Snake Bites (Sawyer Extractor) works or not

Although this has been brought up from time to time all across the different forums and we have many paramedics on this site, I guess my question is this: If you were out in an area that you could not get medical attention and were bitten by a rattler, water moccasin or what have you, what if any would be the best thing you could do after being bitten by a venomous snake.

Now I own 3 of the Sawyer Extractors, 1 in the truck,1 in the house, 1 in my BOB and had very good results from insect and spider bites as long as I used it within 5 min. of the bite. Now I have never tested it out on a snake bite and insurance companies like Cigna and several organizations tell you not to use it because it's ineffective as well as I think I saw one article on a FDA or CDC site saying it was ineffective. Even on Doug's site showed a 35% effectively, all though recent testing has shown less. I think if I new I would not be able to get to a doctor that it would be worth the risk of using the Sawyer Extractor as long as it's within 3 minutes of the bite. I don't know of any portable anti venom that would be available but you would think some of these snake hunters carry a vile or something. Anyway what do you think would be the best carry option for snakebites?

Watch this idiot:
http://www.youtube.com/watch?v=uWITKklxeLw



Doug's View:
http://www.equipped.org/medical.htm
The only kit worth carrying is the Sawyer "Extractor." This has proved very effective with insect bites, if used promptly. It will also improve your chances after a snake bite, reportedly removing about 35% of the venom, if treatment is started within three minutes, without causing further injury or trauma. The Extractor uses a venom pump suction device, akin to a syringe but it creates suction when the plunger is depressed, with various form fitting adapters to create a *very strong* vacuum, sucking the venom out through the original punctures. )

Jeffrey A. Manion's view
http://survival.com/IVB/index.php?showtopic=33
Sawyer Extractor (vacuum suction): Some evidence of limited effectiveness. One animal study reported up to 34% removal of venom; others 10-20% efficacy, and some found no benefit. Needs to be used immediately - before venom can move outward. General recommendation is within 3 minutes of bite, continuing for 30 minutes. Probably cannot increase damage, in any case, so is not unreasonable to try, in my opinion.


Cigna's View
http://www.cigna.com/healthinfo/snake.html
Do not use a suction extraction device. There is no proof these devices actually help, and they cause further injury and increase your chances of having an infection.

Others
http://www.kingsnake.com/toxinology/foru...178b664d51ecaf1

See pages #105 (Overdose/Poisoning: Injection Insect/Snike Bite) and #240 (approx. half way down the page of the Maryland EMS-Wilderness Protocol -

Use distal and proximal contricting bands

Use of the Sawyer Extractor is recommneded for use within 5 mintues of bite.

Pete

Maryland EMS Protocols

Keep in mind that this portion does not apply directly to the Sawyer Extractor, but refers to suction extraction devices in general. Many of the suction extraction devices recommend cutting an X in the skin to (supposedly) allow for more fluid removal, and this is the action that "causes further injury and increases your chances of having an infection".

This point of view is also expressed in Doug's recommendations (http://www.equipped.org/medical.htm):

First Aid advice given in current U.S. Armed Forces Survival Manual is to bind the limb so as to constrict blood flow and to elevate THE BODY above the limb. This is to slow or stop the venom from reaching the casualties vitals.

Note: THIS IS THE OPPOSITE TREATMENT TO THAT GIVEN TO A SUSPECTED HEART ATTACK VICTIM.

One major problem you have is identifying the snake. Some venom's are blood agents that act as a coagulant. Causes Heart failure. Others are nerve agents. Nerve agents are far and away the most life threatening.

All that assumes that the bite is to an extremity. If it is to the body then unless you have a supply of the antivenin to hand it is quite likely that the victim will die.

Devices like the Sawyer might help to reduce the dosage from the bite but that depends on time since bit, type of venom etc.

I carry a suction-type extractor for use on insect bites and stings, most notably bees and wasps. If I were bitten by a snake and was more than 60 minutes from medical assitance, I would probably use it on the snakebite, along with a tourniquet for whatever its worth. If I had a real good chance of getting help within an hour, I would probably be inclined to follow the "current" theories that you're better off not implementing these measures.

