Northern Kenya Snake Bite Case Study

Bio-Ken Snake Seminar

23 October 2014

Scenario & Incident

Challenges

Outcomes

Learnings

Corrective Actions

Turkana Insight

Overview

Pai Pai Site in the Chalbi Desert Northern Kenya – Block 10 A

3 – 4 week demobilisation of a driling project 4 hour drive to Marsabit Flat Arid Terrain Clear Sky Evening At 19:20 an employee on site exits tent to walk

towards an area of the site, known for better mobile signal

Near a soak pit which had formerly been a waste water treatment plant

Scenario & Incident

Employee was wearing flip flops Stepped on something and felt a sharp painful

sting on left inner foot below his ankle Alerted colleagues who took him to the

Advanced Life Support Paramedic on site who had an ALS Jump Bag

Communications to both Ardan Head Office Incident Management Team and Bio-Ken Snake Farm for guidance and advice

Ardan alert AMREF flying doctors that a Medical Evacuation may be required

Scenario & Incident

Medic in contact with specialist medical personnel in Nairobi advised that there were bite sized fang marks, minimal bleeding, initially moderate swelling to the left foot and ankle and then progressive swelling and numbness to his left leg

Given the duration of the demobilisation medical support was limited without a full resuscitation clinic on site

Medic administered First Aid monitoring employee and in constant consultation with the Nairobi team

Scenario & Incident

AMREF flying doctors had not flown into this very remote airstrip for over one year

Should AMREF decide to fly at night, they would require two pilots Sufficient lighting on site to light up airstrip AMREF departure ex Nairobi was at 11.45 pm and arrived on site at 1:45 am. Departed site at 2.15 am Arrived JKIA at 4:15 am

Challenges & Learnings

Patient admitted to Aga Khan Hospital at 5 am

Total time to mobilise from first call to site arrival was just over 5 hours

Time taken from bite to hospital was just over 8 hours

Upon admission, vital signs fine, lab tests normal, analgesics, antibiotics and intravenous steroids administered

Discharged Tuesday 17th, one week follow up with further follow ups as a result of swelling after standing and walking

Challenges & Learnings

An assumption was made on site that the patient had been bitten by a puff adder

The bite visuals and symptoms indicated that he had been bitten by a carpet viper

A four hour bumpy road drive to Marsabit Hospital (antivenom?) was not an option

Doctors on AMREF flight administered SAVP Saimr polyvalent which is suitable for cobras, mambas and vipers

Carpet Viper bites require an echis monovalent There are two monovalent antivenoms

available – one is for carpet vipers and the other one is for boomslang

Challenges & Learnings

Insight: Puff Adder

Big, fat, broad-headed, heavy-bodied viper, with a pale line between the eyes

1.7 m in low-altitude areas, smaller in the highlands, average 70 cm to 1.1. m

Colour variable (grey, brown, yellowish) with a series of V-shapes, light and dark, along the back, pointing towards the tail

Usually terrestrial Active by night, sometimes basks Shelters under ground cover, below thick

bushes, in leaf litter or in holes during the day Eats mammals especially rats, mice,

sometimes birds and amphibians

Insight: Puff Adder

Kenya’s most dangerous snake Large size, wide distribution in all types of

savanna, good camouflage, tendency to remain motionless when approached

Rapid strike, long fangs and toxic venom Bites are characterized by strong pain,

swelling, tissue destruction and blood blisters

Recover but permanent tissue damage often results

Treat bites as medical emergencies: Polyvalent

Insight: Carpet Viper

A small, fairly stout snake with a pear-shaped head and thin neck

70 cm, average 30-50 cm Ground colour variable (rufous, grey, brown,

yellowish). Light cross bars along the back, series of light-

edged triangles or sub-triangles Terrestrial and nocturnal Spirited snake, threatened it forms a series of C-

shaped coils which are shifted against each other, the friction produces a sizzling sound

May move back or forward and strike vigorously Eats a variety of prey, scorpions, centipedes

also known to eat other snakes, mammals and lizards

Insight: Carpet Viper

This snake causes a lot of bites in northern Kenya.

Venom is an anticoagulant, as well as causing pain, swelling and necrosis.

Bites should be treated as medical emergencies: Echis Monovalent

• Walking in an isolated area when dark• Wearing flip flops and not safety boots• Area not well lit

Root Causes

Corrective Actions Improve channel of communications – Bio-Ken & Nairobi• Tool Box talks on snake awareness, prevention and approach• Additional lighting installed on site• General snake awareness training facilitated by specialists • Stocking of appropriate antivenom on site(s)• Sufficient medical support for the duration of the well closure• Ongoing HSE training: safety boots, water on site, rubbish on site,

fencing etc

Sightings in Lokichar Area from

March 2013 to April 2014

• 57 sightings: 34 carpet vipers, 6 red

spitting cobras, 3 puff adders, 6 non

venomous • Back to back handlers in field• Tullow Turkana Training initiative

Turkana Insight