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Nigel Monaghan is a public health consultant based in Cardiff and is a member of the Welsh committee for public health medicine as the British Dental Association cross-representative
The situation: Imagine someone who is breeding 47 varieties of poisonous snake and milking for venom. He wants to be reassured that he will receive the appropriate treatment if bitten. How would you advise him?
For me, one advantage of a career in public health is the variety of problems you come across. Some of the problems do stretch you, but there is usually time to think your way through them. I recall a communication I received from a member of the public. He had already informed the local council that he was breeding snakes and they suggested that he should contact public health.
He was concerned that he might get bitten by a poisonous snake and wanted to get the right treatment in A&E for the type of venom injected into him. Ideally, he wanted each of the local A&E departments to be notified in advance of his circumstances and concerns to ensure that he would get the right treatment for the snakebite. I would add that he was breeding and milking for venom over 40 different species, so this was not a straightforward task.
I couldn’t be sure which A&E department he would be taken to, and did not want to have ambulance staff playing ‘hunt and identify the escaped poisonous snake.’ We had a chat on the telephone and I suggested that he keep a log book of the snakes he was handling and login/logout his handling of them. The log book could also contain details of his preferred treatments for bites from each species. I also suggested that he could wear a notice around his neck stating the following:
‘If I am unconscious or appear to be drunk, I have probably been bitten by a snake. Please locate my logbook and take it with me to A&E urgently.’
Further discussion a few days later led to him producing notices for each snake, describing the species, symptoms of snakebite and preferred anti-venom care. He would then put the appropriate notice around his neck before handling a snake and take it off after work was completed, thereby avoiding the need for a logbook.
Within two years, I had reports from A&E staff that he had attended following snakebites on three separate occasions, so this solution must have worked successfully at least twice.