The best cure for snakebite is not getting bitten in the first place. In snake country I usually wear tall boots and work jeans or canvas pants. Yes, they're heavy and hot in summer. But unless you're crawling around on all fours you probably will not receive a bite that breaks the skin, at least in my part of the country where we don't have tree-dwelling vipers. I also will pick up or cut a staff and poke it ahead and move slowly, pausing often to look and listen if I find myself having to go through heavy brush. The point is, an ounce of prevention is normally worth a pound of cure, but where poisonous snakes are concerned that ounce is worth something more like a ton.

Frank2135

DISCLAIMER: I'm providing the following excerpt for INFORMATION ONLY, not at a TREATMENT guideline!! Edited slightly for length.

From Harrison's Principles of Internal Medicine, 16th Ed., P. 2593:

"Initial (prehospital) measures should focus on rapidly delivering the victim to definitive medical care while keeping him/her as inactive as possible to limit systemic spread of venom. Any other measures employed should at least do no further harm to the victim.
Although mechanical suction has been recommended in the field management of venomous snakebite for many years, there is now literature that demonstrates that this intervention is of little, if any, benefit...
...There is concern that severely restricting venom to the bite site may, in fact worsen local tissue necrosis. If the victim is >1 hour from medical care, a constriction band or pressure-immobilization may be considered, but with realization that one may be sacrificing tissue in order to reduce systemic toxicity... The bitten extremity should be splinted if possible and kept at approximately heart level.
For elapid or sea snake bites, the Australian pressure-immobilization technique, in which the entire bitten extremity is wrapped with an elastic or crepe bandage and then splinted, is highly effective..."

There are several more pages of in-hospital treatments, but that's outside this discussion (and quite frankly, my expertise and experience).

It's useless, according to the recent 10 First Aid Myths forum thread:

1. Sucking Venom From a Snakebite

Cutting the skin of a snakebite victim to suck out the poison may be a classic first-aid technique, but doctors now say it’s useless and even dangerous. “Cutting and sucking, or applying a tourniquet or ice does nothing to help,” says Dr. Robert Barish, an emergency physician at the University of Maryland. The outdated measures “may do more harm than good by delaying prompt medical care, contaminating the wound or by damaging nerves and blood vessels,” Barish says in an article released by the university’s School of Medicine and the Rocky Mountain Poison Center.

“The victim should be moved out of harm’s way and transported to the nearest medical facility as soon as possible,” Barish advises. So the best cure for snakebite: a cell phone and a helicopter.

So you can trash it right now and buy a pocket survival helicopter (I guess you have the cell phone already).

Thanks Pete for the link to that pdf file!

Adam

So I wonder what would be a more effective method a stun gun or the extractor? Both are not really proven and shocking myself is a little hard for me, I had tried a 50K stun gun in the past before and it felt like getting burned when they first came out but I could never get my self to do it again. In the field you would probably want a magneto from an aircraft or a hand cranked one to get rid of battery problems out in the field. I have heard of the shock in the past but I haven't heard any true positive feedback. I know the sawyer has worked for insects unless it gives me a false since of security. I was bitten in the back of the neck awhile back by a wasp and it felt like being hit by a bat, I used the extractor within 2 min and the pain went away immediately and had no issues after that.

Many good points are brought up which has a lot of merit and thanks also pete for the PDF file.

< Use distal and proximal contricting bands

< Use of the Sawyer Extractor is recommneded for use within 5 mintues of bite.

I've got one in my backpack, it's there for emergencies, but I've never had the occasion to use it.

Do you think that it would be a serious mistake to push down on the plunger while treaing a person for snake and insect bites ?

I get the impression that it would be a SERIOUS MISTAKE to push down on the plunger because it would force toxic venom right back into the wound. The downward motion of the piston would force the venom deeper into the victim's body. OK, but how are you supposed to maintain "suction" with the device if you cannot push the down on the plunger while treating someone for snake and insect bites ?

