Effect of inadequate antivenin stores on the medical treatment of crotalid envenomation.

The case of a 27-y-old male with a serious Crotalus atrox envenomation is presented. His medical care was compromised by the lack of readily available polyvalent Crotalidae antivenin. An investigation of antivenin stocking by health care facilities in Arizona was undertaken. Failure to stock sufficient quantities of antivenin to initiate treatment of a single patient with a severe envenomation was found in 43.5% of urban hospitals, 41.2% of rural hospitals within 25 miles of another hospital, 52.9% of rural hospitals greater than 25 miles from another hospital, and 41.7% of Indian Health Service hospitals. Current antivenin stocking was related to antivenin use during the previous year. Reliance on recent antivenin use to guide current antivenin stocking leaves many hospitals with insufficient antivenin stores and may seriously compromise the medical care of patients suffering from rattlesnake envenomations.