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Wednesday, November 26, 2014         

NEW YORK TIMES


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Near the zoo's snakes, a hospital's collection of medicine

By Charles Delafuente

New York Times

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NEW YORK » The Bronx Zoo has an impressive collection of venomous snakes on display in its Reptile House. But out of sight it also has an impressive collection of antivenin to treat snakebites — though none of the zoo's snakes have ever bitten an employee or a visitor.

The antivenin is stored at the zoo because it is just a few miles from Jacobi Medical Center, which has one of the nation's leading snakebite-treatment centers, the only one in New York City, and the two work hand-in-hand to treat snakebite victims.

"We need each other," Dr. Michael Touger, the medical director of Jacobi's snakebite center and associate director of emergency medicine at the hospital, said.

Hospitals are not licensed to stock most exotic-snake antivenin, which are considered somewhat similar to experimental drugs, said Don Boyer, the zoo's curator of reptiles.

The zoo, which is run by the Wildlife Conservation Society, has a permit to hold the antivenin, and supplies it to Jacobi as needed.

That is not very often, Touger said. Jacobi treats only a few patients a year, most of them in warm weather. They arrive by ambulance and sometimes by helicopter from around the New York, New Jersey and Connecticut region.

New York is not well known for snakes — at least not the reptilian kind — but people still manage to get bitten occasionally. The bite of a venomous snake can be fatal if the victim is not treated quickly, because some kinds of venom can stop the victim from breathing and others can cause internal bleeding.

The Jacobi-Wildlife Conservation Society snakebite treatment program "is quite special," Touger said, "with a very substantial body of clinical experience." It has treated about 175 patients with antivenin since it was established in the 1980s. About half were bitten by snakes in the wild, and the others by snakes acquired by collectors, Touger said. Without that treatment, he said, some of those victims might have died.

The standard treatment for a bite from a poisonous snake is to inject the victim with antivenin, which is where the zoo comes in, though the antivenin does not come from Bronx Zoo snakes.

But the zoo keeps on hand 14 kinds of antivenin, which it can supply to Jacobi, or other institutions, on short notice. Some antivenins can counteract the bites of several kinds of snakes from specific regions, and the zoo's supplies provide "broad coverage for venomous snake bites from species around the world," but not against every snake in existence, Boyer said.

An antivenin not available at Jacobi could be in stock elsewhere. Poison control centers have access to an index of which institutions in the U.S. have which antivenins — a list kept by a collaboration of the Association of Zoos and Aquariums and the American Association of Poison Control Centers, Boyer said.

Sometimes, the zoo or the hospital will send antivenin by helicopter to another hospital, but Touger's preference is to have the helicopter bring the patient to it, if possible, because "the outcomes are better." The antivenin is injected at intervals of two to four hours.

The most common culprit in regional snakebite cases is a timber rattlesnake or copperhead, both of which are indigenous to New York, Boyer said. In fact, Jacobi is allowed to keep antivenin for those two species on hand.

Victims may have been bitten while rock-climbing, farming or during an outdoor activity at a summer camp, Touger said.

One patient treated at Jacobi this summer was bitten by a timber rattlesnake in his suburban garden in Montebello, N.Y., just about 35 miles from Times Square. He had a very low platelet count when he arrived, but treatment saved him. Even then, Touger said, it took a month to get the platelets back to normal.

New York state and New Jersey require a permit to possess venomous snakes, but many other states, including Pennsylvania, do not. There are frequent swap meets there where people buy, sell and trade venomous reptiles, Touger said, recalling the case last year of a young man who bought an Asian snake, an albino monocled cobra, that was supposedly treated so it would not be venomous, but was. He brought it to his home in northern New Jersey. And it bit him.

The snake lover was found by a relative, gasping for breath, and was soon sent to Jacobi. At one point, he stopped breathing, "He had multiorgan system involvement and was near death," Touger said, but was saved and now feels fine.

Another case did not have such a happy ending. A woman in Putnam Valley, N.Y., had 57 venomous snakes in cages. Last summer, she put her arm in a cage, was bitten by a black mamba, a snake native to parts of Africa, and did not seek help, Touger said.

"The state police called it suicide by snakebite," he said.

She died at her house.

The collaboration between Jacobi and the zoo began in 1980 and the program was first intended to treat staff members at the zoo if the need ever arose.

That evolved into the current program for treating other bite victims, Touger said.

Asked what a snakebite victim should and should not do, he said it was imperative to call 911 to get medical help immediately. Since most bites are on limbs, the affected area should be kept at the level of the victim's heart, and tightfitting clothing in the wound area removed, until help arrives.

Neither the victim nor those with him or her should try to suck out the venom or cut out flesh around the bite. Nor should tourniquets or ice water or electric shocks be applied, he added.

When he takes medical students to the zoo's reptile house, "they love it," he said, adding of his bite-treatment work: "Of all the different jobs that I do, this is the most interesting and the most fun."






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