Snakebite a neglected health problem

Snake specific ASV not available

Carrying anti snake venom in ambulances can mean the difference between life and death for snake bite victims. The impact of this practical intervention was observed while transporting snake bite victims to health facilities in 108 emergency ambulance service across the country, which is free of cost.The first documentation of the life-saving innovation, wherein snake bite victims were administered anti-snake venom (ASV) in the emergency ambulance on the way to hospital in Himachal Pradesh prompted six other states and UTs to follow the same pattern. The intervention has also been acknowledged by the World Health Organisation ( WHO ) in its latest guidelines for snakebite management. The previous guidelines came in 2010.The research paper titled, 'Transporting snake bite victims to appropriate health facility within golden hour through toll free emergency', authored by Dr Omesh Kumar Bharti (corresponding author) from Himachal Pradesh with a team of GVKEMRI (Emergency Management and Research Institute), Hyderabad, has been referenced in WHO guidelines for snake bite management, 2016, released earlier this week.It analyzed the output of the initiative of transporting snake bite victims in emergency ambulance while administering ASV in dire emergency in 12 out of 16 states for the year 2014. (The WHO guidelines for snake bite management are spread over 206 pages and incorporate new innovations). The other two authors of the research paper are Aruna Gimkala and Dr G V Ramana Rao from GVKEMRI, Hyderabad.The research paper was published in the International Journal of Tropical Disease and Health in 2016.“Initially, we studied the impact of quick transportation of snake bite victims in free of cost ambulance in Himachal Pradesh for one year since its launch in December, 2010.Forty two lives were saved out of the 469 snake bite victims transported in the ambulance in one year. The paper was published in the Indian Journal of Applied Research in 2015,“ said Dr Omesh Kumar Bharti, field epidemiologist with the Himachal government. He presented the research study at the Geneva Health Forum in Geneva (Switzerland) last year and was a part of national consultations in the Government of India for drafting snake bite management guidelines in 2016.After documentation of the Himachal experience, GVK-EMRI, based in Hyderabad and service providers of 108 emergency ambulance, replicated the model of keeping anti-snake venom inside more than 1,000 ambulances (that have all the emergency drugs and all resuscitation equipment inside) in different states across the country .“The country's data was then documented, which showed that more than 95% of snake bite victims transported in emergency ambulances and followed for over 48 hours in the hospitals, survived,“ said Dr Bharti.Data for the research study was extracted from the emergency response centre of GVK EMRI in Hyderabad and analyzed to ascertain the impact. According to Dr Bharti, reference in WHO guidelines would mean that other endemic countries for snake bite in Asia and Africa can also take advantage of the innovation.Data suggests that in India alone, more than 50,000 snake bite victims die, mostly due to delayed arrival in the hospital or non-availability of anti-snake venom in health facilities. In some states, the ASV was provided to government health facilities from the stock of 108 ambulances in emergency to save lives.Snake bite is a neglected public health problem in India and remains an underestimated cause of accidental death in developing countries. In India, more than 50,000 deaths are caused by snake bites.The shortage of anti-snake venom in health facilities across the country, however, remains a major concern. Snake bite deaths are not properly documented in India.An important factor for treatment failure is that the anti-venom is not specific to snake species. Himachal, that 0 has anti-snake venom manufacturing facility at CRI, Kasauli, does not produce anti venom for snakes of Himachal Pradesh. The state reports bites by green pit viper but its ASV is not manufactured in India