NurseWeek: The Buzz: Health care workers step up training to prepare for killer bee attacks

The buzz
Health care workers step up training to prepare for killer bee attacks
By José Alaniz
August 7, 2000

The Africanized honey bee is, essentially, a honeybee, so it carries few distinctive characteristics from the European honey bee commonly found in the United States. Both subspecies are roughly 5/8 of an inch long, brownish and slightly fuzzy. Any physical differences between the two are viewable only at the microscopic level.

Illustration: Photodisc/Hal Pham


	You've read the article. Now tell us what you think. Related site Preparing for Killer Bees U.S. deaths August 1993 Texas 82-year-old man 40 stings June 1994 Texas 98-year-old man 50 stings October 1995 Arizona 88-year-old woman >1,000 stings October 1995 Arizona 66-year-old man 130 stings April 1997 Arizona 72-year-old man NA September 1999 California 83-year-old man ~ 50 stings Source: Department of Entomology, UC Riverside

Virgil Foster, a Long Beach, Calif., beekeeper, was mowing his lawn Aug. 31 when he bumped into a nest of bees. The enraged hive attacked the 83-year-old and, by the time his son Kevin could pull him into the house, Foster had suffered more than 50 stings.

He died several days later at nearby Lakewood Regional Medical Center. The tragedy was a shock, but not a surprise to public officials and entomologists: Foster had disturbed a nest of Africanized honey bees. Five years after migrating to California from the south, they claimed their first victim in the state – and sixth nationwide.

Some observers were surprised at the relatively little trouble the bees had caused; they were spotted in California in 1994 and have steadily crept north as far as Oxnard. Despite their reputation – the media dubbed them "killer bees" – and an early- to mid-1990s campaign to increase public awareness and train health workers, the bees did not live up to the hype.

Until they killed Virgil Foster.

Africanized honey bees are the result of a botched Brazilian interbreeding experiment in 1956, when scientists tried to mate the more aggressive African bee with the common European honey bee. The "Africanized" hybrid escaped, retaining its namesake’s extremely defensive behavior, and has spread as far south as Argentina and as far north as Southern California, South Texas and Arizona.

Because the bees have migrated slowly, some experts warn, caregivers and the public may have grown dangerously complacent.

"There’s been a need for continued retraining," said P. Kirk Visscher, Ph.D, associate professor of entomology at the University of California, Riverside. "Massive envenomization is not seen all that often, so emergency rooms aren’t always on top of it in terms of the best approach to care. In a massive attack, large amounts of tissue breakdown substances are injected into the body, which could lead to kidney failure."

Medical personnel need to know how to treat massive envenomization (also called venom overload) because unlike most other insects, Africanized honey bees attack in coordinated, overwhelming force. Their venom is no more poisonous than that of other bees, but they will sting a perceived interloper far more and far longer, continuing the pursuit up to half a mile from the hive. This makes children and the elderly most at risk for an attack.

"The public awareness campaigns made people afraid enough that they stay away from hives, so there have not been that many stingings," said Suzanne Goodrich, MSN, RN, an EMS manager at the Orange County Fire Department. "A lot of the initial training for fire departments and paramedics dealt with getting past the bees, reaching the victims. But we haven’t paid as much attention to what physiological changes take place as a result of the stings."

Medical personnel tend to treat Africanized honey bee attacks as they would smaller-dose poisonings, Goodrich said, even though they are different.

"Our initial response would be the same as for anaphylactic shock: Check and clear the airway, use Benadryl or Epenephrine," said Patricia Faillers, RN, an ER and mobile intensive care nurse at Hemet Valley Medical Center near Palm Springs, Calif. "But because we don’t see these bee attacks that frequently, people don’t stay as attuned to the problem."

In the Rio Grande Valley of South Texas, where the bees first entered the country in 1990 and stinging incidents are more common, nurses and paramedics remain vigilant, said Linda McKenna, RN, a private practice nurse in Harlingen. She and her husband, an immunologist and allergist who is developing a bee venom antidote, keep in touch with paramedics eager to stay up to date on response methods to Africanized honey bees.

"Eventually, we would like to have a formula based on the number of stings, the overall health situation of the patient and other factors to know if the serum is indicated," McKenna said. "But until then, there’s no specific initial treatment for these attacks, other than what we already do for anaphylactic shock."

But more could be done while waiting for a specific serum, Goodrich said. "We need to train nurses and paramedics on the concept of venom overload, not just anaphylaxis," she said.

Venom overload may lead to multiorgan complications, hepatic dysfunction, and cerebral and pulmonary edema as late as 10 days after the stinging, as well as many other possible symptoms. Multiple sting victims require hospital observation for severe allergic and toxic reaction for up to two weeks after apparent recovery, according to a 1994 article by R.E. Reisman, MD, "Insect Stings," in the New England Journal of Medicine.

Despite the relative scarcity of attacks in California (more than 50 since 1994), Visscher pointed to a greater abundance of flowers in the state’s deserts (thanks to El Niño rainfall) as well as a reduction in the numbers of parasitic bee mites, which indicate the Africanized honey bees may be reproducing and spreading faster.

This isn’t just a rural problem, either, Visscher added: "Lots of people keep flowers in the city, and there’s a lot of building crevices to set up hives."

So far, California has been relatively fortunate in its experience with the aggressive bees, experts said. Foster’s death may be the first sign that the state’s luck is running out. Southern Hemet, which has a large senior citizen population, could become prime attack country, Faillers said.

"We get lots of heart attacks and respiratory distress cases in the ER here, and those could certainly be brought on or complicated by a bee attack," she said. "But even though we’ve expected attacks, we haven’t seen any such victims. We’re rather relieved not to have had the problem. We’ll see what the future holds."