Lice, Bedbugs, Cockroaches, Mites, Rodents, Venomous Arthropods, Insect Bites and Stings, Snakebites, Poisoning, and Intoxication

Lice

• Relation to Man:

  • Infestation of lice on a human host is termed pediculosis.
  • Prevalent in parts of Europe, North Africa, and Asia.
  • Cause misery for infested people.
  • Responsible for the transmission of louse-borne typhus, trench fever, and louse-borne relapsing fever.

• Louse-borne typhus:

  • A historical medical problem.
  • Man serves as the infection reservoir.

• Trench fever:

  • Thought to be related to typhus fever.
  • Does not kill but can be a debilitating epidemic disease among louse-infected troops.

• Louse-borne relapsing fever:

  • Caused by a spirochete, which is a flexible and spiral-shaped form of bacteria.

• Three Species of Lice Infest Man:

  • Head Louse/Body Louse
    • Acquired by personal contact, wearing infested clothing, or using contaminated objects.
    • Incubate by host's body heat and hatch in about a week.
    • Head:
      • Found upon the head and neck, clinging to the hairs.
      • The egg of the head louse, a "nit," is cemented to the hair.
    • Body:
      • Found upon the body, spending much of its time attached to the undergarments.
      • The egg of the body louse is attached to fibers of the underclothing.
  • Crab Louse
    • Found upon hair in the pubic and anal regions, but may be found in the eyebrows and other areas.
    • Feeds intermittently for many hours at a time and cannot survive long away from the host.
    • Spread mainly by physical contact, but also from toilet seats or objects recently used by infested individuals.

• Control and Prevention Method:

  • Hatching is greatly reduced or prevented by exposure to temperatures above 37.8 degrees C (100 degrees F).
  • Regular washing or dry cleaning of clothes provides a reliable control method.
  • Delousing of individuals, treatment of infested clothing, bedding, living areas, and toilet facilities, and the prevention of new infestations.
  • Human louse control measures should be coordinated with a medical officer.

• Preventive Measures (During Crowded Operations):

  • Avoid physical contact with louse-infested individuals and materials.
  • Observe personal cleanliness (daily bathing with soap and water and clothing changes).
  • Avoid overcrowding of personnel.
  • Instruct personnel on the detection and prevention of louse infestation.
  • Lice die within a few days if prevented from feeding.

• Treatment:

  • Head and Crab Lice:
    • Insecticidal ointment and shampoos are available as prescription medication.
    • Apply the powder lightly to the hair and rub it in with the fingertips.
  • Body Louse:
    • Wash all clothing and bedding in hot water and repeat in 7 to 10 days.
    • Wash extra clothing, bedding, and toilet facilities.
  • Head Louse:
    • Insecticidal shampoos are effective and available at military pharmacies.
  • Crab Louse:
    • Insecticidal ointments and shampoos are also available and quite effective.
    • Do not bathe for at least 24 hours.
    • One or two repeat treatments may be necessary.

Bedbugs

• Infest warm-blooded animals, including man, and are occasional pests aboard ships.
• Not known to vector human diseases but are annoying and can affect morale.
• Infestations are not necessarily associated with unsanitary conditions.
• Often transported on clothing, baggage, and laundry.
• Habitual hiding places are in the seams of mattresses, indicated by dried black or brown excrement stains.
• Bloodstains on bedding may indicate their presence.
• Assessment:
  • Approximately 6 mm (1/5 in) in length, flat, reddish-brown, and wingless insects with sucking mouthparts.
  • Have nocturnal movement and only feed on blood.
  • Bite usually produces small, hard, white swellings (wheals).
• Control Method:
  • Light applications of an appropriate insecticide, recommended by the area entomologist, should be made to the sides and seams of mattresses, which are best treated by folding and placing them in the center of the bunk at a 45-degree angle.
  • Other sites to be sprayed include cracks and corners of the bunks, empty lockers, springs, canvas bottoms and grommets, stanchions, and behind all equipment close to bulkheads.
  • Bunks may be made up and occupied after 4 hours of ventilation following application.
  • Complete control should be expected within 10 to 14 days.

Cockroaches

• Probably the most common and persistently troublesome arthropod pest encountered indoors.
• Among the most adaptable insects known.
• It has never been demonstrated that cockroaches directly vector pathogenic organisms but, significant circumstantial evidence indicates that cockroaches maintain and disseminate pathogens.
• Habits and close association with humans make them well adapted for mechanical transmission of diseases such as amoebiasis or other gastrointestinal disease organisms.
• Considerations Concerning Cockroach Infestations:
  • Their presence is considered an indication of substandard sanitation by most people.
  • Often cause anxiety and repulsion and may lead to entomophobia (fear of insects), which is of special consideration in regard to hospital patients' comfort and recovery.
  • Habitually disgorge portions of partly digested food and defecate wherever they go.
  • They also discharge a nauseous secretion from oral and abdominal glands, which leaves a persistent and typical "cockroach odor" on all surfaces contacted.
  • Cockroaches defile, contaminate, or damage food, linens, books, utensils, and other supplies and equipment.

