The use of pressure immobilization bandages (PIB) for first aid for snakebite has been policy in Australia since endorsement by the NHMRC in 1979. In Australia PIB is well established and publicly accepted, and yet recent studies have shown that both volunteers and trained first aiders have poor knowledge of and performance in its application.
A study published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine, highlights this, as does a letter to the editor in the same publication.

Professor Bart Currie, head of the Tropical Toxinology Unit at the Menzies School of Health Research, based at Royal Darwin Hospital, with University of Melbourne medical student Elizabeth Canale and Associate Professor Geoffrey Isbister from the Tropical Toxinology Unit at the Menzies School of Health Research, examined the effectiveness of pressure immobilization first aid for snakebite.

They say that pressure immobilization (PI) “remains poorly adhered to in Australia, despite widespread publicity for over 25 years and universal acceptance as policy by all national first aid organizations.”

“Earlier studies showed that around 18% of children were treated correctly in the field in Queensland, while at least 31% of children with suspected snakebite in Western Australia had no first aid applied in a study from 1984 to 1993.

“The more recent review of children presenting to the same Perth hospital between 1994 and 2004 [see below] found that the use of effective PI had actually dropped since the previous decade, with around only a third of the 151 children having appropriately applied PI.

“In another recent study, recommended PI was not complied with in the majority of snakebites from north Queensland.”

Until the currently ongoing Australian Snakebite Project, the only prospective study of PI was the Royal Darwin Hospital prospective snakebite study.

That study found pressure-immobilization first aid was used more often than in previous studies. However, bandages were frequently too loose or not applied to the whole limb, and immobilization was often neglected.

The authors concluded that, “while PI should continue to be promoted as the standard for Australia for the present, prospective multicentre studies of snakebite with quantitative assays for blood venom concentration will hopefully better elucidate the real effectiveness of PI and define the limitations of timing of application and determine the optimum types of bandage materials to use and the pressure required to be maintained.”

A letter to the editor by Dr Noel Eatough, from the emergency department at Perth’s Princess Margaret Hospital, says that PI continues to be underused in suspected snakebite in children.

Dr Eatough and his colleagues reviewed all cases of potential pediatric snakebite presenting to Princess Margaret Hospital for 10 years from 1994. This work followed the study of the subject conducted at that hospital during the previous 10 years.

They found that most patients (101/151) did not receive appropriate first aid prior to attending emergency medical services. Seventy-five (49.7%) had no recorded first aid, 14 (9.3%) patients had tourniquets applied and a further 12 (7.9%) had other forms of inappropriate first aid. These included sucking the wound, washing with water, vinegar or Stingose, applying ice and applying PIB only above the wound site itself. Only 49 (32.5%) received PIB. Three patients had combinations of first aid, such as PIB and a tourniquet.

“The application of effective PIB first aid is difficult to ascertain retrospectively from the medical records and it is not possible to retrospectively assess the adequacy of the bandaging technique,” Dr Eatough said.

“However, it is apparent from the present study that most patients did not receive timely first aid. Furthermore, even when application was performed by emergency medical services, there were notable cases of inadequate PIB and subsequent delays in its application.”

He said he was worried that comparison with the previous decade shows a falling rate of PIB application.

“The challenge is to develop new strategies and techniques for teaching this potentially life-saving first aid technique.”

This paper is published in Emergency Medicine Australasia (Vol.20 Issue 3, 193-289).

Source: Blackwell Publishing

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