Who snakebite guidelines pdf

The incidenceof snakebite mortality is particularly high in South-East Asia. Rational use of snakeanti-venom can substantially reduce mortality and morbidity due to snakebites.These guidelines are a revised and updated version of Regional Guidelines for theManagement of snakebites published by the WHO Regional Office in South-East Asiain 2011 v Guidelines for the Clinical Management of Snake bite in the South-East Asia Region Preface The geographical area specifically covered by this publication extends from Pakista The guidelines for the prevention and clinical management of snakebite in Africa have been developped by the World Health organization Regional Office of Africa with contributions from technical experts. They are meant to assist health workers to improve medical care for snakebite victims; they also serve as a source of information for the. snakebite experts convened in May, 2010. No algorithm can anticipate all clinical situations. Other valid approaches exist, and deviations from this worksheet based on individual patient needs, local resources, local treatment guidelines, and patient preferences are expected. This document is not intended to represent a standard of care Chairman, SLMA Expert Committee on Snakebite MBBS, MD, FRCP Science is evolving day by day and, in keeping with that, revisions to update existing documents are required. The initiative taken by the SLMA Expert Committee on Snakebite in 2007 to develop guidelines on the management of snakebite and make the

4. Identify the snake, if possible.Identify the snake, if possible. Most bites are nonpoisonous. (The appearance of the snake, especially the rattlesnake, may vary considerably from the illustrations, depending on season, terrain, and so on.) Use caution even when handling a dead snake. 5. Grade the envenomationGrade the envenomation patients succumb more easily to snake venom) as well as nature of first aid given. Factors not contributing to outcome are size of the snake and time of bite (day/night) 2. Incidence of Snake Bite in India There is a huge gap between the number of snakebite deaths reported from direct survey and official data

The numbers of snakebite fatalities in India has long been controversial. There is a huge gap between the number of snakebite deaths reported from direct survey and official data. Only 7.23% snakebite deaths were officially reported (Majumdar et al, 2014; Mohapatra et al, 2011). Earlie An estimated 7,000 to 8,000 venomous snake bites occur annually in the U.S. Thanks to prompt medical attention, only about five per year are fatal. Globally, the World Health Organization reports snake bites are a serious public health threat, particularly among rural farmers in tropical and subtropical countries. A recen Guidelines for the Management of Snakebites 2nd Edition PDF Free Download. Snakebites are well-known medical emergencies in many parts of the world, especially in rural areas. Agricultural workers and children are most affected. The incidence of snakebite mortality is particularly high in South-East Asia

First Aid Management Of Snake Bite - The Y Guide

Guidelines for the management of snakebite

Snake Bite: Indian Guidelines and Protocol Surjit Singh, Gagandip Singh Chapter 94 BACKGROUND India is estimated to have the highest snakebite mortality in the world. World Health Organization (WHO) estimates place the number of bites to be 83,000 per annum with 11,000 deaths. 1 Most of the fatalitie GUIDELINES FOR THE MANAGEMENT OF SNAKEBITES 30 surfaces of (opisthoglyph) fangs at the posterior end of the maxilla (Fig 2c) (Weinstein et al., 2011) . Fangs allow the snake to introduced venom deep into the tissues of its natural prey. If a human is bitten, venom is usually injected subcutaneously or intramuscularly Guidelines for the Prevention and Clinical Management of Snakebite in Africa iv 7. Clinical Profiles of Envenoming by Some Snakes of Medical Importance 4 Use a light (torch, flashlight or lamp) when walking at night, especially after heavy rains. Be careful when handling dead or apparently dead snakes -even an accidental scratch from the fang of a snake's severed head may inject venom. Snake restaurants pose a threat of bites to staff and customers SNAKEBITE & SPIDERBITE GUIDELINES - South Australia AN OVERVIEW OF SNAKEBITE MANAGEMENT Snakebite is a potential medical emergency and should always receive high priority assessment and treatment, even if the patient appears initially well. The major-ity of snakebiteswill not result in significant envenoming and will not require antivenom

