As said in the last post, I will go through the WHO snakebite guidelines 2016 to see what do the studies / publications have to say about the selected text. Let's start with the first statement:
WHO Guidelines for the Management of Snakebites.
Searo Region 2016
pg. 14
"First-aid: most of the familiar methods for first-aid treatment of snakebite, both western and “traditional / herbal”, have been found to result in more harm (risk) than good (benefit) and should be firmly discouraged".
"Familiar" methods could be understood by "popular", what most of us considered the appropriate thing to do. If we do now a poll on street people, what will they answer? and from where is this answer coming from? did they watch it on a movie? somebody told them? studied at the school? did a first-aid training?
The top three worldwide misconceptions are: Tie, Cut and Suck.
Recently I read the post of a blogger (stellaV) on the episode (10th of May) of ZKM, a popular Indian soap opera.
A cobra bites the female main character in the hand in a house (in this case a luxury house as the bite is non-accidental). And what do they do? the male character, the husband, ties a cloth, cuts the wound and sucks the venom (all this takes about 10 minutes (zoom in and out... music... never ending!). The wife fully recovers, awakening like a princess coming from a dream, after some miraculous Ayurveda drops are instilled into her mouth.... and yes, they call a doctor which appears in a hurry, writes the prescription of something in 5 sec. and leaves the scene as fast as he arrived...
And this is one of stellaV's reflections:
"This is criminal, to show such a lax attitude in treatment of medical emergencies. Are they even aware that some people might actually try whatever they just showed today instead of going for the treatment which is required for snake bite...They are spreading this nonsense openly on national television.
I apologize for my rants but it was just too much for me"
http://www.india-forums.com/forum_posts.asp?TID=4844882
Most probably they get more audience on this way that by showing the main actor doing a pressure pad with immobilization... could be, but it seems necessary a kind of regulation as thousands of people watch those programs and a correct first aid can be the difference between life and death.
As my mother says, it is like keeping sugar and ants together. We do awareness campaigns, with a lot individual efforts, small groups of people, schools, and very vocational, and then they show that on TV! At least the good news is that there was a reaction and some followers agreed too. Thank You StellaV!
On another very recent YouTube video about "Home remedies and Snakebite First Aid", the voice in off advices to "deep cut the wound" and to mix "onion and kerosene" and apply it to wound... make the victim vomit using ghee... and more things of that kind while the video shows messages like immobilize, do not cut, keep calm... that they "cut and paste" from other websites, totally contradictory, absolutely non-sense...
Recently I read the post of a blogger (stellaV) on the episode (10th of May) of ZKM, a popular Indian soap opera.A cobra bites the female main character in the hand in a house (in this case a luxury house as the bite is non-accidental). And what do they do? the male character, the husband, ties a cloth, cuts the wound and sucks the venom (all this takes about 10 minutes (zoom in and out... music... never ending!). The wife fully recovers, awakening like a princess coming from a dream, after some miraculous Ayurveda drops are instilled into her mouth.... and yes, they call a doctor which appears in a hurry, writes the prescription of something in 5 sec. and leaves the scene as fast as he arrived...
And this is one of stellaV's reflections:
"This is criminal, to show such a lax attitude in treatment of medical emergencies. Are they even aware that some people might actually try whatever they just showed today instead of going for the treatment which is required for snake bite...They are spreading this nonsense openly on national television.
I apologize for my rants but it was just too much for me"
http://www.india-forums.com/forum_posts.asp?TID=4844882
Most probably they get more audience on this way that by showing the main actor doing a pressure pad with immobilization... could be, but it seems necessary a kind of regulation as thousands of people watch those programs and a correct first aid can be the difference between life and death.
As my mother says, it is like keeping sugar and ants together. We do awareness campaigns, with a lot individual efforts, small groups of people, schools, and very vocational, and then they show that on TV! At least the good news is that there was a reaction and some followers agreed too. Thank You StellaV!
On another very recent YouTube video about "Home remedies and Snakebite First Aid", the voice in off advices to "deep cut the wound" and to mix "onion and kerosene" and apply it to wound... make the victim vomit using ghee... and more things of that kind while the video shows messages like immobilize, do not cut, keep calm... that they "cut and paste" from other websites, totally contradictory, absolutely non-sense...
