For Clinicians | Diabetes Sick-Day Rules in a Disaster

couple looking at computer asking questions

For Clinicians | Diabetes Sick-Day Rules in a Disaster

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education
Medically reviewed and edited by Kristen Carpenter, PA-C

Diabetes is already hard to manage. Sick days just make everything worse. And a sick day in a disaster, when healthcare isn’t readily available, compounds the hardship. Put the three together and it’s 1 + 1 + 1. For someone’s health, that doesn’t equal 3.
It equals 20. 

And the disaster itself counts as its own 1, even before anyone gets sick. In a Puerto Rico cohort of adults who didn’t have diabetes, new cases showed up at about twice the pre-storm rate in the years spanning Hurricanes Irma and Maria¹.

Disaster guidance for diabetes focuses mostly on a supply list (have plenty of insulin on hand and stored properly!). Sick days barely come up as a management topic. That’s a big gap when about 40 million Americans have diabetes, 2.1 million of them type 1². Their care really does change in a disaster, whether that’s a hurricane or a week when they can’t reach their clinic or pharmacy. We have to address that.

Today we’ll cover:

  • what a diabetes sick day is
  • which medications pause (+ why insulin never pauses)
  • how ketones work, and why a normal meter reading can fool you
  • what to look for in the OTC aisle
  • how to write the plan before storm season

What is a diabetes sick day?

I’m including this here to start because even as a pharmacist I have to admit (abashedly) that I didn’t know much about this topic. 99% of my diabetic counseling focused on medications in general and blood sugar testing.

A diabetes sick day is any illness that changes how the body handles glucose, fluids, or medications: a stomach bug, a fever, a UTI, or a really rough flu. The hormones the body releases to fight illness push blood sugar up ³…. even in a patient who has barely eaten all day. Vomiting, diarrhea, and fever drain fluid, and the kidneys feel it first. That’s where the medication problems start.  Several of the drugs these patients take every day either depend on the kidneys or make dehydration worse. And when insulin runs short, the body breaks down fat for fuel and starts making ketones.

Sick-day rules exist to catch all of that early: check glucose more often, keep fluids going, check ketones, and call when the numbers cross a line. The ADA’s patient guide ends with “call your doctor or go to the ER” ⁴. Yep, every version ends there, which doesn’t really work.

A disaster amplifies everything. Bad water brings on vomiting and diarrhea. Heat causes dehydration. Meals get skipped. Smoke or mold sets off someone’s asthma, and the steroid burst that settles their breathing raises glucose on its own (we covered that in our asthma and COPD flare article). The clinic is often closed, flooded, or not picking up, so care isn’t available.

Which medications pause on a diabetes sick day?

Canadian clinicians teach the pause list as SADMANS, a Diabetes Canada mnemonic ⁵, and UK sick-day cards carry close versions of it⁶,⁷. Each class gets much riskier when a patient is dehydrated or not eating, and most of the list comes back to the kidney’s filter, which needs pressure to work. Picture a garden hose with me for the kidneys. Blood volume is the water from the spigot. When the water runs low, the kidney keeps the spray going two ways: it holds the inflow open, and it puts a thumb over the end of the hose so pressure builds inside, where the filtering happens. That’ll help you picture how the SADMANS medications affect the patient’s kidney.

  • S: sulfonylureas like glipizide and glimepiride keep pushing insulin out when the patient isn’t eating. Some linger as kidney function drops.
  • A: ACE inhibitors like lisinopril shut off angiotensin II, and angiotensin II is the kidney’s thumb. Take it away from a dehydrated patient and filtering pressure drops.
  • D: diuretics like HCTZ and furosemide turn the spigot down further on a patient who’s already losing fluid.
  • M: metformin doesn’t hurt the kidneys, but they’re its only way out. When they slow down, metformin builds up, and so does the risk of lactic acidosis.
  • A: ARBs like losartan take the thumb off the same way ACE inhibitors do.
  • N: NSAIDs like ibuprofen and naproxen kink the hose near the spigot by blocking the prostaglandins that hold the inflow open. (Spigot down, hose kinked, thumb off: that’s the triple whammy from our drug interactions article)
  • S: SGLT2 inhibitors like Jardiance and Farxiga pull glucose and water out through the urine, deepening dehydration, and raise DKA risk, sometimes with a normal glucose (more on that next).

GLP-1 drugs like semaglutide aren’t in the mnemonic, but the ADA Standards note they may need holding when GI symptoms are significant ⁸.

SADMANS isn’t a US guideline, and the evidence behind sick-day lists is mostly expert opinion⁵. The ADA Standards say to consider holding metformin and SGLT2 inhibitors when the patient can’t keep up with eating and drinking or kidney injury is a concern ⁸, and Jardiance’s label says to withhold it, if possible, in situations that could predispose to ketoacidosis ⁹. The ADA’s patient guide says to keep taking diabetes medications as prescribed unless the doctor advises otherwise ⁴. That “unless” is our job. Which pills pause for which patient, and when they restart (UK practice is usually after 24 to 48 hours of normal eating and drinking⁶, are prescriber decisions that belong in the written plan. The plan is for emergency use only, after the patient has tried to reach their prescriber or pharmacist first.

And just to be clear here, insulin never pauses. Basal insulin keeps going even when the patient isn’t eating⁸. Mealtime doses follow the food¹⁰, and the total dose can change while they’re sick ³, which is exactly the kind of adjustment that belongs in the plan. Stopping basal insulin because they can’t eat is the classic road to DKA, and in type 1 that road is short. (For keeping insulin cool when the power’s out, see our insulin storage article.)

Who owns the sick-day conversation?

The ADA already tells patients to make a sick-day action plan with their doctor before they ever get sick ⁴. I don’t think many of us are having that conversation, in the office or at the pharmacy. In more than 10 years as a pharmacist, I’ve had five or fewer of them. I’m not proud of that at all, but patients rarely, if ever, proactively brought up the topic. At my busy 24-hour pharmacy, counseling got to the single most important thing a patient needs to start the medication (and sick days didn’t usually make the cut). 

Part of the problem is that nobody owns the med list. The pills that pause on a sick day often come from two prescribers: metformin and an SGLT2 inhibitor from primary care, lisinopril and a diuretic from cardiology. Each prescriber may only see their half. The pharmacy profile shows every prescription filled there, from every prescriber, and our interaction software checks across all of it.

