Snake bite: what to do in the first hour

Snake bites kill about 1,600 Ethiopians every year — mostly farmers, children fetching water, and people working in fields in Amhara, SNNPR, Oromia, and Gambella. Many more are left with permanent damage — tissue loss, kidney failure, blindness.

Most snakes in Ethiopia are harmless. Even venomous bites often don’t inject much venom (“dry bite”). But you can’t tell at the time — so every snake bite is a medical emergency until proven otherwise.

The first hour matters most. Antivenom is available at zonal and referral hospitals. Get there.

On this page

• What to do (first 60 minutes)
• What NOT to do — old advice that harms
• Getting to hospital
• Signs of serious envenoming
• Antivenom
• Prevention
• Which snakes matter in Ethiopia

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What to do (first 60 minutes)

::: doList

Do — right now

• Move the person away from the snake. Get them at least 5 metres from where the bite happened.
• Keep them calm and still. Movement pumps venom through the body faster.
• Have them sit or lie down. Bitten limb below heart level.
• Remove tight clothing, watches, rings from the bitten limb — swelling will happen fast.
• Gently wash the bite with clean water and soap (don’t scrub).
• Cover with a clean cloth. Nothing else on the wound.
• Note the time of the bite. Write it down.
• Photograph the snake if it’s dead and you can do it safely — but do NOT chase it or try to kill it (many bites happen this way).
• Call for transport to the nearest hospital. Do not wait for symptoms.
• Keep the person from eating or drinking in case they need surgery. :::

What NOT to do — old advice that harms

::: dontList

Do NOT — even if elders or the internet advise it

• Do NOT apply a tourniquet. It causes tissue death and does not stop venom spread. Ethiopia has had many limb amputations from tourniquets.
• Do NOT cut the wound. Increases infection, doesn’t remove venom.
• Do NOT suck the venom out. Puts venom in your mouth; doesn’t help the victim.
• Do NOT apply ice. Damages tissue.
• Do NOT apply electric shock. Doesn’t work.
• Do NOT apply herbal preparations, ash, or cow dung — cause severe infection.
• Do NOT give alcohol. Speeds absorption of venom.
• Do NOT walk if you can be carried. Movement matters.
• Do NOT wait to see if symptoms develop. By the time they do, some organ damage is already happening. :::

Getting to hospital

Every venomous bite needs a hospital with antivenom. In Ethiopia, that means:

• Zonal hospital or higher
• Some primary hospitals stock antivenom
• Health centres may not — they will refer you upward but the referral time can be critical

If in doubt about which is closest with antivenom:

• Call ahead if you can — ask “Do you have snake antivenom in stock right now?”
• If the nearest facility says no, go straight to the next level up
• Bring the note of the bite time — antivenom timing decisions depend on it

If you have no transport, tell your kebele or health extension worker — many woredas have emergency transport for envenoming cases.

Signs of serious envenoming

Not every bite is dangerous. But watch for these — if any appears, you need antivenom urgently:

Local signs (usually appear in 30 minutes to 3 hours):

• Swelling spreading up the limb
• Severe pain
• Bruising, blisters, blackened tissue
• Bleeding from the fang marks

Systemic signs (usually appear in 30 minutes to 8 hours):

• Bleeding from gums, nose, cuts, or in urine
• Vomiting blood
• Difficulty breathing
• Drooping eyelids, difficulty swallowing or talking (neurotoxic snakes)
• Weakness, fainting, low blood pressure
• Little or no urine (kidney damage)
• Sudden severe headache (stroke can occur)
• Confusion or unresponsiveness

::: urgentAdvice severity=“emergency”

These mean go to a hospital immediately:

• Any spreading swelling
• Any bleeding beyond the bite
• Difficulty breathing
• Drooping eyelids or trouble swallowing
• Very little or no urine after some hours
• Unconsciousness or confusion :::

Antivenom

Antivenom is the only specific treatment for venomous snake bite. In Ethiopia the main products are:

• SAIMR polyvalent (South African) — covers cobras, mambas, some vipers
• VINS African polyvalent (Indian) — similar coverage
• Inosan African polyvalent — newer, coverage varies

Given as an intravenous drip in hospital. Takes 30-60 minutes. Sometimes a second dose is needed.

Side effects:

• Mild reactions (rash, itching, mild fever) are common and treatable
• Severe allergic reaction (anaphylaxis) is rare but possible — that’s why antivenom must be given in a hospital

Antivenom works best when given within 4 hours of the bite. It still helps at 24 hours or more if envenoming continues. Better late than never.

Cost: subsidised at government hospitals; sometimes free depending on the region.

Prevention

Snake bites happen most often when people can’t see where they’re stepping or reaching.

::: doList

Prevention

• Wear closed shoes and long trousers in fields, tall grass, and bush
• Use a torch when walking outside at night — most bites happen at night
• Look where you step, sit, and reach. Especially near firewood piles, water pots, latrines.
• Keep grain stores, latrines, chicken coops tidy and away from house walls — snakes hunt rats there
• Sleep off the floor if you can. Under a bed net helps.
• Do not sleep with the door open on the ground floor
• Teach children never to reach into holes, hollow logs, or thatch
• Kill rats around the home — snakes come for the food :::

Which snakes matter in Ethiopia

You do NOT need to identify the snake to be treated. Just get to hospital.

The most medically important:

• Puff adder — thick, brown/grey with dark chevron pattern. Ambush hunter, often stepped on. Massive local damage.
• Saw-scaled viper — small (30-60 cm), sandy colour, hissing “saw” sound when threatened. Common in lowland, causes bleeding.
• Egyptian cobra — long, dark, hood when threatened. Widespread. Neurotoxic.
• Boomslang and twig snakes — green tree snakes; rare bites but severe bleeding
• Black mamba — large, fast, olive-brown (not black); highland areas. Extremely rare bites but rapidly fatal without antivenom

Photograph if safe — helps the hospital choose antivenom. But NEVER approach a live or “dead” snake — dead snakes can still bite reflexively for hours.

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa

Sources: WHO Snakebite fact sheet 2024; WHO Snakebite Envenoming Strategy 2019; WHO Africa Snakebite Management Guidelines 2010.

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Draft notes: ~1150 words · grade 6 (deliberate — rural readers) · isTimeCritical true · Ethiopian context: real annual death count, real regions, specific snake species in Ethiopia, real antivenom brands stocked, addresses harmful traditional practices explicitly (tourniquet, cutting, ash/dung) · Emergency contraception-adjacent tone: clear action list first, then rationale · Directly named lifesaver: get to hospital with antivenom, do not delay.