Guidelines for the Clinical Management of Snake bites in

  1. This guideline should not be used outside Victoria due to regional differences in Snake species. See also. Anaphylaxis . Resuscitation. Key points. Specific advice about children with potential snakebite should be sought early from a clinical toxicologist (Poisons Information Centre 13 11 26, 24 hrs/day)
  2. An Indian guideline on the management of snakebite has been evolved through intensive discussions and workgroups amongst 12 invited experts from India, plus a review and discussion of relevant research publications and papers (list of experts enclosed). The invited experts comprised a select group of professionals drawn from the fields of.
  3. Asclepius Snakebite Foundation Time to shift the thinking on antivenoms is to as is to Antivenom is to snakebite what whole blood and a surgeon are to trauma! New field stable antivenoms and a symptom-driven syndromic approach to snakebite management make field treatment the new standard of care (and you don't need to identify the snake
  4. Guidelines for the Management of Snakebite in Hospital - 2017. a. Introduction to the 2017 Revision. b. Epidemiology of Snakebite in Sri Lanka. c. Medically Important snakes in Sri Lanka. d. Management Algorithm
  5. g Strategy for prevention and control. Since 1976, we have been studying the clinical effects, management, and prevention of enveno
  6. g in Nepal is due to respiratory paralysis (and rarely shock due to bleeding from Russell's viper enveno

View Guideline_ Management of Snakebite (2017).pdf from HS MISC at University of Malaysia Sabah. MINISTRY OF HEALTH MALAYSIA MOH/P/PAK/341.17(GU) GUIDELINE: MANAGEMEN (1,7). In fact, 20-25% of venomous snake bites are dry and provide no venom to the victim; antivenom in these cases will provide no benefit. The severity of envenomation by North American pit vipers can be assessed by using the guidelines provided below. Guidelines for Assessing the Severity of North American Pit-Viper Envenomations (8 Guideline for management of snake bite in south east Asia countries by David Warrel Menon JC, Joseph JK, Jose MP, et al. Clinical Profile and Laboratory Parameters in 1051 Victims of Snakebite from a Single Centre in Kerala, South India Bites, Stings and Envenomation CPG ID: 60 Guideline Only/Not a Substitute for Clinical Judgment 2 BACKGROUND Bites, stings and envenomation can occur in almost all environments in which the military operates.1 Depending on the species and location, these can be mild events to life threatening situations

Snakebite management with signs of envenomation should occur in conjunction with advice from Clinical Toxicologists via the Poisons Information Centre. The nation-wide number is 131126. 2. Important Information . 2.1 Introductory remarks This guideline and its supporting procedure seek to ensure that snakebite managemen Inconsistent guidelines as to end points for ASV ther-apy8 Anti snake venom reactions handled by test dosing and administering hydrocortisone and antihistamine7,8 The new protocol included: Anti snake venom administration criteria limited to presence of incoagulable blood, visible neurologica Snakebite is a major public health problem in many parts of the world. WHO has readded snakebite to the list of neglected tropical diseases in 2017. The two WHO guidelines on management of snakebite were appraised and found to have poor quality. The guidelines had inadequate stakeholder involvement, poor methodological rigour, and competing. SNAKEBITE / CROTALID ANTIVENOMS SUMMARY severity of envenomations by North American pit vipers can be assessed by using the guidelines provided below. Antivenoms work by binding and neutralizing venom toxins, facilitating redistribution away from target tissues and elimination from the body (4).. www.eymj.org 1443 Snakebite in Korea: A Guideline to Primary Surgical Management Jung Ho Rha 1, Sung Min Kwon , Jin Rok Oh1, Byung Keun Han2, Kang Hyung Lee3, and Jae Hyun Kim1 Departments of 1Orthopedics, 2Internal Medicine, and 3Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. Purpose: Snakebite is an emergency which causes local symptoms such as pain and edema.

snake bite management guidelines ppt 1. snake bite abhija babuji. crri. department of pediatrics. smims. 2. out line introduction epidemiology types of snake bites classification identification features. clinical features of snake bite national snakebite management protocol, india. 3. introduction • envenomation, FabAV, fasciotomy, pitviper, rattlesnake, snakebite, Viperidae Introduction The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of North American pitviper envenomations. We present a review of pertinent path