That makes this a pharmacy counter conversation as much as an office one. For a patient on metformin, Jardiance, lisinopril, and HCTZ, here’s how it would sound coming from me:

“When you’re sick, it can really change your diabetes and your medications and you have to be extra careful. Here’s what to know in a nutshell. If you’re throwing up or can’t keep fluids down, some of your pills may need to pause until you’ve been eating and drinking normally for a day or two. For you, that’s probably all four, but your doctor makes that call, so let’s ask them to put it in writing now. I’ll send a fax requesting that right now.  Because you’re on Jardiance, check your ketones when you’re sick, even if your sugar looks normal. Call your doctor or the pharmacy first. If you can’t reach anyone, these symptoms mean you need to get to emergency care ASAP: throwing up or diarrhea for more than 4 hours, moderate or large ketones, or a sugar over 300 twice.“

How ketones work, and why a normal meter reading can fool you

Ketones are what the liver makes from fat when cells can’t get enough insulin to use glucose. A little after a long fast is normal. When insulin runs short in a dehydrated patient, ketones build faster than the body clears them. Then the blood turns acidic, and that’s DKA (diabetic ketoacidosis).

On an SGLT2 inhibitor, the kidneys keep dumping glucose into the urine, so the meter can read 150 while ketones climb. Jardiance’s label warns that glucose at presentation can sit below what we’d expect for DKA, for example under 250 ⁹, and the ADA defines euglycemic DKA as DKA with a glucose under 200 ¹¹. The glucose number stops being a warning light, so an SGLT2 user’s plan needs to be checking ketones when sick, whatever the meter reads.

The tool matters too. There are two main ketones in the blood, and urine strips only see one of them. In DKA, most of the ketones are the other kind¹², so a strip can read low while the real level is high. That’s why the ADA wants at-risk SGLT2 users to have a blood ketone meter¹³. From what I’ve seen working in the pharmacy a lot of urine strips and keto meters are being bought up by the keto, weight-loss, and muscle-building crowds, so they can be kind of hard to find sometimes. (Funny twist, since the ADA also tells us to steer SGLT2 users away from keto eating¹³.) Put the strips, or a blood meter, on the written plan and make sure that patients actually have some on hand so they’re handy before they are needed.

The Wilderness Medical Society tells insulin users heading into the backcountry to carry a ketone kit, and it treats DKA as an emergency that calls for evacuation¹⁴. A hurricane week at home isn’t the backcountry, but it shares the part the guideline is written around: limited access to care. Moderate or large ketones means to get to emergency care, not wait for the phone.

What to look for in the OTC aisle

The ADA’s guide tells patients to work out which OTC medications are safe with their doctor before they get sick ⁴, but it doesn’t say which ones. The pharmacist is the natural person to fill in that blank. Every pick comes back to the two questions from the pause list: what it does to the kidneys, and what it does to glucose.

  • Ibuprofen and naproxen are the N in SADMANS, and they hide in combination products (one 12-hour sinus product pairs naproxen with pseudoephedrine). The plan should name the swap for pain and fever, usually acetaminophen if the liver allows.
  • Pseudoephedrine’s Drug Facts tell anyone with diabetes to ask a doctor before using it¹⁵. 
  • The ADA’s guide says to alternate water and electrolyte drinks ⁴, and sugar isn’t automatically the enemy. A patient who can’t eat still needs about 50 grams of carbohydrate every 4 hours ³, and regular juice or soda may be how they get it.
  • Glucose tabs or gel are on the ADA’s sick-day supply list ⁴, and they matter most for anyone on a sulfonylurea or insulin who can’t eat.

Like everything else on the plan, these are emergency-use answers, for when the patient has tried to reach their pharmacist or prescriber first and can’t get through.

How to write the plan before storm season

The ADA’s guide already lists what belongs in a sick-day plan ⁴. The disaster version fills in every line with this patient’s medication names and strengths written on paper, kept with their medication list:

  • Which of their pills pause, by name, and when each one restarts
  • For insulin users, the basal dose that keeps going and how to adjust mealtime and correction doses
  • How often to check glucose and ketones, and with what (urine strips or a blood meter)
  • The OTC picks for fever and pain, congestion, fluids, and lows
  • The numbers that mean get to emergency care when no one answers:
    • vomiting or diarrhea for more than 4 hours
    • moderate or large ketones, or the blood ketone number you set
    • glucose over 300 on two readings despite corrections
    • fever over 101°F lasting more than 24 hours
    • signs of dehydration, like dizziness or dark urine
  • Who to call first, their number, and when they are reachable: the prescriber or the pharmacy

The plan is for emergency use only, after the patient has tried those calls and can’t get through.

The bottom line

Sick-day care for diabetes is all or nothing right now. Either the clinic or the pharmacy picks up, or the patient is alone with four bottles and a meter just guessing and winging it with what they look up online. A written plan is the missing middle layer: the decision made ahead of time by the person who should make it, ready for the day nobody answers. That’s appropriate medical preparation at its simplest. It’s in no way a replacement for primary care; we’re here for the times when primary care isn’t there. Our team of physicians, PAs, and pharmacists is building the version of this plan for the week the clinic’s phone is dead, and we’ll publish the framework as we go.

Before the next storm, write the plan for every patient on an SGLT2 inhibitor, metformin, or insulin. Pharmacists, start it at the counter.

A sick day in a disaster will never be easy. A plan on paper keeps 1 + 1 + 1 a lot closer to 3.

