What to do for snakebites

If you get bit: Call 911 immediately.

In the event of a snakebite,

DO NOT:

• Use tourniquets

• Cut or apply suction to bite site

• Apply cold packs or ice to skin

• Use ibuprofen or other anti-inflammatory drugs

• Use shock treatments or apply electricity to bite

• Attempt to capture or kill snake

• Attempt to transport snake

DO:

• Call 911 immediately

• Transport bite victim to emergency department as soon as possible

• Remove victim’s jewelery and any tight-fighting clothes, including shoes

• Record leading edge of swelling and time using a marker on skin; repeat as swelling or tenderness advance (every 15-30 minutes)

• Keep bite area raised (e.g., drape arm over chest)

• Keep victim as still as possible. An increase in heart rate can increase the rate at which the venom spreads

Source: BTG, maker of CroFab antivenom

Local hospitals are stockpiling extra antivenom used to treat rattlesnake bites ahead of the August solar eclipse that’s expected to bring hundreds of thousands of campers and festivalgoers to Central Oregon.

The precaution is mostly due to the sheer number of visitors expected to camp or attend a music festival or other mass gatherings the week of the eclipse. But many visitors will be unfamiliar with the landscape. And rattlesnakes’ tendency to hunt at night during the hottest time of the year may not bode well for those partying until dawn.

Snake experts say to avoid getting bit, people should be aware of their surroundings, wear boots and long pants and bring a flashlight if they’re milling about at night.

“That’s going to be tough because the recommendation is going to be … be careful, keep your eyes peeled — which doesn’t usually coincide with music festival behavior,” said ­Nicole Strong, a forestry and natural resources agent with Oregon State University-Extension for Deschutes, Crook and Jefferson counties. “It’s going to be interesting.”

McKesson, the company that supplies pharmaceuticals for St. Charles Health System, will effectively allow the hospitals in the health system to borrow dozens of additional doses of antivenom, which costs $2,500 a vial. The arrangement will allow St. Charles to more than double the number of doses at its hospitals, from the current stock of 72 vials to an anticipated 156 during the eclipse. St. Charles will return the unused doses once crowds leave.

Patients can require up to 12 doses of antivenom initially, and then additional maintenance doses hours later, said Michael Powell, St. Charles’ pharmacy director.

“If you double the population, we expect to double the amount of bites,” he said.

Experts say they don’t expect to see a higher rate of bites. The Western rattlesnake, the only venomous snake native to Oregon, bites to defend itself — typically if it’s stepped on or picked up.

“As long as you keep your eyes open and you see them, they really aren’t that much of a danger,” Wade Bale, a paramedic and firefighter with Redmond Fire & Rescue, said. “Having said that, a whole bunch of people drinking — you know what happens when you get a teenager and he’s got a little bit of alcohol in him and you start doing things with the snakes — that’s a different story.”

A costly encounter

The cost of a rattlesnake bite can be astronomical. Although the manufacturers’ price for a vial is $2,500, St. Charles charges $6,000 for the same amount. That doesn’t include the cost of the hospital stay.

CroFab, the only commercial antivenom for Western rattlesnake bites sold in the U.S., comes as a powder that hospital workers mix with 18 milliliters of saline and administer intravenously. Each vial contains up to 1 gram of the active ingredient.

Patients get an initial dose of four to six vials that’s tapered over the course of an hour, according to CroFab’s dosage instructions. If that doesn’t stabilize them, they may need another four to six vials. After that, patients receive maintenance doses of two vials every six hours for about 18 hours.

The maximum number of doses under that regimen would be 18 vials, or $108,000 worth of antivenom for St. Charles patients.

Dr. Zane Horowitz, director of the Oregon Poison Center at Oregon Health & Science University, said serious cases can require up to 40 vials of antivenom.

“There isn’t a complete one-size-fits-all way to give it,” he said. “It depends on the assessment of how sick the patient is.”

All told, snakebite patients will spend a day to 36 hours in the hospital, Horowitz said.

Oregon sees as many as 50 snakebites per year and as few as 20, Horowitz said. Horowitz is only aware of one snakebite fatality in the state that occurred decades ago.

Simon Wray, a Bend-based conservation biologist with the Oregon Department of Fish and Wildlife, said unless the person is very old, very young or has an underlying health issue, he or she probably won’t die from a snakebite.

“If you get bitten, you’re looking at much less than a 1 percent chance that it would be fatal,” he said.

Making antivenom

When a snake bites into its prey, its venom immobilizes the meal by blocking its muscle function. Venom has the same effect on humans.

Antivenom provides antibodies, proteins that bind to and eliminate components of the venom that disrupt muscle function.

“It’s attaching itself to the venom and helping your body to clear it,” said Chris Sampson, a spokesman for London-based BTG, the company that makes CroFab.

The drug’s high cost is largely because of the painstaking manufacturing process, which involves snakes, sheep and a trip across the globe.

It starts at a facility in Salt Lake City that houses four types of snakes, including the Western rattlesnake. Workers there very carefully extract the snakes’ venom by prompting the snakes to bite over the lip of a glass vessel that collects the liquid.

The venom then gets shipped to Wales in the United Kingdom, where it undergoes a purification process. Next, the venom goes to Australia, where it’s injected into sheep that have developed immunity to it. Workers then extract blood from the sheep and take it to another facility down the road. There, they extract the blood’s plasma, which is where antibodies are located.

The plasma is frozen and shipped to Wales, where the antibodies are filtered out and further processed to avoid unwanted immune reactions. Finally, the drug is shipped to the U.S., where it gets freeze-dried, placed into vials and brought to hospitals.

“It’s got quite a few miles under its belt by the time it bets back to the U.S.,” Sampson said.

Stay calm

Experts’ resounding advice for snakebite victims? Don’t panic. Running or getting otherwise worked up increases the heart rate, which gets the blood flowing faster, hastening the venom’s spread throughout the body.

Instead, walk away from the snake slowly. Calmly walk to an area where you can seek help, said Horowitz, of the Oregon Poison Center. You can still walk on your own; no need to have a hiking partner carry you out of the wilderness.

“I wouldn’t say, ‘Oh, let’s do another 5 miles on this hike and have lunch and then maybe I’ll think about going to the hospital,’” he said. “It’s more like, ‘Maybe we should turn around and head out to the trailhead where we parked the car and where the ambulance would probably show up.’”

Several experts advised against the dramatic technique depicted in old Western movies wherein a hero inserts a knife, cuts across the fang holes and sucks the venom out. Given that venom dampens the blood’s ability to clot, this could cause more bleeding and swelling, Horowitz said. He also advised against using suction cups sold for this purpose.

Rattlesnakes prefer to hang out in rocky outcroppings, rodent holes or riverbanks. They’re most likely to live in rural stretches of land outside of cities, but will occasionally cozy up in freshly watered lawns to keep cool.

St. Charles usually stocks the most antivenom at its larger Bend hospital, but during the eclipse, the Madras hospital will have the same number of vials — 42 — as will be in Bend. Madras is expected to be the best spot from which to view the eclipse.

Bale, of Redmond Fire, said rattlesnakes are known to be fairly common in parts of Antelope, where a music festival will take place during the eclipse. If you’re a “comfortable” 6 feet away, they won’t bother you, he said.

“Then just observe it, admire it,” he said.

Rattlesnakes are widely misunderstood, Wray said. They tend to get vilified in popular culture but are actually a crucial component of High Desert ecology.

“They’re not the vicious, aggressive animals that are this huge threat to life and limb,” Wray said.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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