Pre-hospital interventions in snakebite: A telephonic survey and follow up investigating snakebite envenoming from a tertiary care centre in Coastal Karnataka

Background: Snakebite envenoming remains a major public health issue, particularly in tropical and subtropical regions, where it disproportionately affects rural and socioeconomically disadvantaged communities. In India, especially in rural and tribal areas, inappropriate pre-hospital practices are common and often delay definitive medical care, contributing to poor outcomes and preventable complications. Objectives: This study aimed to assess community knowledge, attitudes, and practices related to snakebite first aid; describe the nature of medical and non-medical pre-hospital interventions; identify challenges in timely access to care; and examine the association between these factors and clinical outcomes. Methods: A prospective survey based cross-sectional study of cases of snakebite envenoming enrolled in the VENOMS registry (CTRI/2019/10/021828) and hospital records was conducted. Patients who reported between August 2019 and July 2024 were identified from the VENOMS registry and Medical Records Department of Kasturba Medical College, MAHE, Manipal. After obtaining verbal consent, the victim, family member or first responder at the scene underwent a structured interview assessing pre-hospital interventions, awareness, attitude, present status of the victim, and concluded with a brief health education session. Geographic Information System (GIS) mapping was performed using QGIS (version-3.38.0). Results: Of the 273 patients, tourniquet was the most used intervention in civilian first response (70%). Patients who reached healthcare centre within 30 minutes were significantly associated with higher recovery rates and lower mortality (p=0.003). Patients who used traditional healing methods had worse outcomes, higher mortality (7.3% vs. 0.9%) and disability (p=0.023). Visiting three or more healthcare facilities was linked to increased disability, suggesting delays in definitive care (p=0.003). Ambulances were utilized only in 46.1% of cases, where only 3 respondents reported using ambulance to reach a healthcare facility from home. In the remaining cases, ambulance was used only for inter-facility transfers. Furthermore, 22.71% of respondents reported unavailability of ambulance services in their area. Conclusion: Our study found that rapid transfer to definitive healthcare facility was associated with better outcomes, and that there are challenges in accessing emergency care for snakebite envenoming in our region. There is a pressing need to strengthen pre-hospital systems, improve public understanding of snakebite management, and enhance the capacity of Emergency Medical Services-trained and qualified paramedics through structured training programs like Bachelor and Master of Sciences in Emergency Medical Technology.