Suspected Snakebite at a Village Health Camp
At 4 p.m. in a village near Nagaon, a 38-year-old farmer is carried to the courtyard where you are holding a health camp. He was bitten on the right ankle 25 minutes ago by a snake he describes as 'brown with a dark pattern'. The ankle is swelling and he says it burns. A relative has already tied a cloth tightly above the bite and another is heating a knife to 'cut and drain' the wound. The nearest PHC is 40 minutes away by motorcycle; the nearest traditional healer is 5 minutes away. The patient is sweating, his pulse is 110/min, and he is frightened. Your camp has a first-aid box with roller bandage, splint, antiseptic, gloves, and a phone with intermittent network. He has no known allergies and no other visible injury.
1. What should you do in the first three minutes, and which of the relatives' actions must be stopped? Justify each stop.
Read the worked answer
Stop the tight cloth above the bite. A cloth tied tightly acts as a tourniquet; it can cut off blood supply and cause limb damage, and it does not stop venom from spreading. Stop the heated knife. Cutting and burning the wound causes pain, bleeding, and infection, and can push venom into tissues. Do not suck the wound. Then lay the patient flat, keep him calm, remove rings or tight items from the bitten leg, and keep the limb still. Apply a light compression bandage over the bite and splint the leg; the bandage should be snug but not so tight that the pulse disappears. Reassure him, check pulse and breathing, and arrange transport. These steps slow venom movement and prevent further injury while avoiding harmful traditional first aid.
2. How should you position and transport him, and what information should you give the PHC when you call?
Read the worked answer
Keep him lying down with the bitten leg at or slightly below heart level, not raised above the heart. Carry him to the vehicle; do not let him walk, because walking pumps venom through the body. Keep the splint and bandage in place and check the toes for warmth and colour every few minutes. When calling the PHC, give: the time of the bite, the site (right ankle), the snake description, the symptoms (swelling, burning, sweating, pulse 110), what was removed (the tight cloth), what first aid was given (bandage, splint), and the expected arrival time. Ask whether antivenom is available and whether they want him brought directly. Because the network is intermittent, send a text with the same details and ask a bystander to keep trying.
3. The family wants to take him to the traditional healer five minutes away before going to the PHC. What should you say and do?
Read the worked answer
Acknowledge the family's belief without mocking it: 'I understand you trust the healer, and you want to do the right thing.' Then explain the time risk: 'The hospital has antivenom and oxygen. The healer is close, but a delay can allow swelling and breathing problems to worsen.' Offer a compromise that does not block their choice: 'The healer can travel with us, or we can call him on the way, but let us start moving toward the PHC now.' If they still refuse, do not physically stop them; give first aid, explain danger signs (breathing difficulty, drooping eyelids, bleeding, vomiting), document the refusal, and ask them to come immediately if these appear. This respects autonomy while keeping the door open.