I think it says somewhere in the instruction manual that you're supposed to get "suction" by coating the wound with a fine layer of petroleum jelly. OK, but now let's imagine the worst-case scenario and let's assume that you don't have any petroleum jelly on you, then what ?

LW.

SOME FREE THOUGHTS – I was treated in the emergency ward of St Al’s Hospital in Boise, Idaho for a bad yellow jacket sting in the face. In the 18 hours of getting back to town, it had gotten into the eye, ear, throat and neck. The attending physician was the resident expert for bee stings and rattlesnake bites.

My opinion based on his advise -

1. It is a vacuum pump. It cannot hurt anything.
2. If it removes any percentage of the venom it is good.
3. Time is of the essence. Think in seconds, not minutes.
4. Practice: quick draw, Providone swab, shave, pump.
5. Replace the razor with a Twin Blade Schick
6. Double dosage of Benadryl
7. Bandage with wet pack of Adolph’s Meat Tenderizer.
8. Don’t waste time getting to a trauma center if you can.
9. If you can’t get out, turn on the PLB and leave a note.
10. Cook and eat the damn snake

If it works like a syringe, you pull up on the plunger, then withdraw the device off the skin. Depress the plunger to original position. Reapply device, pull back on plunger. Remove, reset. Repeat.

You don't just leave it on our skin frantically pumping up and down like you're filtering water.

After the device withdrawal, the common sense would recommend to wipe the skin and the suction cap before reapplying. Not throughly, just really quick. I doubt any venom will be in the syringe, just air. If no Sawyer Extractor is available, the mouth sucking technique, I believe, is still more than nothing. At least much better than those rubber cap based kits available on the market (though, one may need some practice sucking hard).

NightHiker: The venom in the mouth is nothing compared to venom in the tissue. Just spit once in a while if you wish so. But if nothing else is available, it's a chance. Whatever doctor said (Ok, - IMHO).

Could you also cut the top of a normal syringe, and use that in a emergency?

I don't own a Sawyer extractor, but I have played with one and the suction is created by pushing down on the plunger. Yes it is counter intuitive but it does create a heck of a lot of suction. Try it on yourself, doesn't hurt.

Wow! Now I understand why it's so effective. It's not just a syringe with a simple piston, but the real pneumatic pump! So sad there is no information on its construction. I'd be convinced to get one much earlier seeing that some real physics is involved .

JIM, I think the cut off syringe will work better than sucking by mouth, but its hard edges may damage the skin severely. I'm going to buy Sawyer today, and also I have some plastic syringes at work. I'll try to measure the difference in suction.

Shoot, my browser crashed so I can't reference the article I was reading. It was actually something from a Department of Defense site on snakebite. The article had collected some interested stats on snakebites and might help put this tool into some perspective.

There are roughly 7,000 snake bites a year in the US, and 15 fatalities. So, if you're bitten, there's a 466 out of 467 chance that you'll live. Not bad odds, and I doubt that many of those people had a Sawyer around.

The article also mentioned that about half of bites by snakes are "dry" bites, where no venom is actually injected (it's not clear if this figure includes non-poisonous snake bites or is limited to bites by poisonous varieties). That's a very high proportion of "harmless" bites. The article was mentioning something about how defensive bites are more likely to be dry, compared to when the snake is trying to actually hunt and kill some prey.

Here's a disturbing stat--about 3,000 of those 7,000 bites happened when someone was handling or otherwise bothering a snake. Most of these bites occured on the hands and forearms. Most bites that occurred when the person was just minding their own business occur below the knee. I'm not sure how they define these groups, but it sounds like almost 40% of snake bites could be avoided if people did not try to handle a snake or just left them alone. It's gotta be partly how they define these terms because I find it hard to believe that so many people would want to try and grab a snake with their bare hands. Well, I didn't grow up in the country, so maybe I'm missing something here. I just don't see how so many people could be defined as "handling" a snake when they get bit unless it includes pet snakes, but I don't think it does.

Interestingly, the article mentioned that military medics carry antivenin. That was news to me.

