Updated: Jul 11
The thought of snake encounters while hiking in South Africa can make you shake in your boots. Although, typically very few fatal snakebites, around 12 annually, actually occur in South Africa. Nonetheless, it is important to know how to reduce the risk of a snakebite and what to do if someone is bitten.
In this article:
How to reduce snake encounters while hiking in South Africa
When hiking, stay on footpaths and watch where you are walking, particularly early in the day as a number of snakes like to bask in the morning sun on footpaths. Step onto rocks and logs – not directly over them as there could be a snake on the other side and be careful where you put your hands when stopping for a rest or when gripping onto rocks to climb up or down inclines.
Most snakebites happen at dusk, largely in summer between November and April and when accidentally standing on them. The majority of victims are bitten well below the knee which encourages some hikers to wear leather hiking books and snake gaiters. Proper snake gaiters will provide good protection against most snakebites from the boot to just below the knee. Modern snake gaiters are light (±400 grams a pair), flexible and comfortable, even on long hikes.
Snakebites: Be prepared
Emergencies are not something anyone wants to deal with whist hiking, but they are a reality and being prepared for them can save a life. Make sure you have the necessary emergency numbers on your cell phone for the area you are hiking in. Keep in mind that the international emergency number - 112 - works even if you do not have airtime.
Every Forge map is accompanied by the relevant emergency contacts for the region. ✅
Most snakebites in Southern Africa are from snakes with cytotoxic venom (attacking tissue and muscle cells). Unfortunately there is little one can do in terms of first aid, other than safely getting the victim to the nearest medical facility that is able to administer anti-venom, if required. Meeting a private ambulance en route to a hospital is often hugely beneficial, as paramedics are often very well equipped to assist snakebite victims.
First aid for a snakebite
When a snakebite occurs the first thing you should do is get the victim, and any other hikers away from the snake. If there is a chance to get a photograph of the snake without risking another bite, do so - you can send the image through to the African Snakebite Institute for identification. This can help with both panic levels - in determining whether the snake is harmless or mildly venomous - as well as medical advice once the victim gets to a hospital.
Quickly access the African Snakebite Institute's contact details on the 'Useful Links' tab in the Forge app menu. ✅
Keep the victim calm and reassured. Immobilise the patient and lay him or her down as unnecessary movement stimulates the movement of venom through the lymphatics or bloodstream. More than 99% of snakebite victims that are hospitalised within the first few hours survive, so it is imperative that you transport the victim to the nearest medical facility as quickly as possible.
Many people are bitten by harmless or mildly venomous snakes that inject an insufficient amount of venom to do serious damage. Throughout most of Southern Africa, nine out of ten serious snakebites are from snakes with a predominantly cytotoxic venom (attacking cells and tissue), this includes bites from snakes such as the:
In these instances, there is very little that a first aider can do to help, other than getting the victim to the nearest hospital.
DO NOT cut and try to suck out venom or put any pressure bandages or an arterial tourniquet (e.g. a tight bandage) on. Your priority is to get the victim to hospital and if you are hours away from the nearest help, either send someone to call for help or walk back to the vehicles - do not run. Cytotoxic venoms are slow-acting and getting to a hospital within an hour or two will greatly benefit the victim. In serious bites, the longer it takes for the victim to be treated with anti-venom (if required), the more severe the tissue damage. Bites from these snakes are seldom fatal.
For predominantly neurotoxic bites (attacking the nervous system) from snakes such as a Black Mamba or Cape Cobra it is vital to get the victim to a hospital urgently and before breathing is compromised. Victims will soon experience pins and needles in the lips, have difficulty swallowing, sweat profusely, get nauseous and may vomit, experience ptosis (drooping of upper eyelids) and pupil dilation and eventually breathing becomes more and more laboured.
