Emergency Medicine, Snakebites, and the Bronx Zoo

On Tuesday, October 23, 2012, nine medical students, including four from Einstein, rotating in emergency medicine (EM) at Jacobi and Montefiore Medical Centers, received a one-day seminar at Jacobi on a unique aspect of EM: treating snakebites. Jacobi has the only Snakebite Treatment Center in the tri-state area, offering a rare opportunity for the medical students.

Fortuitously, the Bronx Zoo, which is only a short drive from Jacobi, has the most elaborate collection of antivenin in the nation. Because of this proximity, the zoo initiated a partnership with Jacobi in 1980, to provide treatment in the event reptile house employees experienced a venomous snakebite.

The antivenin has proved to be a precious resource to Jacobi EM staff members, who, each year, rely on it to treat four to eight snakebite patients from among the general public, and call upon the zoo whenever antivenin is needed. Since 1980, the hospital's Snakebite Treatment Program has treated 175 patients with antivenom, half using exotic antivenoms from the zoo supply, and the remainder using rattlesnake/copperhead antivenom stored in the Jacobi emergency department.

Dr. Smeeta Verma, medical student elective coordinator, explained, "Equally important to treating snakebites, students receiving this didactic learn about the important conservation research done by staff at the zoo, along with the knowledge of potential medical implications needed for addressing venomous snakebites."

During the didactic, led by Dr. Michael Touger, associate professor of clinical emergency medicine, as well as medical director of the Jacobi Medical Center Snakebite Treatment Program and Hyperbaric Chamber and associate medical director of emergency medicine, students learned that the species of venomous snake most prevalent locally is the northern copperhead. However, because many patients who come to Jacobi for snakebite treatment are collectors of exotic snakes, such as black mamba and puff adder, the zoo's antivenin collection serves as a valuable resource for a variety of venomous bites.

On a tour of the reptile house led by Dr. Touger and zoo curator of herpetology, Don Boyer, students saw a number of these snakes, along with the storage area for the antivenin. Upon seeing the stored antivenin, Lee Jacobson, an Einstein MSTP student exclaimed, "It's mind-blowing to see this little fridge, knowing it stores one of the biggest resources for antivenin in the world."

Dr. Touger noted, "Even places like Tuscon, Arizona, the center of research for rattlesnake bites, have trouble finding medication in instances when there is an exotic snakebite."

With more than 1,000 venomous snakebites occurring in the United States annually, Jacobi's unique snakebite didactic provides students in their EM rotation with insights and knowledge for treating them.