Sources

  1. Martínez-Lozano M, Noboa C, Alvarado-González G, Joshipura KJ. Hurricanes Irma and Maria and diabetes incidence in Puerto Rico. BMC Public Health. 2023;23:1019. https://pmc.ncbi.nlm.nih.gov/articles/PMC10227808/
  2. Centers for Disease Control and Prevention. National Diabetes Statistics Report. Updated September 16, 2026. https://www.cdc.gov/diabetes/php/data-research/index.html
  3. Centers for Disease Control and Prevention. Managing sick days. Updated May 15, 2024. https://www.cdc.gov/diabetes/living-with/managing-sick-days.html
  4. American Diabetes Association. Sick Day Guide for People with Diabetes (patient version). September 2025. Based on the Standards of Care in Diabetes-2025. https://professional.diabetes.org/sites/dpro/files/2025-09/SickDayGuide_Final.pdf
  5. Watson KE, Dhaliwal K, McMurtry E, et al. Sick day medication guidance for people with diabetes, kidney disease, or cardiovascular disease: a systematic scoping review. Kidney Med. 2022;4(9):100491. https://pmc.ncbi.nlm.nih.gov/articles/PMC9420951/
  6. Healthcare Improvement Scotland. Medicines sick day guidance card, version 4. 2026. https://www.healthcareimprovementscotland.scot/wp-content/uploads/2026/05/Medicines-sick-day-guidance-card-A6-June-2026.pdf
  7. Northern Ireland Formulary. Sick day rules. Accessed October 5, 2026. https://niformulary.hscni.net/formulary/6-0-endocrine/6-1-drugs-used-in-diabetes/6-1-2-antidiabetic-drugs/sick-day-rules/
  8. American Diabetes Association Professional Practice Committee for Diabetes. 6. Glycemic goals, hypoglycemia, and hyperglycemic crises: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Suppl 1):S132-S149. https://pmc.ncbi.nlm.nih.gov/articles/PMC12690178/
  9. Jardiance (empagliflozin) prescribing information. Boehringer Ingelheim Pharmaceuticals; revised January 2026. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=faf3dd6a-9cd0-39c2-0d2e-232cb3f67565
  10. RxFiles. Protecting the kidneys. September 2025. https://www.rxfiles.ca/RxFiles/uploads/documents/SADMANS-Rx.pdf
  11. American Diabetes Association Professional Practice Committee for Diabetes. 16. Diabetes care in the hospital: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Suppl 1):S339-S355. doi:10.2337/dc26-S016
  12. Umpierrez GE, et al. Hyperglycemic crises in adults with diabetes: a consensus report. Diabetes Care. 2024;47(8):1257-1275. https://pmc.ncbi.nlm.nih.gov/articles/PMC11272983/
  13. American Diabetes Association Professional Practice Committee for Diabetes. 9. Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Suppl 1):S183-S215. https://pmc.ncbi.nlm.nih.gov/articles/PMC12690185/
  14. VanBaak KD, et al. Wilderness Medical Society clinical practice guidelines for diabetes management. Wilderness Environ Med. 2019;30(4 Suppl):S121-S140. Written for wilderness athletes; recommendations cited: carry a ketone testing kit (grade 1B), and evacuate for DKA or HHS (grade 1A). https://pmc.ncbi.nlm.nih.gov/articles/PMC7510348/
  15. Sudafed Sinus Congestion 12 Hour (pseudoephedrine HCl) Drug Facts label. Kenvue; revised November 8, 2024. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d600b5d5-7d95-4ad6-a95b-6d73502743d7

 

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Burns in a Blackout

couple looking at computer asking questions

Burns in a Blackout: First Aid When the Tap Doesn’t Run

By the Jase Medical Team

Almost every burn first aid guide starts with the same instruction: cool the burn under clean, cool running water.

But what happens when the tap doesn’t run?

For households that rely on a well, a power outage can also mean losing the electric pump that moves water through the house. At the same time, blackouts can introduce new burn risks as families start using candles, generators, space heaters, camp stoves, and other backup sources of light, heat, and cooking.

After Hurricane Ida, generator and cooking accidents accounted for 56% of storm-related burns treated at one New Orleans burn center, and most of those patients were admitted to the hospital.

So burn first aid during a blackout requires a slightly different plan. The fundamentals haven’t changed. Cool the burn, protect it, and know when it needs medical care. What changes is how you accomplish that when the usual faucet isn’t available.

First, Forget the Home Remedies

Before we get to the water problem, there are a few things that should never become the substitute.

Don’t put ice directly on a burn. Extreme cold can further damage already injured tissue. You want to cool the burn, not freeze it.

And skip the butter, oil, toothpaste, and other kitchen or bathroom remedies that tend to get passed down through generations. Greasy substances can trap heat against the skin and make the burn harder to assess and clean.

Butter does roughly the same thing for a burn that it does for a steak. It isn’t first aid.

For a fresh thermal burn, the goal is much less dramatic: clean, cool water.

What If You Don’t Have Running Water?

Running water is convenient because it continuously carries heat away from the injured tissue. But losing the faucet doesn’t mean you should skip cooling altogether.

If you have access to clean, cool water, use it to cool the burn. That might mean clean bottled water, stored potable water, or another safe source of cool water available in the home.

The water should be cool, not icy.

If you’re using a limited supply rather than a running faucet, the practical goal is still to cool the injured area without making the person excessively cold. This is especially important for children and for larger burns, where prolonged cooling can contribute to hypothermia.

Don’t sacrifice drinking water recklessly during a prolonged outage, but don’t assume that burn cooling only counts if the water comes directly from a faucet. If clean, cool water is available, it can still be useful.

A Few Seconds of Cooling Isn’t Enough

This is another place where common first aid habits can fall short.

Someone burns a hand on a hot pan, holds it under water for ten seconds, decides it still hurts, and moves on to finding a cream or bandage.

Cooling needs more time than that.

The American Burn Association recommends cooling thermal burns with clean, cool running water for at least five minutes. International burn guidance commonly recommends approximately 20 minutes of cooling, and research supports a meaningful benefit from adequate cool running water first aid.

The exact duration recommendations differ somewhat between guidelines, but the practical lesson is the same: don’t treat burn cooling as a quick rinse.

And if you couldn’t cool the burn immediately, don’t assume you missed your chance. Research suggests cooling can still provide benefit when started later, potentially up to several hours after the injury.

That matters during an outage. Maybe the burn happened while you were away from the house. Maybe clean water wasn’t immediately accessible. Maybe the first priority was getting away from the fire or shutting down the source of the injury.

Once the immediate danger is controlled and clean, cool water becomes available, cooling the burn may still be worthwhile.

After Cooling, Keep It Simple

Once the burn has been adequately cooled, remove jewelry, watches, or tight clothing near the injured area if they aren’t stuck to the skin. Swelling can develop quickly, and something that fits comfortably now may become constricting later.

Don’t pull away clothing or material that has adhered to the burn.

Then cover the area loosely with a clean, dry cloth or appropriate clean dressing. The goal is to protect the injured skin without wrapping it tightly.

For a small, superficial burn, that basic care may be enough while you monitor how it develops. But not every burn belongs in the home care category, and a blackout doesn’t change the threshold for getting help.

Some Burns Can’t Wait for the Power to Come Back

If the lights are out, roads are difficult, or the nearest urgent care is closed, it’s tempting to lower the threshold for what you’re willing to manage at home.

With serious burns, don’t.

Burns that are deep, extensive, or located in certain high-risk areas need professional evaluation. Burns involving the face, hands, feet, genitals, perineum, or major joints deserve particular attention because even a relatively small injury in these areas can affect function or require specialized care.

As a simple household reference, a burn larger than the injured person’s hand deserves medical attention. Deep burns, burns with white, charred, leathery, or numb areas, electrical burns, and chemical burns also require prompt evaluation.

Smoke exposure changes the situation too. Burns around the face or mouth, soot around the nose or mouth, coughing, hoarseness, difficulty breathing, or suspected smoke inhalation can signal an airway injury that isn’t visible from the outside.

Young children also deserve a lower threshold for evaluation. Their smaller bodies make both burn severity and problems such as hypothermia more consequential.

If you’re looking at the burn and wondering whether it’s serious enough to make the drive despite the outage, location, depth, size, age, and breathing symptoms matter more than whether the lights are on.

