Does the Sawyer Extractor Work?

The following is a rather long and extensive write up on the efficacy of the Sawyer Extractor, which also applies to other suction devices.

I didn’t write it, rather found it on a Reddit thread dated back to 2014. But it does align with my thoughts of long ago

What I found very interesting are all the replies, including Sawyer’s responses to the piece. While several people responded citing various academic papers, they were also quick to pick apart Sawyer’s responses for their lack of credible citations and use of words such as “They Feel” and “probably.”

I’ve left the entire original piece as I found it, only inserting paragraph breaks to help make it more digestible and easier to read.

For the entire piece, including replies, visit….. HERE

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By Jordan Benjamin on May 17, 2014

Hello,

My name is Jordan Benjamin, I am a herpetologist specializing in venomous snakes and a wilderness medicine practitioner with experience treating many snakebite patients in West and East Africa, most of them in remote health centers that pose some of the same challenges as treatment of a snakebite in the wilderness or backcountry environment in the US (supplies are limited or non-existent, the patient has a long way to go to reach a hospital, etc). I have also been fortunate to have the opportunity to train a number of individuals and groups in snakebite medicine and field management of snake envenomations in remote conditions including medical officers and corpsmen with the US military, local & international doctors and nurses in African hospitals, wildlife rangers, etc. I am including my background and real name because this issue is important to me and I stand by everything I am about to write; I want to give you all the peace of mind that I am who I say I am and not some competing company throwing out baseless accusations behind the cloak of online anonymity. Feel free to look me up online, I gave a TEDx talk on the issue of snakebite in sub-Saharan Africa last year and I invite those who doubt my identity or simply want to learn more about the issue of snakebite in the developing world to check it out. Moving on to the review…

The short answer to the question of whether or not the Sawyer Extractor can effectively remove venom from the site of the bite is a resounding no: the Sawyer Extractor and all of the other “snakebite kit” variations employing suction, incisions, electricity, heat, cold, and so forth have been repeatedly shown to be utterly ineffective at the job they are designed and marketed to accomplish. They simply do not work! The caveat it that there is one clever application of the sawyer that has been proven to work great, which is for the removal of flesh-eating botfly larvae that can be acquired in various tropical regions of the world…see “Simple and effective field extraction of human botfly, Dermatobia hominis, using a venom extractor” […]. I am afraid to say that at the moment that is the only medical situation where this device may possibly prove helpful. When it comes to snakebites, it is not only completely ineffective at removing venom from tissue following a snakebite, but may actually prove harmful and cause a serious local necrosis (think in terms of a cookie-cutter style wound forming a deep cylinder of rotting dead tissue under the site of application). This may be due to a concentration of residual cytotoxic and myotoxic venoms near the site of the bite, while the majority of the venom will continue to diffuse into systemic circulation – but since we really don’t know exactly why this happens that is purely speculation. For any interested parties, the article demonstrating this is titled: “Effects of a negative pressure venom extraction device (Extractor) on local tissue injury after artificial rattlesnake envenomation in a porcine model.” I am attaching a link to the article here: […]

There are probably several reasons why this type of first aid does not work. One issue is that the recurved fangs of vipers penetrate and inject venom deeply into the tissues beneath the skin, and the tunnel created when a fang penetrates the skin immediately collapses as soon as the fang is withdrawn. Another issue is that large quantities of venom are believed to diffuse very rapidly into different tissue compartments. This means that there is no direct route between the visible puncture marks on the surface to the area where venom was injected, and the significant quantity of venom is already well on its way.

I have read the company’s testimonials and seen the occasional news stories about a snakebite victim “whose life was saved by the Sawyer Extractor” or similar device, and all too often that is a quote attributed to the physician who treated them. I don’t doubt the veracity of the quote as deeply entrenched myths and misinformation about snakes and snakebite are unfortunately as common in doctors as they are in the rest of society at this time.

