BITES (NON-VENOMOUS ANIMAL, HUMAN)
(see also snakebite protocol)

DESIGNATION OF CONDITION

Signs and symptoms may include any or all of the following: local pain, swelling, and lacerations.

EMPHASIS ON PATIENT CARE

Scene safety, control of bleeding, prevent further contamination.

FIRST RESPONDER, BASIC, INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT

1. Assess the scene for safety. Remove patient to a safe area for assessment and treatment.
2. Initial Management - Assess airway, breathing and circulation and manage as indicated.
3. Focused H&P - History, physical exam, vital signs.
4. Irrigate the wound with sterile solution.  Remove jewelry from affected area
5. Have someone attempt to find the animal and check vaccination history. If the bite was from a human, if possible, ascertain the identity and medical history of the person.
6. Do not attempt to secure animal, leave it to the Police or Animal Control Officers. All animal bites must be reported. This will normally be done at medical facility.
7. Transport the patient to an appropriate medical facility.
8. If patient exhibits signs and symptoms of shock, follow Shock Protocols.

BITES (VENOMOUS)
(see also snakebite protocol)

DESIGNATION OF CONDITION

Signs and symptoms may include any one or all of the following: pain, local swelling, puncture wounds, bleeding at site, tachycardia, tachypnea, vomiting, abdominal pain, numbness at extremities, and headache.

EMPHASIS ON PATIENT CARE

Scene safety, control of bleeding, prevent further contamination.FIRST RESPONDER AND BASIC PRE-HOSPITAL MANAGEMENT
1. Assess the scene for safety. Remove patient to a safe area for assessment and treatment.
2. Initial Management - Assess airway, breathing and circulation and manage as indicated.
3. Manage bite wound and extremity

• Remove jewelry from affected area.
• Stabilize extremity and place at the level of the heart.
• Place a constricting band (restricting lymphatic flow only) 2” -3” above and below bite.
• Irrigate bite with sterile isotonic solution or sterile water.
  

4. Initiate transport to an appropriate medical facility.
5. Focused H&P - History, physical exam, vital signs

• Obtain history of bite.
• Try to safely identify type of animal, spider or snake.
  • Ascertain time of bite and onset of signs and symptoms.
• Keep patient calm and still.

6. If anaphylaxis develops, see Anaphylactic Reaction Protocols.

INTERMEDIATE PRE-HOSPITAL MANAGEMENT
7. Adults: Enroute establish two IV's of LR or NS with blood set or regular drip tubing and bolus 20 ml/kg reassess and adjust to desired effect.  
     Child: Enroute establish an IV or IO line with LR or NS, and bolus 20 ml/kg, reassess and titrate to effect.

PARAMEDIC PRE-HOSPITAL MANAGEMENT
8. If the bite was by a Black Widow, and severe signs and symptoms are present, consider DIAZEPAM [2.5 - 10 mg IV] or 10% CALCIUM [5-10 ml] preparation. Must have Medical Control orders prior to administration..
9. If no response to IV Fluid bolus: Dopamine drip @ 4-12 mcg/kg/min.
10. Treat pain per Pain Management Protocols. Use Morphine cautiously with hypotensive patients.

Note: Rapid onset of signs and symptoms indicate a major envenomation.
Do not cut and attempt to remove poison.