First aid: Laypeople

First-aid treatment is carried out immediately or very soon after the bite before the patient reaches a health centre or hospital. It can be performed by the snakebite victim himself/herself or by anyone else who is present and knowledgeable.

The bite may occur in such a way that the victim does misinterpret it or misinterprets other conditions (in particular other skin lesions) as spider bites.

• the urgency of the problem.
• the expectation of signs & symptoms still to develop – very important to move quickly to a health post or hospital for assessment and observation (move preferentially to a health post or hospital that have antivenom* available!).

Stay calm

Reassurance will reduce fear and excitement, slow the victim’s heart rate, and reduce the spread of venom.

Immobilize the patient

Place the victim in a comfortable and safe position, ideally in the recovery position, and immobilize the bitten limb with a splint. Movement or muscular contraction, even undressing or walking, will increase absorption and spread of venom.

 CAUTION: Delay the release of tight bands, bandages, and ligatures.

If these, unfortunately still very popular methods of first aid were applied, they should not be released until the patient is under medical care, the initial antivenom dose administered and resuscitation facilities in place.

Pressure-immobilization is recommended only for bites by Australian funnel web spiders (Warrell 2023).
Apply pressure-immobilisation-technique (PIT) as quickly as possible.

It is imperative to apply pressure-immobilization as early as possible, ideally within 10 minutes after the bite (Miller et al 2000).

If an extremity is affected, a compression bandage is applied and the extremity is immobilised (Sutherland and Duncan 1980, Sutherland and Tibballs 2001)

Early removal of compression bandage results in rapid clinical deterioration (Miller et al 2000).
The bandage must remain in place until the envenomation syndrome has completely resolved. The first aid knowledge of the population is dangerously deficient (Miller et al 2000).

If resuscitation is needed it takes precedence over the PIT. However, the resuscitation team should apply PIT as soon as possible to potentially minimise further venom flow.

*Antivenom

Australia (Atrax sp. and Hadronyche sp.)

• Antivenom has decidedly transformed the treatment of Atrax sp. and Hadronyche sp. envenoming. According to the available study and case reports, antivenom dramatically reduces case fatality and mortality.

Other medically important spider species

• The currently available results provide contradictory results. 
• New developments need to be followed-up.
• see 'Antivenom'in 'Clinical entries: Spiders' 

Transport the victim on a stretcher, "fire-man's lift" method, bicycle, motorbike, chart, horse, boat, etc.

• A stretcher can be made with materials that are available in villages or at work.
• Transporting the patient with a stretcher avoids any movement that increases systemic absorption of venom.
• The recovery position will allow for vomit and other secretions to drain from the mouth with less risk of airway obstruction. This is particularly important when the patient is unconscious or semiconscious.
• Fix the patient to the stretcher with straps.
• Let somebody walk alongside the patient to continuously observe him/her.

Two-wheeler transport

• Support the victim between the driver and a pillion passenger
• Protected the victim’s legs from exhaust burns
• Drive safely
• All passengers should wear helmets!!

If a service is available, call the ambulance

• Inform the responder about
• Number of mobile phone
• Name of the caller (victim, first responder)
• Nature of spider bite envenoming (Unconscious? Difficulties breathing? Cannot lift head whilct lying on the ground? Bleeding)
• Name of the incident location
• Nearest place where the ambilance can get to the victim
• Never put down the phone / mobile, wait for the call agent for any medical information / pre-arrival iinstructions