The sawyer extractor is popular because it provides us with an intuitively sound solution to the terrifying prospect of suffering a snakebite far from medical care, suddenly rendered utterly helpless as the venom takes effect and all we (or our loved ones) can do is wait and watch as the venom takes over. It is nothing more than a modern variation of the infamous “black stone” from Asia and Africa, a charred piece of cow bone that is stuck to the site of the snakebite and remains there absorbing fluid until all the venom has been drawn out of the bite whereupon it suddenly detaches and falls to the ground, is boiled or washed in milk to cleanse it of the venom, and ready to go when the next snakebite happens. Both of them provide the perfect optical illusion by visibly extracting some quantity of blood and straw-colored fluid (which looks incredibly similar to many viper venoms) from the site of the bite, but this is nothing more than the pale-yellow plasma (whats left after you remove the red cells and clotting components from blood) and other exudate draining from the wound as edema sets in and the venom begins to show effect. If you feel like you have been duped, don’t take it personally – the notion that a snakebite can be treated by somehow extracting the venom has successfully fooled us since at least the 1400’s, when the black stone was first mentioned as the go-to remedy for treating snake envenomations. Several years ago, a close colleague of mine met a European surgeon who was in Central Africa on a medical mission and explained that he needn’t worry about snakebite, because he always carried a black stone with him for such a situation…as you can see, even the most highly educated medical professionals are not immune to the myths that pervade the issue of snakebite. I grew up carrying a sawyer extractor with me whenever I went out to look for snakes and lizards, and no one would be happier to hear that the sawyer extractor did what it claims than those of us who work with snakes and face an incidence of snakebite many times higher than that of the larger population. But the reality is that these devices do not work for snakebites, and marketing them for that purpose is a dangerous action with potentially tragic consequences. Evidence-based medicine and all studies to date suggest that they are at best ineffective and at worst harmful. If you would like to see more evidence of this, check out:

Snakebite Suction Devices Don’t Remove Venom: They Just Suck” […] and Suction for Venomous Snakebite: A Study of ‘Mock Venom’ Extraction in a Human Model” […].

This product has no business being marketed for use on snakebite. Out of more than 40 snakebite patients I have treated in Africa, 95% of them had already been given bad first aid prior to seeking treatment at the hospital. Practices like cutting at or around the site of the bite, applying tourniquets to the bitten limb, and attempting to extract or neutralize venom using electricity, fire, permanganate, black stones, magic, mouths, mud, dung, leaves, ground up dried snakes, and yes – even fancy suction devices like the Sawyer Extractor – are dangerous and detrimental for two reasons. First, in a snakebite time is tissue and a lot of it is wasted performing bad first aid. Many snakebite patients injure themselves by panicking immediately after the bite, I have seen more than a few individuals who suffered serious traumatic injuries in addition to the snakebite because they took off running from the snake at full speed only to suddenly fall face-first onto a rock or trip and stumble over the edge of a steep embankment. The second issue is that signs of an envenomation may in some cases take hours to appear, and the combination of seeing a useless suction device drawing fluid out of the bite along with a delayed onset of symptoms is an easy way to decide that you don’t need medical care after all because you the used extractor less than minute after the bite and saw it remove the venom, or you feel fine and don’t want to inconvenience the whole group because you’ve all been planning this trip for months, or any number of other rationalizations we can make with ourselves to keep from going in to get the bite checked out.

The majority of bites from venomous snakes in the United States are suffered by young men between the ages of 18 – 25 who are intoxicated (usually alcohol) and attempting to pick up, kill, or otherwise interact very closely with a potentially deadly snake. This is a demographic that is particularly prone to making the wrong decision about whether they should laugh it off cause they feel okay or should immediately seek medical care for a life-threatening emergency.

I have had patients come early after the bite and I have had patients come after great delays, and I have noticed two things. The first is that those who arrive early often do so because they are suffering from a severe envenomation and become very ill very quickly, while those who come late often waited because they believed falsely that the first aid measures taken were sufficient or that they were not seriously envenomated. The second observation is that many of the patients who wait come in when they finally reach their own line in the sand for what constitutes a serious enough problem to go to the hospital, and they often tend to have more complications, longer hospitalizations, and a higher chance that the bite will result in permanent disability because of how long the venom has been allowed to work unchecked. They often arrive in the critical condition with severe envenomations just like the group of severely envenomated patients with the shortest delay to care, but instead of showing up in a critical state of hemorrhagic or hypovolemic shock they arrive in shock with their kidneys failing, or with late-stage bleeding into the brain, meninges, abdominal cavity to compound all of the other symptoms. Late-stage complications can be incredibly difficult to treat, they are excruciatingly painful for patients, heart-wrenching cases for medical personnel, and they are entirely preventable with prompt care.

If you are bitten by venomous snake or are unsure as to whether or not the snake is venomous, please, please, please focus on how to get yourself safely to emergency medical care and don’t bet your life on any of these commercial snakebite kits. The only effective, definitive treatment for a snake envenomation is the appropriate antivenom to neutralize the venom of the species you were just bit by. I repeat, THE ONLY EFFECTIVE TREATMENT FOR SNAKE ENVENOMATION IS THE APPROPRIATE ANTIVENOM. Repeat that five times and them move on to some helpful tips on what you actually should do in the event of a snakebite in the middle of nowhere.

To end this lengthy review on a positive note, there are several things I would suggest you do following a snakebite that are extremely beneficial.

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Follow the rest…. HERE

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