Pat is an environmental scientist with over 30 years of experience field investigations in the Northeast. Unlike the beginning of his career, Pat’s typical workday consists of office work. But, back in 2018 he jumped at the opportunity to get back into the field to oversee a project. Pat is no stranger to tick borne dangers of field work but, little did he know that this field work event would land him in the emergency room. I sat down with Pat and chatted all things ticks, Lyme disease with co-infections, and employee field work safety.
Until 1977, Lyme disease was almost unknown. The disease was first discovered in an unusual cluster of arthritis cases in Lyme, Connecticut. Traced to tick bites, Lyme disease has since become the most reported tick-borne illness in the country. Common symptoms of Lyme disease include a bull's-eye rash followed by flu-like symptoms. But as Pat learned, not everyone experiences both these common symptoms from a tick bite.
The Center for Disease Control (CDC) says individuals who live or work in residential areas surrounded by tick-infested woods or overgrown brush, or those who engage in outdoor occupations, are at a greater risk for Lyme disease. The number of reported cases of Lyme disease has tripled since the 1990s, and there are about 50,000 cases of tick-borne illnesses diagnosed every year.
Where Pat completed the field work in the eastern US, the deer tick is the primary carrier of the disease. The deer tick and several other types of ticks including the lone star and the dog tick can carry and transmit other tick-borne diseases and parasites including anaplasmosis, Rocky Mountain spotted fever and babesiosis. As Pat experienced, one tick bite may infect you with diseases and parasites simultaneously. After completing his field work project in 2018, it was not long after that Pat was rushed to the emergency room and diagnosed with Lyme disease and babesiosis.
Symptoms of tick-borne illnesses can range from swollen joints to meat allergies and can vary between individuals. Pat’s symptoms included fatigue, fever, headaches, muscle aches, night sweating, and severe dehydration. Many of these diseases have a typical bull’s eye rash of Lyme disease, but, as Pat knows, the absence of a rash does not mean you do not have the disease. Early recognition and treatment decrease the risk of severe infection, however sometimes the disease can be challenging to diagnose and not all people are aware of having been bitten by a tick.
Symptoms can develop days, months, or longer after a tick bite, and you can be reinfected through another bite. Pat’s Lyme disease and babesiosis symptoms lasted days before he sought medical attention. If he left his symptoms untreated, the disease could have spread throughout the body, causing debilitating pain.
The best way to avoid the chances of catching a tick-borne illness is avoiding areas that ticks like, such as high grasses, gardens, bushes, woods. But that is a bit difficult if you are Pat and your occupation takes you to high-risk areas.
As Pat loaded his field work bag that day, he knew he was going to a high-risk tick environment. Before he started work that day, Pat reviewed the Job Safety Analysis (JSA), which listed ticks as a vector hazard. The JSA listed the following preventative actions to take to prevent tick exposure:
- Wear long pants and sleeves.
- Tuck pants into socks.
- Wrap tape around the tucked pants.
- Spray tick repellent on clothing and skin.
- Complete a tick check after field work each day.
After taping his pants, Pat realized his tick repellant spray, with the active ingredient Deet, was missing from his vehicle. Even though the Job Safety Analysis instructed the employee to use tick repellent spray before starting field work, Pat thought he was wearing enough protection and continued into the high grass to start his field work.
As Pat mentioned in our chat, not applying Deet before entering the tall grass affected his life for months, and forever changed his company tick prevention policies. His company now strictly mandates in the Job Safety Analysis that before employees enter the field, they apply tick repellent spray to skin and permethrin to clothing.
Deet and permethrin can go a long way toward keeping you protected and using at least one is better than not using anything. Deet repels ticks, and permethrin can immobilize them on contact. If clothing is coated appropriately with permethrin, the tick will die when it contacts the chemical. Repellants include those with ≥ 20% DEET, picaridin, IR3535 or some essential oils. When creating your next field work Job Safety Analysis, Job Hazard Analysis or Activity Hazard Assessment make sure you consider adding deet and permethrin spray as a safe job procedure.
Unfortunately, Pat did not see a tick embedded in his skin while performing his post field work tick check which would have alerted him to get tested for tick borne illnesses. If Pat did find an embedded tick in his skin, he would follow the steps developed by the CDC:
- Remove an embedded tick as soon as possible - If you do find a tick, do not panic. It is important to remove the insect relatively quickly but stay calm. Once one crawls onto your body, it can take hours before it attaches and then another 48 hours until it starts transmitting disease.
- Take deep breaths - Using pointy tweezers, grab the tick as close as you can to your skin. Do not squeeze the tick.
- Pull it straight out - The goal is to remove the whole tick, intact. If the head remains in your body, leave it there. Digging around your skin for the detached head is not ideal because the wound could get infected.
- Seal the tick in a plastic zip-top bag (double bag it if it is still alive, just in case).
- Rub the bite with alcohol and wash your hands.
As Pat learned, it is extremely important to review and complete all the steps of your Job Safety Analysis or Activity Hazard Analysis to remain safe on the job. As you prepare your next Job Safety Analysis or Activity Hazard Analysis for outdoor work, ticks may be an essential part of your hazard assessment. Implementing a few simple measures can make a huge difference and help “everyone return home safely at the end of the day!”.