Looking at issue of snake bites

Emergency physicians are being urged to take part in a survey looking at current practices in snake and spider envenoming management in Australian emergency departments.

FACEMs Professor George Braitberg and Associate Professor Vasilios Nimorakiotakis (Bill Nimo) are the Principal Investigators of the Survey of National Attitudes and Knowledge in Envenomation (The SNAKE Study).

The study follows two Victorian deaths in close succession, each from a snake bite. The death of 27-year-old Shane Tatti in 2014, and Mrs Z, in 2015, prompted Coroner Caitlin English late last year to recommend her findings be circulated to ACEM Fellows to highlight the evidence, guidelines and potential issues in the management of snake bite (download Coroner Caitlin English’s findings below).

Complete the survey

The aim of the survey is to understand current clinical practice in managing snake and spider envenoming in Australia. The Investigators and Study Coordinator would also like to assess knowledge and perceived barriers to management of snake and spider envenoming among clinicians working in the emergency setting.

The data will be used to plan further research to address knowledge gaps, learning needs and to support evidence-based national policy review and implementation.

Physicians (ACEM, ACRRM or RACGP fellows) who have treated at least one snake envenoming or spider (Redback or Funnel Web) envenoming case in the last three years are invited to take part in the survey.

It is estimated the survey will take 15 minutes to complete.

Complete the survey now

What is the ‘state of play’?

Professor Braitberg said there has been considerable research undertaken over the past decade into the use of antivenom in the management of snakebite and the pathophysiology of envenomation.

“But when we reviewed the documentation of the recent Coroner’s case in Victoria, it was clear that there was a lack of agreement amongst the experts that the coroner sought advice from,” Professor Braitberg said.

“So what we really don’t know is whether the current guidelines across Australia are consistent, are being adhered to, what the actual practices of emergency physicians who manage snake envenomation are, where their sources of information are and what the barriers are to care.

“We have looked at venom –antivenom interaction and venom pathophysiology but we haven’t looked at how this knowledge has translated into practice and how this knowledge influences the behaviour of doctors caring for envenomed patients. And this really is what the aim of the study is to show: have we got consistency in our care. If not, why not. And what we need to do about that.”

Professor Braitberg said the survey asked questions about the amount of antivenom given, how much anitvenom is kept in an emergency department, escalation of care, where, when and how advice is sought, and the coordination of patients’ treatment.

The importance of research in emergency medicine

Professor Braitberg said the SNAKE study demonstrated how important research was to emergency medicine.

“We’re very fortunate in emergency medicine,” he said. “We have thousands and thousands of patients go through our departments and we’re really well placed to ask questions about why they present.

“And I think that we often allow others to ask the questions of the patients that we see, and it’s really important that we initiate those questions through our own research.

“Emergency medicine physicians hold expertise in many areas including toxicology, agitated behaviour, mental health emergencies, retrieval medicine etc., but every patient comes through an emergency department can raise a question and I think we miss opportunities if we don’t try and answer those questions as they arise in the emergency department.”

Background

Download Coroner Caitlin English’s findings into the death of Mr Tatti.

Download Coroner Caitlin English’s findings into the death of Mrs Z.

The research project has been approved by the Human Research Ethics Committee of The University of Melbourne and is conducted under the auspices of the Centre for Integrated Critical Care. If you have any questions please

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