Snake envenomation in Florida: a 20-year analysis of epidemiology and clinical outcomes at a tertiary medical centre.

Background: Venomous snakes are among the most lethal animals worldwide and envenomation survivors face lifelong morbidities. Envenomation is colloquially considered highly prevalent in the US state of Florida, yet envenomation trends here are currently unassessed.

Methods: We present a comprehensive analysis of causes, characteristics and treatments of Florida's snake envenomations via medical records review of envenomated patients presenting to a major academic medical centre between 2002 and 2022.

Results: Envenomation occurred predominantly in adult men when handling wild snakes. The major envenomating species were the pygmy rattlesnake (Sistrurus miliarius) and cottonmouth (Agkistrodon piscivorus), and most patients were bitten on their hand/finger. Oedema, paraesthesia and nausea were typical, although life-threatening symptoms presented in some after envenomation by the timber rattlesnake (Crotalus horridus) and eastern diamondback rattlesnake (Crotalus adamanteus). After being bitten, 10% of patients attempted contraindicated self-treatments. Although 2.03 h elapsed prior to patients encountering a healthcare provider, there was no correlation between patients' distance from the hospital and their time until arrival. An additional 4.22 h elapsed prior to administration of antivenom, and three patients died during hospitalization.

Conclusions: Many envenomations were preventable incidents caused by intentional engagement with wild snakes. Education regarding avoidance of venomous snakes and seeking immediate medical care may reduce the prevalence and morbidity of future envenomations.