Snakebites in North Carolina: What to Know Before You Step Outside

By Sarah Spelsberg, MD

North Carolina is rich in wildlife—and that includes snakes. Most are harmless, play an important role in controlling rodents and insects, and only bite when threatened. Still, each warm season, emergency departments see hundreds of snakebite visits statewide, most from venomous pit vipers like copperheads, timber and pigmy rattlesnakes, and cottonmouths, but also elapids like coral snakes in our eastern wetlands. The good news: with calm, smart first aid and timely medical care, most people recover well.

Snakes are referred to as “venomous” not “poisonous.” If it bites someone and kills them, it is venomous. If one were to bite it and it kills someone, it is poisonous.

What is a “dry” bite and how often are bites “dry?”

Not every venomous strike injects venom. Roughly one in five pit viper bites are “dry,” meaning symptoms stay mild—pain and tiny punctures without spreading swelling or tissue damage. Because you can’t tell at the scene which bite is dry, treat every bite as an emergency. Go to your nearest emergency department to be monitored.

First aid you should (and shouldn’t) do:

• Stay calm and call 911 (or head to the nearest hospital if you’re close and have a safe ride).
• Limit movement and remove rings/watches—as the swelling can build quickly.
• Keep the bitten limb at heart level (not high above or dangling low).
• Gently rinse visible dirt; cover with a clean, loose dressing.

Avoid outdated tricks: DO NOT APPLY tourniquets, no cutting or sucking, no ice, no electric shock, and no alcohol. These do more harm than good. Stay calm, immobilize, remove any constrictive jewelry or clothing, and head towards the hospital. One more thing: a description or photo of the snake is sufficient. Please do not bring a live snake to your care provider.

What happens at the hospital?

Clinicians will identify the likely species by your story and symptoms (while helpful, you do not need a photo or the snake, as the description is usually good enough). Caregivers will monitor swelling, pain, and blood tests that reflect blood clotting and tissue injury. If symptoms are significant or worsening, they treat with modern antivenoms (such as CroFab® or Anavip®). These medicines neutralize venom, limit further damage, and reduce complications. Pain control, tetanus updates, wound care, and follow-up instructions round out the plan. Most patients go home within a day or two; severe cases may need longer observation. You might ask “why not give everyone antivenom?” It is very expensive, difficult to get and keep in stock, and, most importantly, some people have allergic or other reactions to it. This is why it is only administered if we think you need it!

Recognizing venomous snakes—patterns with a big disclaimer

Identification in the field is risky—don’t approach a snake “to be sure.” Remember: head shape, pupil type, and color are unreliable at a glance. When in doubt, back away. That said, local educators teach a helpful pattern tip:

• Copperheads often show side markings that look like chocolate “Hershey-kiss” shapes, parts of their hourglass bands when viewed from the side.
• Rattlesnakes (timber and pigmy in our state) tend to have more jagged, banded blotches—some describe these as “tornado” swirls or chevrons.
• Coral snakes have red, yellow and black markings and in the US the saying goes “red on yellow kills a fellow, red on black is a friend of jack”. Down in South America this is NOT THE CASE!

Prevention: Simple steps that work

• Watch your step—use a flashlight at night and never step or put your hands where you can’t see.
• Dress for terrain—sturdy boots and long pants on trails or yard work. Boot and leg coverings called “gators” are helpful for extra protection hiking in likely snake areas.
• Tidy the yard—reduce brush, wood piles, and tall grass that attract rodents (and snakes).
• Leash pets and teach children to look, not touch.
• Give snakes space—most bites happen when people surprise or try to handle or kill a snake.

The bottom line

Snakebites are scary, but panic and myths cause more trouble than snakes do. If bitten, keep still, call for help, and get to a hospital. With prompt, evidence-based care—including antivenom when needed—most North Carolinians make a full recovery and are back on the trail, the yard, or the ballfield in short order. Respect wildlife, use common-sense prevention, and you’ll lower your risk while enjoying our great outdoors.

Dr. Sarah Spelsberg is an Emergency Medicine Resident at UNC Health Southeastern. In addition to offering services you’d expect from a community health care system, UNC Health Southeastern provides a number of specialized services that are unique to our healthcare system and not available anywhere else in the region. To schedule an appointment, call our referral line at (910) 735-8864. To learn more, visit UNCHealthSE.org. To submit questions for consideration for a Frequently Asked Questions article, email unchsoutheasterninfo@unchealth.unc.edu.