What About Blisters?

Blisters can develop with partial-thickness burns, often called second-degree burns. They don’t automatically mean a burn requires hospitalization, but they do tell you that the injury extends deeper than simple surface redness.

Avoid deliberately popping or peeling the blisters at home. The skin provides protection to the tissue underneath, and opening it creates another pathway for contamination.

Large or extensive blistering, significant pain, worsening swelling, signs of infection, or blistering involving high-risk areas such as the hands, face, feet, or major joints should prompt medical evaluation.

When you’re uncertain about the depth of a burn, let a healthcare professional make that assessment rather than trying to classify it from an online photo or description.

Preventing the Blackout Burn Is Easier Than Treating It

Power outages change normal household routines, and that’s often where the burn risk comes from.

Use flashlights or battery-powered lighting instead of candles whenever possible. Keep portable heaters well away from furniture, bedding, curtains, and anything else that can burn. If you’re using a generator, let it cool before adding fuel. Gasoline spilled onto a hot generator can ignite.

Generators also introduce another danger that may not produce a burn at all: carbon monoxide. They should never be operated inside a home, garage, or other enclosed space. We’ve covered that risk separately in our guide to carbon monoxide after a storm, including why early symptoms can be mistaken for the flu or heat exhaustion.

A few minutes of planning before an outage is easier than trying to improvise around heat, flame, fuel, and darkness once the power is already gone.

Medical Readiness Is Knowing What You Can Handle at Home

Burn first aid is a good example of why medical preparedness isn’t simply a matter of owning more supplies.

A first aid kit can’t make a deep burn superficial. A medication can’t undo an electrical injury. And nothing you keep in a cabinet changes the urgency of smoke inhalation.

What preparation can do is help you make better decisions before stress starts making them for you.

At Jase Medical, we’re a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation held to high clinical standards. That includes knowing what can reasonably be managed at home when normal access to care is disrupted and recognizing the point where home care needs to stop.

JaseCase provides physician-prescribed contingency medications for specific medical situations after review by a licensed provider. Those medications are intended for emergency use after first trying to reach a qualified healthcare provider. They don’t replace professional treatment for a serious burn.

So if the lights go out and someone gets burned, remember the basics. Cool it with clean, cool water if available. Skip the ice and home remedies. Cover it loosely. Then look at the burn itself, not the blackout, to decide whether it’s time to go in.

Because the power may be able to wait until morning.

A serious burn can’t.

The Jase Medical Team is a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: clinically grounded readiness that complements, rather than replaces, the healthcare professionals you already trust.

This article was prepared by the Jase Medical content team for informational purposes only and does not constitute medical advice. Prescription requirements, emergency dispensing rules, insurance coverage, and controlled-substance regulations vary by medication, jurisdiction, and individual circumstances. Consult a licensed healthcare provider or pharmacist regarding your specific medications.

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For Clinicians | Diabetes Sick-Day Rules in a Disaster

For Clinicians | Diabetes Sick-Day Rules in a Disaster

For Clinicians | Diabetes Sick-Day Rules in a Disaster By Dr. Jamie Wilkey, PharmD, Director of Clinical EducationMedically reviewed and edited by Kristen Carpenter, PA-C Diabetes is already hard to manage. Sick days just make everything worse. And a sick day in a...

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For Clinicians | Burn First Aid Without Running Water By Dr. Jamie Wilkey, PharmD, Director of Clinical EducationMedically reviewed and edited by Aaron Asay, PA-C, DMSc, FIBODM, FAWM Every burn first-aid guide starts the same way: cool it under running water. That's...

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Join Our Newsletter

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For Clinicians | Burn First Aid Without Running Water

couple looking at computer asking questions

For Clinicians | Burn First Aid Without Running Water

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education
Medically reviewed and edited by Aaron Asay, PA-C, DMSc, FIBODM, FAWM

Every burn first-aid guide starts the same way: cool it under running water. That’s the one thing you can’t count on in a power outage, when homes on a well lose the pump, or at a campsite miles from the nearest faucet. Burns are already the most common injury in my house full of boys, and they’re hard enough to manage with running water. Without it, they feel so much harder. Today we’re covering where these burns come from, how long to cool one, how to do it without a tap, and which burns must be escalated to a provider no matter what.

Where do these burns come from?

Mostly from the heat sources we bring in when the usual ones aren’t there. In a power outage, that’s a candle lit for light, a space heater pulled too close to the couch, a pot of water on a camp stove, or fuel spilled on a generator that’s still hot. (That same generator is behind our carbon monoxide article, same outage, different injury.) After Hurricane Ida, generator and cooking accidents caused 56% of the storm-related burns treated at two New Orleans hospitals, and 78% of all those burn patients were admitted¹. Those high admission rates tell you these burns are serious stuff.

Outdoors the campfire is the big culprit. Interestingly, the most dangerous stage of the fire is the one that looks like it is put out. In a review of children burned by recreational fires, 40% fell into and another 30% crawled or walked onto the remnants of a fire that hadn’t been fully put out. The same study found a small charcoal fire stayed hot enough to burn at least 16 hours after it was lit². Hands and feet were the most common places those burns were incurred.

How do you cool a burn without a tap?

Cooling really matters here. In a human model, burns kept getting deeper after the heat was gone, and 20 minutes of cooling at 16°C (about 60°F) saved about a quarter of the skin’s deeper layer³. If that doesn’t make sense, picture a pan you just pulled off the stove. The flame is off, but the pan keeps cooking whatever it’s touching. Burned skin holds heat the same way.

How long? The Wilderness Medical Society’s 2025 burn guideline, written for remote and low-resource settings like a blackout or a campsite, recommends 20 minutes of cool running water for burns covering less than 10% of the body¹⁰. A 2022 systematic review backs the number: 20 minutes of cooling within the first 3 hours lowered the odds of needing a skin graft or surgery⁵. The American Burn Association’s patient page says at least 5 minutes⁴. That’s a minimum. The target is 20. Twenty minutes is roughly one good ‘ol sitcom episode.

All of that evidence comes from running water, which is exactly what a blackout or a campsite takes away. So, in our disaster scenario without a running tap the patient has to rebuild the water flow with what they have available:

  • Pour clean, cool water slowly and steadily over the burn from a jug, a bottle, or a camp water bag.
  • If there’s enough water but no way to keep it flowing, immerse the burn in a basin, pot, or cooler of cool water. WMS lists immersion as acceptable when running water isn’t available¹⁰.
  • Keep it cool, not cold, around 53 to 64°F¹⁰. No ice, which can worsen the damage⁴.
  • If water is scarce, a clean cloth soaked in cool water and swapped out often is the fallback. It’s less reliable than flow⁶, and it still cools and is better than nothing.

