Discussion
deaths, snakebites, snakebite
MINOR
There were no deaths within the entire cohort. Rates of overall satisfactory treatment, including appropriate identification and transfer decisions for high-risk cases, were high in both study arms (> 90%). This suggests the combination of prior education, experience, and 10 years of SLMA national guidelines has been effective in addressing the core clinical challenges of snakebite in Sri Lanka.Disappointingly, the educational intervention had no impact on the high rates of inappropriate inter-hospital transfers occurring without medical indication and outside of the current guidelines in both groups. Even with medically minor snakebites, the majority of patients who present to the primary hospital are subsequently transferred to territory care for further management [There was no difference in the quality of documentation between the groups. There are a number of explanations for this, and it needs to be addressed in the context of the high rates of overall clinical compliance. The first is that some of the scored items may have little clinical relevance, such as patient education and occupation details, in determining individual patient management. While structured admission forms for toxicology have been shown to improve documentation [As over 80% of snakebites in Sri Lanka are treated in primary hospitals [