In the event of confirmed neurotoxic bites, the following first aid measures may be considered:
i. Pressure Pads
In a confirmed Black Mamba or Cape Cobra bite, one can immediately put a pressure pad directly on the bite. Such a pad, made of rubber, cloth or cotton wool and measuring roughly 6 x 3 x 3 cm, should be bandaged as tight as one would for a sprained ankle and with a non-elastic bandage. It can be applied anywhere on the body. Such a pressure pad may trap the venom in the bitten area and delay the rate at which it spreads and does damage. Experiments on pressure pads have been done for more than 40 years and with good results, but this form of first aid has had little appeal and for no good reason.
ii. Pressure Immobilisation
Pressure bandages have been around since the 1980s but are difficult to use effectively without training. If pressure bandages are going to be added to your first aid kit, ensure that they are designed for first aid in snakebites and have printed rectangles along the length of the bandages.
If you are more than an hour or two from the closest medical facility after a suspected Black Mamba or Cape Cobra bite, consider applying a pressure bandage to the affected limb whilst transporting the patient to hospital. Do not apply a pressure bandage if swelling is already present or beginning to form, or if it is known that the victim was bitten by a snake with a predominantly cytotoxic venom such as an adder, Mozambique Spitting Cobra or Stiletto Snake as this may cause excessive swelling,
The purpose of the pressure bandage is to apply pressure on the lymphatic system as snake venom is initially absorbed and transported largely through the lymphatic system. If correctly applied, a pressure bandage may slow down the rate at which venom spreads via the lymphatics and buy the victim some time. If there is evidence of local swelling (cytotoxicity) a pressure bandage should not be applied.
Immobilise the affected limb and immediately apply firm pressure to the site of the bite, then wrap the site tightly as you would for a sprained ankle and continue to wrap the entire limb from the bite towards the heart.
For a pressure bandage to work effectively, a specific pressure of around 50 – 70 mm Hg should be applied, and this is no easy task. It is best to use a bandage that has rectangles printed on it – the bandage is stretched until the rectangles become squares and the right pressure is then achieved.
To minimise movement, splint the limb and if the bite is on a leg, wrap another bandage around both legs. Loosen the bandage if there is severe swelling, but do not remove it.
If the bite is on a hand or arm, straighten the arm and once the pressure bandage has been applied, and splint the straightened arm to minimise movement.
It is important to note that the idea of pressure bandages is not to cut off blood circulation – if you press on a nail there should still be signs of good capillary refill (within 2 seconds).
The pressure bandage should stay in place until such time as the patient reaches a medical facility and should only be removed by medical staff.
Important: Do not waste valuable time applying a pressure bandage – this can be done while the patient is being transported to the nearest medical facility. 🚨
Like many aspects of first aid for snakebites, there are those that have no faith in pressure immobilisation while others accept it and use it widely. It is however a standard procedure for medical personnel in South Africa for neurotoxic envenomation.
In serious snakebite cases involving snakes with predominantly neurotoxic venom such as the Black Mamba or Cape Cobra, the patient may soon experience trouble breathing. The onset of breathing difficulty usually takes around one to three hours but in rare cases, it can be in less than 30 minutes. This is a very serious medical condition and respiratory support could be lifesaving.
Did you know: there are 175 snake species in southern Africa. 🐍
Mouth-to-mouth resuscitation may be beneficial, but a barrier device may be required if you do not know the patient.
If a patient stops breathing, it is vital to start with rescue breathing immediately. While most first aid kits have a face mask (a smallish plastic one-way valve situated in the centre of a piece of plastic), they are not easy to use. A far better piece of equipment is a pocket mask.
It is easy to get a good seal over the mouth and nose of a patient with a pocket mask and rescue breathing is provided at one breath every six seconds in adults, one breath every five seconds in children and one breath every four seconds in infants. Each breath is given slowly over one second with just enough air for the chest to rise – nothing more. While providing respiratory support via mouth-to-mouth breathing using a pocket mask is effective, it is also tiring is difficult to maintain for very long periods.
