A Perth fam­ily’s hol­i­day in WA’s north turned into a night­mare when their lit­tle girl was bit­ten by a deadly snake. Her sur­vival de­pended on quick ac­tion and a big med­i­cal team ef­fort.

The Sunday Times - - Front Page - KATE CAMP­BELL re­ports

RUN­NING slightly ahead of her par­ents on the way to the beach was all it took for Perth girl Emilia Barnard to be caught in the mid­dle of a re­mote med­i­cal emer­gency that nearly claimed her life.

Look­ing at her now, Emilia is like any nor­mal four-yearold girl — she loves danc­ing, horses, uni­corns, kindy, jump­ing on the tram­po­line and play­ing with her dog, Harry.

But only a month ago, Emilia was in the fight of her short life, bit­ten twice by a west­ern brown snake — one of the world’s dead­li­est which can eas­ily kill adults many times her tiny size — on her fam­ily’s hol­i­day to idyl­lic Co­ral Bay, 1100km north of Perth.

To com­pli­cate mat­ters, Emilia and her par­ents faced a pro­longed wait for an­tivenom to ar­rive as the nurs­ing post did not have any. The Royal Fly­ing Doc­tor Ser­vice, on its way from Port Hed­land to evac­u­ate Emilia, ar­rived with an­tivenom af­ter about 31⁄2 hours.

At one point, Emilia stopped breath­ing for up to two min­utes and it took a mas­sive team ef­fort in­volv­ing nearly a dozen med­i­cal pro­fes­sion­als and vol­un­teers, in­clud­ing a doc­tor and two nurses on video link screen from Perth, to save her life.

Emilia’s brush with death hasn’t left any sign of last­ing trauma, but her eter­nally grate­ful par­ents, David and Kari, are still pro­cess­ing how close they came to los­ing their only child.

It was WA Day — the June 4 pub­lic hol­i­day — and the Mt Hawthorn fam­ily had just started their sec­ond day of a planned week-long hol­i­day at a friend’s beach­front house in Co­ral Bay.

Emilia was ea­ger to get to the beach, so much so that her mother had to chase af­ter her to en­sure she didn’t head straight into the wa­ter.

Within sec­onds, Emilia screamed at the top of the stairs lead­ing to the beach.

Ms Barnard right away spot­ted what had caused her daugh­ter’s pained re­ac­tion — a brown snake, dis­ap­pear­ing down a hole and sim­i­lar in colour to the lime­stone steps.

She yelled out to her hus­band it was a snake, and af­ter pry­ing Emilia’s feet apart they could see bite marks on Emilia’s right foot.

The pan­icked par­ents quickly bun­dled up their only child and, guided by di­rec­tions from their friends, sprinted to the lo­cal nurs­ing post. They ar­rived at the sin­gle nurs­ing post within 10 min­utes, for­tu­itously at a time when reg­is­tered nurses Caro­line Cordy-Hedge and Jan Sax­ton were do­ing a han­dover.

It was the only hour in the week when both nurses were to­gether. And as it was a pub­lic hol­i­day, if the Barnards had ar­rived a lit­tle later the nurs­ing post would have been closed and pre­cious min­utes would have been wasted call­ing the nurse in.

“I didn’t have a lot go­ing through my mind other than try­ing to work out how se­ri­ous the sit­u­a­tion was. Part of me was think­ing it’s prob­a­bly not poi­sonous, but when we got to the nurs­ing post I said that and they were like, ‘it’s Aus­tralia, they’re all poi­sonous’,” Ms Barnard, a digital me­dia and IT ex­ec­u­tive, said.

Ms Cordy-Hedge im­me­di­ately started ap­ply­ing pres­sure ban­dag­ing to Emilia’s right leg and then splinted both legs to­gether in a bid to stop the venom spread­ing through her small body, while her col­league ur­gently di­alled the 24/7 Emer­gency Tele­health Ser­vice (ETS) to get ex­pert help from Perth on the video link screen.

By the time doc­tor Peter Le­man was con­nected, the emer­gency be­came even more life-and-death as Emilia had col­lapsed soon af­ter com­plain­ing of a sore head and stom­ach and stopped breath­ing on the gur­ney, forc­ing Ms CordyHedge to ven­ti­late her for about two min­utes be­fore the lit­tle girl came to and started breath­ing on her own again.

“She sud­denly let out a scream, ‘my head, my head’, at which stage she col­lapsed and prob­a­bly within 30 sec­onds had stopped breath­ing,” Ms Cordy-Hedge said.

Dur­ing this time, the nurses sent the par­ents out of the room, task­ing Ms Barnard with call­ing triple zero to get help from the town’s vol­un­teer am­bu­lance of­fi­cers.

In the au­dio of Ms Barnard’s fran­tic triple zero call, she can be heard ask­ing the nurses “is she breath­ing” to which they say no. Mid-way through the call, Emilia re­gains con­scious­ness.

Af­ter about 20 min­utes, Emilia started to sta­bilise but her par­ents knew they were in for a long wait for the RFDS.

Im­per­a­tive un­til the an­tivenom ar­rived was keep­ing Emilia in­cred­i­bly still to stop the venom spread­ing.

Un­der guid­ance from Dr Le­man, the nurses ad­min­is­tered the cor­rect weight-ra­tio dosage of life-sav­ing medicine to help keep Emilia breath­ing and sta­ble as well as in­sert­ing in­tra­venous sa­line drips into each of the girl’s arms.

Both Emilia’s par­ents ad­mit they dealt with the shock in dif­fer­ent ways — Ms Barnard said she went into “auto-pi­lot” fol­low­ing in­struc­tions from the nurses and do­ing her best to calm and still her daugh­ter, while her hus­band felt a heavy sense of help­less­ness and was bat­tling with thoughts of a worst-case sce­nario.

