APPENDIX: ARTHROPOD ENVENOMIZATION REACTIONS AND TREATMENT 39 Chart 1: Antihistamines 48 Chart 2: Treatment of Anaphylaxis—Shock 49 INTRODUCTION Although most residents of the United States are aware of the pain and discomfort associated with contacting a venomous arthropod, many are not aware that these arthropods (such as ants, bees, wasps, spiders, and scorpions) are responsible for more human deaths in the United States each year than any other group of venomous animals, including snakes. In fact, a study by Parrish[15] showed that venomous arthropods accounted for more than 65% of the reported human fatalities caused by venomous animals in the United States from 1950 through 1959. His findings are summarized as follows: _Venomous animal group_ _Human fatalities (1950-59)_ Hymenoptera (bees, wasps, and ants) 229/460 or 49.8% Poisonous snakes 138/460 or 30.0% Spiders 65/460 or 14.1% Scorpions 8/460 or 1.7% Others 20/460 or 4.4% It would be incorrect, however, to assume from the above information that a high percentage of arthropod envenomizations are fatal. In actuality, the opposite is true. Of the estimated millions of people envenomized by arthropods in the United States each year, about 25,000 have severe reactions; and of these, approximately 30 result in reported deaths.[19] Therefore, the high number of fatalities caused by venomous arthropods, relative to other venomous animals, can be attributed to the high incidence of arthropod envenomizations rather than the efficient killing power of their venoms. This high-incidence rate is accounted for by the tremendous abundance of venomous arthropods and their ability to live in close proximity to man. Air Force personnel stationed in the continental United States face a greater risk of contacting a venomous arthropod than the average United States resident because: (1) a large portion of bases are located in the southern half of the United States, where venomous arthropods are most numerous; (2) many facilities (such as radar, communications, security, and missile sites) are located in remote areas where venomous arthropods are not controlled; (3) numerous Air Force training and work activities must be performed outside; and (4) many military structures (such as older wooden buildings, storage buildings, and field training facilities) provide excellent habitats for venomous arthropods. It is important, therefore, that Air Force medical facilities have current information available concerning the most important venomous arthropods in their areas.