In Mouth Piece

Effective Snakebite Management in Himachal Pradesh

Snakebite management through free emergency ambulance service during Golden Hour in Himachal Pradesh  

In India every half an hour there is death due to snakebite as the total mortality is pegged at 49,500 cases every year. Snake bites are a common cause of morbidity and mortality in the hills. The risk of snake bite is high due to the presence of a huge fauna flourishing in a favourable temperate climate–low environmental temperature and heavy rainfall. Delayed presentation to the hospital contributes to increased morbidity and mortality from snake bites. The timely and free ambulance service can save lives and lessen morbidity due to snakebites. This study aims at evaluating how a free, round the clock emergency ambulance service having facilities for anti-snake venom injection, can help save lives by responding to a toll free number 108 and transporting the patient to nearest appropriate hospital within the first hour of the bite which is also referred as the golden hour.

Picture1

A total of 469 patients of snake bite cases availed the free emergency ambulance service between 25th December 2010 to 30th November 2011 by dialling toll free number 108. All patients were examined for evidence of snake bite and where possible the snakes were identified based on description, identification (if the snake was brought) and symptoms of envenomation. Based on signs & symptoms, ASV was used inside the ambulance, where applicable. All patients were shifted within the golden hour to the nearest appropriate health facility.

Seasonal variation in snake bite was seen, with a peak in the months of August. No bites were recorded in the month of December and January and only one case was reported in the month of February. Highest snake bite cases were reported in August (27%).  76% of the bites were on the feet (up to the ankle) where as 22% bites were on hand (finger & elbow) and only 1% bite cases were reported  on the lower back and head.  Female to male ratio was 54:46 percent .The age group most affected was between 11- 40 years (56%). Within this category the highest affected age group was 21-30 year (24.9%). Most bites occurred while the person was cutting grass, working in the fields or walking in the hills (75.3%). Snake bites while sleeping were at uncommon sites (Ear and Head).  Highest  22.38% cases were reported in warm Kangra district just opposite to cold tribal district of Lahul and Spiti  where only one case was (0.21%) reported. Out of 469 cases, in 47cases (10.02%) ASV had to be used inside the ambulance in critical condition. Only one patient had a mild allergic reaction to ASV and lives saved after ASV utilization was 42 ( 89.36%). Total life saved out of 469 cases was 451 cases (96.2%).

Doli ambulance in Uttrakhand pic2

Snake bites occur frequently in the hills of Himachal Pradesh. The initiation of toll free and user charge free emergency ambulance service 24X7 called Atal Swasthya Sewa in PPP (public-private partnership) mode with GVK-EMRI helped snakebite victims to avail of the services anytime in an emergency.

Recommendation:  We recommend a fully equipped free emergency ambulance network equipped with ASV in all the states of India to save victims of snakebite. A timely medical response helps in treatment and increases the chances of survival and recovery in patients.

Way Forward: The GVK-EMRI has done a great service to mankind by transporting more than 30,000 patients of snakebite across the country within the golden hour in 2014. The endeavour is to induce ASV inside the ambulance if patient is in critical condition.  Efforts are on to equip the  boat ambulances with ASV in water logged areas. GVK-EMRI has done this in Assam to save lives that required immediate  medical attention.

Boat ambulance in Assam pic3

Since the modern ASV is free of reactogenic segment Fc, the reaction rate due to serum administration is low. Keeping this in view we need to think of new protocols that are simple, effective and easy to administer so that patients need not face complications of haemorrhage and dialysis. Since the issue of snakebite is internal (national) with various facets to this problem, let’s not look externally to solve this issue for us. The solution has to come from a national level protocol that addresses regional challenges. This requires all of us to collectively share our experiences and expertise just as we are doing on the Whatsapp group created by Dr Dayal Bandhu Majumdar from West Bengal.

Lastly more frequent conferences and sharing platforms need to be developed and hands-on training for young doctors need to be given top priority for better management of snakebite cases in India.

Snakebite is a treatable disease. Let nobody die of Snakebite in India!

Written by Dr. Omesh Kumar Bharti and Dr. Gaje Singh

8 Comments

  • Dr. Kaushik Bharati
    Jan 17, 2016 at 06:01 pm

    I congratulate the authors for writing such an informative article. The unprecedented initiative of providing a free round-the-clock ambulance service as well as ambulance motorboat services by GVK-EMRI is indeed highly commendable. Importantly, there is an urgent need for more such Public-Private-Partnerships (PPP) for addressing the issue of snakebite management.

    • admin
      Jan 24, 2016 at 06:19 pm

      Dr Kaushik Bharati…Many thanks for your response.

  • Himmat Saluba Bawaskar
    Jan 22, 2016 at 04:25 pm

    sir
    Hearty congratulation for treating transferring so many snake bite victims, not only save the life and earning member of family. I was moved by reading this vital data and hats of to the health service
    yours,
    Himmatrao saluba Bawaskar, Mahad, Raigad

    • admin
      Jan 24, 2016 at 06:20 pm

      Dr Bawaskar – Many thanks Sir for your response and support to our initiative.

  • Rom Whitaker
    Jan 22, 2016 at 04:27 pm

    Thanks Priyanka, please do cc Shonali on interesting things like this. It’s really great that the 108 ambulances are reaching more and more remote areas, but if people aren’t convinced that they need antivenom and continue to prefer cheap country ‘remedies’ from the local ‘doc’ the snakebite mortality figures aren’t going to go down very quickly

    Meanwhile please check out online a little film done by Bangla Communications called ‘Training video on what to do when a snake bites’. It’s crude but says all the right things. This is the kind of thing that should be publicized.
    Best, Rom

    • admin
      Jan 24, 2016 at 06:22 pm

      Dear Rom – Your involvement and guidance on Snakebite mitigation is like a shot in the arm for all of us including the author, Dr Bharati.

  • Dr Jaideep Menon
    Jan 22, 2016 at 04:28 pm

    Wonderful initiative this. Hope the same could be done in other areas as well, especially the North East.I presume that blood tests could be done in the ambulance. Please keep it going, this for the sake of the victim. regards

    • admin
      Jan 24, 2016 at 06:26 pm

      Dear Dr Jaideep – Thank you for your inputs. Point noted about the need for such an initiative in more states in India. GVK EMRI has its presence in Assam.

Leave a Reply

Send Us Message

*

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>