Prevent and prepare

• To prevent diseases caused by insects, such as malaria and Lyme disease, use insect repellent and promptly remove any ticks.
• Consult local authorities for information on landscaping and pest management to support any locally recommended behaviour or places to avoid in order to reduce risk.
• In some countries, in accordance with local regulations, report any tick bites to authorities. Some authorities request that you send the biting tick or ticks for identification and testing.

In first aid education, explore the following information with learners on avoiding bites and the behaviours to adopt during an insect attack:

• Keep away from flowering plants, ripe fruit bushes and trees, rotten fruit, compost and food waste. If this is not possible, wear long trousers and long-sleeved clothes and cover your hands and face.
• Wear shoes when walking outside, particularly on grass or flowering ground.
• When outside, cover your drinks and food and check them before drinking or eating.
• Wipe off any food from the clothes, hands and faces of children as this may attract bees or wasps.
• Before moving objects with your hands (such as containers that have been left outside), check underneath and inside them for insects that may bite or sting.
• Shake out shoes, socks and clothing before putting them on as they might contain insects.
• Do not touch or disturb bee or wasp hives. If you want to harvest honey, protect yourself by wearing long trousers and long-sleeved clothes and cover your hands and face as much as possible.
• Remain calm if attacked by a bee or wasp. Do not wave your hands in an attempt to brush them away, since they react to movement.
• Run and find shelter if attacked by a swarm. 

Early recognition

A tick bite is not painful and is often not detected, or only discovered by accident. Initially, a tick is only a pinhead in size, making it difficult to spot. An engorged tick is about the size of a small pea. After a few hours, the bite may start to itch.

A person who is bitten or stung by an insect may experience:

• initial sharp pain
• swelling, itching or a rash at the site of the bite or sting.

The person may develop a mild or severe Allergic reaction following an insect bite or sting.

Observe the person closely for any development of an allergic reaction. A rash can be more difficult to see on black or brown skin (Nolen, 2020). Checking lighter areas of skin such as the palms of hands or soles of feet may help you to see it.
 

First aid steps

Tick bite

1. Reassure the person and remove the tick as quickly as you can. Use a manufactured tick removal device to remove the tick according to the manufacturer’s instructions. If a manufactured device is not available, use fine forceps or tweezers to grab the tick as close to the skin as possible and pull it gradually and firmly out of the skin.
2. Wash the site of the bite with water and then disinfect it with an antiseptic solution.
3. Write down the date and the area where the person was bitten in order to monitor the area around the bite.
4. Seek medical advice if there is concern about an infection (fever, inexplicable fatigue, or joint pain) or if a rash appears. The Lyme disease rash is a circular rash that appears as a patch surrounded by a ring.

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CAUTION

• Do not squeeze the body of the tick, as this may trigger the release of the disease-causing bacteria onto the skin.
• Do not use chemicals or heat to numb or kill the tick.

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Other insect bite or sting

1. Reassure the person and advise them not to scratch, as this may aggravate the injury.
2. If the stinger is still in the person, remove it as quickly as possible, by grasping and pulling the stinger.
3. Thoroughly clean the site of the bite or sting with water. If no clean water is available, use an antiseptic solution.
4. Cool the stung area with ice cubes in a bag of water or a cooling bag to limit swelling, itching and pain. If the sting was on the hand, remove the rings.

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CAUTION

When removing the stinger avoid your fingers, or any other object that can pierce or press down on the venom bag, as this will aggravate the symptoms.

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Access help

• Access EMS immediately if:
  >   The person is bitten or stung in the mouth or on the throat, as it can be dangerous as any swelling could block their airway. While waiting for medical care, try to cool the injured area with ice (for example, by letting the person suck on an ice cube) to reduce swelling.
  >   The person shows any signs of a severe allergic reaction.

• Access medical care if:
  >   You can’t get the stinger out.
  >   The person develops a painful itchy swelling or a rash.
  >   The person feels progressively worse after being bitten or stung (this can occur up to 24 hours after the bite or sting).
  >   The person was bitten or stung many times.
  >   The person suspects they are not sufficiently protected from tetanus.

Recovery

Monitor for signs of infection. The skin may become red, purple, or darker, as well as warm and painful at the site of an insect bite or sting. This should improve over the course of a day or two. However, if it gets progressively worse, the person should seek medical advice as this could be a sign of infection.

Context considerations

• Programme designers should consult local medical centres to find out which insect-related diseases are common in the area and what preventative measures to take. These measures may include:
  >   using repellent or a bed net
  >   taking medication for malaria prevention
  >   getting vaccinated for tick-borne encephalitis
  >   wearing long sleeves and trousers (especially at dawn when insects are active).
• In Europe and North America, several species of Ixodes ticks are carriers for tick-borne infections. One major infection is Lyme disease. Typical symptoms include fever, headache, fatigue and a specific skin rash that is circular and appears as a ringed patch on different parts of the body. If left untreated, the infection can spread to the joints, heart and nervous system. Most cases of Lyme disease can be treated successfully with antibiotics.
• In Sub-Saharan Africa and South Asia, malaria is transmitted by the bite of a mosquito. A person with malaria is usually very sick with symptoms such as high temperatures, shivering with shaking and flu-like illness. Many effective medicines are available to prevent and treat malaria. Health professionals can advise you on how to take the medicine that is best for you.

Learner considerations

• In regions where Lyme disease is prevalent, all people are at equal risk of contracting it, though the visibility of skin rashes will vary according to skin colour (Fix et al., 2000). First aid education should emphasise rash recognition across all skin colours and describe other symptoms that may be present. Programme designers should actively look for opportunities to increase awareness of this topic in groups that are more likely to include learners who are black.
• While nearly half the world faces the risk of malaria, children under five years old are the most vulnerable group affected by it. Pregnant women, those with HIV or AIDS, and mobile populations (travellers) are also particularly at risk (WHO, 2020).
• Learners who are aware of family members, friends or colleagues who are allergic to insect bites and stings should be encouraged to familiarise themselves with what support that person might need.

Facilitation tips

• Ask learners to share experiences of being bitten or stung, including how it feels and how they responded to develop the group’s confidence to handle this type of injury.
• Demonstrate how to use a manufactured tick removal device or tweezers to effectively remove a tick and a bank card or the blunt side of a knife to remove a sting.

Facilitation tools

• Share photos of local insects and their associated injuries or infections to help learners identify them.
• Bring a variety of tick removal tools to show learners.

Learning connections

• Ensure learners are comfortable monitoring a person for signs of an Allergic reaction and anaphylaxis.
• Link this topic to the removal of stingers of marine and freshwater animals. (See Aquatic animal injuries.)
• Give time to practise giving emotional support and comfort to the injured person as a bite or sting can be very distressing.