Mites

• Classification Based on Habitats:
  • Nest-inhabiting mites parasitic on birds and rodents, which occasionally bite man.
  • Mites parasitic on animals and which occasionally bite man.
  • Mites parasitic on man.
  • Food-infesting mites that occasionally bite man.
    • Parasitic found on Man
      • Scabies or Itch mite
      • Transmitted through close body contact and may appear wherever social conditions cause excessive crowding of people.
      • This mite burrows in the horny layer of the dermis, causing an intense itching, especially at night, and occasionally erythema.
• Recognized by the fact that they lack distinct body segmentation.
• They are usually very small, some being less than 0.5 microns long.
• Developmental Stages (After Hatching):
  • Larva, nymph, and adult.
  • The larva has six legs, while the nymph and adult forms have eight.
  • In the species that transmit scrub typhus, the larval forms are parasitic on rodents and incidentally parasitic on man.

Rodents

• Several species are particularly well suited for specialized conditions found both aboard ship and ashore.
• The distribution of rodents is worldwide; consequently, the problem of control presents itself during operations in any geographical location.
• Rats, mice, and ground squirrels may serve as reservoirs for plague, endemic typhus, tularemia, and other debilitating diseases.
• Rodent control programs should include elimination of food and shelter, rodent proofing of structures, use of rodenticides, and glue boards and snap traps.
• The Most Important Rodents (Medical and Economical Viewpoint):
  • Norway Rat
  • Roof Rat
  • House Mouse

Common Venomous Arthropods

• Millions of people in the United States are affected by these arthropods each year.
• About 25,000 of these envenomizations result in severe injury, and about 30 result in death.
• This mortality contrasts markedly to the usual 14 deaths per year that are caused by poisonous reptiles.
• Clinical manifestations associated with envenomizations include anaphylactic shock, hemolysis, necrosis, paralysis, cardiopulmonary dysfunction, allergenic asthma, and antigen-induced dermatologic manifestations.
• Venoms Produced by Arthropods (Mixtures of Four Toxic Types):
  • Vesicating (blister beetles)
  • Neurotoxic (black widow spiders)
  • Cytolytic (brown recluse spider)
  • Hemolytic (horse flies)
• Assessing Insect Bites and Stings
  • Gather information from the patient, bystanders, and the scene.
  • Gather information about the insect or other possible source of envenomation.
    • Did anyone see what bit the patient?
    • Is the insect still in the vicinity?
    • How long ago did this happen?
    • Is patient allergic?
  • Assess for these common signs and symptoms of envenomation:
    • Altered states of awareness.
    • Noticeable stings or bites on the skin.
    • Puncture marks (especially note the fingers, forearms, toes, and legs).
    • Blotchy (mottled) skin.
    • Localized pain or itching.
    • Numbness in a limb or body part.
    • Burning sensations at the site followed by pain spreading throughout the limb.
    • Redness.
    • Swelling or blistering at the site.
    • Weakness or collapse.
    • Difficult breathing and abnormal pulse rate.
    • Headache and dizziness.
    • Chills.
    • Fever.
    • Nausea and vomiting.
    • Muscle cramps, chest tightening, and joint pains.
    • Excessive saliva formation and profuse sweating.
    • Anaphylaxis.
• Treating Insect Bites and Stings
  • First aid for envenomation depends upon the nature of the venom, but the following general procedures are recommended:
    • Treat for shock, even if patient does not present any of the signs of shock.
    • Call medical direction. Skip this only if the organism is known and there is a specific protocol for care.
    • Remove the stinger or venom sac.
    • Remove jewelry from the patient's affected limb in case the limb swells.
    • If local protocol permits and if the wound is on an extremity (not a joint) place constricting bands above and below the sting or bite site.
    • Keep the limb immobilized and the patient still to prevent distribution of the venom to other parts of the body.
    • Treat for anaphylactic shock.
• Assessing Snakebites
  • Gather information from the patient, bystanders, and the scene.
  • Gather information about the possible type of snake
  • Assess for common signs and symptoms of snakebites:
    • Noticeable bite on the skin, which may appear as nothing more than a discoloration.
    • Pain and swelling in the area of the bite, which may be slow to develop, taking from thirty minutes to several hours.
    • Rapid pulse and labored breathing.
    • Progressive general weakness.
    • Vision problems (dim or blurred).
    • Nausea and vomiting.
    • Seizures.
    • Drowsiness or unconsciousness.
• Treating Snakebites
  • Ensure the scene is safe.
  • Call medical direction to determine the best receiving facility where anti-venom will most readily be available to treat the patient.
  • Treat for shock and conserve body heat.
  • Keep the patient calm.
  • Locate the fang marks. There may only be one fang mark.
  • Remove any rings, bracelets, or other constricting items on the bitten extremity.
  • Keep any bitten extremities immobilized - the application of a splint will help.
  • Do not elevate the limb above the level of the heart.
  • Transport the patient.
  • Monitor vital signs.
  • Treat for anaphylactic shock.