Watch the patient’s temperature along with the burn. Twenty minutes of cool water on a cold night, in a house with no heat, or at a campsite can drop a person’s core temperature, and WMS notes hypothermia is more common with larger burns and in older patients¹⁰. When hypothermia is a real risk, WMS suggests not cooling the burn in the field at all¹⁰. Short of that, cool only the burned area and keep the rest of the person covered and warm.

And don’t fret too much if that burn can’t be cooled right away. It can still be cooled late, so if the water shows up 30 minutes later, please use it.

What do you put on a burn?

First of all, nothing greasy on a fresh burn. The American Burn Association says to skip butter, oils, and ointments, because they trap heat⁴. Toothpaste is the other household remedy people sometimes use, and it doesn’t cool either. The British Red Cross notes that its menthol can feel cool on the surface without actually helping⁷.

Once the burn is cooled, cover it loosely with sterile gauze or a clean cloth⁴. If care is less than a day away, that’s all it needs. WMS says no antibiotic ointment or special dressing is required when definitive care is within 12 to 24 hours¹⁰.

Ointment earns its place after cooling, when care is delayed. For a deep partial-thickness burn (wet or waxy, with mottled color) that has to be managed in the field, or when getting to care will take a while, WMS recommends antibiotic ointment or honey¹⁰. Those deeper burns carry a much higher infection risk¹⁰, and they’re on the referral list below regardless. The ointment covers the gap until the patient gets there. Oral antibiotics aren’t part of this: WMS says not to use them prophylactically for burns, because they can raise the risk of a later resistant infection¹⁰.

For pain, start with over-the-counter analgesics, which WMS recommends as the first treatment¹⁰. Ibuprofen helps with both pain and swelling. Acetaminophen treats the pain. No aspirin for anyone under 19, obviously⁸.

And leave the blisters alone. MedlinePlus says to avoid breaking them⁸, and WMS agrees for most situations¹⁰. That fluid-filled roof is the body’s own dressing, and it matters even more when clean water and clean hands are in short supply. WMS makes one field exception: if a blister limits movement of a joint or sits where it would keep the person from hiking out, it suggests draining it through a small hole¹⁰.

Which burns can’t wait?

Some burns go to care no matter what the power grid or the camping trip is doing. The American Burn Association’s 2025 referral guidelines call for immediate burn center consultation, with transfer considered, for⁹:

  • Full-thickness burns
  • Partial-thickness burns covering 10% or more of the body
  • Deep burns of the face, hands, feet, genitals, perineum, or over a joint
  • Burns in patients with other medical conditions or other injuries
  • Pain that isn’t controlled
  • Any suspected inhalation injury, including facial burns, singed facial hair, or smoke exposure
  • All chemical burns, high-voltage electrical injuries, and lightning

Every pediatric burn (14 and under, or under 30 kg) may benefit from referral, and any burn that might be deep, at any size, warrants a consult⁹. That toddler with a campfire burn on their hand checks two boxes at once.

The ABA’s patient guidance uses size to help parents know when to stop self-treating and get to care ASAP: don’t delay care for a burn larger than a hand⁴. If the burn is on the face, hands, feet, or a joint, comes from a chemical or electricity, involves smoke, or is on a child, it gets care now, power outage or not.

What to tell patients before storm season or a trip

Burn first aid assumes running tap water to cool that ouchy burn. Plenty of families find out it’s missing at the worst possible moment. The middle layer of healthcare between “run it under the faucet” and “drive to the ER” is a plan made ahead of time. For patients on a well, in rural areas, running a generator, or heading out camping, that plan comes down to two questions: where would the cooling water come from, and which burns go straight to care? That’s a two-minute conversation in your office or your pharmacy before storm season or the trip.

That’s appropriate medical preparation for burns: the first-aid steps worked out before anyone needs them, and a clear line where first aid stops. We’re here for the times primary care isn’t there, and in no way a replacement for it. If you’d rather hand the preparation conversation off, you can refer patients to us at Jase.com. A licensed provider reviews every request before anything is prescribed, and every medication we dispense is for emergency use only, after first seeking help from a qualified healthcare provider. We’ll keep publishing how we draw these lines, including where first aid self-care ends and care begins.

I’ve switched tenses in this article where it feels like I’m writing to the patient, but this is for you as healthcare professionals to communicate with patients before the disaster happens. 

The bottom line

Burn first aid without a tap comes down to a few moves. Cool the burn for 20 minutes with whatever clean, cool water is on hand, poured slowly or in a basin, and keep the rest of the person warm while you do it. Also, remove any clothing or jewelry like rings that could exacerbate the problem like swelling or contribute to infection. Keep anything greasy off a fresh burn, cover it loosely, and leave blisters intact unless one keeps the person from moving. Save antibiotic ointment for a deep burn after it’s cooled, when care is delayed. And know which burns go to care no matter what.

Sources

  1. Kopari NM, Rivera M, Phelan HA III, Kearns RD, Carter JE. 570 Burn-related injuries treated at two Gulf Coast hospitals following a Category 4 hurricane. J Burn Care Res. 2022;43(Suppl 1):S121. https://academic.oup.com/jbcr/article/43/Supplement_1/S121/6552619
  2. Cahill TJ, Rode H, Millar AJ. Ashes to ashes: thermal contact burns in children caused by recreational fires. Burns. 2008;34(8):1153-1157. https://pubmed.ncbi.nlm.nih.gov/18789590/
  3. Wright EH, Tyler M, Vojnovic B, Pleat J, Harris A, Furniss D. Human model of burn injury that quantifies the benefit of cooling as a first aid measure. Br J Surg. 2019;106(11):1472-1479. https://pubmed.ncbi.nlm.nih.gov/31441049/
  4. American Burn Association. Burn First Aid. https://www.ameriburn.org/patients/burn-first-aid
  5. Griffin B, Cabilan CJ, Ayoub B, Xu HG, Palmieri T, Kimble R, Singer Y. The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: a systematic review and meta-analysis. Australas Emerg Care. 2022;25(4):367-376. https://pubmed.ncbi.nlm.nih.gov/35688782/
  6. Yuan J, Wu C, Holland AJ, et al. Assessment of cooling on an acute scald burn injury in a porcine model. J Burn Care Res. 2007;28(3):514-520. https://pubmed.ncbi.nlm.nih.gov/17438497/
  7. British Red Cross. Learn first aid for burns. https://www.redcross.org.uk/first-aid/learn-first-aid/burns
  8. MedlinePlus Medical Encyclopedia. Burns. Reviewed April 9, 2026. https://medlineplus.gov/ency/article/000030.htm
  9. American Burn Association. Burn Center Referral Guidelines (2025). https://ameriburn.org/resources/burn-center-referral-guidelines/
  10. Bitter CC, Storkan M, Overmiller A, Respicio JA, McGowan T, Park A, Culhane JT. Wilderness Medical Society Clinical Practice Guideline on Care of Burns in the Wilderness. Wilderness Environ Med. 2025;36(4):549-558. https://journals.sagepub.com/doi/10.1177/10806032251345768. Recommendations cited, with grades: cool running water for 20 minutes for burns under 10% TBSA (strong recommendation, moderate-quality evidence); no field cooling when hypothermia is a risk (weak, low); blisters left intact in most situations (weak, low); drainage through a small window when a blister limits joint movement or self-evacuation (weak, low); antibiotic ointment or honey on deep partial-thickness burns when field management is attempted or evacuation is delayed (strong, moderate); over-the-counter analgesics as initial pain treatment (strong, moderate).

