Snakebite:

Great Parlor Conversation for Mountain Bikers and Runners in Malaysia

By Pat "Pigpen" Brunsdon 		Pigpen Pat at Janie's Drop-off

Disclaimer: The information here is a combination of stuff drawn from other peoples' knowledge, a bit of personal experience, and a bit of hearsay, all run through the filter of my personal opinion. Hey, I could be wrong. But there's a lot of non-knowledge on the subject out there, so if by presenting this article I get some people thinking about the subject, good. However, if you get bitten by a snake, follow the instructions presented herewith, and die, don't sue me. Even if you figure out how to.

Acknowledgements: Francis Lim Leong Keng and Monty Lee Tat-Mong have written a book called "Fascinating Snakes of South East Asia" (1989) that provides some pretty good stuff on local snakes, but may be less than up to date on first aid. Australian Geographic publishes a terrific book called "Australia's Most Dangerous" that is geared specifically toward creatures you might encounter in Australia, but the snakebite first aid section should be very applicable to Malaysia as the most dangerous snakes in both countries are of the Elapid variety. Plus, there is lots of stuff available on the web, but of course anything taken from there must be taken with a grain of salt as it's accuracy is as open to question as mine.

Background

The venomous snakes to be concerned about come in two varieties in Malaysia: Vipers and Elapids. Vipers have large moveable fangs and inject a hemotoxic venom, one that attacks your muscles directly. This venom can cause swelling and hemorrhaging and is rumored to hurt like f**k, but is rarely fatal in the quantities delivered by the local species. (If you were from the Americas, you would be much more interested in Vipers. They have big ones.) Of the 8 varieties reputed to inhabit South East Asia, the only one I've seen for sure is the Wagler's Pit viper, and the representatives I've seen were either in the Snake Temple in Penang or on the road, dead. (Very pretty snake. Even when flat.)

The other family is the Elapids. The fangs of these are fixed and inject a highly toxic venom that attacks the central nervous system. Around these parts, they can be roughly separated into five families: Sea Snakes (22 species), Coral Snakes (4 species), Kraits (3 species), Cobras (3 species) and the King Cobra. If you wonder about the distinction between the last two families, the King Cobra is a totally separate beast from all other cobras, only sharing with the others the exciting habit of flaring it's hood to scare you and the fact that it's an elapid.

Unless you ride your mountain bike in the ocean, you need not be worried about sea snakes, even though some of them have the most potent venom of all snakes. So kiss that category off. Kraits and Coral Snakes are apparently highly venomous as well but are docile and nocturnal, so no worries there, unless you're clumsy and also ride at night. I may have seen one of these once, but I can't be sure whether it was a Blue Coral Snake or a Red Headed Krait in the half second or so I had to notice it when it crossed my line on a rather terrific downhill. "Wow. Whuzzunthatta... Oh, never mind. Gone now."

King Cobras have a reputation bordering on mythic. (Actually, for several religions they ARE mythic). Biggest, up to six meters long and as big around as a fire hose. When they stand up to get a better view of things or just to scare the pooh out of you, they can look you in the eye. Mostest, at least in these here parts, able to deliver enough highly toxic venom to kill an elephant. However, the only one I know who may have seen a King Cobra in the wild was my friend Simon. When we got to the bottom of a long downhill in the foothills of the main range, he said "Didja see it? Didja see it? You must have, you almost ran over it. It was huge!" Apparently I may have disturbed it while it was snoozing on the trail, causing it to wake up just as Simon zoomed by. What he went on to describe matched a King Cobra more than anything else, but we'll never know for sure. Whew! Cool thought, anyway.

It's those Black Cobras that get all the attention. And why not, they ask for it. There's lots of them around, (I've seen dead ones on the streets of Bangsar and Sri Hartamas and a live one tooling down the road in Taman Tun), they aren't as shy as all the others, they have extremely toxic venom, (potentially able to kill a human within an hour) and they put on a great show when aroused. For a Mountain Biker in Malaysia, if there is to be an encounter, it's more likely to be with one of these than anything else. What pops up out of nowhere, can be up to 7 or 8 feet long, have a head/hood the size of a badminton racket and sounds like you stepped on Darth Vader's foot? Hufffff! Hufffff! Black Cobra! Wow. About enough to produce spontaneous urination.