WHO Guidelines for the prevention and clinical

  1. Division of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Snake Bites . Clinical Practice Policy . Contacts Poison Control Center 1-800-222-1222 (This is first contact for snakebites to help facilitate anti -venin
  2. guidelines are for crotaline snakes in the United States and Canada, and should not be applied to other snake species or geographic regions. Figure 1. Geographic range of some common pit viper snakes in the United States and Canada. From top to bottom: Western rattlesnake - Crotalus oreganus & geographic range of Crotalus & Sistrurus
  3. SNAKEBITE--OBSERVATION GUIDELINES I. Exclusion Criteria A. Fever over 103 B. Need for Antivenom C. Unstable VS D. Need for fasciotomy E. Systemic disorder (Renal failure, D.M., Sickle cell disease, immunosuppression) II. OBS Interventions A. Serial exams including vital signs B. Analgesic C. Antipyretic D. Antiemetics E. IV hydratio

Snake characteristics Mamushi (G. blomhoffii). Mamushi is a pit viper that is seen in a wide variety of colors (Figure 1).As mamushi is a small snake (about 60 cm), its attack range is only about 30 cm [].The fangs are about 5 mm long, with very thin tips (Figure 2a). This snake lives near rivers, ponds, and paddy fields and is active in the daytime in spring and autumn and at night in the summer Snakebite is a truly Neglected Tropical Disease (NTD) and is in priority list amongst NTDs in South East Asia. It was observed that in West Bengal, there is a rising trend of snake bite incidence and reported deaths over the year. Management of snake bite cases and patients affected by common poisons is always challenging speciall SNAKES OF NEPAL 17 3.1 Local manifestations 18 3.2 Systemic manifestations 19 3.3 Clinical syndrome of snakebite envenoming in Nepal 27 3.4 Long term complications (sequelae) of PATIENT CARE GUIDELINES CARE OF THE PATIENT WITH VENOMOUS SNAKE BITEPage 4 of 6 Systemic effects such as hypotension, vomiting, fasciculation, or confusion. Tissue reaction to snake venom is a dynamic process Snake Safety Generally not aggressive, rattlesnakes strike when threatened or deliberately provoked, but given room they will retreat. Most snake bites occur when a rattlesnake is handled or accidentally touched by someone walking or climbing. The majority of snakebites occur on the hands, feet and ankles

Management of Poisonous Snakebite

This Guideline elaborates on the important aspects of snakebite clinical management, particularly on the recognition of the species involved and the clinical syndrome caused by envenoming as well as the appropriate investigation and treatment. Medically important species found in Malaysia and the predominant clinical features of envenoming are described to facilitate species diagnosis and. guideline + Aztreonam 40 mg/kg/dose IV q8h (max: 2 g/dose) + Metronidazole 10 mg/kg/dose IV q8h (max: 500 mg) Only a minority of snake bites become infected and need antibiotics. Antibiotics should be determined by culture results. Most infections of snakebites are associated with the introduction of pathogenic bacteria durin - Management of snakebite should occur in a setting with a 24-hour pathology service and resuscitation facilities - Snake handlers are managed as per standard guidelines Clinical features of envenoming: - Patients may be envenomed, but remain asymptomatic - Early collapse (suggests Brown snake), cardiac arres Non-poisonous snake bites can be handled similar to other bites with local wound care, tetanus immunization, etc. We will deal only with poisonous Crotalinae family snake bites in this document. See [Figure A] for an illustration of poisonous and non-poisonous snakes. Pre-hospital EMS evaluation and treatment- Snakebite Parasite Control Guidelines Reporting Purchase Examinations Rescue and Retirement Thoroughbred Race Day Injury Management Transitioning Retired Racehorses Vaccination Guidelines PrinciDles ofVaccination Venomous snake bite of equids occurs in certain areas of North America. The risk of rattlesnake envenomation may justify the use of Crotalus.