A Survey of Snakebite Knowledge among Field Forces in China
Chulin Chen, Li Gui *, Ting Kan, Shuang Li and Chen Qiu
Department of Emergency Nursing, School of Nursing, Second Military Medical University, Shanghai 200433, China
This is an Open Access Article. Please refer always to this link:
http://www.mdpi.com/1660-4601/14/1/15/htm
Background: A snakebite is a neglected extrinsic injury associated with high morbidity and global mortality. Members of Chinese field forces are at high risk of snakebites, and their perception and knowledge of snakebites are unknown.
The aim of this study is to assess perception and knowledge of snakebites in field forces in southeast China;
Methods: A cross-sectional questionnaire-based survey was conducted in July 2016. A total of 216 field force members participated in this study;
Results: A total of 10.3% had experienced snakebites and 86.4% rated their demands for knowledge about snakebite as “high”. No significant correlation between the actual and perceived snakebite knowledge status was detected (κ = 0.0237, p = 0.3852).
Ineffective and harmful traditional first-aid methods, such as the application of tourniquets, sucking the venom out of the wound, and making local incisions, were used by more than three quarters of the respondents. However, pressure immobilization bandages were applied by only 17.3% of members.
The proportion of responses for each question was not significantly different among the respondents when considering separate demographic groups;
Conclusions: Snakebite knowledge among Chinese field force members is inadequate and in some cases misleading, when focusing on manifestation, prevention, and first-aid. A pragmatic, intensive educational scheme should be undertaken in at-risk populations.
 |
| Chinese character for Snake |
The Chinese cobra (Naja naja atra) belongs to the elapid family (Elapidae) with the characteristic “glasses” sign, which is one of China’s top ten poisonous snakes, and is mainly distributed south of the Yangtze River. The Mamushi or Fu-she (Agkistrodon halys), is one of the most widely distributed poisonous snakes in China. Other venomous species, such as the Chinese bamboo viper (Viridovipera stejnegeri), the Chinese krait (Bungarus multicinctus), and the Chinese habu (Protobothrops mucrosquamatus), are all common in China.
Snakebites and their management in China have been reported to a certain extent. However, to the best of our knowledge, this is the first study to investigate knowledge of snakes and snakebites within members of the Chinese military. Our goal is to provide baseline data for understanding the current perception and knowledge of snakebites, and for improving medical education in order to decrease the morbidity and mortality rates of snakebites in China. To achieve this goal, we conducted a survey on the knowledge of snakebites among military personnel in a specific field troop in southeast China.
Design and Sample
The research was formed of a cross-sectional study. A convenience sample was taken from military personnel from a field troop in southeast China. Six platoons that didn’t operate under field conditions at this time were surveyed. A platoon is a military unit containing between 30 and 50 soldiers, and thus 216 military personnel were requested to participate in the study. Those who had engaged in health care were excluded from the study.
A questionnaire which could be understood by people with minimal reading ability was developed, based on Guidelines for the Management of Snakebites, American Heart Association and American Red Cross Guidelines for First-Aid, and the materials used to train medics in China.
The questionnaire consisted of three parts:
1.- Demographic information
2.- Self-evaluation: about their current perceptions of snakebites and demands for knowledge of snakebites, knowledge acquisition approach, experience of snakebites, and their immediate reaction to the occurrence of a snakebite;
3.- Knowledge about snakebites (seven questions), including general knowledge about snakebites, prevention, and first-aid for snakebites.
Demographic characteristics:
All of the participants were male, and 97.2% were below 30 years old. Most of them (95.8%) were of Han nationality. Of the military personnel, 93.1% had served in the army for less than 10 years and approximately 95% had received an education higher than junior high school.
Self-Evaluation:
A total of 10.3% (n = 22) of individuals reported that they had experienced snakebites, out of which 4.2% (n = 9) had been bitten by snakes more than once.
The survey revealed that military members generally received information on snakebites from the military medical education (89.7%), and they also used books, magazines, and newspapers (13.5%), television (8.5%), family and friends (8.4%), and Internet (7.5%), in order to access information.
In response to self-evaluated current perceptions of snakebites, nearly three fifths of the participants (57.9%, n = 124) rated their knowledge as “average”, 35.1% (n = 75) rated their knowledge as “good”, and 7.0% (n = 15) rated their knowledge as “poor”.