Do not use Mouth to try and suction out venom! Whatever miniscule amount of venom you could draw using your mouth will not be worth the risk of exposure. Should your mouth come in contact with any venom, the membranes in and around the mouth are very permeable to venom and you will become a victim as well. Spitting once in a while will not eliminate all the venom, and what remains or gets absorbed in the meantime will put you in a real crisis.

Ok. Just got that Sawyer's wonder at the local REI. Well, it works nicely. You need just fully extend the plunger, apply the suction cap over the wound, and depress it completely to activate the spring inside, which in turn will produce the force on an internal piston. So you don't need to apply force anymore, just leave it stuck to the skin and do its sucking job for 2-3 minutes. Pull the plunger to release the vacuum. Repeat 4-5 times, wiping the extracted liquids. 15 min total. All this is according to the instruction manual.

Funny enough - the Sawyer's suction caps fit perfectly the standard disposable plastic 60ml syringe (big one, just a little larger than the Sawyer), which I took at work for comparison as promised. The test was simple. I've applied the Sawer to some place on my thigh, activated it and watched the skin bulge growing. Then, using the same Sawyer cap attached to the syringe I've pulled the plunger. Ouch! I've pulled too hard! The sucking power of the syringe is much stronger! But yes, you have to continuously stretch your muscles for 2-3 min. An you'll need both hands to do the job. Yes, I was able to make a much nicer bulge with the syringe.

Conclusion? Nice suction caps for my syringe, some fascinating survival reading about venomous species, cute yellow box, and a disposable shaving razor as a bonus (an ancient single bladed though)...

By the way. The manual says the mouth sucking is only dangerous if you have an open wound in your mouth.

Greetings - thanks for the great post. I'm not an expert on the issue and have no personal experience treating venomous bites, but I've done some personal research on the matter and about the Sawyer Extractor.

The Sawyer Extractor efficacy has been much debated ever since the Wilderness Medical Society released an equipment/treatment update to its members a few years ago. The WMS reported on a medical/scientific study they funded which was designed to test the effectiveness of the Sawyer Extractor on snake bite envenomation. As a result of the studies findings, the WMS advised against the use of the Sawyer Extractor for venomous snake bites, although the WMS did previously endorse the product.

Some scientfic/medical papers have been published that declare the Sawyer pump ineffective: "Suction for venomous snakebite A study of “mock venom” extraction in a human model." Annals of Emergency Medicine, Volume 43, Issue 2, Pages 181-186, M. Alberts concludes; "The Sawyer Extractor pump removed bloody fluid from our simulated snakebite wounds but removed virtually no mock venom, which suggests that suction is unlikely to be an effective treatment for reducing the total body venom burden after a venomous snakebite."

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WB0-4BGH766-M&_user=10&_coverDate=02%2F29%2F2004&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5056b65943bd717615bb6786d328be58

http://www.annemergmed.com/article/PIIS0196064403008138/abstract

Unfortunately, Sawyer does not seem to provide any scientific evidence for their snake-bite kit's effectiveness claims: http://www.sawyeronline.com/ Surely a medical emergency device manufacturer should be able to provide some scientific validity to such claims.

An older study exists that did site very postitive results, but its claims were also found to be controversial among some members of the medical community: https://content.nejm.org/cgi/content/extract/328/7/516?ck=nck

I was inspired to research this subject last year after I watched a Science Education TV program in which they demonstrated the ineffectiveness of the Sawyer using real snakes and dead pigs(I can't find the video or information on the show anywhere - I believe it was a goofy titlelike "Mr. Science"...). The host and attending lab techs demonstrated that the Sawyer Extractor did not remove much if any fluid or venom from the wound site. It was not a very sophisticated test, but it did seem realistic enough to suggest that the Sawyer Extractor was not effective, as they declared at their experiment's end.

The suggestion has been made that even a small two percent reduction in venom may do some good, and also that some envenomation sites will repond differently to treatment with the device - for instance, a pocket or blister of subcutaneous venom may exist and be more treatable, insect bite/sting toxins may be more treatable due to their proximity to the surface of the skin, etc...

