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RE: How many of you keep your own stock of antiven
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by JoeCrotalid on July 13, 2008
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John and Karl are absolutely correct! Historically zoo's hve provided AV to hospitals to assist with exotic bites at risk to their own staff. Reimbursement for the AV however does not fall on the hospital but the individual who was bitten. If that person does not have insurance coverage or pay their hospital bill then the hospital takes the initial loss and the zoo takes the secondary loss because they are not reimbursed. Their staff is then placed at risk because it is difficult for them to obtain replacement AV due to cost, permits, shipping, etc.
The Poison Centers maintain an AV index consisting of zoo's and other sources who maintain AV in the event of exotic bites. In addition we are lucky in Florida to also have the Miami-Dade AV Bank which also provides AV for exotic bites, but I'm sure they take a loss when bills are not paid and they are not reimbursed for the AV and transport cost. I have also been made aware of another agency in North Florida who is starting an AV bank. Generally the AV problem does not involve Native species since most ER's carry CroFab. In addition, relatively few exotic bites occur each year which is the reason most hospitals do not stock exotic AV. In 2007, the Florida Poison Information Network only received 10 calls regarding non-venomous and venomous exotic bites combined.
I further agree that obtaining AV by the private sector is very difficult due to cost, permits, etc. A couple of years back, I did try to get keepers in central florida to provide me a list of the species they kept, bite protocols, and AV they had available if any to maintain a reference book to better assist these keepers if bitten-information that I had available if consulted as a specialist for a bite by an ED. Almost like a co-op. Information tha I could fax to the ED to provide appropriate treatment. A few keepers contacted me and said they would not provide species list because they felt it would then make their collections known to the public which I felt raised concern because it made it sound like they were doing something illegal if they were that worried. ER's and doctors are always criticized about their knowledge regarding envenomations but keepers should not be so fast to criticize MD's about taking care of exotics bites which they are not trained for when keepers are not willing to provide appropriate info on managing those bites. I posted a request for you the keepers to provide me with info to help address these issues in the medical community and have only received one response. Sorry! Had to jump onto my soapbox for a minute.
Is it feasible for the private sector to maintain it's own AV-yes! Is it likely to happen?-No! At least not until obtaining it becomes easier. Should hospitals stock exotic AV-maybe it something to look at if keepers develop relationships with ED's and make species list and bite protocols available to them. Should AV banks exist? A partnership between such an EMS AV bank and poison control would be a very valuable system but the venomous community would have to be willing to contribute to such an undertaking.
Most exotic keepers are very responsible as I have said when ever interviewed by the news but accidents do happen, and there are always those keepers who are not responsible or keeping species illegally-these are generally the ones that cause zoo's and wildlife experts to view private collectors negatively. So I again put it to keepers in Central Florida-if you want to ensure you are treated appropriately in an ED if bitten provide me with your info, contact info, species kept and bite protocols. ED are more likely to follow such a protocol if it is sent from the poison center even if it is the same one you hand them when you walk in. Think of it as an insurance policy to make sure your protocol is followed. Sorry! Soap boxing again.
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RE: How many of you keep your own stock of antiven
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by Cro on July 14, 2008
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If Dr. Steve Seifert can bring this about, it will be a good thing to have regional AV banks.
However, he is making a major mistake in wanting Zoos to house the AV. The resentment this will cause because of the additional unpaid work and responsibility will be huge.
He should be smart enough to know that. I assume that he chose Zoos because the folks there are allready familiar with antivenin, and because he thought they would welcome having the additional stocks of antivenin that they did not have to pay for available for them. And those are goood points.
However, if they are housing antivinin that they have no use for themselves, and still have to get up in the middle of the night to retrieve the antivenin for someone else, the resentment will continue.
Antivenin should be housed at fire stations, where it can be transported quickly with flashing lights to an airport in the middle of the night, or relayed by state troopers accross the state. Fire stations are open 24 hours a day, and most have trained medical folks on staff, and are tied into the emergency response radio network. All they need is an extra small refrigerator, and minor training for some of their folks.
The reptile buildings at zoos sometimes only have a skeleton crew in town, when many of the folks who work there are on vacation out of town or out of country.
You could be relying on getting in touch with a 20 year old junior reptile keeper at 3:00 am, and wanting him to drive an hour to the zoo to open the reptile building and retrieve the antivenin, and a further hour to the airport. And you know what, that 20 year old will not have his telephone # on the Antivinin index as a contact. They will have to contact the Curator who is in Belieze, and then he will have to tell the hospital which of his reptile keepers to contact.