Guidelines for the Management of Snakebites 2nd Edition PD

Information on How to Prevent or Respond to a Snake Bite. After a natural disaster, snakes may have been forced from their natural habitats and move into areas where they would not normally be seen or expected. When you return to your home, be cautious of snakes that may have sought shelter in your home. Provided by the Centers for Disease Control and Prevention (CDC) South Florida Ecological Services Office 1 DRAFT May 25, 2004 Species Conservation Guidelines South Florida Eastern Indigo Snake The Species Conservation Guidelines (Guidelines) for the eastern indigo snake (Drymarchon corais couperi) provide a tool to determine if a project, i.e., a Federal permit, a Federal construction project, or other such action, may adversely affect eastern indigo snakes 5050 SNAKE BITE GUIDELINE EMR EMT/EMT-IV AEMT Intermediate Paramedic NWRETAC Combined EMS Guidelines Approved January 1, 2019. Next Update: January 2020 Obtain specific information: Appearance of snake (rattle, color, thermal pit, elliptical pupils) Appearance of wound: location, # of fangs vs. entire jaw imprint Timing of bit Ashe S, Blaylock R, Chisale MGP, et al. Guidelines for the Prevention and Clinical Management of Snakebite in Africa. World Health Organization, Regional Office for Africa, Brazzaville, 2010. Blaylock RSM. Snake bites at Triangle Hospital January 1975 to June 1981 SNAKE BITE MANAGEMENT. Snake bite is one of the major public health problems in the tropics. It is also emerging as an occupational disease of agricultural workers. In view of their strong beliefs and many associated myths, people resort to magico -religious treatment for snake bite thus, causing delay in seeking proper treatment

Snake bite who guidelines - SlideShar

DOWNLOAD PDF . Share. Embed. Description Download Snake Bite WHO2016 Comments. Report Snake Bite WHO2016 Please fill this form, we will try to respond as soon as possible. Your name. Email. Reason. Description. Submit Close. Share & Embed Snake Bite WHO2016 Please copy and paste this embed script to where you want to embed. Camping Guidelines on Public Land U.S. Department of the Interior Bureau of Land Management Idaho USING UNDEVELOPED AREAS FOR DISPERSED CAMPING • In undeveloped areas, you may camp for up to 14 days before having to move at least 25 miles from your original spot. You may not return to that area for 28 consecutive days Get away from the snake. No need to hurt the snake just because you're angry, and you don't want to incur additional injury. If you (or someone else) can safely and quickly get a picture of the snake, great, but don't waste time or risk a second envenomation. Ultimately, pit viper (rattlesnakes, copperheads, cottonmouths/water moccasins) envenomations are diagnosed clinically

Short-tailed snake habitat is fire-dependent and proper fire management is important for ecosystem maintenance. Snake fungal disease (SFD) is an emergent threat to wild snakes and has been documented in at least 10 states including Florida (Sleeman 2013, Glorioso 2016). Snake fungal disease may contribute to drasti Snakebite envenomation turns again into a neglected tropical disease! Jean-Philippe Chippaux1,2,3 Abstract: On June 9th, 2017 WHO categorized snakebite envenomation into the Category A of the Neglected Tropical Diseases. This new situation will allow access to new funding, paving the way for wider and deeper researches According to the CDC, about 8,000 snakebites happen in the U.S. each year. Even a bite from a harmless snake can cause infection or allergic reaction in some people. For your safety, treat all snakebites as if they were venomous and get to a hospital emergency room as quickly as possible. This is. view of the Guidelines and are addressed by separate documents. The Guidelines set criteria for euthanasia, spec-ify appropriate euthanasia methods and agents, and are intended to assist veterinarians in their exercise of professional judgment. The Guidelines acknowl-edge that euthanasia is a process involving mor

(PDF) Does the traditional snakebite severity score

(PDF) Guidelines for the Management of Snake-Bites

Snakebite is a mark or a puncture wound caused by the bite of a poisonous or a non-poisonous snake. The signs of a poisonous Snakebite can range from simple puncture wounds to fang marks and can lead to death, while those of the non-poisonous snakes can lead to infections and not death Standard Treatment Guidelines (Speciality/Super Speciality wise) 1. Guidelines for Cardiovascular Diseases. 2. Guidelines for Critical Care. 3. Guidelines for Gastroenterological Diseases. 4. Guidelines for Obstetrics and Gynaecology Snake Venom Detection Kit. The Snake Venom Detection Kit (SVDK; CSL Ltd) is designed to assist in determining the appropriate antivenom to use in envenomed patients.2 Its results must not be used to either diagnose or exclude envenoming.17 However, even for envenomed patients, the SVDK has shown high rates of inaccuracy. This includes misdiagnosis of brown snake envenoming in one in 10 cases. Most snakebites occur on the extremities. Typical symptoms of the bite from a nonvenomous snake are pain and scratches at the site. Usually, after a bite from a venomous snake, there is severe burning pain at the site within 15 to 30 minutes. This can progress to swelling and bruising at the wound and all the way up the arm or leg Snake Bite its First Aid & Anti Snake Venom (ASV): Details Guidelines Amitava Sinha Ray* RANBAXY LABORATORIES LTD. West Bengal, India *a.amitava.s@gmail.com ABSTRACT Snakebite is an injury caused by a bite from a snake. It can be dangerous and life threatening if the snak