Bag Valve Mask Reserve
If possible, the use of a bag valve mask reserve is far more effective and can be used for much longer. However, one ideally needs two trained people to use it effectively.
To use a bag valve mask, the patient needs to be laid on his or her back with a rescue breather behind the head. A good seal is required over the mouth and nose with two hands on the face mask, the head tilted back and the chin lifted. Tilting the head back and lifting the chin is important as it pulls the tongue away, off of the throat. The second rescue breather should ideally be on the side of the patient squeezing air into the lungs of the patient every six seconds in adults, five seconds in children and four seconds in infants. The bag is squeezed gently over a period of one second with just enough air to see a chest rise. Using a bag valve mask in a vehicle while transporting the patient to hospital is no easy task. Another complication, especially in Black Mamba bites, is saliva accumulating in the mouth as the tongue becomes paralysed and no longer functions. In such instances it is best to drain excessive saliva from the mouth using a hand pump or laying the patient on his or her side to allow the saliva to drain.
Advantages of using a bag valve mask
Disadvantages of using a bag valve mask
Reduced risk of contamination of bodily fluids as you no longer have to place your face close to the patient’s.
Bag valve masks can only be used effectively by trained people.
Reduced rescuer fatigue and therefore can be used effectively for long periods of time.
The greatest difficulty is getting a proper seal on the face and this has an effect on its efficiency and the amount of oxygen that the patient gets. Men with beards are quite difficult to bag and infants need an infant bag valve mask.
For single operators it is difficult to get a good seal using one hand, tilting the head backwards to open up the airway and getting the chin to lift while the other hand is needed to squeeze air into the lungs.
If available, oxygen can be connected to the mask. Oxygen may be set at 5 – 8 litres per minute for rescue breathing.
Spitting Snakes: how to deal with sprayed venom
The common spitting snakes in South Africa are the Mozambique Spitting Cobra (aka "M’Fezi") and the Rinkhals. Both snakes spray their venom up to a distance of three meters and do so in self-defence to temporarily blind their attacker so that they can make a quick escape. The other spitting snakes in southern Africa are the Black Spitting Cobra that occurs in the Western and Northern Cape and up into Namibia, the Zebra Cobra that occurs from southern Namibia northwards into Angola and the Black-neck Spitting Cobra that enters Namibia in the north. All of these snakes also bite using the same venom that they spit.
Although spitting snakes accurately aim for the region of the eyes, the venom diffuses into a spray over a wide area and will get onto your hair, face, arms, neck and chest. Venom in the eyes causes immediate pain and must be rinsed with water under a tap as quickly as possible.
The first reaction of the victim will be to keep the eyes closed tightly due to the pain, so rinsing the eyes is no easy task. The production of tears will start immediately and will help somewhat to rinse excess venom. It is best to flush the eyes with copious amounts of water but diluted anti-venom should not be used. If water is not available, other bland liquids can be used to flush the eyes.
Bear in mind that you are not trying to neutralise venom but rather flush away excess venom. ⛑
The damage to the cornea and eyelids is done virtually instantly and the victim should be transported to a medical facility. Doctors treat the eyes with local anaesthetic, will examine the eyes for corneal damage and may additionally treat the eyes with antibiotic drops or cream (something like Chloramphenicol) to prevent secondary infection of the damaged cornea.
If the eyes are flushed with water immediately after being spat and the victim is taken to a medical facility for treatment, the chances of permanent damage to the eyes are exceptionally remote.
Be careful of Berg Adders – they are small and bite readily. Their venom is quite unique, causing pain and swelling, blurred vision, dilated pupils, loss of smell and taste and eventually affecting breathing. Most victims need to be ventilated for a few days but only after about 5 – 8 hours after a bite. A Berg Adder bite victim must be taken to hospital urgently – do not apply bandages.
The African Snakebite Institute offers courses on Snake Awareness and First aid for Snakebite at various venues throughout South Africa – consider signing up and learning more about snake encounters while hiking in South Africa.