Snakebite management in India, the first few hours: a guide for primary care physicians.

Snakebite in India continues to be a matter of medical concern and India remains amongst the group of countries with the highest mortality. India is also one of the world's leading producers of snake venom antiserum and therefore the understanding of the causals of snakebite mortality does not rest in snake venom antiserum shortages. The availability of treatment, particularly close to the scene of the bite, is a crucial factor in ensuring a positive outcome. In the majority of the States in India, 90+% of medical facilities are primary healthcare centres run by one doctor and with only basic equipment. If snakebite treatment is to be successful, these centres are a vital element, but virtually all existing treatment guides assume treatment at tertiary care hospitals with better equipment. A great many of these primary care hospitals do not treat snakebite, even when snake venom antiserum is available, simply because the doctor lacks confidence in being able to treat the patient. The result is that patients are referred to distant, better equipped hospitals and thus make journeys without the cover of snake venom antiserum. This paper provides guidance for the primary healthcare doctor in identification of medically significant snakes, treatment, referral criteria and equipment necessary to successfully manage snakebite in a primary care environment.