Hello my friend,
The group of questions you pose are actually very complex issues to sort out since the medical legal implications are vast. I propose that the best way of dealing with these issues is a two-pronged approach to make everyone comfortable with the situation.
First of all, it's very important to build a rapport with your personal physician, as well as the emergency room physicians at your local medical center. Your personal physician will actually grease the wheels regarding this liaison with the hospital emergency room. What you need to do is make an appointment with your personal physician to discuss what to do what animals you keep and provide copies of treatment protocols, as well as emergency numbers in important places and people to contact. Ask your physician if they would make initial contact and set up a meeting with the medical director of the emergency services at your local medical Center. One thing you need to remember is, you were the customer and you do have the right to direct the way you're treated. Just explain to them that emergency treatment for snakebites is just not very common for an emergency room to treat. You're just making sure for your benefit as well is there's that proper treatment protocols are established.
The other part of the equation is selecting the correct medical center and physician to be in charge of the antivenom bank. For instance, the medical director selected for the bank here in the Northeast has no problem using Bioclon over CroFab. He also mentioned that he actually prefers the old Wyeth anti-crotalid serum over CroFab.
If the AVB member was to be bitten and the local emergency room physician was told to contact Dr. XYZ is your specialist for snakebite, he would most likely do so without hesitation. Dr. XYZ would be informed that his patient Joe “Parcel Tongue” was admitted to the emergency room suffering a “ tubesnake” bite and needed antivenom and to treat this bite. Under this sort of circumstances, the local ER doctor would put up far less resistance if told to treat the bite using an imported serum and methods prescribed by Dr. XYZ.
The only problem of major concern is time. As Dr. Sean Bush correctly says, "Time is tissue". However, none of the current serums available really do very much to abate the local effects of the snake venom. For members here in the northeastern United States the bank is relatively is centrally located and the Bioclon serum could be flown into the hospital in a short time. For members that are further away there would be no other option but to treat with the antivenom on hand. I see no alternative to this till Bioclon is FDA approved over the next few years.
Obviously, this flawed in the antivenom bank system is only valid for domestic snakebite. As spelled out previously, if a keeper and is bitten by a foreign snake and you are not close to the serum bank, antivenom would be obtained from the nearest AZA facility, which has the proper serum. The zoo's serum would be immediately replaced from the antivenom bank stock, so the zoo is not without serum. This will alleviate AZA institutions from beating up on private keepers in the press.
I will have to rethink the antivenom bank concept regarding including coverage for North American crotalids. Wyeth Labs, has already told me they have limited stocks of their Anticrotalid serum and are only replacing serum used on a case-by-case basis. Subsequently, with Wyeth, and Protheric's CroFab out of the picture the antivenom bank may have to be limited to those keepers who have exotic snakes who wish coverage. I will certainly have a better picture of the situation after talking to many of the poison control center, physicians that will be attending these snakebite symposium. The third weekend in October.
Cheers!
Al
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If you give somebody a match and they can keep warm for a while.
If you light them on fire, They will be warm for the rest of their life.