Another trait worth noting is the somewhat alarming (and also somewhat disgusting) ability of the Black Cobra to spit, up to 2 meters. Yuck. They aim for the eyes, the venom is rumored to burn like hell and can cause permanent blindness. Wash the victim's eyes immediately with the cleanest fluid at hand. Normal saline is best, distilled water next best, tap water not terrific but still better than leaving the venom in.

I bet you don't think you are carrying anything close to normal saline with you when you are riding, but you're wrong. You might have as much as a pint on hand at any given time. Yes, what could be more appropriate to counter having something spit in your eyes than using your urine to wash it out? It's all to disgusting too think about.

But what are the chances?

Really? Almost nil. Snakes are generally shy and don't want anything to do with humans at all, and why should they? They can't eat us. For a venomous snake, venom is a precious resource, and indeed their only method of securing food. Why waste it? Most of the snakes I have seen, including cobras, have been heading in the opposite direction at high speed. I've run over at least one and come pretty close with a couple more, and despite that, they still wanted to leave the scene. (And, chivalrous soul that I am, I let them! By the way, if you come across a small black snake with knobby tire marks on it's tail while riding Bukit Kiara, apologize to it for me, please.) What's to be gained with an extended encounter with one of us? Nothing.

The exception to this may occur if you threaten their nests. Or at least if they think you are. Lim and Lee suggest that egg laying season for Black Cobras is June-ish in Malaysia, but the behavior of a couple Cobras encounters recently suggests if it was hot and dry in May, that would do. I mean, do snakes have calendars? Anyway, add an 88 day brooding period and you have a period of May through September when Mr. and Mrs. Vader are potentially a bit testy.

Real Stats

According to Lee and Lim, in the ten years between 1960 and 1970 there were more than 50,000 snakebites of all types in Malaysia, but only 249 deaths. If you factor in as well that half of those bites occurred in Kedah (Malaysia's rice bowl, with only 10% of the population), this would suggest the most effective way to meet the business end of a snake would be to take up a career as a rice farmer. Here's how it goes: Rodents eat rice. Snakes eat rodents. Humans stomp around in rice paddies for a good part of the day in their bare feet and now and then get their toes caught in a link in the food chain. Ouch.

Our Stats:

Close Encounters of the fourth kind (i.e. Bites): 0. Try these numbers to calculate the statistics: 18 weekly hashes in the Klang Valley. 50 runners per hash. That works out to 900 runners tromping about the undergrowth every week. No bites that I've heard of. (Well, maybe one. Kieran McDonald, if you're out there, could you confirm? And if anyone else has heard of any, email me here and we'll rewrite the statistics. The Malaysian Government was a little less than forthcoming on the subject). It's just those exciting near misses that keep the interest up.

Close Encounters of the third kind (contact): Low. Five years. Thousands of kilometers on bike and on foot. I've run over two... oddly enough, both in the last month. (For all I know it may have been the same snake, and it's just that he's remarkably deaf and slow.)

Close Encounters of the second kind (sighting): Still low. I've seen maybe 15 or 20 cobras, and been close at hand for a few more when others came across one. This includes both Larry Chan and John McCawley playing Olympic hurdler in separate incidents. Undoubtedly exciting, but no bites.

But What If...

O.K., so it's not likely. But still. Run around on a golf course with a steel pole in your hand, you might get struck by lightning. Run (or bike) around plantations inhabited by hard of hearing, legless wonders packing a mouthful of lethal venom and sooner or later you might have an encounter. It doesn't take much to be prepared.

Here's what the Australians say with reference to envenomation by Elapid (reading enough scientific journals makes you start talking this way). Why the Australians? When it comes to dangerous snakes, they done got the lock hold: more species, more potent, more, more, more. Why, before they developed Antivenin for the Taipan, apparently only two people were known to have survived being bitten. Wow. So understandably they are VERY interested in this sort of thing. It shows. Anyway:

  1. Move away from the snake if it's still present. Don't try to kill it. (Good basic first aid in any emergency—it prevents anyone capable of giving help from also becoming a victim).

