Based on these recommendations, the following first aid treatment for poisonous snake bite is suggested:
1. IMMOBILIZE THE AFFECTED ARM OR LEG whenever possible. Where this is not practicable, keep movement of the bitten limb to a minimum. Muscular activity helps increase the spread of venom. Whenever feasible, transport the victim by litter to further medical aid.
2. APPLY A CONSTRICTING BAND from two to four inches above the bite, between the wound and the heart. This will help to limit the spread of venom until it can be removed by incision and suction or neutralized by antivenin. A piece of rubber tubing or a strap tourniquet, included with every snake bite kit, is best for this purpose. When these are not available, items of clothing may be used. A shoe lace, neckerchief or a strip of clothing torn from shirt or trousers will do. The poison, unless injected directly into a major blood vessel or deeply into a muscle, is absorbed slowly by the lymphatics below the skin. Therefore, do not restrict the deeper blood circulation by applying the constricting band too tightly. It should be loose enough for a finger to be slipped under it with little difficulty. Remember that during first aid treatment the constricting band must be loosened every 15 minutes for about two minutes. This precaution may prevent gangrene. If the bite is on the hand or forearm, take off rings, bracelets or other jewelry because subsequent swelling may make their removal difficult.
[Illustration: Applying constricting band]
3. MAKE INCISIONS after sterilizing the cutting instrument and the bite area with iodine or alcohol. If no antiseptic is available, the blade of the cutting instrument can be sterilized by holding it over a flame (a match will do). Make _one_ cut over each fang mark parallel with the long axis of the bitten limb, not across it. Incisions should be one-quarter inch long and one-eighth to one-quarter inch deep, but definitely no longer than the diameter of the suction apparatus being used. This would allow air to enter the suction bulb from the outside and the device would then be unable to work. Incisions are of the utmost importance to first aid treatment; without them little or no poison can be withdrawn from the wound by suction. However, making even a small incision involves some risk and this operation should be done with considerable care. Improper or carelessly applied first aid may actually do more harm than good. Although a physician may later decide to make additional incisions to relieve the pressure of swelling, only the cuts over the fang marks are recommended for first aid.