South Africa is home to several venomous snake species. Snake envenomation is a medical emergency requiring immediate ER assessment. Antivenom is expensive (R8,000–R15,000+ per vial) but is a PMB-covered emergency treatment. This guide covers what to do immediately after a bite, which snakes pose the greatest risk, and what your medical aid covers.
Immediately After a Snake Bite — What to Do
Do
- Move away from the snake. Do not attempt to catch, kill, or handle the snake — many bites happen during the capture attempt.
- Call 10177 (ambulance) or ER24 (084 124) or Netcare 911 (082 911) immediately. Snake bite = medical emergency — do not wait for symptoms.
- Keep the victim calm and still. Restrict movement of the bitten limb. Physical exertion speeds venom absorption.
- Immobilise the bitten limb below the level of the heart — similar to managing a fracture.
- Remove constricting clothing and jewellery near the bite site before swelling begins.
- Note the time of the bite — this matters for clinical management.
- If safe to do so: Take a photograph of the snake from a distance — species identification helps antivenom selection.
- Call the Poison Helpline (Toxinology): 0861 555 777 (24-hour expert guidance)
Do NOT
- Do NOT apply a tourniquet
- Do NOT cut the bite site or attempt to suck out venom
- Do NOT apply ice, heat, or electric shock
- Do NOT give alcohol
- Do NOT attempt to catch the snake
- Do NOT drive yourself to hospital — call an ambulance or have someone drive you
South Africa's Major Venomous Snakes
Cytotoxic (tissue-destroying) venom: - Puff adder (Bitis arietans): SA's most common and dangerous snake. Responsible for the majority of SA snake bite fatalities. Slow-moving; struck when stepped on. Massive local swelling, tissue necrosis, coagulopathy. - Boomslang (Dispholidus typus): Rare but highly dangerous. Slowly evolving coagulopathy (DIC — disseminated intravascular coagulation). Haemorrhage into tissues; may appear fine for hours before rapid deterioration. BOOMSLANG-SPECIFIC antivenom required. - Vine snake (Thelotornis capensis): Similar coagulopathy to boomslang. Vine snake antivenom required.
Neurotoxic (nerve-paralysing) venom: - Black mamba (Dendroaspis polylepis): Most feared SA snake. Large, fast, highly venomous. Neurotoxic venom causes progressive descending paralysis and respiratory failure within 30–60 minutes. Fatality without antivenom is near certain. POLYVALENT antivenom. - Green mamba (Dendroaspis angusticeps): Coastal areas; neurotoxic; less aggressive than black mamba. - Cape cobra (Naja nivea): Neurotoxic; causes ptosis (drooping eyelids), respiratory paralysis. POLYVALENT antivenom. - Mozambique spitting cobra (Naja mossambica): Spits venom at eyes causing severe ocular injury. Also causes cytotoxic bite wounds. - Rinkhals (spitting rinkhals): Also spits; mainly cytotoxic.
SA antivenom: The South African Vaccine Producers (SAVP) Polyvalent Antivenom covers all SA elapid (cobra, mamba) and viper (puff adder) species. The boomslang requires boomslang-specific monovalent antivenom.
Is Snake Bite Treatment a PMB Condition?
Yes. Snake bite / animal envenomation is a PMB emergency Diagnosis and Treatment Pair.
Your scheme must fund: - Emergency ER assessment - Antivenom administration - Hospital admission and monitoring - ICU admission if required (respiratory failure, haemodynamic instability) - Surgical treatment (fasciotomy for compartment syndrome in puff adder bites)
How Does Medical Aid Cover Snake Bite Treatment?
| Service | PMB? | Typical cover |
|---|---|---|
| Emergency ER assessment | Yes — PMB | Hospital benefit |
| FBC, coagulation (INR/PT, aPTT, fibrinogen, D-dimer), blood group | Yes — PMB | Pathology benefit |
| SAVP Polyvalent Antivenom (10 vials may be needed) | Yes — PMB | Hospital benefit |
| Boomslang monovalent antivenom | Yes — PMB | Hospital benefit |
| Hospital admission (observation, ward) | Yes — PMB | Hospital benefit |
| ICU admission (respiratory failure, envenomation severity) | Yes — PMB | Hospital benefit |
| Mechanical ventilation (mamba/cobra paralysis) | Yes — PMB | Hospital benefit |
| Fasciotomy (compartment syndrome, cytotoxic bites) | Yes — PMB | Hospital benefit |
| Ophthalmology assessment (spitting cobra venom, eye) | Yes — PMB | Hospital/specialist benefit |
| Physiotherapy (post-fasciotomy rehabilitation) | Partial — limited sessions | Day-to-day |
Antivenom cost: R8,000–R15,000 per vial; severe puff adder envenomation may require 5–10 vials (R50,000–R150,000 in antivenom alone). This is PMB-covered — the scheme must fund it regardless of plan tier.
Eye Exposure to Spitting Cobra Venom
Mozambique spitting cobra and rinkhals can spit venom up to 2–3 metres into the eyes.
Immediate action: Copious irrigation with clean water (at least 15–20 minutes). This is a true ocular emergency — do not wait. Irrigation must happen immediately, even before reaching hospital.
At hospital: Ophthalmology assessment, topical analgesia, anti-inflammatory drops. Severe cases may require topical antivenom (off-label). This is PMB-covered.
Day Costs: What to Budget For
| Scenario | Estimated hospital cost |
|---|---|
| Dry bite / minor envenomation (observation only) | R8,000 – R20,000 |
| Moderate envenomation (antivenom + 1–2 days ward) | R30,000 – R80,000 |
| Severe envenomation (antivenom + ICU) | R80,000 – R300,000+ |
| Gap cover: | Relevant for ER and ICU specialist shortfalls |
Antivenom Availability — Know Before You Go
SAVP Polyvalent Antivenom is stocked at most major SA private hospitals and government hospitals. However, in remote areas (adjacent to Kruger, KZN wilderness, Eastern Cape), antivenom may only be at the nearest district hospital.
Before travelling to remote malaria/snake-risk areas: identify the nearest hospital with antivenom and note the contact number. Add 10177, ER24 (084 124), and Netcare 911 (082 911) to your phone.
Boomslang monovalent antivenom is less widely stocked — it is held at major referral centres (Groote Schuur, Inkosi Albert Luthuli, Charlotte Maxeke, Tygerberg). In a suspected boomslang bite, the treating hospital should contact the SAVP or Poisons Centre immediately.
Emergency Numbers — Save These Before You Go
| Contact | Number |
|---|---|
| Ambulance (national) | 10177 |
| Police (national) | 10111 |
| ER24 (private ambulance) | 084 124 |
| Netcare 911 (private ambulance) | 082 911 |
| Poison Helpline / Toxinology (24h) | 0861 555 777 |
| Council for Medical Schemes | 0861 123 267 |
Talk to Eldon
Snake bite antivenom is PMB-covered regardless of plan tier. The Check shows what each plan on our panel pays for this, side by side, and Eldon advises from there.
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