Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 184

repellent on clothing, especially around cuff and neck openings. Following these recommenda- tions, your teammembers may look silly, but they will substantially reduce the chance of feeding a tick and acquiring a tick-borne disease. It is also important to check for ticks frequently on your skin and clothing. Wearing light-colored clothing will help. They usually crawl around for a while before settling in to feed. Frequent inspections will get rid of most of them before they attach.

Arthropod Disease Vectors The phylumArthropoda includes insects, spiders, crustaceans, and others that comprise over 80% of known animal species. Since many arthropods feed on humans, they are a significant disease vec- tor. Some arthropods merely transmit viruses or bacteria from person to person. Others serve as a host for one stage of the parasite life cycle with humans hosting another. In either case illness is often, but not always, the result.

Tick-borne Disease

General Principles

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Prevention: • DEET, Picaridin, or IR 3535 on skin

• Permethrin on clothing • Tight weave clothing • Frequent tick checks

• Prompt removal of attached ticks • Post Exposure Prophylaxis in Lyme endemic regions “Tick country" is vegetated: woods, grass, and brush. Tick season is spring, summer, and fall.”

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Ticks that are attached can be most safely removed by grasping them at the skin surface and gently pulling them off with tweezers. Sometimes, the mouth-parts break off and remain in the skin. Try to scrape these out with a sharp blade or needle. The host should not attempt removal by burning the tick, or by suffocating or poisoning it with Vaseline, alcohol, gasoline, or mineral oil. These tactics may cause the tick to regurgitate infectious material into the bite. Do not handle the tick with- out gloves or other protection. Prompt removal of ticks can also help reduce the transmission of disease. Lyme disease, for example, is not effectively transmitted until the tick has been in place for a day or so. Rocky Mountain spotted fever can be transmitted in just a few hours. In regions where Lyme disease is endemic, medical practitioners will often pre- scribe a single-dose treatment of doxycycline or other antibiotic to patients who have suffered a prolonged tick attachment. Tick country is vegetated with woods, grass, and brush. Tick season is spring, summer, and fall.

Adult deer tick Ticks serve as a vector for diseases from anaplas- mosis to ehrlichiosis, sometimes with several all in one tick. Fortunately for the medic on a short expedition, most of these conditions manifest themselves many days to weeks after exposure. Unfortunately for the patient and his doctor, these diseases present with a constellation of confusing symptoms making a definitive diagnosis difficult. The primary work of the practitioner in the field is prevention and education. Inform your teammates or expedition members of the risks involved in hosting ticks. Instruct them to wear long-sleeved shirts with long pants tucked into high socks, and a bandanna high on the neck under a low hat. Encourage the use of