 

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What to Do If You're Bitten by a Snake: Forget What the Movies Taught You By the Jase Medical Team If you're bitten by a venomous snake, forget almost everything the movies taught you about snakebite first aid. Don't cut an X over the fang marks. Don't suck out the...

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What to Do If You’re Bitten by a Snake?

couple looking at computer asking questions

What to Do If You’re Bitten by a Snake: Forget What the Movies Taught You

By the Jase Medical Team

If you’re bitten by a venomous snake, forget almost everything the movies taught you about snakebite first aid. Don’t cut an X over the fang marks. Don’t suck out the venom. Don’t tie a tourniquet above the bite. Don’t pack it in ice.

And one terminology note before we go further: the snakes we’re talking about are venomous, not poisonous. Venom is injected through a bite, while poison causes harm when it is swallowed, inhaled, or absorbed.

Every year, an estimated 7,000 to 8,000 people in the United States are bitten by venomous snakes, and about five die. Prompt medical treatment dramatically improves the odds. The challenge is that snakebites often happen exactly where medical care isn’t close. You might be hiking with your kids, clearing brush in the yard, spending the weekend at a lake cabin, or out at hunting camp.

That’s a bad time to discover that most of your snakebite first aid knowledge came from Hollywood.

True Grit Got the Dramatic Part Wrong

In True Grit, Rooster Cogburn responds to Mattie’s snakebite the way generations of movie characters have. He cuts an X over the fang marks and tries to suck out the venom. It’s great cinema, but terrible first aid.

Cutting into a snakebite doesn’t create an escape route for the venom. It creates another injury in tissue that may already be damaged. Suction doesn’t solve the problem either. Researchers tested a commercial snakebite suction device using mock venom injected into human volunteers. The device recovered approximately 0.04% of the mock venom load. In practical terms, almost nothing useful came back out.

Current CDC guidance specifically advises against cutting a snakebite or attempting to suck out the venom. So if a bite happens, leave the knife and your mouth out of it.

Don’t Tie It Off or Pack It in Ice

The tourniquet is another movie favorite. Someone gets bitten, another character grabs a belt, rope, or strip of fabric, and they tie it tightly above the bite to keep the venom from spreading.

That’s not what you should do. A tourniquet that restricts blood flow can worsen local tissue injury and put the affected limb at additional risk. Tourniquets can be lifesaving for catastrophic bleeding, but a venomous snakebite is a different medical problem.

Ice is another seemingly logical response that can cause more harm than good. A snakebite may become painful and swollen, so cooling the area feels intuitive. However, ice and cold therapy can worsen local tissue injury. Current CDC guidance advises against applying ice or immersing the bite in water.

That leaves you with a snakebite first aid plan that is surprisingly simple: no cutting, no suction, no tourniquet, and no ice. That’s not because snakebite isn’t serious. It’s because the treatment that matters isn’t something you’re carrying in your backpack.

What Should You Actually Do After a Snakebite?

First, get away from the snake. Don’t try to catch it, kill it, pick it up, or bring it to the hospital. Even a dead venomous snake can still pose a hazard. If you can safely take a photo from a distance without approaching the snake or delaying care, it may be helpful, but identifying the snake should never become the priority.

Then call 911 and get to emergency medical care as quickly as possible. Keep the person calm and relatively still while help is arranged. Remove rings, watches, or other constricting items before significant swelling develops. The bite can be washed gently with soap and water and covered with a clean, dry dressing. If swelling or tenderness is progressing, CDC guidance also suggests marking the leading edge and noting the time so clinicians can see how quickly it is changing.

If another person can drive or emergency transportation is available, don’t drive yourself. Snake venom can cause weakness, dizziness, or loss of consciousness.

This is one place where True Grit eventually gets something right. After all the dramatic first aid, Rooster gets Mattie moving toward medical care as fast as he can. Skip the dramatic part. Keep the ride.

Antivenom Is the Treatment Your First Aid Kit Can’t Provide

Depending on the snake and severity of envenomation, hospital treatment may include antivenom. Antivenom can prevent worsening effects of venom, including progressive swelling and effects on the blood. The antivenom used for native pit vipers can be used across rattlesnake, copperhead, and cottonmouth bites.

Those snakes are also much more relevant to an American household than the exotic species we tend to see in movies. In the United States, the overwhelming majority of venomous snakebites involve native pit vipers such as rattlesnakes, copperheads, and cottonmouths.

That’s why a suspected venomous snakebite isn’t a “wait and see how it looks tomorrow” injury. There is no tablet, ointment, extractor, or wilderness trick in a household medical kit that neutralizes venom. The treatment you may need is at the hospital.

What About Ibuprofen for the Pain?

It’s also important not to let the pain turn into another round of improvisation. Some snake venoms can affect blood clotting, and medical toxicology guidance advises avoiding aspirin and nonsteroidal anti-inflammatory drugs, including ibuprofen and naproxen, after a suspected venomous snakebite unless a physician determines they are appropriate.

That doesn’t mean pain should simply be endured. It means pain management should be handled by the clinicians treating the envenomation rather than improvised from whatever happens to be in your backpack or medicine cabinet.

Any prescription contingency medication provided through Jase is prescribed after review by a licensed provider and is intended for emergency use after first seeking help from a qualified healthcare provider. Those medications do not treat snake envenomation.

What If It’s “Just” a Copperhead?

Copperheads account for many venomous snakebites in the United States, and their bites are often less severe than some rattlesnake envenomations. But “often less severe” does not mean “safe to manage at home.”

A bite can initially look unimpressive and still evolve. Swelling can progress, systemic symptoms can develop, and determining whether antivenom or additional monitoring is needed is a medical decision.

