Anaphylaxis Insights

I teach beekeeping at a local college. One early summer evening, one of my students, “Doris,” an experienced beekeeper, was stung three times while working hives. Doris had been stung before; nothing seemed different this time. She finished up hive inspection and told me she was returning to the classroom because of the heat (as were others, although they trailed her by a few minutes.) What then happened has forever changed the way I keep bees and teach.

Through divine intervention and because of the heat, another student had (unusually) stayed in the classroom that night. He and Doris began chatting. With apparently no warning, Doris suddenly lost consciousness and collapsed. Anaphylactic shock.

Based upon witnessing firsthand how life-threatening that was, here are some of the changes I’ve made—both in the teaching environment and when I work bees with just a few friends. It happens so fast.

General points:

  • I discuss the possibility of anaphylactic shock every time I work bees with a “new” person, what it can look like, how fast it comes on, what to do. I suggest the Mayo Clinic information on anaphylaxis for us non-medical folks, and if you understand medical terminology, beekeeper and ER physician Tyler Andre recommends https://www.wikem.org/wiki/Anaphylaxis. Review that information at least seasonally so it is fresh in your mind.
  • My cell phone is always in an OUTSIDE pocket of protective wear – not in my purse, not (somewhere) in my vehicle, not in a pocket inside my suit.
  • At least seasonally, I review epinephrine autoinjector (Some of us with over-50 eyes can’t read the directions without reading glasses, and those glasses are not always handy.)
  • If you lock your vehicle, keep the keys in an OUTSIDE pocket. You may need to quickly escape to your vehicle.
  • Identify who carries epinephrine autoinjector if with a group. Make sure the injectors are in the apiary, not locked in a vehicle across the field.
  • Know who in the group has medical training. (We were blessed to have a nurse in the group monitoring vitals who rapidly brought the EMTs up to speed upon their arrival.)
  • Make it standard procedure that when anyone gets a sting, they let someone else know. That includes the folks who are routinely stung and think nothing of it. They will probably be just fine, but any sting could be the one that causes a severe reaction.
  • Know where other emergency equipment is located (first aid kid, AED if available.)
  • Have emergency contact information for anyone you’re working with.
  • Don’t work bees alone if possible. If not possible, make sure someone knows where you are and what you are doing. My EMT friend who works bees alone keeps his cell phone in his chest pocket and on an open call to a buddy, letting them know he’s OK every few moments, and if he gets stung.
  • Carry Benadryl into the yard, and let everyone where it is. However, do not force Benadryl into an unconscious person; it can cause more problems. Please note there are conflicting recommendations regarding whether it should be used if medical help is readily available.
  • Know your location so you can provide that information to First Responders. I often work with folks in fields “down that dirt road, turn right at the red barn.” I now ask for specific addresses.
  • No shortcuts on the protective wear. I know an experienced beekeeper who wore shorts on an incredibly hot day, thinking it’d be a quick in-and-out of the hive to release a caged queen. He was stung over 20 times he says “within seconds,” and ended up having to use epinephrine … which he fortunately had in the house. He crawled back to the house because he feared passing out and hurting himself so he wanted to stay low; fortunately his wife saw him coming and ran to him with the injector.
  • Be smart about when you’re working in the hive: not too early, not too late, not when there’s bad weather. (Along with not when there are children, animals or innocent bystanders nearby.)
  • If you are involved with a bee club or group, it may be important for participants to sign waivers acknowledging the (very real) risk of working bees for protection of the club, landowner, institution, participants and instructors.

If you’re stung:

  • Step AWAY from the hives and scrape out the stinger as quickly as possible. GETTING AWAY FROM THE BEES is critical; First Responders typically do not have the protective wear to treat someone near bees and they won’t approach you until it is safe.
  • Smoke the stung area heavily to override the pheromone the stinging bee(s) left behind.
  • Tell someone so they can keep an eye on you.
  • If you are feeling “off” / thirsty / warm / jittery / confused / whatever – get out of the yard and be monitored closely. Recline at about 30-45 degrees so you minimize injury if you collapse, and if nauseous, rest on your side. Gravity assists with vomiting and minimizing aspiration. Plus, if you’re already lying on the floor and you go into shock, you avoid possible further injuries from falling down.

If someone develops anaphylaxis:

  • Call 911 immediately. Time is critical.
  • Position the victim so blood can get to their brain – horizontal if possible, or head between their knees. Dr. Andre prefers horizontal; it allows the person to be turned on their side if they start vomiting. Plus, if you’re already lying on the floor and you go into shock, you avoid possible further injuries from falling down.
  • Monitor their pulse. Start chest compressions if they don’t have a pulse while awaiting First Responders.
  • If you are transporting the victim to the ER, it is helpful if there are two of you in the vehicle.
  • When you arrive, pull up to the door and tell hospital personnel why you need immediate assistance.

Our impacted student went home from the ER later that night, shaken but alive (!!) She’s okay, thank goodness and amen.

Almost like bees in a hive, our class came together in these moments of crisis to administer treatment, flag down the ambulance, and take care of the impacted student and each other. We are grateful it worked out; we feel responsible to work to make sure that the next time it happens it will also have a happy ending.