayan pit vipers, and water moccasins (cottonmouth) are called pit vipers because of the small, deep pits between the nostrils and eyes on each side of the head (Figure 6-2). In addition to their long, hollow fangs, these snakes have other identifying features: thick bodies, slit-like pupils of the eyes, and flat, almost triangular-shaped heads. Color markings and other identifying characteristics, such as rattles or a noticeable white interior of the mouth (cottonmouth), also help distinguish these poisonous snakes. Further identification is provided by examining the bite pattern of the wound for signs of fang entry. Occasionally there will be only one fang mark, as in the case of a bite on a finger or toe where there is no room for both fangs, or when the snake has broken off a fang.
(2) The casualty’s condition provides the best information about the seriousness of the situation, or how much time has passed since the bite occurred. Pit viper bites are characterized by severe burning pain. Discoloration and swelling around the fang marks usually begins within 5 to 10 minutes after the bite. If only minimal swelling occurs within 30 minutes, the bite will almost certainly have been from a nonpoisonous snake or possibly from a poisonous snake which did not inject venom. The venom destroys blood cells, causing a general discoloration of the skin. This reaction is followed by blisters and
numbness in the affected area. Other signs which can occur are weakness, rapid pulse, nausea, shortness of breath, vomiting, and shock.
d. Corals, Cobras, Kraits, and Mambas. Corals, cobra, kraits, and mambas all belong to the same group even though they are found in different parts of the world. All four inject their venom through short, grooved fangs, leaving a characteristic bite pattern. See Figure 6-4 for illustration of a cobra snake.
Figure 6-4
(1) The small coral snake, found in the Southeastern United States, is brightly colored with bands of red, yellow (or almost white), and black completely encircling the body (Figure 6-5). Other nonpoisonous snakes have the same coloring, but on the coral snake found in the United States, the red ring always touches the yellow ring. To know the difference between a harmless snake and the coral snake found in the United States, remember the following
“Red on yellow will kill a fellow. Red on black, venom will lack.”
Figure 6-5
(2) The venom of corals, cobras, kraits, and mambas produces symptoms different from those of pit vipers. Because there is only minimal pain and swelling, many people believe that the bite is not serious. Delayed reactions in the nervous system normally occur between 1 to 7 hours after the bite. Symptoms include blurred vision, drooping eyelids, slurred speech, drowsiness, and increased salivation and sweating. Nausea, vomiting, shock, respiratory difficulty, paralysis, convulsions, and coma will usually develop if the bite is not treated promptly.
e. Sea Snakes. Sea snakes (Figure 6-6) are found in the warm water areas of the Pacific and Indian oceans, along the coasts, and at the mouths of some larger rivers. Their venom is VERY poisonous, but their fangs are only 1/4 inch long. The first aid outlined for land snakes also applies to sea snakes
Figure 6-6

6-2. Snakebites
If a soldier should accidentally step on or otherwise disturb a snake, it will attempt to strike. Chances of this happening while traveling along trails or waterways are remote if a soldier is alert and careful. Poisonous snakes DO NOT always inject venom when they bite or strike a person. However, all snakes may carry tetanus (lockjaw); anyone bitten by a snake, whether poisonous or nonpoisonous, should immediately seek medical attention. Poison is injected from the venom sacs through grooved or hollow fangs. Depending on the species, these fangs are either long or short. Pit vipers have long hollow fangs. These fangs are folded against the roof of the mouth and extend when the snake strikes. This allows them to strike quickly and then withdraw. Cobras, coral snakes, kraits, mambas, and sea snakes have short, grooved fangs. These snakes are less effective in their attempts to bite, since they must chew after striking to inject enough venom (poison) to be effective. See Figure 6-7 for characteristics of a poisonous snakebite. In the event you are bitten, attempt to identify and/or kill the snake. Take it to medical personnel for inspection/identification. This provides valuable information to medical
personnel who deal with snakebites. TREAT ALL SNAKEBITES AS POISONOUS.
Figure 6-7
a. Venoms. The venoms of different snakes cause different effects. Pit viper venoms (hemotoxins) destroy tissue and blood cells. Cobras, adders, and coral snakes inject powerful venoms (neurotoxins) which affect the central nervous system, causing respiratory paralysis. Water moccasins and sea snakes have venom that is both hemotoxic and neurotoxic.
b. Identification. The identification of poisonous snakes is very important since medical treatment will be different for each type of venom. Unless it can be positively identified the snake should be killed and saved. When this is not possible or when doing so is a serious threat to others, identification may sometimes be difficult since many venomous snakes resemble harmless varieties. When dealing with snakebite problems in foreign countries, seek advice, professional or otherwise, which may help identify species in the particular area of operations.
* c. First Aid. Get the casualty to a medical treatment facility as soon as possible and with minimum movement. Until evacuation or treatment is possible, have the casualty lie quietly and not move any more than necessary. The casualty should not smoke, eat, nor drink any fluids. If the casualty has been bitten on an extremity, DO NOT elevate the limb; keep the extremity level with the body. Keep the casualty comfortable and reassure him. If the casualty is alone when bitten, he should go to the medical facility himself rather than wait for someone to find him. Unless the snake has been positively identified, attempt to kill it and send it with the casualty. Be sure that retrieving the snake does not endanger anyone or delay transporting the casualty.
* (1) If the bite is on an arm or leg, place a constricting band (narrow cravat [swathe], or narrow gauze bandage) one to two finger widths above and below the bite (Figure 6-8). However, if only one constricting band is available, place that band on the extremity between the bite site and the casualty’s heart. If the bite is on the hand or foot, place a single band above the wrist or ankle. The band should be tight enough to stop the flow of blood near the skin, but not tight enough to interfere with circulation. In other words, it should not have a tourniquet-like affect. If no swelling is seen, place the bands about one inch from either side of the bite. If swelling is present, put the bands on the unswollen part at the edge of the swelling. If the swelling extends beyond the band, move the band to the new edge of the swelling. (If possible, leave the old band on, place a new one at the new edge of the swelling, and
then remove and save the old one in case the process has to be repeated.) If possible, place an ice bag over the area of the bite. DO NOT wrap the limb in ice or put ice directly on the skin. Cool the bite area—do not freeze it. DO NOT stop to look for ice if it will delay evacuation and medical treatment.
Figure 6-8