Clinical Practice Guidelines : Snakebit

sbc_Guidelines The Sri Lanka Medical Association (SLMA

  1. A snakebite is an injury caused by the bite of a snake, especially a venomous snake. A common sign of a bite from a venomous snake is the presence of two puncture wounds from the animal's fangs. Sometimes venom injection from the bite may occur. This may result in redness, swelling, and severe pain at the area, which may take up to an hour to appear
  2. year. Though snakebite is a life threatening centuries old condition, it was included in the list of neglected tropical diseases (Warrell and WHO 2009; Bawaskar HS 2014). With its triad of high mortality, high disability, and substantial psychological morbidity, snake bite warrants high priority research (lancet 2015)
  3. medical toxicologist or other snakebite expert should be consulted. CroFab® should be used with caution in patients with allergy to latex, papaya, pineapple, papain, bromelain, and sheep. Crotalidae Immune F(ab') 2 Equine (Anavip®) is FDA-approved for the treatment of North American rattlesnake bite
  4. Guidelines > > > > > > > > Parent Handouts ACE the ACEM Blog Snake Bite. Management of suspected snakebite Snake Bite. Management of suspected snakebite: File Size: 31 kb: File Type: pdf: Download File. Use of the VDK and antivenom: File Size: 86 kb: File Type: pdf: Download File. Management of the envenomated patient: File Size: 32 kb.
  5. utes in a critica care area with monitoring - Remove pressure bandage after AV has been ad

Snake bite: prevention and management in rural Indian

National Guideline for Snake bite Management in Nepal 201

Snakebite & Spiderbite Clinical Management Guidelines - Third EditionNSW HEALTH PAGE 21 Definite spider bites are then managed in one of three clinical pathways: 1. Big black spider bites. This includes potential bites by funnel-web spiders, but also trapdoor spiders, mouse spiders and other mygalomorphs (large, primitive spiders) §Applicable guidelines at treatment site. NB. Some geographical regions with different venomous snake fauna are not well represented in our dataset, and local modification of this pathway may be needed to account for differences in snake fauna. Patient Sticke

Guideline_ Management of Snakebite (2017)

{ DOWNLOAD AS PDF } ABOUT AUTHOR: Amitava Sinha Ray B.Pharmacy, DPM RANBAXY LABORATORIES LTD. West Bengal, India a.amitava.s@gmail.com ABSTRACT: Snakebite is an injury caused by a bite from a snake. It can be dangerous and life threatening if the snake will venomous. India is the top country having the highest no. of death due to snake bite. Snake bites and envenomation - More than 50% of the bites are dry bites, i.e. no envenomation occurred. In the event that venom is injected, the severity of envenomation depends on the species, the amount of venom injected, the location of the bite (bites on the head and neck are the most dangerous) and the weight, general condition and age of the individual (more serious in children)

look out for a snake. • Do not approach a snake; if you see one, back away slowly. Treatment (before going to the hospital) • If bitten, no matter how small or minor the bite may seem, call 9-1-1 or the poison center immediately. • Do not attempt to kill or capture the snake • Remove constrictions, such as rings an Indian National Snakebite Protocols Electrical Therapy and Cryotherapy Electric shock therapy for snakebite received a significant amount of press in the 1980's. The theory behind it stated that applying an electric current to the wound denatures the venom (Guderian et al, 1986). Much of the support for this method came from letters t Snake-bite is a significant problem worldwide. Despite frequent deployments and exercises to countries where venomous snakes are endemic there are few reported cases of British Army personnel being bitten. Clinical Guidelines for Operations includes direction on the treatment of snakebite, including the application of pressure immobilisation All patients with a history of snake bite or possible snake bite should be transported to hospital for assessment and management as envenomation can be life-threatening. Most snake bites do not result in envenomation

