Wild Tiger Health Project
Created by Dr John C M Lewis

Prevention of human drug exposure:

Accidental human exposure to anaesthetic drugs may happen under fraught field conditions either by being hit with a loaded dart intended for an animal or by accidental self-injection/contamination whilst preparing darts or injecting animals. Extra caution should be taken during these procedures.

• Always work in pairs in the field, especially when preparing anaesthetic agents.
• Injectable anaesthetic agents should only be handled by trained staff.
• At least one member of a capture team should be trained in human first aid and CPR techniques.
• Anaesthetic drugs, in both liquid and powdered form, can be absorbed from oral mucus membranes, through the eyes, and from cuts on your hands, so use caution when loading syringes and darts. It is best to use gloves and eye protection during these procedures.
• Staff should not eat, drink or smoke when handling anaesthetics.
• Cuts and abrasions should be covered with suitable dressings to prevent absorption through the skin.
• Do not pressurise vials with air prior to withdrawing the drug.
• Use small bore needles to withdraw dangerous drugs from multi-use vials to avoid making large holes in the rubber bung through which drug could leak.
• Loaded syringes (with or without needles) must not be carried in pockets or other clothing.
• Drug handling and dart preparation should take place in a well-lit, stable area and not take place in a moving vehicle.
• Treat all capture guns, darts, and syringes as if they were loaded firearms.
• Use safety caps on all darts.
• Store loaded darts, and used darts and syringes in non-breakable, leak-proof containers.
• Dispose of any used needles and syringes in a hard container.
• All personnel must be advised to wash their hands if they come into contact with injectable veterinary anaesthetics.
• Make all efforts to determine whether any member of staff is allergic to penicillin. If so, they must not be allowed to handle bottles containing ANY penicillin preparation or syringes and needles that may have contained the drug. The most commonly used penicillins in the field are the long-acting formulations such as “Amoxypen LA”. Serious allergic reactions to penicillin may occur following exposure to very small amounts of the drug.

Accidental human exposure to any immobilising drugs:

Don’t panic! Stay calm! Most of the drugs used to immobilise tigers are relatively safe.

• Make the person sit down.
• Remove the dart or syringe.
• Keep the victim calm as possible as panic can confuse symptom recognition.
• Wash any exposed site copiously with water.
• Try to estimate how much drug to which the person has been exposed. Most accidents will result in only slight exposures.
• If the person appears fine, just assess vital signs continuously. If no adverse signs appear within 30 minutes it is unlikely that the exposure is clinically significant.
• Apply the ABC approach to monitoring. Ensure the person’s airway is clear, carefully monitor breathing and circulation as for any animal.
• If breathing ceases start artificial respiration by chest compressions or mouth to mouth resuscitation. (Trained staff only)
• If the patients heart stops begin external cardiac massage as well as artificial respiration. (Trained staff only)

Human exposure to ketamine or “Zoletil”:

• The cyclohexamine drugs ketamine and tiletamine cause disorientation, hallucinations, abnormal behaviour (this may be excitement or even aggressive or violent), respiratory depression, collapse and coma – depending on the dose.
• There are no antidotes.
• Avoid stimulation (lights, horns, sirens, sudden movements, etc.).
• Do not leave the person alone and be prepared to physically restrain to prevent injury.
• If the person is exhibiting signs of exposure, be certain to maintain the patient’s airway.
• Keep patient on their side and maintain normal temperature.
• Assist breathing if necessary.
• Following exposure to ketamine seizures are possible. Give 10 mg diazepam or midazolam intramuscularly if persistent or repeated. (Trained staff only)
• Victim may be given cranberry juice (acidifies urine and helps eliminate the drugs), but be aware of the possibility of vomiting or aspiration.
• Transport to hospital in lying down position, patient on his/her side, with feet slightly raised.

Human exposure to medetomidine or xylazine:

• These drugs may cause a dose dependent sedation with lowered heart rate and blood pressure, dizziness, hypothermia, nausea and decreased respiration rate.
• There is no field antidote for humans, although in emergency situations atipamezole could be used. (Trained staff only)
• Avoid stimulation (lights, horns, sirens, sudden movements, etc.).
• Monitor the person closely for toxic effects.
• Observe for depressed mental alertness and breathing especially.
• If the person is exhibiting signs of exposure, be certain to maintain the patient’s airway.
• Keep patient on their side and maintain normal temperature.
• Assist breathing if necessary.
• Transport to hospital in lying down position, patient on his/her side, with feet slightly raised.

Human exposure to diazepam or midazolam:

• These benzodiazepines cause ataxia, sedation, slurred speech and respiratory depression. In large doses the patient may become comatosed.
• Monitor breathing closely. Artificial respiration may be necessary if the respiratory rate significantly slows or mucous membranes become cyanosed. (Trained staff only)
• There are antagonists to benzodiazepines – flumazenil and sarmazenil. These are unlikely to be available in the field.