What to do until medical arrives: Allergic reactions

An inmate is having an allergic reaction to a insect sting. Do you know how to respond?

A number of medical emergencies can arise in a jail or prison. That is why it is handy to have health care staff available to respond and treat life threatening conditions. Depending on the location of the man-down, however, it may take a while for medical staff to arrive. So, it is important to know what to do in the early stages of any medical emergency. This is the start of a series to help corrections officers manage medical emergencies until health staff arrive to provide definitive care. I made a list of the common emergencies officers may encounter in the course of a shift. We’ll work through them in alphabetical order, starting with an allergic reaction. Consider this emergency situation:

While stationed in the exercise yard monitoring inmate activity on a sunny summer day, you notice unusual activity on the north corner where a pick-up game of hoops was going on without incident until now. One of the men fell to the ground and  others have gathered around him. Your partner calls a line-up while you head to the inmate on the ground to evaluate the situation. You quickly see that he was stung by some type of insect on the right calf. His calf is swelling around the sting site and the inmate looks like he is having trouble getting his breath. You radio in the Man-Down code for back-up and medical assist.

What is going on

This inmate is having an allergic reaction to an insect sting. It is normal to have a small local reaction to the insect venom released during a sting. The pain, itching, redness, and swelling at the sting site is familiar to most of us. However, severe reaction to stings from bees, wasps, or fire ants is possible in up to 3% of adults and 1% of children. Allergic individuals have an immune system sensitized to the proteins in the venom.  When stung, the immune system responds to the allergen by dumping histamine and other chemicals into the blood causing tissue swelling, airway constriction, and leaking of fluid from blood vessels. The allergic sting victim shows signs of these responses with expansive swelling, such as the entire limb, and difficulty breathing. The leaky blood vessels can also cause falling blood pressure.

What to be concerned about

The greatest concern in a systemic allergic reaction of any kind is airway closure from swelling tissue. The inflammation of a severe immune response is taking place in many areas of the body, however, airway closure is the most concerning as a simple bee sting can turn fatal in a matter of minutes if the person stops breathing.

Actions Until Medical Arrives

Everybody stay calm. Keep the person as calm as possible to minimize hyperventilation or air hunger responses to airway obstruction. Your calm attitude will go a long way toward this goal.

Treat if you can. The definitive treatment to reverse a severe allergic reaction is epinephrine. This medication needs to be administered quickly by injection; usually in the thigh muscle. Many severely allergic individuals care an epinephrine auto-injector (EpiPen) at all times. Your facility may have a policy regarding the availability and use of epinephrine auto-injectors for custody staff.  Otherwise, medical staff should have this available in their emergency kit when they arrive on the scene.

Be ready for the worst. Monitor breathing and consciousness. If the person stops breathing or passes out, check for a heartbeat and initiate appropriate basic life support (BLS/CPR) efforts. It may be difficult to breath against a closed airway but do the best you can until medical arrives. Do you carry a face shield or barrier mask for such situations? Be prepared!

What to Do Before This Happens to You

  • Be up-to-date on basic life support training
  • Review the facility policy on epinephrine auto-injectors. Can you use one? Do you know how? Where are they secured?
  • Check for any severely allergic inmates in your care. Is this information in your classification and documentation system?

Have you had to deal with a severe allergic reaction while on duty? 

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