There is also such a thing as a dry bite, in which a venomous snake bites without injecting a clinically significant amount of venom. The problem is that you can’t confidently determine that while standing on a trail or sitting at the lake cabin. CDC guidance recommends seeking medical attention rather than waiting for symptoms to appear.

Do Hurricanes Really Bring a Surge of Snakebites?

Another dramatic snake story tends to appear whenever major flooding occurs. Floodwaters displace snakes, so the assumption is that snakebites must surge after every hurricane.

Flooding can certainly displace wildlife, and people cleaning debris or returning to flooded properties should use caution. But the available data are more nuanced than the headlines suggest. Researchers examined snakebite reports surrounding nine Texas tropical storms and hurricanes that received federal individual-assistance declarations between 2000 and 2017. They found no evidence of an overall increase in snakebites after the storms in the affected counties.

The practical precautions still make sense. Be careful when moving storm debris, reaching into places you can’t see, or working around piles of wood and vegetation. Wear appropriate boots and gloves when clearing debris. The point isn’t to ignore snakes after flooding. It’s to replace a dramatic assumption with a proportionate understanding of the risk.

The Best Snakebite Preparation Happens Before the Trip

Snakebite preparedness isn’t about adding a suction device or another gadget to your backpack. It’s about knowing what to do, and what not to do, before adrenaline takes over.

If you’re heading somewhere snakes are common, learn which venomous species live in the area. Wear appropriate footwear and clothing. Watch where you step and where you place your hands. Teach kids never to approach or handle snakes. If you’ll be somewhere remote, know where the nearest appropriate medical facility is and how you’ll reach it.

That last part matters. If you’re camping, hunting, hiking, or staying somewhere far from town, “call 911” may not mean an ambulance arrives in five minutes. Knowing your location, your route out, and where definitive medical care is available can be more useful than filling your pack with snakebite gadgets that don’t work.

Good Preparation Usually Looks Less Dramatic

Snakebite is a useful example of a bigger problem in emergency preparedness. Popular culture has trained us to associate action with effectiveness. When something goes wrong, we want to cut something, suck something out, tie something off, apply something, or take something.

Good medical preparation is often much less dramatic. With a suspected venomous snakebite, the goal is to avoid making the injury worse, keep the person calm, call for help, and get to definitive medical care.

At Jase Medical, we’re a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation. That means helping families understand what they can reasonably handle when normal access to care is delayed. It also means being very clear about the medical problems a home kit cannot solve.

A venomous snakebite is one of them.

JaseCase provides physician-prescribed contingency medications for specific medical situations after review by a licensed provider. It is intended for emergency use after first trying to reach a qualified healthcare provider. It does not replace antivenom or emergency treatment for a venomous snakebite.

So if a snake bites you on the trail, at the lake, or at hunting camp, you don’t need to remember what Rooster Cogburn did. Remember the one part he eventually got right: get to the hospital, fast.

The Jase Medical Team is a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: clinically grounded readiness that complements, rather than replaces, the healthcare professionals you already trust.

This article was prepared by the Jase Medical content team for informational purposes only and does not constitute medical advice. Prescription requirements, emergency dispensing rules, insurance coverage, and controlled-substance regulations vary by medication, jurisdiction, and individual circumstances. Consult a licensed healthcare provider or pharmacist regarding your specific medications.

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For Clinicians | Should You Suck Out Snake Venom?

couple looking at computer asking questions

For Clinicians | Should You Suck Out Snake Venom? The Snakebite Myths Your Patients Still Believe

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education
Medically reviewed and edited by Aaron Asay, PA-C, DMSc, FIBODM, FAWM

I really love gathering my little boys with me on the couch under a cozy blanket and watching the Disney show Something Bit Me! Snakebite might be the most mythologized emergency in first aid. Everyone seems to know what to do… and almost all of it is wildly wrong. The snakebite episodes keep proving the same thing: the wrong advice gets carried out where nobody can check it, miles from care, scared, with no cell signal. Today we’re covering the big snakebite myths, why each one fails, and what to tell our patients before a trip that keeps a bad bite from getting way, way, way worse.

One quick note before we start: everything here is about native North American pit vipers (rattlesnakes, copperheads, and cottonmouths). Coral snakes, exotic snakes, and bites outside the U.S. and Canada can need different management¹.

What happens when snakebite first aid goes wrong?

Season 1, Episode 8, “No Time to be Terrified,” is the one I still probably think about every day after watching it². A couple is hiking in California, 6 miles from the trailhead with no cell service, when a rattlesnake bites him through his shoe before he even sees it. The bite doesn’t look that bad. Then they do everything wrong, in order, like a slapstick comedy except it’s real life.

First, a tourniquet on his leg so the blood stops flowing up. Then they try to suck the venom out of his sweaty foot. (Thankfully, nobody had a knife for the famous X.) Then he runs for help on the bitten foot.

By the time he reached a hospital multiple hours later he’d need more than 100 vials of antivenom for his treatment over the next few days. The hospitals in the area ran out, and more had to be flown in from other hospitals. A bite that didn’t look that bad became a life-threatening injury.

And I have to admit, watching these freaky episodes I couldn’t always tell if they were doing the right thing. As a pharmacist I know antivenom needs to happen as soon as possible, but as for the first aid, I probably would have made the same mistakes! So this article is good advice for me too, since I hike with my dog daily in the Utah foothills, which have their fair share of rattlesnakes.

If a pharmacist on the couch can’t call it, our patients on the trail can’t either. Every move that couple made came from a movie or a campfire story, and our patients carry the same list into the backcountry.

Sucking out the venom + other myths

Here’s a list of the biggest snakebite myths and what’s inherently wrong with each one.

  • Cutting an X over the bite. It removes nothing and adds a second wound on top of a venom that can already cause bleeding³.
  • Sucking the venom out. It barely pulls anything out. In a human model using mock venom, a commercial suction extractor recovered 0.04% of the injected load⁴. Just say no.
  • A tourniquet or tight band. Cutting off blood flow traps the venom in the limb and starves the tissue around it, and tourniquets can lead to gangrene and amputation⁵. Doing that is really hurting the limb you are trying so hard to save. The 2026 Wilderness Medical Society (WMS) guideline is clear: don’t apply one¹.
  • Pressure immobilization. Some of us learned this snug elastic wrap from snakebite protocols in other parts of the world, like Australia. It was designed for different snakes with different venom, and it’s not recommended for North American pit vipers¹.
  • Running for help. Venom from a bite on an arm or leg travels mostly through the lymphatic system, and working muscles pump lymph toward the rest of the body⁵. Every step on a bitten foot moves the venom along faster. When there’s any choice, being carried, driven, or flown out beats walking¹.
  • Ice. It’s on the CDC’s “don’t do” list too³, and the WMS guideline lumps cold therapy in with the other techniques that can cause harm¹. Cold adds injury to tissue that the venom is already damaging.
  • “It doesn’t look bad, so it’s probably a dry bite.” Some bites are dry, but it is impossible to tell from the wound itself. Lack of initial symptoms doesn’t mean that no venom was injected, and a bite with little early swelling can still progress over the next several hours¹. The CDC’s guidance is blunt: don’t wait for symptoms to appear to get help³.

