By Alan Eade, Chief Paramedic Officer, Safer Care Victoria
It’s estimated that fewer than 100 Victorians require snake antivenom each year. But while the numbers are low, the clinical response must be quick and safely administered to be effective.
This is why, for the first time, Safer Care Victoria has published statewide guidance to help Victorian health services determine whether they need to stock snake and spider antivenom, and what quantity is required.
Presentations for snake or spider bites are not common in Victoria. In 2016–17, 216 people were admitted to hospital with a presumed snake bite. Many of these turned out to be false alarms, or ‘dry bites’ – meaning no venom was in the bite.
Our guidance will help health services maintain the appropriate stock holdings for tiger snake, brown snake, and red back spider antivenom to meet their service need and to reduce unnecessary waste.
We’ve also produced this guidance to cover the transfer and location of care for snake and spider bites and support existing statewide guidance around the clinical treatment of snake bite within Victoria.
Through implementing this guidance we anticipate that more urgent care centres will stock antivenom than do currently.
We want to make sure we can get anyone who has been envenomed by a snake or spider to a supply of antivenom quickly – no matter where they are located.
In Victoria every urgent care centre is a maximum two-hour drive by ambulance to an emergency department. Our guidance will ensure that all Victorians are no more than two hours from receiving snake bite antivenom even if they present to a centre that does not stock antivenom.
Which health services should stock antivenom?
We’re recommending that to administer antivenom, a health service should have an emergency department, or urgent care centre that is adequately staffed by medical practitioners.
Snake antivenom can cause serious allergic reactions in some people. So the best places to treat potential snake bites are the emergency departments where we have the people and facilities to administer antivenom safely.
Those services should carry and maintain a minimum stock level of two doses for each antivenom: tiger snake, brown snake and red back spider. Other services should arrange for immediate transfer of potential snake and spider bites to the nearest service that stocks antivenom, with care ultimately being provided in an emergency department.
Our guidance also considers the use of Snake Venom Detection Kits (SVDK) and recommends that they should only be used by pathology services, not clinicians, due to their sensitivity and potential for inaccurate results.
Most snake and spider bites occur in outer metropolitan areas, not in rural or remote locations. If a snake bite presents to a service without antivenom, we have been working with the state’s retrieval services and Ambulance Victoria to ensure transfer can be arranged as quickly as possible.
For the first time, antivenom may be moved to the patient in extreme circumstance, such as when a patient is in a remote location.
Our new statewide guidance will help assure that snake and spider antivenom is available where it’s most needed to give Victorians access to safe high quality healthcare.