Firsf Aid 



ately following bites by vipers, particularly pit 

 vipers of North Americii. Tiiey are of lesser 

 value following bites by the South American 

 vipers and Asiatic vipers, and probably of little 

 value following envenomation by elapids and sea 

 snakes (see discussion of first aid measures, p. 



17). 



In viper bites, excluding those by small Euro- 

 pean vipers and small Xorth American cojiper- 

 heads, make cross-shaped or longitudinal incisions 

 Vs to y4 inches long through the fang marks 

 (fig. 3), except in those cases where there is an 

 abnormal amount of bleeding. The incisions 

 should be made as deep as the fang jienetration. 

 The direction of the animal's strike and the 

 curvature of the fang should be borne in mind 

 when determining the plane of incision. Suction 

 should then be applied and contiiuied for the 

 first hour following the bite. To be effective, 

 suction nuist be apjdied within flie fir.st few 

 minutes following the biting. It is of little value 

 if delayed for 30 minutes or more. Oral suction 

 should not be used if other means of suction are 

 available. Multiple incisions over the involved 

 extremity or in advance of progressive edema are 

 pot advised. 



Figure ."5. — Iiici.sed fans marks of a viper. Note how 

 .small the incisions throvigh the wounds need to be. 

 Photo by Findlay E. Russell. 



STEP SIX 



Administer Antivenin.— It is reconunended that 

 medical corpsmen, in the absence of a physician 



and after suitable training, be given permission 

 to conduct sensitivity tests and to administer ap- 

 propriate antivenin to victims of snake venom 

 poisoning. This might be done in those cases 

 where severe signs and symptoms develop early 

 in the course of the illness, or where 4 hours or 

 more following viper venom poisoning or 2 hours 

 or more following elapid venom poisoning can be 

 expected to elapse before professional care will 

 be available. 



In such cases, following ajipropriate skin or 

 eye tests (.see Sensitivity Tests, page 16), the 

 antivenin should be given iiuiamuscularly at a 

 site distant from the wound. Ajiflveiu'n fshoiiJd 

 never he injected into ii fnger or toe. and it should 

 be administered inl ia\enously only by qualified 

 ])ersonnel. As tiie amount of antivenin available 

 in I lie field is limited, one unit (vial or ])ackage) 

 will probably i)e all that is available for a corps- 

 man to give. The earlier this is injected, the better 

 liie res>dts. However, several units may be needed 

 for full neutralization of the venom. 



XOTE : If the victim is in shock the antivenin 

 will be absorbed slowly from an intranniscular 

 site. 



No Antivenin Available.— If autixenin is not avail- 

 able or if no qualilied person is present to ad- 

 minister it, tiien proceed with STEP SEVEN. 



STEP SEVEN 



Transport Victim to Doctor, Aid Station or Hospital.— 

 Tins should be done by litter, if at all possible; 

 if not, try to provide some other means of trans- 

 portation. Do not let the victim walk if this can 

 be avoided. Keep the victim warm, and the bit- 

 ten \n\Y\. ill a (lejifiidciit jiosition. 



STEP EIGHT 



Institute Supportive Measures.— Should any of the 

 following sequelae to the bite develop during 

 evacuation of the victim, consider these measures: 



Shod-: 



1. Place victim in recumbent or shock position 

 (lying down on his back, head slightly lower 

 thai! his feet). 



2. Maintaiit an adequate airway. 



3. Keep victim comfortably warm. 



4. Control any severe pain. This can usually 

 be done with salicvlates or codeine. Do not give 



15 



