Insect Stings and Bites

Spiders, ants, wasps, bees, scorpions, flies, mosquitoes, and other insects can all bite and/or sting humans. Given the work firefighters do, they often encounter these insects.

The degree to which a person reacts to these insect stings or bites is very individual and can range from mild swelling and itching to severe anaphylaxis. Before going into the field, anyone who is allergic to insect stings or bites should inform their supervisor and coworkers about their condition and the possible danger if they were to be stung. It is important to distinguish an allergic reaction from a normal reaction to insect stings and bites. Swelling, redness, and itching around the sting or bite are normal. Itching and hives far from the sting or bite can be signs of an allergic reaction. Firefighters that have had significant reactions should consider carrying medications to treat these including an epinephrine auto-injector if they have been prescribed one by a physician.

Tips to Prevent Being Stung or Bitten

Knowing about stinging and biting insects may help you avoid them. Stinging and biting insects usually attack when they’re defending their territory. Be aware of your surroundings. If you are close to a nest, remain calm and quiet while moving away slowly. Remember, some insects nest underground. Some tips include:

• Avoid insect nests and communicate their location to your co-workers. Clearly mark their location with flagging.

• Be alert for insects when you are eating and drinking, the scent of food can attract insects.

• Using unscented soaps and deodorants can help. Be clean, just don't smell pretty.

• Do not swat or crush insects; when some insects are injured, they send chemical signals that incite other insects to attack.

General Treatment for Insect Stings and Bites

All individuals suffering from insect stings and bites should be watched for signs of an allergic reaction. General treatment for insect stings and bites includes:

• If you have been stung by a bee, look for the barbed stinger and venom sac that may be embedded in your skin. Remove the venom sac and stinger by scraping the area with a straight-edged object, such as a credit card or driver’s license. Take off rings and tight-fitting jewelry.

• Wash the area of the sting or bite with soap and water or with an antiseptic wipe.

• Elevate the affected area and use ice or a cold compress to reduce swelling and pain.

• If needed, apply a topical steroid ointment, or take an over-the-counter oral antihistamine, such as Benadryl or Chlor-Trimeton to help reduce swelling, itching, and redness. An anesthetic spray containing benzocaine may provide some pain relief. Hydrocortisone cream or calamine lotion applied to the skin may also help relieve itching and swelling.

• Monitor for advanced symptoms and allergic reactions.

Anaphylaxis

Anaphylaxis is a serious and potentially life-threatening medical situation that requires immediate emergency treatment. If there is any concern or suspicion of anaphylaxis, epinephrine should be administered. Someone with allergies usually will begin to show signs of a reaction within 1 to 15 minutes after an insect sting or bite. Sometimes a reaction may not begin for up to 4 hours. If you are allergic and have been stung:

• If you have been prescribed epinephrine by your doctor, administer the proper dose.

• Make sure your coworkers know that you’ve been stung or bitten and that you may suffer an allergic reaction. Ensure your co-workers know the location of your epinephrine and know how to administer the dose.

• Contact EMS.

• Epinephrine treatment benefits begin to fade within 20-30 minutes. If transport time to higher care will be greater than 20-30 minutes, be prepared to administer additional doses of epinephrine and an antihistamine which will help reduce airway swelling and increase patient comfort.

Rarely do the insects themselves cause an infection. More likely the initial redness and swelling is due to the body’s immune system destroying the toxins. However, persistent itching and breaking down of the skin with your nails and fingers does introduce bacteria and can cause a secondary infection. These are often seen several days after the initial bite. Thus, it is best to avoid scratching or picking at the bites as much as possible.

Discussion:

• Does anyone on your crew have a history of severe reactions? If so, what supplies do they have and where do they carry them? What supplies does your crew have?

• What stings and bites are likely in the area you are working in now? What precautions can you take?

References:

• Harvard Health Publishing – Ephinephrine is the only effective treatment for anaphylaxis