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Pressure Immobilization Bandage for all Snakebite (August 2011)

Pressure Immobilization Bandages for all snakebite

Recently the American Red Cross (ARC) and American Heart Association (AHA) recommended pressure immobilization bandages (PIB) for all snakebite.  In our curriculum PIB is only recommended for neurotoxic snakebites (primarily elapid).

The evidence used by the AHA/ARC is based on studies on pigs, and while the pig is an accepted model, the studies are small (German 2005, Bush 2004).  The researchers are noted practitioners in snakebite treatment.  Their experience may allow them to decide that a PIB is warranted in rattlesnake bites, and to monitor the patient in the controlled environment of their emergency rooms.  I question whether there has been sufficient science done to warrant such a change, and whether it is wise advice for first aid providers in the field.  I'm frankly surprised the ARC/AHA made this recommendation.

For years constriction bandages and tourniquets have been discouraged for pit viper and viper snakebite based on the concern that they will sequester venom and increase local damage, or cause damage simply by virtue of the tourniquet.  A voice in this argument has been the respected snakebite authority Findley Russell.  This concern is not addressed in the discussion on PIB in the 2010 AHA/ARC Guidelines.  As well, there are two studies (Norris 2005, Simpson 2008) noting that it is difficult, if not impossible for lay providers to use PIB properly and numerous studies questioning the retention of complex first aid skills by lay providers.

We do not plan to change our curriculum.

Tod Schimelpfenig

Curriculum Director

Wilderness Medicine Institute of NOLS

August 2011

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