Poisoning

• A poison is any substance that can harm the body; a large percentage of chemicals in everyday use contain substances that are poisonous if misused.
• Poisonings may be a result of suicide attempts or accidents.
• People react differently to various poisons; the reaction is often far more serious in the ill, very young, and elderly.
• A poison can do damage in a variety of ways.
  • Corrosive or irritant-Destroying skin and other body tissues
  • Suffocating agent-Displacing oxygen in the air
  • Systemic poison--Causing harm to the entire body or body system
• Poisons can be classified into four types, according to how they enter the body:
  • Ingested
  1. Ingested poisons are poisons that are swallowed and include common household and industrial chemicals, medications, improperly prepared or stored foods, plant materials, petroleum products, and agricultural products
     * Food Poisoning
  • Inhaled
    • Poisons that are breathed in.
    • Takes the form of gases, vapors, sprays.
    • Includes carbon monoxide, ammonia, chlorine gas, sprayed agricultural chemicals and pesticides, and carbon dioxide.
    • If you suspect a patient has inhaled a poison, approach the scene with care and go only where your protective equipment and clothing allow you to go
  • Absorbed
    • Poisons taken into the body through unbroken skin.
    • Just as poisonous substances can be absorbed by patients, they can also be absorbed by HMs. It is critical that the HM take protective measures to prevent exposure to these substances. It may be necessary for a patient to be decontaminated before you touch him.
    • Many are corrosives or irritants that injure the skin and slowly absorb into body tissues and the bloodstream.
    • Include insecticides, agricultural chemicals, plant materials, and certain forms of marine life
  • Injected
    • Poisons inserted through the skin.
    • Includes illicit drugs injected with a needle and venoms injected by fangs or stingers.
• Assessment of the four different types of poison:
  • Ingested
    • What substance was involved?
    • When did the exposure occur?
    • How much was ingested?
    • Over how long a period did the ingestion occur?
    • What interventions has the patient, family, or well-meaning bystander taken?
    • What is the patient's estimated weight?
    • What effects is the patient experiencing from the ingestion?
  • Inhaled
    • What substance was involved?
    • When did the
    • exposure occur?
    • Over how long a period did the exposure occur?
    • What interventions has anyone taken?
    • What effects is the patient experiencing after the exposure?
  • Absorbed
    • What substance was involved?
    • When did the exposure occur?
    • How much of the substance was the patient exposed to?
    • Over how long a period did the exposure occur?
    • What interventions has anyone taken?
    • What effects is the patient experiencing from the exposure (e.g., liquid or powder on the patient's skin, burns, itching, irritation, and redness)?
  • Injected
    • How to asses for injected poisons will be discussed during Intoxications.

Intoxication

• Alcohol Abuse Considerations
  • Emergencies arising from the use of alcohol may be due to the effect of alcohol that has just been consumed, or it may be the result of the cumulative effects of years of alcohol abuse.
  • Provide care for the patient suffering from alcohol abuse the same as you would for any other patient; treat these patients with respect and dignity.
  • Do not neglect your duty to provide medical care.
  • When serving in a prehospital capacity your safety is critical, do not hesitate to ask for police assistance with any patient who appears intoxicated or irrational or who exhibits potentially dangerous behavior.
  • Scene assessment:
    • Protest your safety
    • Conduct a complete assessment to identify any medical emergencies
    • Do not allow the presence of alcohol or the signs and symptoms of alcohol abuse to override your suspicions of other medical problems or injuries..
    • Since getting a history from an intoxicated patient may be difficult, rely on your powers of observation and resourcefulness, as well as family members and bystanders.
  • Signs and symptoms of alcohol abuse:
    • Odor of alcohol on patient's breath or clothing
    • Swaying and unsteadiness of movement
    • Slurred speech, rambling thought patterns, and incoherent words or phrases
    • Flushed appearance to the face, patient sweating, and complaints of being warm
    • Nausea or vomiting
    • Poor coordination
    • Slowed reaction time
    • Blurred vision
    • Confusion
    • Hallucinations, visual or auditory
    • Lack of memory
    • Altered mental status
  • Patient may be suffering from alcohol withdrawal.
    • Seizures
    • Delirium tremens (DTS), a condition characterized by sweating, trembling (hands), anxiety, and hallucinations
    • Confusion and restlessness
    • Unusual behavior to the point of demonstrating "insane" behavior
    • Hallucinations
    • Gross tremor of the hands
    • Profuse sweating
    • Hypertension
    • Tachycardia
  • Be on the alert for signals-such as depressed vital signs that the patient has mixed alcohol and drugs.
  • When interviewing the patient, do not begin by asking the patient if he is taking drugs; ask if he has taken medications while drinking.
  • All patients with seizures or DTs must be transported to a medical facility as soon as possible.
  • Patient Assessment
    • Take standard precautions
    • Stay alert for airway and respiratory problems.
    • Be prepared to perform airway maintenance, suctioning, and positioning of the patient should the patient lose consciousness, seize, or vomit.
    • Help the patient so vomitus will not be aspirated.