Meds for a snake bite

Now here’s a pharmacy question I can answer! Can you take ibuprofen for the pain? Not on the trail. The CDC puts aspirin, ibuprofen, and naproxen on its snakebite don’t-take list³. Pit viper venom can already lower platelets and interfere with clotting¹, and an NSAID stacks more bleeding risk on top of it. The 2026 WMS guideline does add one bit of nuance: NSAIDs may be used cautiously for some copperhead bites when there’s no clotting problem and bleeding risk is low¹. But on a trail, nobody knows the species or the clotting status yet, so skip them.

Antibiotics are the other reflex, especially for anyone who’s read our bite-and-scratch article, where some animal bites do need them. A snakebite isn’t a dog bite. In a study of 2,748 rattlesnake bite patients, fewer than 1% developed an infection, and the authors concluded prophylactic antibiotics aren’t needed⁶. The WMS guideline agrees: save antibiotics for signs of infection. The exception is a wound that’s heavily contaminated or has been cut or tampered with by bad first aid¹. (One more reason to skip the X!)

Nothing in a home medical kit treats envenomation. Every medication in a JaseCase is prescribed after a licensed provider reviews the request, and it’s for emergency use only, after first seeking help from a qualified healthcare provider. For a snakebite, that help is antivenom, and only a hospital has it¹.

What actually helps after a snakebite?

Less than most people expect. Every myth above is a big, dramatic move, and every one makes the bite worse. This is a rare emergency where doing less helps you more! The boring, simple stuff, like sitting still and slipping off a ring, is the help. The WMS guideline’s field priority is getting the patient to definitive care promptly and safely¹, and first aid should never delay that. If the patient has trouble breathing, signs of anaphylaxis, or shock, treat those first while help is on the way.

What helps on the way:

  • Call 911, or Poison Help at 1-800-222-1222, as soon as there’s signal. Poison centers can also help figure out which hospital should take the patient¹.
  • Keep calm and keep the bitten limb still, loosely splinted at about heart level¹.
  • Take off rings, watches, and anything tight before swelling starts³.
  • Clean the bite with soap and water, cover it with a clean, dry dressing, and mark the edge of the swelling with the time¹,³. Re-mark it as it spreads.
  • For clinicians with the training and gear: start IV or IO access in an unaffected limb¹.

For the clinicians: what to watch for

Don’t judge severity by the fang marks. Watch for spreading pain, swelling, redness, or bruising, and for systemic signs like low blood pressure, vomiting, neurologic changes, trouble breathing, or bleeding. Low platelets and clotting abnormalities can’t be checked in the field, which is one more reason a patient who looks fine still needs to get out¹.

At definitive care, expect serial exams and labs including a CBC with platelets, a basic metabolic panel, PT/INR, and fibrinogen. When there’s progressive swelling, systemic toxicity, or a clotting problem, the 2026 guideline favors giving antivenom early, ideally within 6 hours of the bite, though it can still help later¹.

Six miles in with no signal

Six miles in with no signal, there’s no perfect option. The WMS guideline says to use the safest and most efficient way to get the patient to definitive care¹. If walking out is the only way, the less exertion the better.

That couple’s story has one more lesson: the nearest hospital may not have enough antivenom. The guideline recommends consulting poison control or a toxicologist, and poison control can help coordinate getting antivenom sent from another facility¹.

What to tell patients before the trip

On the trail, care is all or none. Either the patient reaches an ER, or they’re on their own. The middle layer is getting care before the situation that needs it: a clinician’s guidance ahead of time, and for the conditions that allow it, an emergency supply prescribed after a provider’s review, for emergency use only after first seeking qualified care. For snakebite, there’s almost nothing physical to prepare ahead of time except knowledge (and choosing good hiking boots instead of tennis shoes). For this one, the preparation is the conversation, and the minute to have it is when a patient mentions a hike, a hunting trip, or a cabin weekend.

That minute is what appropriate medical preparation looks like for a snakebite, and part of it is knowing what a kit can’t do. We’re here for the times primary care isn’t there, and in no way a replacement for it. If you’d rather refer patients who want a trip-ready kit, you can send them to us at jase.com, where a licensed provider reviews every request before anything is prescribed. And we’ll keep publishing the clinical frameworks behind decisions like these.

The bottom line

Snakebite first aid is mostly about what not to do. The couple in that episode did everything they’d ever heard of, and almost every move made the bite worse. I think we remember sensational things like cutting an X over a snakebite and sucking out venom way better than other first aid tips. That, combined with feeling like we aren’t doing enough if we don’t do much in an emergency like a snakebite, keeps these myths alive. Well, that and Hollywood’s portrayal of snakebites!

Our patients deserve to be better prepared in their active lives than a campfire story. The best time is before the trip, likely in our office or pharmacy.

Sources

  1. Brandehoff N, Greene S, Benjamin J, et al. Wilderness Medical Society clinical practice guidelines for the treatment of pit viper envenomations in the United States and Canada: 2026 update. Wilderness Environ Med. Published online May 30, 2026. doi:10.1177/10806032261451823. https://journals.sagepub.com/doi/10.1177/10806032261451823
  2. Something Bit Me!, Season 1, Episode 8, “No Time to be Terrified.” National Geographic WILD, 2022. https://www.imdb.com/title/tt18339292/
  3. Centers for Disease Control and Prevention, NIOSH. Venomous Snakes at Work. Accessed September 2026. https://www.cdc.gov/niosh/outdoor-workers/about/venomous-snakes.html
  4. Alberts MB, Shalit M, LoGalbo F. Suction for venomous snakebite: a study of “mock venom” extraction in a human model. Ann Emerg Med. 2004;43(2):181-186. https://www.sciencedirect.com/science/article/abs/pii/S0196064403008138
  5. Parker-Cote J, Meggs WJ. First aid and pre-hospital management of venomous snakebites. Trop Med Infect Dis. 2018;3(2):45. https://pmc.ncbi.nlm.nih.gov/articles/PMC6073535/
  6. August JA, Boesen KJ, Hurst NB, Shirazi FM, Klotz SA. Prophylactic antibiotics are not needed following rattlesnake bites. Am J Med. 2018;131(11):1367-1371. https://www.sciencedirect.com/science/article/abs/pii/S0002934318305552

 

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