By Bart Pfankuch
South Dakota News Watch
Concerns over rattlesnake encounters in South Dakota first arose when an Illinois man died after a rattler bit his ankle as he searched for a wayward golf ball on a course near Spearfish in early June.
Worries were heightened a few weeks later when a Custer State Park burro died after being bitten on the face by a prairie rattlesnake.
The deaths of the man and the burro have fueled fears that more of the venomous snakes and more frequent encounters with them were cropping up in South Dakota.
Herpetologists and other rattlesnake experts say it’s too early to tell if 2018 will be worse than past years. Despite the high-profile snakebite incidents, there is no evidence so far to indicate a major spike in bites or in the number of snakes afoot.
However, development of homes, roads and infrastructure into once-natural areas will over time make encounters between rattlesnakes and humans more common and likely lead to a rise in snakebites.
A few facts remain clear about the prairie rattlesnake – the only venomous snake in South Dakota – which inhabits grassy, rocky or wooded areas mainly west of the Missouri River but is known to exist across the state.
• Snakes are fairly abundant and if threatened, molested or startled, they can and will bite.
• While death due to snake bite remains rare in the U.S., and exceedingly rare in South Dakota, getting bit results in a painful emergency and a medical condition that almost always requires antivenin administered by a doctor at a hospital.
• Getting bit by a prairie rattler and receiving treatment is costly, with medical bills often reaching into the tens of thousands of dollars.
• Snake encounters tend to rise in pleasant weather conditions, such as moderate temperatures and normal rainfall amounts, when both humans and snakes will be outside and active.
Snake experts say that knowing more about prairie rattlers and their habits is the best way to avoid a bite.
Recent bites turn fatal
As golfers often do, 70-year-old Lawrence Walters of Geneseo, Illinois, hit his golf ball into the rough on Monday, June 4. While playing the fifth hole at Elkhorn Ridge Golf Club south of Spearfish with his wife, Walters reportedly waded into some tall grass to look for his ball on the par-5 hole where home construction has recently taken place.
A prairie rattlesnake bit him on the ankle and Walters immediately had trouble breathing. He was rushed to the course clubhouse, where employees administered CPR. He was transported to Spearfish Regional Hospital, where he later died.
While the snake’s venom played a role in Walters’ death, it was not the primary cause, according to Marty Goetsch, the Lawrence County Medical Examiner who listed Walter’s cause of death as cardiac arrhythmia.
"If the rattlesnake hadn’t bitten him, he probably would not have passed away," Goetsch said. "The individual had extensive heart issues and the rattlesnake bite was the beginning of a chain of events that unfortunately took his life."
Course operators said after the incident that they would post more warning signs that snakes are present on the course, and that they would change the local rules to make it easier for golfers to play on rather than hunt for wayward golf balls.
The number and severity of snake bites and injuries is not recorded in South Dakota or other states, said Brian Smith, a biology professor and snake expert at Black Hills State University.
Snake encounters have been reported with some frequency of late, however. On the same day the man was bitten at Elkhorn Ridge, golfers at Boulder Canyon Golf Course in Sturgis reported a rattler on a golf cart path. On June 5, a Lead man was bitten by a rattler at a campground in eastern Wyoming and received treatment at the hospital in Spearfish.
In late June, one of the burros that reside in Custer State Park was bitten on its face by a rattlesnake. The female burro, which had survived the Legion Lake Fire in December, was discovered in peril in the far southeast corner of the park by a visitor who reported the injury to park officials.
The burro was quickly loaded onto a trailer and taken to a veterinary clinic, said Mark Hendrix, Custer State Park resource manager. The burro was given antivenin at a veterinary office but died from its injuries, Hendrix said.
Hendrix said prairie rattlers are known to live in the park and visitors occasionally report sightings on social media, but no one knows how many are present.
"We see them in different areas of the park, even in the forested areas, but they’re most common in the prairie," he said.
Hendrix said park visitors should be cautious when hiking or walking in grass they cannot see into, but that there is no reason to be "on high alert" regarding rattlesnakes. Hendrix said he doesn’t know of any humans or other animals being bitten in the park and has only encountered a rattler once in his six years of employment there.
Bites from prairie rattlesnakes are rarely fatal in humans because the snakes are relatively small and do not possess the amount and potency of venom required to quickly kill a human. The speed with which medical treatment can now be provided also helps keep fatalities low, said Smith.
The death related to a snakebite stunned Smith, who said he knows of very few snakebite deaths in South Dakota over the past century (Paul Emerson, a soil expert, is known to have died of a snakebite on a trail near Rapid City in 1937.)
"I was just shocked that somebody had died from it," Smith said. "Even in the worst-case scenario, if the fang had pierced through a vein, it would still take several hours for someone to die."
In 2013, the state Department of Health performed a study showing that from 2000 through 2011, about 160 people were hospitalized due to venomous snakebites across the state.
July, August and June were the months that most bites took place, and most occurred in counties west of and along the Missouri River, though five hospitalizations were reported in Minnehaha County, and four each in Yankton and Hughes counties during that 12-year time period.
A spokeswoman for Avera Health said the emergency room at St. Mary’s Hospital in Pierre treats about seven or eight snake bites a year.
Experts say the number of snakebites is vastly underreported because the bites receive little attention from media and most victims recover quickly.
