If a tourniquet is already in place, see Tourniquet Algorithm. Do not remove it until you are ready to treat and resuscitate the patient as a rapid decompensation can occur.67,68

3. If and when conditions allow, minimize patient activity, and loosely immobilize the bitten limb to reduce movement without constricting tissues.

a. If antivenom isn’t available, get the patient to a facility with antivenom as fast as safely possible, even if they have to walk.

b. If conditions allow during transport, maintain the bitten limb in a position of comfort that is elevated below the level of the heart.

c. Once the patient has arrived at a medical facility with antivenom, aggressively elevate the bitten limb (aim for a minimum 60º angle in a supine patient if possible and tolerated by patient) to reduce oncotic pressure on swollen tissues.

4. Evaluate for specific signs and symptoms of snake envenomation. Refer to the STAT treatment algorithms in Appendix A for specific criteria for initial antivenom treatment and repeat doses for additional information.

5. Consult a Medical Toxicologist as soon as possible. Within the United States, a Medical Toxicologist can be reached via a Poison Control Center by calling 800-222-1222. Within the Department of Defense, a Medical Toxicologist can be reached via the Advanced Virtual Support for Operational Forces (ADVISOR) teleconsultation service by calling 833-ADVSRLN (833-238-7756)/ DSN: 312-429-9089.