title: Exotic venomous snakebite drill.
abstract: BACKGROUND
  There were 900 exotic venomous snakebites reported from 2000 to 2009. The Association of Zoos and Aquariums' recommends institutions housing venomous reptiles have protocols for appropriate and timely transport of envenomed individuals to hospitals. The study objective was to evaluate functional aspects and potential problems of our emergency operation procedure designed for handling the response to an exotic venomous snakebite during implementation via a simulated drill. The emergency operation procedure consists of two protocols, the protocol for zoo personnel and exotic snakebite protocol for hospital personnel.
  
  
  METHODS
  Before the exercise the poison center (PC), zoo, Emergency Medical Services (EMS), receiving hospital emergency department (ED), and pharmacy were contacted. The emergency operation procedure was reviewed to determine areas of deficiency. A checklist of all required actions for each participating institution was created for use during the exercise. The exercise was divided into four phases: zoo, EMS, PC, and ED. Each phase was evaluated by an independent observer.
  
  
  RESULTS
  Review of the emergency operation procedure revealed sufficient and easy to follow information for zoo personnel. However, the exotic snakebite protocol for hospital personnel lacked details regarding signs and symptoms expected from each exotic venomous species in the zoo; and indications, dosing, and instructions on reconstitution for each of the antivenom carried by the zoo. Zoo, EMS, ED, and PC personnel completed 95%, 90%, 83%, and 25% of the required tasks, respectively. The PC encountered problems communicating the exotic snakebite protocol for hospital personnel to the ED due to phone and fax equipment failures. Creative solutions to the PC system issues were not identified in a timely manner. Despite the shortcomings, the time from simulated envenomation to antivenom (AV) administration was under an hour.
  
  
  CONCLUSIONS
  This drill identified several issues leading to revision of our exotic snakebite protocol for hospital personnel. We also identified suboptimal PC response in the application of the emergency operation procedure. We encourage every poison center in cooperation with local zoos to perform a similar exercise.
authors.affiliation: Department of Emergency Medicine, Emory University, Atlanta, GA, USA. rothong@georgiapoisoncenter.org
authors.forename: Rittirak
authors.initials: R
authors.lastname: Othong
authors.forename: Sophia
authors.initials: S
authors.lastname: Sheikh
authors.forename: Nahar
authors.initials: N
authors.lastname: Alruwaili
authors.forename: Rachel
authors.initials: R
authors.lastname: Gorodetsky
authors.forename: Brent W
authors.initials: BW
authors.lastname: Morgan
authors.forename: Brad
authors.initials: B
authors.lastname: Lock
authors.forename: Ziad N
authors.initials: ZN
authors.lastname: Kazzi
mesh_terms: D000997:Antivenins / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D006801:Humans; D012909:Snake Bites / Q000628:therapy*; D013997:Time Factors
chemical_list: D000997:Antivenins