This revision of the Joint Trauma System (JTS) Snakebite Envenomation Clinical Practice Guidelines followed the established JTS framework for updating existing CPGs, with emphasis on operational relevance and improved bedside usability for providers at all levels across the continuum of care (prehospital through Role 3). The update was conducted as a focused, expert-driven revision of the original CPG ID 81 (2020) to achieve the following:

1. Improving bedside usability as a clinical reference tool and enabling rapid, time-critical decision-making through streamlined ACLS-style STAT treatment algorithms.
2. Enhancing operational relevance, pre-mission planning, and force health protection in deployed settings globally.
3. Simplified syndrome and severity-driven antivenom dosing guidance designed to reduce preventable deaths and disabilities through rapid initiation of treatment at the POI and early consultation with DoD Advisor toxicologists.
4. Printable rapid-reference tools optimized for austere and resource-limited environments including dosing tables, antivenom coverage algorithms, and suggested antivenom treatment packing checklist.
5. Expanded INDOPACOM algorithms with dedicated regional management pathways to address coverage gaps in Taiwan, Japan, the Korean Peninsula, China/East Asia, and other high-risk geographic regions.

Antivenom Recommendations

Antivenom selection was based on a combination of published evidence and expert experience. Authors prioritized antivenoms which offered broad-spectrum regional coverage of medically significant species, enabled syndromic treatment without reliance on species identification, could be carried for extended periods in field conditions without cold chain, and demonstrated low rates of adverse reactions in peer-reviewed studies or firsthand applications. Due to the lack of high quality studies on many antivenoms globally, whenever possible first line antivenoms were selected from manufacturer product platforms which have been used extensively by the authors in comparable operational environments. Strategic considerations, including supply chain reliability and security risks (e.g. deprioritization of products manufactured by adversarial states) were also considered.