1. Most Paramedic care for these patients is supportive. Some of them may require no more than emotional support and routine assessment.

2. Analgesics may be given for pain management if not contraindicated by your local protocols or the patients' vital signs. If you plan to give analgesics, it's a good idea to go all the way and give them intravenously. I would also advise you to go ahead and place the patient on the monitor. In other words if you are going to start pushing stuff into your patient, go all the way with it and do the O2, IV monitor bit. This covers you as well as the patient since you never know when a patient can have an unexpected reaction to a drug. My personal favorite for pain management in non-cardiac/non-burn patients is Demerol, 25 to 50 mg, and 25 mg of Phenergan (The Phenergan is important. Nausea and vomiting is very common with Demerol). There are of course other choices such as Nubain, Toredol, Nitronox, Stadol and even morphine. I would however avoid some of the drugs we use for analgesia in rapid sequence intubation situations such as etomidate or versed. These are powerful hypnotics and were never intended for simple pain management. Conventional analgesics will suffice.

3. As a rule, don't cover the site with dressings. It will just have to be uncovered at the hospital and it does no good. On the other hand, if it makes your patient feel better, by all means cover it up.

4. Cold packs are recommended because sphingomyelinase D (which is primarily responsible for tissue necrossis) is temperature reactive. Cold packs may slow down the necrossis.

5. Do not use constricting bands. They may do more harm than good.

6. Get as detailed a history as you can but expedite transport. We can't get to the heart of the problem these patients are suffering from. Every minute you spend on the scene is a minute longer the venom has to work on the patient. However, a good history may be critical.

7. Be alert for changes in the patients condition. Changes can come fast, so don't get caught with your britches down. If you see any signs of systemic envenomation, even if the patients vital signs are still within normal parameters, get defensive and do the O2, IV, pulse ox, monitor routine and then watch your patient closely. Do this enroute. Do not delay transport to hook up a lot of gear. The reason you need that stuff is because a toxin is attacking your patients internal systems. This is one case where it does not make sense to delay the patient on the scene and away from the drugs and therapies that can get to that toxin, while you hook up a lot of stuff that can't stop that toxin.

8. If you do have a patient who is showing signs of severe systemic envenomation, treat the symptoms as necessary. If they have severe vomiting, Phenergan can be given. If they are seizing, treat the seizures with 5 mg of valium IV or 2 mg of Lorazapam IV, or whatever your protocols call for. If they are comatose, protect the airway by any means necessary. If they are dehydrated from vomiting, start fluids. I think you get the picture. Treat what you find and do as much of it as you can enroute to the hospital.