What to do when a coral snake bites:
Contact the Poison Center immediately 1 (800) 222-1222.
Call EMS or go to an Emergency Department immediately.
Take a photograph of snake if possible or get good description of snake to provide to Poison Control, Emergency Medical Services, or Emergency Department Personnel.
Rest the envenomated limb lower than the heart.
Wash bite with soap and water to remove venom on skin surface.
Remove all jewelry and constrictive clothing from the extremity.
Attempt to capture or kill snake, which may lead to additional bites.
Apply arterial or venous tourniquets which may cause a build up of toxins which when released.
Incise the bite and attempt to suck out venom.
Use electrical shock - not proven as a treatment in envenomation.
Apply commercial snakebite venom extractors - shown to be of no benefit in removing adequate amounts of venom.
Source: Florida Poison Information Center — Tampa
NAPLES — When Zachary Mazzocchi headed back to school last week, the 6 year old had a tale to tell.
It wasn't a tall one. More like a three-foot-long, red, black and gold one.
The boy was playing on the back porch of his family's Golden Gate Estates home in early December when he reached out for a snake sunning itself. Unlike the family's pet ball python, this one is venomous. The coral snake bit his hand.
NCH North Naples keeps enough snake-specific antivenin to start treatment. But not enough to completely counter the venom. As it spread from his hand to the rest of his body, Zachary had to be flown to Miami Children's Hospital.
"He flat-lined twice," said Louis Mazzocchi, Zachary's father.
There, doctors wiped out the antivenin stock from Miami-Dade Fire and Rescue, which runs the nation's leading public antivenin bank, to save the child's life.
In 2003, pharmaceutical company Wyeth stopped making coral snake antivenin.
With what averages to a few bites a month in Florida and national numbers just shy of 100 annually — which account for about 1 percent of venomous snake bites in the U.S. — there isn't much of a demand for the product.
"Coral snakes are for the most part fossorial (spend most of their time under objects and underground) and bites are so rare — envenomations even rarer," said Dennis J. Giardina, Everglades Region biologist for the Florida Fish and Wildlife Conservation Commission.
Before shutting down manufacturing, Wyeth produced a five-year supply of coral snake antivenin set to expire in 2008. Since then, the FDA has extended the expiration date on the same batch every year.
Currently, vials from that lot are still usable until October 31, 2012.
"As for antivenom, unfortunately that goes with the territory. If it isn't profitable, it is hard to find, even despite the need in some cases," said Michael J. Barry, senior biologist with The Institute for Regional Conservation.
In Collier County, NCH hospitals maintain "a minimal supply on hand to initiate therapy," according to spokeswoman Debbie Curry. Lee Memorial Hospital also typically stocks that antivenin, as well as others.
Louis Mazzocchi said the decision was made almost immediately after he arrived at NCH North Naples with his son to fly to Miami Children's Hospital.
Miami-Dade Fire and Rescue's Venom Response Unit keeps enough on hand to treat two bite cases at a time from any venomous snake.
For the coral snake antivenin, that meant 10 vials. Every one was used to keep Zachary Mazzocchi alive.
A call came in from Jacksonville the same day. There was another coral snake bite.
"If you can locate it closer, you need to do that," Lisa Wood, a lieutenant with the unit, recalled telling the North Florida hospital.
The shortage of coral snake antivenin "has lead to more conservative treatment recommendations to help antivenin supplies last as long as possible," according to the Florida Poison Information Center — Tampa.
"He was so symptomatic so quickly, they just wanted to get him to where the most antivenin was, rather than find two vials here, three vials there," said Wood — one of Venom Response Unit's three members. "He was a sick little boy."
Antivenin loses about 1 percent efficacy annually, Wood said. So in the absence of another product, antivenin that originally expired in 2008 is better than nothing.
But many hospital pharmacists don't know about the extension on expiration, or chose to eliminate their stock anyway because the original expiration has passed, she said.
Despite the claims of shortages, pharmaceutical company Pfizer responded Thursday that it has "an adequate supply" of the coral snake antivenin. There are plans to resume production in the next two years.
"We are in discussions with FDA to ensure the best way to try to maintain a continued supply of Antivenin," Danielle Halstrom, spokeswoman for the company, wrote in an email. "After a comprehensive evaluation of patient need, regulatory processes and Pfizer's capabilities, the company has decided to reestablish manufacture of antivenin."
It is unclear when a fresh supply of antivenin will be available. Production is scheduled to begin in 2013, Halstrom said, with anticipated regulatory approval in 2014.
The last known death from a coral snake bite in the area was a Bonita Springs man in 2006, according to Daily News records.There was a third bite the same day as Zachary's.
His mother, Michelle Mazzocchi, also was bitten trying to catch the snake that bit her son. Her husband said she declined treatment. There wasn't much venom left, she figured. And she wanted to be by her son's side.
There are five other venomous snake species in Florida. Unlike the coral snake, they are all in the viper family.
The coral snake is similar in appearance to the nonvenomous scarlet kingsnake and scarlet snake. The coral snake is identifiable because the red and yellow bands on the snake touch.
The coral snake's venom affects the respiratory and nervous systems. It can cause swelling at the bite site, paralysis, slurred speech, and difficulty breathing.
In Zachary's case, he still has a few neurological tests to undergo to determine if there are any long-term problems as a result of the bite, his father said.
He complains that the top of his head hurts, and the family can't figure out why. But just before Christmas, the boy returned home to his brothers and sisters — and their pet python.
"He knows," Louis Mazzocchi said, "that's the only snake he can touch now."