Tele-Toxinology: Using Mobile Phone Images to Safely Avoid Aeromedical Evacuation for Snakebite in Northern Australia.

We have evaluated the impact of using mobile phone images of snakes to guide aeromedical retrieval and hospital management of snakebite in the tropical Top End of the Northern Territory of Australia, including many rural and remote locations. We retrospectively analysed data from 14 years of using the Top End snakebite management guideline, which incorporates assessment of mobile phone images of snakes implicated in snakebites. The implicated snake was identified for 192 patients with suspected or definite snakebite, with 74 (38.5%) being venomous snakes. Aeromedical retrieval was able to be safely avoided for 25 patients from remote locations, mostly bites at nighttime and some over 700 km from the hospital. Hospitalised patients bitten by confirmed non-venomous snakes were able to be safely discharged without further observation time and blood tests. In conclusion, with guidance on images required, access to expert identification of local snake fauna and strict confirmation of attribution of the bite to the photographed snake, pathways can be safely implemented that avoid aeromedical retrieval and prolonged hospitalisation for snakebites from confirmed non-venomous snakes.