As the Sawyer doesn't seriously damage the envenomation site, I for one would give it a try...the WMS study doesn't claim that any additional harm was done with the Sawyer (nothing life threatening, at least), and it didn't provide test results against insect or spider bites either... The device is small enough to suggest that it is a good addition to a personal medical kit.

The fatality rate for venomous snake bites in the US is extremely low (most estimates I recall are way under 1%), so it is unlikely you will die even if bitten in a remote area. Many bites do not even require antivenom treatment.

Thanks in advance for any additional information or clarity about this issue - Again, please note that I am not a medical expert or affiliated with Sawyer or any other organization related to the independent studies presented.

This study is interesting, but it raises more questions than it answers. They can't conclude that the Extractor is ineffective, just that it is ineffective after 3 minutes. I wonder what the results would be if it was applied within seconds of the "bite". You would think that they would have tested several different intervals like the bee sting study mentioned here recently.

i had the pleasure to hear dr. findlay russell, reknowned herpetologist of the los angeles county - university of southern california - medical center, speak several times in the 80s. he's since left there. an excellent speaker and funny!

he quoted statistics - i don't remember the exact numbers so i can't quote them exactly - but as i recall, people who get snake bit on the hands / fingers are overwhelmingly male, under the age of 30 (perhaps 25?), have tatoos (!?), and have a blood alcohol level that would get them arrested if they were driving.

which explains arney's "hard to believe" sentence.

Where did you encounter information about the Extrator decreasing the spread of venom via negative pressure? I can't imagine the physics of that ever being effective.

Contrary to your opinion, Sawyer markets its device as a venom extractor: "The Extractor Pump is an easy to use suction pump which can safely and quickly remove significant quantities of venom (poison) or irritants from bites and stings."

Sawyer also claims the device to be scientifically validated:
"The Sawyer Extractor Pump is the only kit proven scientifically to remove significant quantities of venom from Snake Bites. Scientific research also proves the Sawyer Extractor Pump removes poison when treating bee stings. It also removes saliva and anticoagulants from mosquito and tick bites."

I've found no scientfic or medical evidence that the Sawyer Extractor is effective, only reports that are contrary to the Sawyer marketing claims. I intend to contact Sawyer directly form more information.

You're right to suggest that one must be wary of junk science (as the WMS study may be), but to casually disregard scientific and medical research and rely on anectdotal evidence and heresay is contrary to common sense and dangerous.

The WMS notification about the ineffectiveness of the device is here: http://www.wildmedcenter.com/news.html
Further forum conversation that includes citations of the New England Medical Journal are here: http://www.ssnakess.com/forums/general-venomous-forum/63462-snake-bite-extraction.html

I concur with your final assesment; because there are no serious medical consequences to using the Extrator, I too think its worth attempting to use unless or until its been proven to be ineffective and not worth the effort.

One thing he brings up a good point in the ssnakess forum is that the manufacture could be held liable for there statements down the road. I myself will still carry it, because I know it works on insects but never tested with snakes. Though it's questionable if it is even effective on snake bites but I doubt anything more harmful will come out of it by trying. If it even takes out any venom, even >.1% then it's positive. On the web site it says:

http://www.sawyeronline.com/sawyer_products/pages/extractor/extractor2.htm

Using your thumb, push the plunger all the way in until you feel the suction, and let the remove poison. This should take from 60-90 seconds for insect bites. The first five minutes are most beneficial for applying the to a snake bite. However, suction may be left in place for several hours or until no longer possible due to swelling. Center a suction cup over one fang hole at a time. Alternate between fang holes every two minutes for the first twelve minutes, than at intervals such as 15 minutes.


http://www.ssnakess.com/forums/general-venomous-forum/63462-snake-bite-extraction.html

As the Food and Drug Administration moves to hold manufacturers of retail food and medical products to their advertising claims, those made by the manufacturers of extractors should not be exempt, but warrant scrutiny.