Management of Snake Bite in India - JAP

  1. The Australian Snakebite Project is a multicentre prospective study of snake bite where serial samples are being collected for quantification of venom and antivenom concentrations. This study should help to address the questions of initial dose and appropriate laboratory and clinical end points for antivenom treatment
  2. , mikerb@mit.edu Department of Mechanical Engineering Computer Science and Arti cial Intelligence Lab MIT, Cambridge MA 02139 1 Overview and Objectives4 2 Put Your Name On Your Code4 3 Variables Use Snake Case.
  3. INTRODUCTION. Snakebites account for significant morbidity and mortality worldwide, especially in South and Southeast Asia, sub-Saharan Africa, and Latin America [ 1 ]. Venomous snakes are widely distributed around the world and clinical effects from envenomation can overlap to a great degree even among different families of snakes
  4. The essence of this study was to provide general information about where snakebite and antivenoms rank on public health agendas, how much is known about these topics, whether access to efficacious antivenoms may become a reality, and whether the international industry and state institutions have been able to implement international guidelines
  5. Serious Versus Deadly Snakebites. Roughly 11% of the 173 species of snakes in southern Africa can be considered deadly and these include mambas, cobras, the Rinkhals, Puff Adder, Gaboon Adder, Boomslang and the Twig Snake.The Mozambique Spitting Cobra accounts for the vast majority of serious bites, followed by the Puff Adder, and then the Stiletto Snake and Rhombic Night Adder
  6. guideline Specific Precautions: • The Rattlesnake is the most common venomous snake in our RETAC. • Exotic venomous snakes, such as pets or zoo animals, may have different signs and symptoms than those of pit vipers. In case of exotic snakebite, contact base and consult zoo staff or poison center for direction

Corn snake care is relatively straight forward. The following will explain the basic care for your corn snake. This care sheet is not intended to be a thorough guide to keeping corns, but rather to outline the basics that every corn snake keeper should know and follow. Doing so will help keep your snake safe and healthy. Feedin Author Summary Every year snake envenoming kills more people in the tropics than some of the world's recognised neglected tropical diseases (NTDs), including schistosomiasis and leishmaniasis. While lacking the epidemic potential of an infectious/vector-borne disease, snake envenoming in rural tropical communities has as great a medical mortality, if not morbidity, as the NTDs Process for obtaining Medical Autopsy for Trauma Patients Clinical Practice Policy. Antibiotic Therapy for Intra-Abdominal Infections. Acute Care Surgery Pre-Operative NPO Protocol. Antibiotic Therapy. Request for Cardiopulmonary Bypass PRIOR to arrival in the Main OR

(PDF) Unified treatment algorithm for the management of

Worker Recommendations. Workers should take the following steps to prevent a snake bite: Do not touch or handle any snake. Stay away from tall grass and piles of leaves when possible. Avoid climbing on rocks or piles of wood where a snake may be hiding. Be aware that snakes tend to be most active at dawn and dusk and in warm weather Guidelines for Species Survey, Monitoring and Protection Measures . 4. The contractor will be informed on the protection status of the eastern indigo snake and penalties that may be imposed if regulations are violated at the pre-construction meeting. 5. At the pre-construction meeting, the applicant will provide the contractor with

Frontiers | Human Mast Cell Tryptase Is a PotentialSnake Spider Guidelines Gl2007 006 3ASKEP SNAKE BITE PDFEmergency Response Plan | Spider & Scorpion Of Southern AfricaFirst Aid Guidelines Are Developed By Australian National

2017 AAHA Canine Vaccination Guidelines. NEW! Interim clinical considerations for North American companion-animal vaccination practice during the COVID-19 pandemic. Originally published 9/7/17. Updated 2/3/18. For a printable PDF, click here. The Guidelines are an authoritative source of evidence-based recommendations and expert opinion. Snake bites. Two words with the ability to destroy pretty much any experience in the bush. And let's be honest, as much as we'd like to believe we're experts at dealing with crises, when the moment arrives most of us end up being a second patient rather than the life-saving heroes we'd like. Many snake bites in Australia do not result in venom entering your body (known as envenomation) and so they can be managed without antivenom. Because you can't always tell if a bite is a dry bite, always assume you have been injected with venom and manage the bite as a medical emergency — call triple zero (000) for an ambulance