Emergency options in Cape Peninsula

[rikusc]

I live in Glencairn, against the mountain side, with nothing between me and open nature. Two close encounters with venomous snakes (boomslang and cape cobra, far as I could tell) in the last week has prompted me to consider emergency procedure in case of being bitten. I am wondering:

(1) Which local hospital would be best prepared to treat a snake bite?

(2) Is there merit in acquiring antivenin kits and keeping it at hand? I know correct identification of the snake and possible anaphylactic response to the antivenin are issues, and am thinking more about taking it with to a hospital that might not have a ready supply.

(3) Has anybody perhaps gone through the experience, first- or close second-hand, of being bitten and treated locally, and can comment on the level of expertise and quality of treatment?

I'm aware of the following facilities, but have no idea of how well they function:
. Western Cape Tygerberg Poison Centre
. Red Cross Poison Centre

Thanks and regards,
Rikus Combrinck

[Sico]

It all depends on how far from the hospitals (and which hospitals and whether you have medical insurance) you are. I don't know the cape peninsula that well, but I would say that Panorama or Milnerton mediclinic in the northern regions are pretty much the best out there, and perhaps Chris Barnard in the city centre, or Southern Cross in the south. Most of the paramedics (of which I am one) tend to refer their most critical patients to these hospitals, but they are all private. As far as government goes, I would say either GF jooste on the "flats" (yes I know, but I know a lot of the docs there and they know their stuff), or Tygerberg or Groote Schuur. for kids, Red cross is the place to go.
As far as keeping antivenom, the last 9 amps that were used on me in June with my mamba bite cost in the region of R700/amp. They only started working after 5 1/2 amps had gone in... that's a lot of money to keep in your fridge that you may never use. With Cape cobra's you have about 6 hours before the effects of the venom do not respond to antivenom therapy and you have to wait them out (as quoted by Branch), and the boomslang venom is a fairly slow acting one, and you should have more than enough time in both cases unless there are significant extenuating circumstances, to get to a suitable medical facility. As far as I know Antivenom is kept at both Groote Schuur and Tygerberg, I can confirm this if you want, but either way it is available in the cape peninsula and the Red Cross Air mercy services will FLY it out with a heli if it is urgently needed.
If you do some searching ont he site, you will see that there was recently a green mamba bite in the cape region that was managed without AV at one of the hospitals, there was a Cape cobra bite in the oudtshoorn region that was managed succesfully with AV at a hospital that I would not have thought would have managed such a case as well as they did, and there was my bite which I managed in West Africa. In my opinion, unless you keep a ton of really venomous snakes, and have a massive risk of getting bitten, the money you'd spend on the AV, would be better spent on doing a snake handling course and getting a good hook stick or grab stick so you can safely chuck them back over the wall. It'll cost you way less and make you more aware of what you are dealing with, without the fear of something going wrong.
Lastly Tygerberg poison centre is pretty top notch when it comes to giving out advice, when you can get them to answer the phones
hope that answers your questions...

[Loslappie]

Hi Rikus

There is some good medical facilities in the Cape. from what I know, there hasnt been a reported envenomation in your area despite all the encounters.
get a list of Hospitals. I would think Constantiaberg or Victoria.. The best thing to have is a protocol on what to do when you encounter a snake, and make sure that the Hospital knows their stuff. so give them a call and ask some questions.

doing a course is first prize as it will teach you identification, and if you are up to it, how to safely relocate the animal..

Send me a message should you need more details.

[rikusc]

Thank you, Sico and Loslappie, the hospital information sounds reassuring.

Thanks also for the suggestion of doing a handling course. It's an excellent idea that just hasn't occurred to me. I doubt I'll have the guts to try and move a snake I encounter in my garden, but being able to confidently identify them and getting a feel for their behaviour is potentially very useful.

Can you recommend a good place to do a handling course? Or is there a more suitable section of the forum where I should be asking?

Rikus

[Sico]

Rikus, just do a search for handling courses on the forum and you should find some info and contact numbers.

[rikusc]

Thanks!

[Loslappie]

Pity, there was actually one held this past week end.. Watch the forum for details, or send me you e mail adress and I will ask the co-ordinaters to e mail you details on the next course..

[rikusc]

Thank you, I'll send you my email address.

[rikusc]

For the benefit of other interested parties: I spoke to a doctor at the Constantiaberg casualty unit (021 799 2196), which is closest to me. She said they do have protocols to deal with snake bites and treat one or two cases a season. She also confirmed that they can get hold of antivenin if and as needed.

[froot]

She also confirmed that they can get hold of antivenin if and as needed.

Then it may be advisable to keep your own antivenom stock providing the doctor will accept it if you bring it along. If it is required then the time saved from fetching some elswehere may save you a good deal of suffering after treatment. The way I understand it is antivenom to a patient is like water to a burning house, the sooner you apply it, the less damage is done. Then it's just the time required to get there and assertain weather antivenom is needed or not.

[armata]

The next Cape Reptile Institute two day course will be held last weekend of Feb 2012. You can pm me and I will pass you on to our admin who will confirm your booking if you are interested.

With regard my Cape cobra bite in Oudtshoorn - I was treated at medi Clinic and it was the docs first case of snakebite - but he had the good sense to phone other docs who were more experienced - well done to him he has my heartfelt thanks.

[rikusc]

Thanks, Armata, Loslappie got me in contact with the CRI people and I'm on the list for the February course.

I've considered keeping my own stock, Froot, but next thing I'm going to start worrying if Eskom keeps my fridge running reliably to preserve the AV. And after I've bought a UPS for my fridge, a car drives over me, or a shark eats me. It seems to me the level of care I can expect from the hospital is sufficient given the level of risk I'm exposed to. The hospital is about 40 minutes' drive from me. If I have a positive ID in case of a bite, I'll phone ahead, which should save some time getting the AV there. For the rest, walking down my garden path slowly and with eyes very wide open will have to do.

[froot]

Judging from what you're saying I'm assuming you don't keep venomous snakes in which case your logic makes perfect sense. My last post was done under the premise you were keeping venomous snakes which would increase the risk quite considerably. Helps if I read properly hey.

[Andrew]

Rikusc being aware of your immediate surroundings and which species of animal you are likely to come across and when can easily be researched. There are a number of very good South African snake books to be found. (Johan Marais / Bill Branch)

Intentionally interfering with a potentially venomous snake you may come across every six months or so may not be the correct advise to follow if you are not directly involved with these animals on a daily bases.
There are a number of very competent snake catches in your immediate area. I will get a friend to PM you a snake rescue co-ordinator.
The only individuals likely to need anti-venom medical treatment would be those who make it their business to handle snakes.

[armata]

Those books mentioned are a must and we all have them. But ID can still be a problem- recognising an unhooded cobra, or a baby boomslang from a whipsnake when moving. Also the books do not go deep into habits and behaviour. When is peak activity, climatic influence. Also distribution is a rough guide as locally it varies-puff adders for example can be common in some areas but absent 10km down the road. An example- the puff adders annual cycle in the Western Cape is very different from that up north. Puff adders here mate in the spring - Sept-Nov and are diurnal at that time - they become crepuscular about now and then nocturnal afyer Xmas.
I could go on, but do the course and all will be revealed.