Toxicology

Snakebite at outdoor festival

Intermediate

Adult · 35yr · male

Patient Information

Dispatch	You are called to a patient (Marcus Hallett, 35YO male) who is sitting on the ground near the back fence of the Vineyard Music Festival grounds reporting he was bitten on the right ankle by a snake approximately 20 minutes ago.
Patient	Marcus Hallett — 35yr (80kg)
Incident History	Pt was walking through a grassed area behind the festival stage to retrieve a hat when he felt a sharp sting on his right ankle. Bystanders report seeing a brown snake near the fence line. Pt walked back to a nearby seating area and called for help. Pt has not received any first aid.
Emergency Contact	Claire Hallett (Wife) — 0412 553 089

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor or swelling.
Breathing	Self-ventilating. Slightly elevated respiratory rate. Nil wheeze or crackles. Able to speak in full sentences.
Circulation	Radial pulse present, regular, adequate volume. Skin warm and dry. Nil active bleeding. Two small puncture marks visible on right ankle with localised redness.
Disability	GCS 15 (E4V5M6). Orientated to time, place and person. Reports mild headache developing. Pupils equal and reactive to light.
Exposure	Two small puncture marks noted on right ankle approximately 1cm apart. Mild localised redness. No bandage applied. No other injuries identified.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	18	96	118/74	<2s	15	4 4 ++	36.8	–	4
10 mins	96% (RA)	Mild	20	104	112/70	<2s	14	4 4 ++	36.8	–	5

History Taking

Treatment Response

Diagnosis

This patient is suffering from a suspected snakebite with early signs of envenomation — presenting with bite site pain, developing headache, nausea, and tingling/paraesthesia ascending the bitten limb approximately 20 minutes post-bite.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee allows the patient to walk or stand and mobilise at any point — patient immediately complains of worsening headache, nausea, and begins to vomit. Reinforce: DO NOT walk the patient.)
! (If the trainee does not apply Pressure Immobilization Technique within 5 minutes — at the 10-minute mark, patient reports the tingling sensation has spread to the groin and he is feeling increasingly drowsy. GCS drops to 13.)
! (If the trainee attempts to apply a CAT tourniquet instead of a PIT bandage — facilitator states 'The patient grimaces and says that feels very tight — it's cutting off circulation.' Prompt the trainee to reconsider and use the correct technique.)
! (If the trainee attempts to wash, cut, or suck the bite site — facilitator states 'You move toward the wound' and provides a verbal prompt: 'Is that the correct approach for snakebite first aid?')
! (If the trainee does not splint the limb after PIT application — patient shifts position and bends knee, facilitator prompts: 'The patient is moving his leg to get comfortable — what else can you do to minimise movement?')
! (If the trainee removes the PIT bandage before hospital handover — facilitator states 'The patient says the bandage feels tight — do you remove it?' Correct answer: No. DO NOT remove prior to arrival at hospital unless authorised by ASMA.)

Treatment Objectives

1. Ensure scene safety — confirm snake is no longer present in the immediate area before approaching patient.
2. Perform Primary Survey — Airway, Breathing, Circulation, Disability, Exposure.
3. Instruct patient to remain STILL — do not allow patient to walk or stand at any point during assessment or treatment.
4. Conduct Vital Sign Survey — GCS, SpO2, RR, BP, HR, CRT, pupils, temperature.
5. Perform Secondary/CNS Survey — assess bite site on right ankle, note puncture marks, assess for signs of envenomation including nausea, headache, tingling, visual disturbances, weakness, or drooling.
6. Apply Pressure Immobilization Technique (PIT) to the right lower limb — commence bandaging from the toes and extend upward as far as possible covering the entire limb, using a snakebite bandage with continuous indicator tensioned to achieve 1.5cm x 1.5cm squares. Firm compression — unable to easily slide a finger beneath bandage.
7. Mark the bite site location clearly on the outside of the PIT bandage with a marker.
8. Splint the right lower limb to further minimise movement — immobilise in position of comfort.
9. Administer oxygen via appropriate mask — titrate to maintain SpO2 94–98%. Apply nasal cannula at 1–4 L/min or simple face mask at 5–8 L/min as clinically indicated.
10. Monitor patient persistently — record full observations every 10 minutes, monitoring closely for signs of respiratory depression, increasing weakness, descending eyelids, difficulty speaking or swallowing, altered GCS.
11. Do NOT remove PIT bandage or splint prior to arrival at hospital.
12. Do NOT attempt to catch, kill, or identify the snake.
13. Reassure patient continuously — explain procedures calmly and advise he must remain still.
14. Arrange Priority 1 transport with pre-notification of receiving facility — state suspected snakebite with early signs of envenomation, PIT applied, vital signs.
15. Scenario ends on arrival of ambulance and IMISTAMBO handover.
16. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Snakebite · Pressure Immobilisation Technique (P.I.T) · Primary Survey · Pulse Oximetry · Oxygen Delivery · Secondary & CNS Survey

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Signs/Symptoms	Sharp pain at bite site on right ankle, mild headache developing, feeling mildly nauseated. Reports tingling sensation beginning in the right leg.
Allergies	Nil known drug allergies.
Medications	Nil regular medications.
Pertinent History	Nil significant past medical history. Non-smoker. Occasional alcohol. Fit and well.
Last Oral Intake	Meal and two beers approximately 2 hours ago.
Events Leading	Pt was attending the Vineyard Music Festival and walked through a grassed area behind the main stage to retrieve a hat that had blown away. Felt a sharp bite on his right ankle and looked down to see a brown snake moving away.
Treatment Prior	Nil. Pt walked back to seating area unassisted. No bandage or first aid applied.

Onset	Approximately 20 minutes prior to EHS arrival. Pt was walking in a grassed area when bitten.
Pain	Sharp localised pain at bite site right ankle 4/10. Mild headache 2/10.
Quality	Sharp, stinging pain at bite site. Dull aching headache.
Radiates	Tingling sensation radiating from bite site up the right leg.
Severity	4/10 bite site pain