  2. Don't Panic. (Hah. Still... worth a try.)

  3. Don't clean, wash, cut, suck, burn or do any other silly things to the bite area.

    This topic is rife with folklore, so here's the explanation: Start with the frightening thought of what an excited but untrained person might do with a sharp implement. You're going to cut HALF AN INCH into someone's arm or leg and suck or burn the poison out? Right. Never mind the thought that if you tried sucking it out, you could ingest the venom yourself. Consider those stats from Lee and Lim. 50,000 bites, 249 deaths. In all that biting, not much dying. There was probably a goodly amount done by non-venomous snakes and a lot more where a venomous snake didn't inject any venom. Apparently they can control how much they administer, and it may be learned behavior. (Yes, apparently those young 'uns might indeed be guilty of gettin' all excited and blowin' the works on first contact). Also, you destroy any hope of a qualified doctor making any judgement by looking at the bite area.

  4. Firmly apply a broad bandage to the bitten area, about as firmly as you would a sprain. At all times try to minimize movement of the bitten limb. The bandage is not to function as tourniquet so don't tighten it so tight that it cuts off circulation. The perfect bandage for this is an elastic type, the same you would use for a sprain. (What? You don't carry one? I do. I've never had to use it for snakebite, but I sure seem to hang out with people prone to sprains. Very handy. Saved a couple of rides from being total write-offs. Not bad for RM5.)

    Alright, I know you're dying of curiosity. Tourniquet, tourniquet, tourniquet. That's what Mom would say. But these days, people have figured out that about all a tourniquet is good for is to save your life when you've already lost the limb in question. That's the sort of thing that happens in a shark or crocodile attack, or a runaway chainsaw. Direct pressure, even for very serious wounds, that's the thing. Unless you're very careful with a tourniquet, the victim could very well end up losing the limb, and at best it's no more effective than direct pressure. If the croc got your arm, go ahead, use a tourniquet. Nothing to lose. Otherwise, direct pressure.

    According to the Aussies, it's been known for quite a while that venom moves through the body predominantly by the lymph channels, not the bloodstream. Apparently the venom molecules may be too large to enter the blood stream in the bitten area and are transferred via the lymph system to the chest area, where they are taken into the blood system. So you don't have to cut off the blood supply to the bitten area, but by applying direct pressure in the manner described you can reduce the circulation and keep the venom localized. An envenomed victim can survive quite a few hours in this state.

  5. Once the bitten area is bandaged, extend the bandage to cover as much of the bitten area as possible. If this means cutting the clothing or binding over it, do so. Careful with that knife, boy. So far our victim is suffering only from snakebite. Let's keep it that way.

  6. Fully immobilize the bitten limb with a splint and more bandages. This is vital as it's the motion of the limb that is going to pump the venom around the system. Immobilize the limb, localize the venom, save the victim.

  7. If the victim is semiconscious or vomiting, gently roll them onto their side (the 'drainage' position) to prevent them choking on their own vomit or saliva. Icckk. By the way, also a good way to leave drunks. More people in Rock and Roll should be trained to do this. Might have saved a couple of great drummers and a lead singer or two.

    From this point, circumstances will dictate the order they will need to be done. Judgement calls required.

  8. Urgently seek medical attention. In the Selangor area indications are your best bet would be with Government Hospitals, in particular the K.L. General Hospital or the University Hospital. Private hospitals don't seem to be prepared to deal with snakebite. Considering all those snakebites in Kedah, I wouldn't be surprised to find out the General Hospital in Alor Setar would be a good place to go. (But not if you were riding in Selangor.)

  9. Avoid giving food or drink to the victim unless a long time will elapse before the victim reaches medical aid, and try to keep that to water only, providing the victim can swallow safely. No alcohol—it increases the heart rate. Tempting though. I mean, doesn't this seem like a good time to relax and have a beer? Uh, huh. Sure.

  10. Try to bring transport to the site. Not an easy thing if you are way out back of beyond on a mountain bike, but there it is. Gotta try. Above all, the more immobilized you keep the victim, the less chance the venom has to work its way into the system.
Other points worth considering:

So there. Did I tell you not to sue me, it's just hearsay and folklore, and don't trust anything you see on the web? I'm sure I said that. Still, it makes interesting food for thought. And good parlor conversation.

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© Pat Brunsdon 2000. To contact KLMB, e-mail Vim.
This page created on 27 June 2000, updated on 24 June 2002.

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