-Environmental Protocol Section Officer Control contact Document 1222 withAnimal Contact and - NO 222 - If If Needed 800 - 1 Carolinas PoisonControl YES Transport bite Animal biteHuman bite(poisonous) Snake bite (poisonous) tick) (bee, wasp, sting ant, / Insect bite Infection risk Rabies risk risk Mammal Bite Mammal

Differential • • • • • • • • if if able NotifyDestination or TE 1 TE ContactMedical Control Snake Bite Snake clothing / bands clothing / if if indicated Redness Time Redness and bands / / bandsjewelry DO NOT DO apply ICE if if indicated if indicated if indicated if indicated if if indicated Pain Control Pain Immobilize Immobilize IV / IO ProcedureIO IV / Monitor and and Monitor Reassess Protocol UP 11UP Protocol Remove any constricting any Removeconstricting

Mark Margin of Swelling/MarkMarginof Age Age Appropriate Age Age Appropriate Keep bite at level of of levelbite at Keep heart Protocol AM 1 / PM AM Protocol 1 / 1 / HypotensionShock PM AM Protocol 3 / 5 Protocol(s) TB 4, 5, 5, TB 4, Protocol(s) 6

Identification Identification Animal of Age Appropriate Trauma Trauma Age Appropriate GeneralCare Procedure Rash, skin break, wound Rash, skin rednesstissue swelling, Pain, soft bite theoozing Bloodwound from infection Evidence of wheezing of Shortness breath, hives, itching Allergic reaction, shock orHypotension Remove any Remove /any constricting clothing Allergic Allergic Reaction/ Extremity Trauma Protocol TBTrauma4 Protocol Extremity

• • • • • • • Signs andSymptoms A Bites Envenomationsand if if able Any local EMS System changes to this document must follow the NC OEMS mustbe Policy the documentProtocolNC this EMS local by followchanges OEMS Any Changeapproved System OEMS and to Apply Ice Ice Apply Packs Keep bite at level of of levelbite at Keep heart resources Spider Bite / Bee or Wasp StingWaspor / BiteSpiderBee Immunocompromised patient Immunocompromised Time, location, size of bite / bitesizelocation,/ of Time, sting bite/ to sting reaction Previous vs.Wild Domestic Rabies risk Tetanus and Type of bite / bite/ of Typesting for / photo Description identification Revised Stage until scene safe scene Stage until 09/29/2017 Call for helpCall/for additional

• • • • • History • • P Toxin-Environmental Protocol Section lack."

- 1222). - 222 - 800 - killafellow, red blackon

- TE 1 TE Bites Envenomationsand Any local EMS System changes to this document must follow the NC OEMS mustbe Policy the documentProtocolNC this EMS local by followchanges OEMS Any Changeapproved System OEMS and to BlackWidow spider bites tendbe to minimally painful, but over a fewhours, muscular pain and severeabdominal pain may develop(spider blackis withredhourglass belly).on BrownRecluse spider bites areminimally topainfulpainless. Little reaction is noted initiallybut tissuenecrosis at thesite of the bite develops over the next fewdays (brown spider with fiddle shape back).on Carnivore arebitesmuch more likely to become infectedand allhave riskRabies of exposure. Catbites may progress to infection rapidly due to a specific bacteria (Pasteurella multicoda). Poisonous snakes in thisarea are generallythe of viper pit family:rattlesnake and copperhead. Coral snake bites are rare: Very little pain butvery toxic. "Red yellowon Amountenvenomation of variable,is generally worsewith larger snakes and early inspring. Human bites have higher infectionrates animalthan bites due to normalmouth bacteria. Revised Spider bites: Snake bites: Dog Cat/ / Carnivore bites: Donot putresponders dangerin attempting to captureand animal or insect foridentification purposes. Evidenceof infection: swelling, redness, drainage,fever, redstreaks proximal towound. Human bites: Immunocompromised patients are anat increased risk forinfection: diabetes,chemotherapy, transplant patients. Considercontacting Norththe Carolina Control Center forguidance (1 RecommendedExam: Mental Status, Skin,Extremities (Location of injury), and a complete Neck, Lung, Heart, Abdomen, Back, and Neuro examsystemic if effects are noted 09/29/2017

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