Wilderness Medicine, First Aid, and Outdoor Skills
Insect Bites and Stings

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US Army First Aid Manual
Fundamental Criteria for First Aid
Basic Measures for First Aid
First Aid for Special Wounds
First Aid for Fractures
First Aid for Climatic Injuries
First Aid for Bites and Stings
First Aid in Toxic Environments
First Aid for Psychological Reactions
Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary

Insect Bites and Stings

6-5. Insect Bites/Stings

An insect bite or sting can cause great pain, allergic reaction, inflammation, and infection. If not treated correctly, some bites/stings may cause serious illness or even death. When an allergic reaction is not involved, first aid is a simple process. In any case, medical personnel should examine the casualty at the earliest possible time. It is important to properly identify the spider, bee, or creature that caused the bite/sting especially in cases of allergic reaction when death is a possibility.

a. Types of Insects. The insects found throughout the world that can produce a bite or sting are too numerous to mention in detail. Commonly encountered stinging or biting insects include brown recluse spiders (Figure 6-9), black widow spiders (Figure 6-10), tarantulas (Figure 6-11), scorpions (Figure 6-12), urticating caterpillars, bees, wasps centipedes, conenose beetles (kissing bugs), ants, and wheel bugs. Upon being reassigned, especially to overseas areas, take the time to become acquainted with the types of insects to avoid.

b. Signs/Symptoms. Discussed in paragraphs (1) and (2) below are the most common effects of insect bites/stings. They can occur alone or in combination with the others.

    (1) Less serious. Commonly seen signs/symptoms are pain, irritation, swelling, heat, redness, and itching. Hives or wheals (raised areas of the skin that itch) may occur. These are the least severe of the allergic reactions that commonly occur from insect bites/stings. They are usually dangerous only if they affect the air passages (mouth, throat nose, and so forth), which could interfere with breathing. The bites/stings of bees, wasps, ants, mosquitoes, fleas, and ticks are usually not serious and normally produce mild and localized symptoms. A tarantula's bite is usually no worse than that of a bee sting. Scorpions are rare and their stings (except for a specific species found only in the Southwest desert) are painful but usually not dangerous.

    (2) Serious. Emergency allergic or hypersensitive reactions sometimes result from the stings of bees, wasps, and ants. Many people are allergic to the venom of these particular insects. Bites or stings from these insects may produce more serious reactions, to include generalized itching and hives, weakness, anxiety, headache, breathing difficulties, nausea, vomiting, and diarrhea. Very serious allergic reactions (called anaphylactic shock) can lead to complete collapse, shock, and even death. Spider bites (particularly from the black widow and brown recluse spiders) can be serious also. Venom from the black widow spider affects the nervous system. This venom can cause muscle cramps, a rigid, nontender abdomen, breathing difficulties, sweating, nausea and vomiting. The brown recluse spider generally produces local rather than system-wide problems; however, local tissue damage around the bite can be severe and can lead to an ulcer and even gangrene.

c. First Aid. There are certain principles that apply regardless of what caused the bite/sting. Some of these are:

  • If there is a stinger present, for example, from a bee remove the stinger by scraping the skin's surface with a fingernail or knife. DO NOT squeeze the sac attached to the stinger because it may inject more venom.

  • Wash the area of the bite/sting with soap and water (alcohol or an antiseptic may also be used) to help reduce the chances of an infection and remove traces of venom.

  • Remove jewelry from bitten extremities because swelling is common and may occur.

  • In most cases of insect bites the reaction will be mild and localized; use ice or cold compresses (if available) on the site of the bite/sting. This will help reduce swelling, ease the pain, and slow the absorption of venom. Meat tenderizer (to neutralize the venom) or calamine lotion (to reduce itching) may be applied locally. If necessary, seek medical aid.

  • In more serious reactions (severe and rapid swelling, allergic symptoms, and so forth) treat the bite/sting like you would treat a snakebite; that is, apply constricting bands above and below the site. See paragraph 6-2c(1) above for details and illustration (Figure 6-8) of a constricting band.

  • * Be prepared to perform basic lifesaving measures, such as rescue breathing.

  • Reassure the casualty and keep him calm.

  • In serious reactions, attempt to capture the insect for positive identification; however, be careful not to become a casualty yourself.

  • If the reaction of symptoms appear serious, seek medical aid immediately.


    Insect bites/stings may cause anaphylactic shock (a shock caused by a severe allergic reaction). This is a life-threatening event and a MEDICAL EMERGENCY! Be
    prepared to immediately transport the casualty to a medical facility.


    Be aware that some allergic or hypersensitive individuals may carry identification (such
    as a MEDIC ALERT tag) or emergency insect bite treatment kits. If the casualty is
    having an allergic reaction and has such a kit, administer the medication in the kit
    according to the instructions which accompany the kit.

d. Prevention. Some prevention principles are:

  • Apply insect repellent to all exposed skin, such as the ankles to prevent insects from creeping between uniform and boots. Also apply the insect repellent to the shoulder blades where the shirt fits tight enough that mosquitoes bite through. DO NOT apply insect repellent to the eyes.

  • Reapply repellent every 2 hours during strenuous activity and soon after stream crossings.

  • Blouse the uniform inside the boots to further reduce risk.

  • Wash yourself daily if the tactical situation permits. Pay particular attention to the groin and armpits.

  • Use the buddy system. Check each other for insect bites.

  • Wash your uniform at least weekly.

e. Supplemental Information. For additional information concerning biting insects, see FM 8-230 and FM 21-10.

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