Wilderness Medicine, First Aid, and Outdoor Skills
Bee Stings

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US Army First Aid Manual
Fundamental Criteria for First Aid
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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

Table of Contents
Trauma Pictures

After reading this article, be sure to check out our Bee Sting Pictures in our Trauma section.

Yellow JacketIntroduction

Bees and wasps belong to the phylum Arthropod. There are more insects than any other living creature. They are crucially important to the pollination of plants, specifically flowers, fruits and vegetables.

Bees and wasps belong to the Hymenoptra family. They vary in size and have induced fear into humans for centuries. Phobias of insects have long been a source for people to avoid the outdoors. This is a perfect example where education and proper preparedness can help individuals get back to enjoying the outdoors.

History of Killer Bees

Leave it to man, the most dangerous animal, to exploit nature to try and increase his monetary status. Hence, the “killer bee” is born. In the 1950’s in South America, an entomologist introduced the African honey bee to Brazil cross-breeding it with the European honey bee. The thought was that it would be a more efficient honey producer. In result, we have the Africanized honey bee.

These bees are much more aggressive, they attack in large swarms, and will chase a human for greater than 1 mile. The first escape from hives was in 1957 in San Paulo Brazil, they have moved northward traveling 200 to 300 miles per year.

In 1993, they have been documented in Texas, Arizona, Southern California, and as far east as North Carolina. In the year 2001 reports have been made with some speculation that they have traveled as far north as Arkansas.

With the reality of global warming, killer bees will slowly progress northward. Their venom is less in quantity than your regular honey bee, and there is no difference in the chemical substance when compared to honey bees. As of 2002 there have been approximately 382 fatal attacks worldwide by killer bees.

Bee Myths

Myth: After your first bee sting reaction, future bee stings double and triple in severity.
Fact: In many research studies, repeated stings over time actually have a lesser reaction not an increased one.

Myth: Elderly individuals are more susceptible to a severe reaction than middle-aged.
Fact: The older one gets, the body's histamine production is less. Subsequently, the allergic reaction is less. This is not to say that an anaphylactic reaction cannot occur, although it is rare.

Myth: Bees can see and sting in the dark.
Fact: This is partially true, bees can sting in the dark as a stimulus response reaction. However, they cannot see in the dark. If being chased by a swarm of bees during the day, you can decrease their intensity by running to a dark garage or a darkened area of a forest.

Myth: A severe anaphylactic reaction will usually occur in the first 5 to 10 minutes after being stung.
Fact: Most anaphylactic reactions do occur in the first 15 to 30 minutes. 60% occur in the first hour, and the remaining occur in the next 3 to 4 hours. If there is not a severe reaction in 5 hours, the chances are very good that one will not occur.

Pathophysiology of Bee Stings

Mining BeeThe venom of bees, wasps and fire ants contains phospholipase A2, hyaluronidase, apamin, meliltin, and kinins. Our body quickly overreacts with histamine production. Histamine is found in higher concentrations in skin, lungs, and stomach mucosa. The release of histamine from the mast cells is usually triggered by skin disruption, i.e. bee sting. Histamine is a potent arterial dilator. Individuals therefore can become hypotensive (lowering of blood pressure) and may pass out. In the lungs you see bronchial constriction, therefore difficulty breathing, wheezing, and in severe cases respiratory collapse. As one ages, histamine production is less. It is rare for the elderly to have a severe anaphylactic reaction from a bee sting.

Bee Sting Symptoms

Symptoms vary from local reactions of pain, redness at the sting site, and formation of a wheal (raised bump usually pale in color). Localized itching is common and redness in the first 24 hours can become as large as 12 to 18 inches in diameter. These reactions are initially scary promoting people to seek medical attention.

As per the Merck manual, the average person can tolerate 10 stings per pound of body wait. The average adult can withstand approximately 1000 stings where around 500 stings can kill a child. Anaphylaxis and death can occur from one sting if the individual is highly allergic. Usually severe reactions will occur in the first hour. Most will occur in the first 15 minutes. Practically all severe reactions if they are to occur, will happen in the first 6 hours.

Many individuals have been given false information on allergic reactions. As per Auerbach in his Wilderness Medicine text: “There is no correlation between systemic reactions and number of stings in the past or number of stings per incident and severity of an allergic reaction.” “In a study of 138 adults with a history of anaphylactic reactions, 99 had no anaphylactic reaction to later stings, 17 had more severe reactions, and 22 had mild reactions.”

Children less than 10 years old and the elderly older than 70 have less severe reactions than younger adults.

Bee Sting Treatment

Stinger Removal
It was once thought that stingers should be scraped out with a credit card, finger nail, or any such device. Research has shown that the best course of action is to pull the stinger out as soon as possible with your fingers. The remaining venom in the sac of the stinger DOES NOT increase the reaction should you inadvertently push more venom into your wound.

Outdoor Treatment and Prevention
During Survive Outdoor presentations, many questions have been posed about Epi-pens. Should children on boy scout outings have them if they have never had an allergic reaction? Yes, we do not know and cannot predict allergic reactions, specifically anaphylactic reactions. All scout leaders and adults should have one in their medical kit before trips to the outdoors. These can be prescribed by your healthcare provider. The ABC’s, Airway, Breathing, and Circulation, must be adhered to in that order.

Here are the steps to take when stung in the outdoors by a bee or wasp:

  1. Pull stinger out.
  2. Cool compresses or ice.
  3. Diphenhydramne (Benadryl) should be given to decrease minimal allergic reactions.
  4. If a severe allergic reaction occurs, you must transport immediately and resort to basic life support.
  5. In addition to Benadryl, it has been shown that Cimetadine (Tagamet) and H2 blocker can also help decrease the allergic response.

Healthcare Provider – Medical Treatment
If initial signs and symptoms occur of systemic reactions, epinephrine should be administered.

  1. Adults – 0.3 to 0.5 mg of 1:1000 epinephrine IM.
  2. Children – 0.01 mg/kg of 1:1000 epinephrine IM.
  3. Diphenhydramine 25 to 50 mg IV, IM, or P.O.
  4. H2 – antagonist ratidine 50 mg IV.
  5. Prednisone has really no acute benefit, however will help decrease urticaria over time.
  6. Tetanus update if not current in the last 10 years.



1. Paul S. Auerbach, Wilderness Medicine
2. Judith Tintanelli,
Emergency Medicine: A Comprehensive Study Guide
3. Mark H. Beers,
The Merck Manual

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