This might be a bit easier these days with cellphones, however, it is still a logistical nightmare, and still will cause the antivenin to reach the patent two hours later than if it had been at an fire station in the first place.
Dr. Seifert, do what you can to bring about the regional AV banks, however, do not put them in Zoos !
Best Regards John Z
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Rob???
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by biff on July 14, 2008
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Just curious, you stated you don't rely on tax $$$ and you don't charge an "entrance fee", quote:"Your statements are 100% false - I'm an elitist? Are you kidding? My facility is NOT AZA, we do NOT get tax support to operate, we do NOT charge a fee to come and visit our facility, we DO PAY a lot of money for A/V to protect me and my staff. How in the hell does that make me an elitist? And, no, I am not above anyone....far from it. " end of quote.
How are you funded? Just curious, but I've got to think public funds (some form of taxes) come into play here. If not, I'm certainly all ears. Perhaps a private individual finances your center?
Anyway, I'm not saying your an elitist or anything like that, frankly, I don't care. The only reason I ask this is because I saw you post it.
thx,
Steve
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RE: How many of you keep your own stock of antiven
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by JoeCrotalid on July 14, 2008
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The Regional AV bank that has been mentioned is actually the AV Index maintained by the American Association of Poison Control Centers which is being placed into a computer program for easier referencing. The index has historically been nothing more than a binder of zoo's and private resources who maintain AV specific to species they keep. Dr. Seifert is heading the project to improve this resource.
The only true AV bank currently is Miami-Dade although as I mentioned before, another agency is developing a bank in Northern Florida.
The Zoo's in the index will not be stocking AV's for all species but only the ones they keep, and can be contacted by the Poison Center to arrange use. Not all zoo's are members of the index and therefore they are not obligated to provide their own AV stock in the event of a bite. Would such AV banks be useful-absolutely but it is only a step to improving an already faulty system. ED staff would have to be trained to administer exotic AV. Most staffs are not even trained to manage native snakebites and administer CroFab. AV Banks are a start but the problem is more universal when it comes to ensuring appropriate care.
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RE: How many of you keep your own stock of antiven
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by atwageman on July 14, 2008
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Yeah and that A/V index is hard to access for some folks. I have access. Unless something has changed that I'm not aware about, they just don't let anybody have access to it.
To add fuel to this already immense fire. Regardless of where A/V is stored, I have also come to the conclusion that the other underlying issue Zoo's have with private keepers is just plain old fashsion jealousy. Let's face it, some of us in the private non tax funded world have "QUALITY" collections that rival most zoo's. Now I'm speaking about the individual zoo keepers at those zoo's, not the overall zoo itself. They rant and rave about the A/V issue and how private individuls or institutions shouldn't keep hots, when if you called them out on it they are just jealous and wish thier zoo had what we had and also wish their zoo had a better budget to work with. I'm so happy my collection isn't dictated by a board of directors counting beans, or some government commision.
I know that was a broad statement I just made, but use a little common sense and read between the lines.
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RE: How many of you keep your own stock of antiven
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by JoeCrotalid on July 14, 2008
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Wayne
You are right! The index is not available to the public and generally only poison centers and zoo's have access. I also have access since I work for the poison center and a treatment specialist.
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RE: How many of you keep your own stock of antiven
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by atwageman on July 14, 2008
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One reason they keep it private I guess is to prevent a false sense of security for the casual keeper. I'm sure there may be legal and or liability issues at stake as well.
