Emergency physician William Rushton, MD, used to lie awake at night, worrying about his snakebite patients. People rarely die from envenomations these days thanks to a new, safer generation of antivenins that came on the U.S. market in 2000.¹ An estimated 7,000–8,000 people are bitten per year by venomous snakes in the United States, though only about five of them die, according to CDC data. But somewhere between 10 and 44 percent of bite victims have lasting difficulties like loss of muscle control or part of a finger, and Dr. Rushton’s patients from the emergency department (ED) at the University of Alabama at Birmingham (UAB) Hospital often contacted him after release about such problems.¹

So many patients returned to UAB with swollen or discolored limbs that Rushton began to require all of them to send him pictures of their extremities three days out—the best system he could come up with even though, as he says, “It was incredibly inefficient.” Rushton—an associate professor of emergency medicine (EM) and pediatrics at UAB Hospital—was agonizing a few years ago over how to help a patient with a badly blistering wound when his colleague Dag Shapshak, MD, peered over his shoulder at the patient’s pictures. “Looks kinda like a leg I would see in my clinic,” said Dr. Shapshak, another associate professor of EM at UAB, who also helps lead UAB’s Comprehensive Wound Care Clinic. The encounter got the two physicians talking not only about that specific patient, but also about how they could better help all bite victims—a long conversation that culminated in 2021, when they launched UAB’s Comprehensive Snakebite Program, the first of its kind in the country. The new center not only provides initial resuscitation but something more difficult to find: comprehensive follow-up care for snakebites that, Dr. Rushton said, goes “beyond the brick and mortar of the ED.”

Alabama sees about 250 snakebites a year, and as medical director of the state’s Poison Information Center, Dr. Rushton consults on nearly every one of them—at least one or two a day through the poison center. In the past, patients often struggled to find any clinician willing to see them after they left the ED. Primary care physicians aren’t typically trained in treating snakebites and were therefore largely unwilling to take on any responsibility for them. Therefore, Dr. Rushton’s patients—suffering from swollen limbs, decreased range of motion, or persistent or rebound coagulopathy—sometimes drove as much as four or five hours back to UAB to see him for further help. That was hard on patients and on Dr. Rushton’s ED, which wasn’t set up for such treatment at the time—though, as Shapshak quickly saw, his wound clinic was. Bite victims needed post-discharge services that dovetailed neatly with those Dr. Shapshak was already providing—localized wound care, treatment for swelling, lab monitoring to ensure proper clotting, and referrals to physical therapy. Obvious as the overlap may seem now, it was obscured for a long time by the gap between the typical snakebite patient and the typical wound clinic patient: The former tend to be young, healthy, and active, between the ages of five and 30; the latter about 80 years old, suffering complications from diabetes or cancer. As Dr. Shapshak said, “The know-how was in our field. What’s novel is that we [were] able to connect the dots.”