Snakebite research in Australia has moved a long way in the past decade, much of it through the Australian Snakebite Project, which has followed thousands of bites through Australian hospitals. Three areas of recent work are worth knowing about: what happens when professional snake handlers get bitten, what snake venom is actually made of, and a fresh look at the first aid we have relied on for more than 40 years.
Who gets bitten and how
One Australian Snakebite Project study looked at 106 snake handlers who were bitten. The median age was 40, nearly all were men (98%), and almost every bite was on the hand or arm (97%). That is no surprise to anyone who handles snakes for a living. Handlers know exactly how dangerous snakes are, expect to be close to them and still get bitten, because handling is the moment of greatest risk.
Red-bellied black snakes were the most common culprit in handler bites (28%), followed by mulga snakes, tiger snakes and brown snakes.
The study also found that handlers were more likely than other patients to have serious allergic reactions. Around one in four handlers had a systemic allergic reaction, compared with fewer than one in five other patients. Repeated exposure to venom over years of handling, and in some cases earlier courses of antivenom, can sensitise the immune system, so a later bite or antivenom treatment can trigger anaphylaxis on top of the envenoming itself.
That is one more reason the message for the public is simple. Do not handle snakes. A University of Melbourne study of Australian snakebite deaths from 2000 to 2016 found that up to one in five people who died were bitten while trying to pick up a snake.
The chemistry of venom
A major review of snake venom proteomes, covering 132 snake species, found consistent patterns in what venoms are made of.
Most venoms are dominated by four protein families:
Phospholipase A2 (PLA2), which can break down cell membranes, damage muscle and attack nerve endings
Three finger toxins, which mostly block nerve signals to muscles
Snake venom metalloproteases, which damage tissue and blood vessels
Snake venom serine proteases, which interfere with blood clotting
Together, these families make up most of the protein in a typical venom. Australian elapids lean heavily on PLA2 toxins, three finger toxins and serine proteases, including the powerful clotting toxins in brown snake, tiger snake and taipan venom. Metalloproteases, the tissue destroying toxins, are far more important in vipers overseas, which is one reason viper bites cause so much more damage at the bite site.
A second group of smaller protein families adds further complexity, including natriuretic peptides, C type lectins, disintegrins, L amino acid oxidases, cysteine rich secretory proteins and Kunitz peptides. They usually make up only a small share of a venom, but some have important effects, and their role is still not fully understood.
The takeaway is that snake venom is a complex chemical mixture, not a single poison. That is why antivenoms are matched to particular snakes or groups of snakes, and why Australia also has a polyvalent antivenom that covers all the major dangerous land snakes when the snake involved is not known.
A fresh look at the pressure bandage
For more than 40 years, pressure bandage immobilisation has been the standard first aid for snakebite in Australia. It is still the recommended first aid today, and it is what we teach.
In 2023, Dr Mark Little, an emergency physician and clinical toxicologist at Cairns Hospital, published two cases that raise important questions about how the bandage is used.
Two men, aged 35 and 44, were bitten by snakes in remote north Queensland. Both had pressure bandages applied promptly. Both were in significant pain and needed strong pain relief during long transfers to Cairns Hospital, and their bandages stayed on for 9.5 and 7.5 hours before they were removed.
Neither man showed evidence of systemic envenoming. Both, however, developed severe muscle breakdown in the bandaged limb, which was attributed to the bandage being left on for so long. The 35 year old developed compartment syndrome, a dangerous build up of pressure inside the limb, and needed urgent and repeated surgery. Two years later, the 44 year old still had altered sensation in his foot.
Little's view is that, given the limited evidence that pressure bandaging improves outcomes and the problems with how it is often applied, the practice should be re-examined. Research is now under way, including a trial comparing pressure bandaging with a simpler pressure pad over the bite.
Dr David Williams, former head of the Australian Venom Research Unit and now a scientist with the World Health Organization, has raised similar questions. In a 2025 WHO webinar on snakebite first aid, he pointed out that the pressure needed to slow venom through the lymphatic system is hard to achieve and hard to hold. Common crepe bandages can lose much of their tension within two hours, and a bandage tight enough for an adult can act like a tourniquet on a child. He also warned that bending a bandaged arm into a sling can turn the bandage into a tourniquet.
His emphasis falls heavily on immobilisation: keeping the person still and splinting the bitten limb. For some bites overseas he favours a firm pressure pad over the bite itself, rather than bandaging the whole limb. Small studies of that approach in Myanmar have shown promise, but larger studies are still needed. None of this has changed Australian guidelines yet, which still recommend a pressure immobilisation bandage over the whole limb. What it does show is that keeping still matters at least as much as the bandage.
What this means for you
These cases do not mean the bandage is doing harm in ordinary circumstances, and they are not a reason to skip it. Most Australians bitten by snakes are in hospital within an hour or two, and pressure immobilisation remains the recommended first aid.
What they do show is that the bandage needs to be applied correctly and removed in hospital as soon as doctors are ready. Firm like a sprained ankle bandage, not tight enough to cut off circulation. If the person is in severe pain in the bandaged limb, or fingers or toes go cold, pale or numb, tell the ambulance crew or the hospital straight away. In remote areas with long transfer times, follow the advice of the paramedics or retrieval doctors.
Snakebite is more complex than it looks. Handlers face their own risks, venom is a sophisticated mixture we are still decoding, and even our standard first aid is being tested rather than taken for granted. That is exactly how it should be.
For current snakebite first aid, step by step, visit snakebitefirstaid.com.au.
Sources and further reading
Little, 2023: Harm due to the use of pressure bandage immobilisation in patients bitten by snakes in Australia, Clinical Toxicology
Tasoulis and Isbister, 2017: A review and database of snake venom proteomes, Toxins
Isbister and colleagues: Australian Snakebite Project study of bites in snake handlers
Isbister and colleagues, 2008: Current use of Australian snake antivenoms and frequency of immediate type hypersensitivity reactions and anaphylaxis, Medical Journal of Australia
For advice or safe reptile relocation anywhere in Sydney, contact Chris Williams at Urban Reptile Removal on 0418 633 474.
