Analyzing first aid in textbooks used by non-medical and paramedical students in Nepal: A need of further attention for snakebite management!

BACKGROUND: Despite the remarkable burden of snakebite envenoming (SBE) and placement of public health importance of SBE at global and national levels, a huge gap still exists in the first aid of snakebites. Herein, we aimed to evaluate the currently used textbooks to know improvements in advising standard first aid of snakebites in textbooks used in Nepalese schools and universities after a similar study published in 2013. METHODOLOGY/PRINCIPAL FINDINGS: We evaluated 46 recently edited textbooks used for teaching safety and first aid in Nepal during January-April 2024 involving thematic analytical approach. We performed an analytical review of safety and first aid in textbook. The counts of harmful or useless advice for first aid significantly decreased [p < 0.001] and standard first aid significantly increased [p < 0.001]. But, the proportions of advice for emergency transport, and going to an appropriate healthcare facility provided with anti-snake venom (RAFA) negligibly increased [p = 0.367 (right)]. However, 6-75% errors reflected the persistent use of teaching materials containing non-recommended first aid measures. CONCLUSIONS/SIGNIFICANCE: Therefore, it is essential to update these textbooks including evidence-based, standard first aid for snakebites to increase the advice for appropriate care of snakebites at pre-hospital condition. We suggest authors revising those textbooks including the advice for application of pressure-immobilization bandaging (PIB) and local compression-pad immobilization (LCPI) by trained first aider and other first aid that can be applied by general people. PIB delays the onset of systemic neurotoxic venom effects due to krait bites. LCPI delays systemic venom effects and minimize local toxicity (i.e., destruction of tissue at the site of the bite) due to cobra and all viperid snake venoms.