Across the United States, it is estimated that between 7,000 and 8,000 snakebites are reported each year, and that only about five of those victims die, according to the Centers for Disease Control and Prevention. The eastern and western diamondback rattlesnakes are larger and far deadlier than the prairie rattler and are responsible for most deaths in America, Smith said.
The prairie rattler venom is comprised of digestive enzymes that attack tissue in the victim, Smith said. Common symptoms include pain and swelling in the area of the bite, numbness in the lips and mouth, nausea and lethargy.
Smith said it is impossible to know exactly where snakes will be present because adult snakes can travel up to 10 miles from their den in a hunt for prey or a mate.
The moderate temperatures and end of the recent drought may be leading to more snake encounters in South Dakota, said Terry Phillip, snake curator at Reptile Gardens near Rapid City.
"Snakes like to be outside and active in the same temperatures people want to be out and active in," Phillip said.
Prairie rattlers are ubiquitous in western South Dakota, including in both rural and urban areas, Phillip said.
"There’s not a corner or a neighborhood or a street in Rapid City where I haven’t been called in to capture a rattlesnake," he said.
While 2018 may be off to a faster-than-normal start for rattler bites in South Dakota, residents should expect to increasingly encounter snakes as growth and development continue, Phillip said.
He said a subdivision near Rapid City was built in recent years virtually on top of a rattlesnake den that still holds more than 100 snakes just 60 feet from one home.
"The more we develop into the wild, the more access to the wild you’re going to have," Phillip said.
Hospitals ready; patient costs high
Most hospitals in South Dakota are well-positioned to help someone who has been bitten by a prairie rattlesnake, but the treatment protocol is expensive for those who are bit.
The Regional Health group of five West River hospitals carry a total of 196 vials of the synthetic antivenin called CroFab, about 60 vials at Rapid City Regional Hospital and the rest spread among the other four facilities, according to Regional Pharmacy Director Dana Darger.
Avera keeps 18 vials on hand at St. Mary’s in Pierre and six at its hospital in Gettysburg, spokeswoman Sigrid Wald said. Some Avera hospitals in East River carry a few vials or none at all, but physicians remain in contact and can move patients or the antivenin to any group hospital in an emergency, Wald said.
Darger said CroFab is a safe drug with few side effects but which requires skill in use and handling in order to limit negative reactions. The drug costs Regional about $1,500 per vial and each vial has a roughly 2-year shelf life. The typical treatment protocol starts with four to six vials up to a maximum of 18 in patients with a high concentration of venom.
Treatment of a snakebite victim, depending on severity, often includes emergency room entry, delivery of several doses of antivenin and a hospital stay of a couple days for observation, Darger said.
Derek Livermont of Lead, who was bitten by a prairie rattler in June, said his hospital bill for emergency treatment and antivenin at Regional Hospital in Spearfish was $27,000, about $10,000 of that for pharmaceuticals. He received two vials of antivenin in Spearfish before being transferred to Rapid City Regional for further treatment and eight more vials of antivenin (he hasn’t received the Rapid City bill yet.)
Some veterinary offices also carry antivenin, though many do not due to the cost and relatively short shelf life, said Kayla Brown, co-owner of Fall River Veterinary Clinic in Hot Springs.
Brown keeps the antivenin on hand because she treats a fair number of domestic pets and livestock for rattler bites each year. This year, Brown has treated five or six pets and another half dozen or so livestock for snakebites, including the burro from Custer State Park.
"I don’t think it’s overly common, but we feel it’s one of those things we need to keep around because it could be life or death for the animal," she said.
The cost per vial of veterinary antivenin is about $425 per vial, and the typical treatment begins at one vial and can rise to five vials in rare cases.
Nighttime stroll turns painful
While Phillip and other snake experts say prairie rattlesnake bites are often the result of humans trying to kill or harass snakes, random encounters do occur.
Livermont, a 26-year-old resident of Lead, was out for an evening stroll in a prairie pasture in early June while camping near Sand Creek near Beulah in eastern Wyoming when he was bitten on the ankle by a prairie rattlesnake. Livermont said he did not hear a rattle until after the bite.
The bite did not hurt much, but by the time he returned to his campsite, his lips and tongue were tingling, and his friends insisted he be driven immediately to Regional Hospital in Spearfish, a 30-minute drive away.
He’s glad he listened to them. "When we were driving, I really started feeling a tightening sensation all over, in my throat, and I wasn’t breathing right," Livermont recalled. "I had a high dose of venom."
Livermont, a restaurant manager in Deadwood, said he has Blue Cross Blue Shield insurance through his employer and was billed for only $318 out-of-pocket of the $27,000 bill he received for treatment in Spearfish. He expects his bill from Regional Hospital in Rapid City to top $100,000 because he received eight more vials of antivenin and had a stay in intensive care before being released.
Livermont spent a week off his feet while recovering from the bite and still has swelling and some pain a few weeks later. At one point, he returned to the campground and was far more careful than he had been the night he was bitten.
"I had a little PTSD (post-traumatic stress disorder) and I was very aware of what was on the ground and kept my eyes on the ground more," he said. "But I feel extremely lucky. I have some bills to pay and was out of work for a week, but it could have been a lot worse — I could have been dead."