This story was originally published on August 26, 2019.
Amy Morrow was dodging boulders as she hiked through her yard on Lookout Mountain when she felt what she thought was a stick jabbing between her toes. She had just finished watching a storm roll in as the sun set from the bluff behind her home.
Her dogs have encountered venomous snakes — a copperhead and two rattlesnakes — in the rocky terrain before, so she knows the risk well. That's why she tells visitors to always wear closed-toe shoes when walking along the bluff. But this July, she broke her own rule and wore flip-flops. By the time she made it inside to wipe off the blood, her foot was swelling, fingers tingling and lips going numb.
Her partner called 911 and they hurried down the mountain. An ambulance greeted them at the base and rushed Morrow to an emergency department. She struggled to breathe and thought about her dog Stranger.
"Luckily, I wasn't thinking of the severity or the possibilities at the time. I was just worried about trying to breathe and thinking about my dog," Morrow said. "Poor little Stranger — his leg is so tiny — I'm a normal-sized human, and it's this yucky his poor little leg has gone through this twice."
Morrow's memory of the emergency department is fuzzy, but doctors determined she was bitten by a rattlesnake. She spent four days in Erlanger's medical intensive care unit, where she was given four bags of anti-venom and left with a "very discolored, swollen and painful foot and leg."
What to do if you’ve been bitten:
— Stay calm. While very painful, snakebites can be treated and are rarely fatal.
— Wash the bite gently with soap and water if this won’t delay transport to the hospital.
— Remove any jewelry and constricting clothing from the area of the bite.
— Keep the arm or leg (usual sites for snakebite) immobile and in a neutral position.
— Call Poison Control (1-800-222-1222) right away. The poison specialists and medical/clinical toxicologists on staff are experts in treating snakebites and will work with the physicians in the emergency department so you’ll get the proper treatment.
Although there are a variety of folklore practices and commercial products for treating snakebites, evidence shows there is nothing that can be done in the field to significantly alter the outcome of a snakebite.
What not to do:
— Don’t risk another bite by trying to capture or kill the snake. If you can take a picture or describe the snake, that is good but not essential for proper treatment. It is also important to know that even a dead snake or decapitated head can still envenomate a person.
— Don’t apply a tourniquet. These can lead to ischemia, gangrene, and amputation.
— Don’t cut the wound and suck out the venom (either by mouth or with an extractor device). Experimental models show these do not extract any venom and increase local tissue damage. Additionally, oral suction can introduce bacteria into the wound and cause an infection.
— Don’t apply ice. This will not slow the spread of venom and can cause significant frostbite.
— Don’t attempt to shock the wound with a stun gun or other electrical current. While there are numerous personal testimonials and anecdotal reports (including a few that involve a car and a set of jumper cables), experimental models show no benefit and delayed wound healing.
Source: Tennessee Poison Center
Dr. Doug Gregorie, an emergency physician at Erlanger Health System who specializes in wilderness medicine, said July and August are peak times for snake bite victims to visit the emergency department. Last year, Erlanger treated 29 snake bites — 10 of which were venomous. Nine of those bites were in July and 15 in August. So far this year, Erlanger has treated 22 snake bites — three venomous — with nine bites occurring in July and three in August.
Although accidents like Morrow's happen, the "vast majority" of those bites could've been prevented if patients avoided snakes instead of trying to handle, provoke or kill them, Gregorie said.
Patients who are bitten by snakes should seek immediate medical treatment unless they are certain the bite came from a non-venomous snake. The Chattanooga region in Tennessee and Georgia is home to two venomous snakes: copperheads and timber rattlesnakes. There's a slight chance water moccasins — also called cottonmouths — could be in the area, but they prefer warmer water.
Copperhead bites are more common but rattlesnake venom is more potent, Gregorie said. The venom of both snakes causes swelling, local tissue destruction and abnormal blood clotting and bleeding. Other symptoms include nausea, vomiting, difficulty breathing, facial and limb numbness, blurred vision, low blood pressure and shock.
Venomous snakes don't inject venom with every bite, but when they do swelling starts almost immediately, Gregorie said.
"Once you see that, it's pretty imperative you seek medical treatment," he said.
People who are bitten in remote areas should head immediately toward civilization. There's thought that the less you move the slower the venom circulates, so if there's a means to be transported that's preferred over walking. If cell phone service is available, get someone to pick you up. If symptoms include high heart rate, sweating or lightheadedness, "then absolutely call 911," he said.
"Getting to health care safely and quickly is the primary concern," Gregorie said, adding that many old folk remedies — such as cutting the wound open — can cause more damage.
"Certainly don't try to suck the venom out yourself, because even if you did get some venom out, you would be ingesting it," he said. "Tourniquets are not effective and, they can actually be harmful because they isolate the venom in one area and increase the risk of losing that limb."
Antivenom is "exceedingly expensive," Gregorie said, so not every medical facility stocks it. Erlanger's main campus and rural hospitals all have antivenom, but Erlanger North and East do not.
Parkridge Medical Center, Parkridge East Hospital and Parkridge West Hospital all have antivenom, as do all of CHI Memorial's hospitals, according to hospital spokespeople.
Thomas Floyd, a wildlife biologist with the Georgia Department of Natural Resources, said snake bites are more common this time of year, because snakes are more active when it's hot and people spend more time outside.
"Any time those two factors come together you have more encounters," he said.
Floyd recommends that people be able to identify the venomous snakes that live in their area. Georgia has 46 different species of snakes. Six of those are venomous — copperhead, Pygmy rattlesnake, timber rattlesnake, cottonmouth, eastern diamondback rattlesnake, eastern coral snake — and for the most part all six's territories don't overlap. Tennessee is home to 32 snakes, four of which are venomous, according to the Tennessee Wildlife Resources Agency. The cottonmouth and Pygmy rattler are seen most often in West Tennessee, South Georgia and states to Tennessee's west and south and along the southeastern coast.
Most snakes avoid humans but can occasionally be spotted in backyards, parks and woodlands. They're an important part of the ecosystem and should not be killed, which can also increase the chance of being bitten.
"Statistics don't lie — a good number of snake bites occur in the process of trying to dispatch a snake. The best thing to do is to keep your distance," Floyd said.
The timber rattlesnake — the snake that bit Morrow — in particular is resistant to strikes, he said, which is why it was chosen as an early American symbol.
"If you poke at it or provoke it, then finally it will bite, so that's where the adage of 'don't tread on me' came from," Floyd said. "If you happen to step on one in just the right manner, it's going to feel like it has to defend itself."
Since they often take refuge in piles of brush or firewood, he encourages people to maintain their property and remove unnecessary brush piles that can harbor prey or snakes themselves.
Most importantly, Morrow said, is to wear proper footwear — not flip flops — when walking in a mountainous or wooded areas.
"I'm quite familiar with the fact that there are snakes out this time of year. I actually said those words but went down, saw the storm coming up the valley anyway," she said. "It was beautiful, but I'm not sure it was worth the snake bite."
Contact Elizabeth Fite at firstname.lastname@example.org or 423-757-6673.