Real­is­ing the RFDS plane could only carry one par­ent, Mr Barnard made the tough call to book a flight from Ex­mouth to Perth, due to leave be­fore the RFDS ar­rived with the an­tivenom, to en­sure he could meet up with his wife and daugh­ter at Princess Mar­garet Hospi­tal as soon as pos­si­ble.

“I didn’t know if I was go­ing to see her again. It was very stress­ful,” Mr Barnard, a soft­ware con­sul­tant, said. Of the mo­ment the RFDS doc­tor and nurse ar­rived, Ms Barnard said: “I don’t think I’ve ever been so happy to see peo­ple walk in the door.”

Adding chaos to catas­tro­phe, the evac­u­a­tion of Emilia to the RFDS plane took place in the mid­dle of a mas­sive sand­storm, mak­ing for a bumpy ride in the air.

In­cred­i­bly, af­ter such an emer­gency, Emilia only needed to stay at PMH overnight for ob­ser­va­tion.

“We’re ex­tremely for­tu­nate that Emilia is here with us and we know that. It was a very close call,” Mr Barnard said.

Emilia talks mat­ter-of-factly about the snake with the “dirty teeth” and de­scribes her

or­deal in a way only a fouryear-old can.

“It was on a step, I saw some­thing slither . . . it bited me (sic),” she said. Stretch­ing her arms as wide as pos­si­ble she said “it hurt this much”.

Phys­i­cally Emilia’s nearly made a full re­cov­ery. Ar­guably, the men­tal re­cov­ery for her par­ents will take a bit longer.

They can­not fault the treat­ment their daugh­ter re­ceived from ex­pe­ri­enced medi­cos, with their only con­cern be­ing that the nurs­ing post did not have its own an­tivenom. They were only told that Co­ral Bay nurs­ing post used to stock an­tivenom, but not any­more, but were re­as­sured a snake bite vic­tim could wait for an­tivenom if quick com­pres­sion ban­dag­ing had been done.

But Emilia and her par­ents have a sim­ple mes­sage for the doc­tors, nurses and vol­un­teers who came to their res­cue — thank you.

“It was a well-oiled ma­chine . . . we’re re­ally ap­pre­cia­tive of all the help we got on the day,” Mr Barnard said.

The Barnards want other peo­ple to learn from their or­deal — by be­ing pre­pared, car­ry­ing a first aid kit, do­ing a first aid course and re­mem­ber­ing to stay calm. “The mes­sage . . . is not to be com­pla­cent, par­tic­u­larly with chil­dren. A lot of us are camp­ing and ex­pe­ri­enc­ing this coun­try of ours, but you need to have that sort of gear with you,” Mr Barnard said. Dr Le­man, an emer­gency spe­cial­ist of 20 years, ad­mits be­com­ing emo­tional and ex­pe­ri­enc­ing a “pow­er­ful sense of re­lief” when the RFDS ar­rived on the scene. He said the risk of fur­ther ab­sorp­tion of the venom re­mained un­til the an­tivenom could be ad­min­is­tered. Dr Le­man said Emilia was “ex­tremely lucky to be alive”. He said while it was a team ef­fort — with the tele­health ser­vice able to rally the RFDS into ac­tion and get ex­pert ad­vice from the Poi­sons In­for­ma­tion Ser­vice — he was full of praise for the nurses, who made the big­gest dif­fer­ence in pro­vid­ing life sup­port and quick, ef­fec­tive first aid. “You want to reach through the TV screen, put your hands in there and help out,” Dr Le­man said. “In ac­tual fact I didn’t need to be there be­cause Caro­line and Jan did all the work . . . they were bril­liant.”

Ms Cordy-Hedge, a nurse of 30 years, said the ETS was an in­cred­i­ble re­source in ru­ral and re­mote WA.

A WA Coun­try Health Ser­vice spokes­woman said an­tiven­oms for WA’s three most com­mon snakes — brown, black and tiger — were widely dis­trib­uted across the State — 46 sites were in the coun­try, in­clud­ing small hospi­tals. Those in­cluded Ex­mouth and Carnar­von, rel­a­tively close to Co­ral Bay.

An­tivenom dis­tri­bu­tion was not as wide­spread in the past be­cause stan­dard snake bite man­age­ment “re­quired pathol­ogy re­port­ing be­fore the rel­e­vant an­tivenom could be ad­min­is­tered”.

But re­search pub­lished last year has re­moved the need for venom de­tec­tion be­fore­hand. The spokes­woman said WACHS dis­trib­uted an­tivenom above the rec­om­mended level, but is aware of a re­cent re­view and wait­ing to im­ple­ment rec­om­men­da­tions.

From Jan­uary to June this year, 151 peo­ple have been ad­mit­ted to hospi­tals in WA for snake bites. Last year, the to­tal was 295 com­pared with 232 in 2012.

Ms Cordy-Hedge es­ti­mated the Co­ral Bay nurs­ing post dealt with at least five sus­pected snake bites a year, but most didn’t in­volve ac­tual in­jec­tion of venom. Emilia’s case was by far the worst she’d seen.

“The stars all lined up for Emilia,” she said.

Sur­vivor: Left, Emilia Barnard plays with her favourite toys af­ter mak­ing a full re­cov­ery from the snake bite. Above, Emilia is trans­ferred by RFDS from Co­ral Bay to Perth. Right, In PMH soon af­ter her or­deal. Below, Mum and dad, Kari and David Barnard, with Emilia. Main pic­ture: Ross Swan­bor­ough

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