With regard to demands for knowledge on snakebites, most of the participants (86.4%, n = 185) rated this demand as “high”, whereas only three (1.4%) rated it as “low”, and the others (12.1%, n = 26) rated it as “moderate”.
It was satisfying to note that upon the occurrence of a snakebite, most of the military personnel (93.9%, n = 201) chose to assess the patient’s condition and take action through simple interventions, while 5.6% (n = 12) selected to call for help from a military surgeon or medical corpsmen; only one respondent (0.5%) was too nervous to do anything.
RESULTS ON PREVENTION AND FIRST AID:
Questions
|
n (%) **
|
Which of the following behaviors are likely to cause a snakebite during field training?
|
|
① Wear proper shoes or boots and long trousers instead of sandals or bare-foot.
|
22 (10.3)
|
② Straight over rocks or logs rather than step on them. *
|
64 (29.9)
|
③ Do not use a light (torch, flashlight or lamp) when walking at night. *
|
113 (52.8)
|
④ Rest near the holes, nests and other hidden places. *
|
184 (86.0)
|
No response
|
3 (1.4)
|
The correct answers: ②③④
|
16 (7.5)
|
What would you do with the wound if someone suffered a snakebite?
|
|
① Rinsing (not scrubbing) the wound with water as soon as possible. *
|
188 (87.9)
|
② Attempt to suck the venom out of the wound.
|
161 (75.2)
|
③ Application of ice packs.
|
60 (28.0)
|
④ Making local incisions at the site of the bite.
|
189 (88.3)
|
⑤ Application of alcohol.
|
57 (26.6)
|
⑥ Massage the bite wound.
|
10 (4.7)
|
The correct answers: ①
|
5 (2.3)
|
Apart from calling for help, which of the following first-aid measures would you take if someone suffered a snakebite?
|
|
① Tell him/her to stay calm. *
|
166 (77.6)
|
② Immobilize the victim’s whole body, especially the wounded limb. *
|
158 (73.8)
|
③ Raise the site of the bite above the level of the person’s heart.
|
28 (13.1)
|
④ Application of tight tourniquets around the upper part of the limb.
|
200 (93.5)
|
⑤ Applying a pressure immobilization bandage. *
|
37 (17.3)
|
No response
|
1 (0.5)
|
The correct answers: ①②⑤
|
2 (0.9)
|
* The correct answer;
** The first number listed represents the number of responses and the number in parentheses represents the percentage number of responses.
Our results showed that the snakebite knowledge of field force members mainly arose from military medical education, indicating that a well-designed and comprehensive medical training program, combined with updating international guidelines, should be implemented in order to convey the appropriate messages. Moreover, televisions, the Internet, and books, newspapers, and magazines, are all feasible methods for field force members to acquire information, and thus making full use of these media outlets contributes to a better understanding of snakebites. To our knowledge, the military medical education is usually given by medics, the most prominent source of the platoon’s healthcare knowledge. A lack of uniform and updated training materials distributed to the military personnel is probably the reason why there exists a gap in their knowledge of snakebites.
The best treatment for snakebites is prevention. Preventive measures are recommended in snakebite prone regions. In our study, preventive measures such as wearing long pants and boots, especially when walking in undergrowth or in the dark, and never resting near the holes, nests, and other hidden places where snakes might rest, were well understood by the respondents. However, only one-half of the respondents were conscious of using a light when walking at night. What’s worse, more than three fifths of the participants chose to walk straight over, rather than step on, facing rocks or logs. Snakes may be sunning themselves on the side of rocks or logs, and thus, stepping on the rocks or logs could decrease the risk of being bitten.
DISCUSSION
Education on Snakebite
Self evaluation
Despite more than one third (35%, n = 75) of the participants stating that they had a “good” knowledge of snakebites in the present study, only one of them was officially classified as “good” (0.5%), whereas the others were “average” (72.9%) or “poor” (26.6%), according to our score-based classification.
The high prevalence of misperceptions of snakebite knowledge in field force members is alarming, because their perception could affect their preventive measures and first-aid. They may have great confidence in applying the appropriate first-aid on occurrence of the snakebite, but inversely, their measures may delay medical treatment or cause further harm This finding reinforces the significance of recognizing the misunderstanding of snakebite knowledge in field forces and conveying correct knowledge to those military personnel.