CAUTION
DO NOT attempt to cut open the bite nor suck out the venom. If the venom should seep through any damaged or lacerated tissues in your mouth, you could immediately lose consciousness or even die.

(2) If the bite is located on an arm or leg, immobilize it at a level below the heart. DO NOT elevate an arm or leg even with or above the level of the heart.

CAUTION
When a splint is used to immobilize the arm or leg, take EXTREME care to ensure the splinting is done properly and does not bind. Watch it closely and adjust it if any changes in swelling occur.

(3) When possible, clean the area of the bite with soap and water. DO NOT use ointments of any kind.
(4) NEVER give the casualty food, alcohol, stimulants (coffee or tea), drugs, or tobacco.
(5) Remove rings, watches, or other jewelry from the affected limb.

NOTE
It may be possible, in some cases, for an aidman who is specially trained and is authorized to carry and use antivenin to administer it. The use of antivenin presents special risks, and only those with specialized training should attempt to use it!

d. Prevention. Except for a few species, snakes tend to be shy or passive. Unless they are injured, trapped, or disturbed, snakes usually avoid contact with humans. The harmless species are often more prone to attack. All species of snakes are usually aggressive during their breeding season.
(1) Land snakes. Many snakes are active during the period from twilight to daylight. Avoid walking as much as possible during this time.
• Keep your hands off rock ledges where snakes are likely to be sunning.
• Look around carefully before sitting down, particularly if in deep grass among rocks.
• Attempt to camp on clean, level ground. Avoid camping near piles of brush, rocks, or other debris.
• Sleep on camping cots or anything that will keep you off the ground. Avoid sleeping on the ground if at all possible.
• Check the other side of a large rock before stepping over it. When looking under any rock, pull it toward you as you turn it over so that it will shield you in case a snake is beneath it.
• Try to walk only in open areas. Avoid walking close to rock walls or similar areas where snakes may be hiding.
• Determine when possible what species of snakes are likely to be found in an area which you are about to enter.
• Hike with another person. Avoid hiking alone in a snake-infested area. If bitten, it is important to have at least one companion to perform lifesaving first aid measures and to kill the snake. Providing the snake to medical personnel will facilitate both identification and treatment.
• Handle freshly killed venomous snakes only with a long tool or stick. Snakes can inflict fatal bites by reflex action even after death.
• Wear heavy boots and clothing for some protection from snakebite. Keep this in mind when exposed to hazardous conditions.
• Eliminate conditions under which snakes thrive: brush, piles of trash, rocks, or logs and dense undergrowth. Controlling their food (rodents, small animals) as much as possible is also good prevention.
(2) Sea snakes. Sea snakes may be seen in large numbers but are not known to bite unless handled. Be aware of the areas where they are most likely to appear and be especially alert when swimming in these areas. Avoid swimming alone whenever possible.

WARNING
All species of snakes can swim. Many can remain under water for long periods. A bite sustained in water is just as dangerous as one on land.

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