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RE: How many of you keep your own stock of antiven
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by jared on July 14, 2008
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Steve, just because its not AZA funded does not mean that it doesnt recieve public funds. You recieve tax exemptions for being an educational facility as well as grants from various other entities. It just seems to me that some people feel "certain" human lives are not worth there stock of antivenin, or that there friends and co workers lives are more valuable (as Greg put it, harsh). I do agree though if used there should be some recourse for the facility to recieve new stock or at least financial compensation for the stock. I keep mostly natives, and for most AV would not be required to save your life from and envenomation (Agkistrodon mostly) but for the few exotics i do keep, i would prefer to have AV but I have not acquired any as i recently got back into exotics. As Karl pointed out this was a big discussion at the columbia show a couple years ago. Again, having worked in AZA and Nonaza facilities, as a reptile breeder and vendor and as an educational lecturer on countless occassions there are various views going into the melting pot here. I see where a facility could be a little upset from the local yahoo who shouldnt have a cobra in the first place calling them for his 3rd supply of bite serum. I can also see the thousands of responsible keepers who may make one mistake and need AV one time, and would gladly restock it. For a long time Zoos have fought private keeping of MANY exotics, and for some this just seems like a way of snubbing private keepers again. Lets face it, its not in a facilities best interest to have other experts in town not affiliated w the zoos, on some scale that would resemble competition in one form or another. For the record, MANY of you guys were private keepers first, as well as the private keeper sector(german american or otherwise) facilitating many of the institutions with there stock. Go to any show and u can find dozens of zookeepers incognito. I am having ethical problems with this myself, as i agree, I HATE seeing these idiots buy gaboons because 'there so calm' and them having to read about them gettin tagged in a parking lot cause they couldnt wait to get it back home to play with it. In that aspect its on the seller, and i for one dont want my animals going anywhere they will be mistreated (Dean once told me, the less u touch a venomous snake the better off it will be) and i for one believe that. This is a tricky subject, but i must say when u argue using a couple vials of AV to save someones life (no matter how big a piece of trash u think they are) there is something wrong with that, esp coming from educators and med personnel. I do agree that people are not being properly educated on alot of these animals HANDS DOWN. I have over a decade of vending at reptile shows and have heard some REALLY horrible advice (I really hate seeing all the gabs passed around) on these animals and very few people there will correct it. I just use this bit of personal advice, know and understand your risks before you engage in such dangerous endeavor and be willing to deal with it if an accident happens. If you go sharkin off hatteras, know a 20ft hammerhead may eat your little 14ft skiff, if you go skydiving know your chute has a chance of not opening, if you keep venomous animals know that there is always a risk of being envenomated, no matter who you are, .02
Jared Watts
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RE: How many of you keep your own stock of antiven
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by Rob_Carmichael on July 14, 2008
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First, a reply to Steve's questions on how we are funded if we don't charge a fee:
1) We do not receive tax dollars to operate, first and foremost. BUT, we do get a facility from the city, and, have many of our utilities taken care of so indirectly, I suppose we do - there are many benefits we enjoy by being under the umbrella of municipality. All other expenses in the form of upkeep of the animals, exhibits, staff, veterinary care, husbandry supplies, equipment, etc are paid for by the user fees we charge for programs such as school field trips, classes, summer camps, lectures, outreach programs, outreach/traveling exhibits, etc. That's how we can operate with free admission. It's not easy but I firmly believe that everyone should have the chance to see a nice collection w/out paying exorbitant fees like many other facilities in our area. Lincoln Park Zoo is still free which is pretty amazing.
2) Zoos do become a logical choice in some regard because having additional A/V supplies serves several purposes including providing additional stock to keepers who work there. Most zoos have two or three emergency contacts and I have found that most are fairly readily available in the event of an emergency. Many city municipal fire departments will most likely not want to have the responsibility of keeping A/V on hand....particulary with such a small market in terms of those who keep hots. In areas of the U.S. where venomous herps are found, most hospitals carry A/V but outside of that, there will be few instances for these fire departments to keep it on hand and be responsible for maintaining it.
If, however, select regional centers could be located (whether that's certain hospitals, etc) and willing to participate, that would obviously be the way to go.
Good discussions! Rob
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RE: How many of you keep your own stock of antiven
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by FLherp on July 14, 2008
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Hospitals in areas with venomous fauna should have the proper antivenoms for animals native to that region, or at least have access to it. It should not be incumbent on a zoo, institution, or individual to provide this medication.
How many bites are to keepers of exotic venomous? For the purposes of this discussion let's define it as animals not indigenous to the US. Last I recall, it may be somewhere around 50 annually. If Joe will check TESS, we can have a better idea of how many bites occurred involving the use of exotic AV and just how much of a demand there is for the medication from zoos. There may be some under-reporting, this information is captured by Poison Control Centers, and there are hospitals, physicians, and nurses that do not call the PCC.
There is no central repository of this information, and all the relevant information so far has been in the form of anecdotes, not a sound way to make a judgement. Thinking and believing things is OK, I would like to know the actual numbers involved. Or at least a reasonable estimate...
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