General Knowledge about Snakebites
General knowledge about snakebites within field force groups in this survey was not as satisfactory as expected. The rate of correct answers for “high-incidence period” was below 40%. Most of the field force members knew that snakebites occurred frequently during nighttime and summer, but were unaware that a number of snakebite cases occurred after the rain. Rain may wash debris and snakes into gutters at the edge of roads, hence, when walking after heavy rains, especially after dark, people should be careful.
Our study suggested that only around 30% of the participants were able to correctly identify all of these local and general manifestations of snakebite, indicating that their knowledge surrounding snakebite manifestations was fragmentary.
In our investigation, nearly 70% of the respondents could not identify the venomous snakes by the oval shaped head and regular teeth marks. We decided that the result arose from either their decision that the depicted characteristics of venomous snakes were incorrect, or their belief that it was unreasonable to identify the venomous snakes by their characteristics. Therefore, further research could be designed to explore the exact reason for this response and further information about snakes could be conveyed in order to eliminate their misunderstanding.
The Centers for Disease Control and Prevention recommends that people do not pick up a snake or try to trap it, because this carries the risk of a snakebite. It was gratifying that a vast majority of field force members were aware that even an accidental scratch from the fang of a snakes’ severed head may inject venom into their body.
Knowledge about Preventive Measures and First-Aid
First-aid aims to retard systemic absorption of venom, control dangerous and distressing early symptoms of envenoming, prevent complications, and preserve life, before victims receive medical care.
When considering how to deal with the snakebite wound, a very high percentage of the respondents attempted to suck the venom out of the wound and make local incisions at the site of the bite, both of which are proved to be ineffective and even dangerous first-aid techniques. Similar useless and harmful methods, such as the use of ice packs and massaging the bite wound, were also selected by a small group of the respondents. Vigorous cleaning should be avoided as this may increase absorption of the venom and local bleeding, according to WHO guidelines.
Reassuring the snakebite victim is recommended, as they may be very anxious and this form of first-aid had been adopted by more than three quarters of the respondents. A total of 73.8% of the investigated military personnel were aware of immobilizing the whole of the victim’s body, specifically the bitten limb, which is a desirable practice for decreasing venom absorption.
Application of tourniquet is a dangerous intervention, carrying a high risk of well-known adverse consequences, such as ischemic damage and rhabdomyolysis, contributing to amputation and skin grafting. However, a substantial proportion of the respondents (93.5%) said that applying a tourniquet was a good idea.
There is an urgent need to avoid inappropriate traditional treatments, including application of chemicals, herbs or ice packs, and use of (black) snake stones, which may delay presentation, distort the clinical picture, and even cause infection, gangrene, and other complications. Moreover, only a small number of the participants decided to apply a pressure immobilization bandage, a safe way to delay toxicity by slowing lymph flow, unless a neurotoxic elapid can be excluded. We consider that the unawareness of applying a pressure immobilization bandage results from a lack of confidence and a poor retention of the skill of pressure immobilization. It has been demonstrated that inadequate pressure is ineffective and too much pressure may cause local tissue damage, and once learned, retention of the skill of proper pressure and immobilization application is poor [19]. Accordingly, it is a challenge to find an effective way to teach the application of the correct snugness of the bandage, and we need to make it possible for military personnel to receive proper first-aid more quickly.
Above all, we suggest that the lack of applying WHO recommended first-aid, associated with an inclination of field force members to use incisions, tourniquets, and suck out the venom, offers an opportunity for military educational intervention.
Conclusions
Snakebites often occur in Chinese field forces. Our research revealed that snakebite knowledge within these field forces was inadequate and in some cases misleading when considering manifestation, prevention, and first-aid. Military personnel desired more information on snakebites. In order to address these issues, we suggest that a pragmatic, intensive educational effort should be focused on basic knowledge of snakes, prevention, and first-aid measures undertaken in these at-risk populations.
ॐ लोकाः समस्ताः सुखिनो भवन्तु ॥
Om Lokah Samasthah Sukhino Bhavantu
May all beings everywhere be happy and peaceful
No comments:
Post a Comment