JERROLD J. SCHARNINGHAUSEN, Ph.D.
Workplace Safety Division
Directorate of Assessments and Prevention
U.S. Army Combat Readiness Center
Fort Rucker, Alabama

Ticks — the mere thought of exposure strikes fear in some people due to the number of diseases these blood-sucking parasites can transmit. Avoidance is the preferred method to prevent tick-borne disease transmission; however, there are several additional precautions you can take to stay safe, including:

• Wear light-colored clothing. Light colors make it easier to spot ticks on your clothing. Stop occasionally and perform a visual check for ticks on your clothing.
• Tuck your pants inside your boots or socks. While it may not look flattering, it does create a physical barrier against ticks.
• Use insect repellent. Most of the chemicals that repel mosquitoes are somewhat effective against ticks, although it may take a heavier concentration of DEET to be effective. Military DEET is 33 percent and very effective against ticks. Permethrin clothing treatment is a stronger chemical that kills ticks as well as repels them. Products containing permethrin should be sprayed only on clothing, not the skin.
• Stay in the middle of the path. Ticks can’t jump or fly, so they can only get on you if you come into contact with vegetation on which the ticks are resting. Avoid moist, shady, wooded areas with leaves, low-lying plants and shrubs.
• Ticks do not survive in open areas that dry out quickly. Lawn furniture and playground equipment should be set back from the edge of shady, wooded or high-grass areas. If you’re picnicking, pick a patch of well-tended lawn or some open ground.
• Inspect yourself, your children and your pets, especially the legs and groin. Ticks usually get picked up on the lower legs and then climb upward in search of a meal. The odds of contracting Lyme or any other tick-borne diseases are minimized if the tick is removed soon after it’s attached. The shower is a good place to conduct a tick check.

What do you do if you find a tick attached to your skin? Since their bites are nearly painless, most ticks are not discovered until after they attach. Fortunately, most disease transmission can take 24 hours or more. Prompt removal using approved methods is effective at preventing disease transmission.

Before discussing the best methods for tick removal, there are a lot of folk remedies that are best avoided. One of the first removal methods I ever heard was to place a blown-out match to the rear of the tick to get it to back out and release. Logic should tell you that if someone pulled a hot poker out of the fire and placed it on your backside, the one direction you would not move is back. Unfortunately, this results in people lighting multiple matches in an attempt to get the tick to release, raising the parasite’s internal temperature and possibly causing the pressure created by the expanded volume of the heated gut contents to inject into the attachment site the very pathogen you are trying to avoid.

A popular removal method is to cover the tick with any number of substances to include petroleum jelly, nail polish, alcohol or gasoline. While this may cause a tick to release, it will only leave a blood meal that it needs to complete its lifecycle as a last resort. When a tick has difficulty breathing from an applied coating, its first response is to regurgitate in an attempt to clear its airway. This potentially results in the pathogen being forced into the bite, theoretically increasing the risk of infection.

Another method is to grasp the body of the tick and pull. Since ticks have relatively soft bodies, substantial pressure needs to be asserted against its body. Squeezing the tick in this manner effectively injects any pathogen in the tick’s mid-gut into the wound. You may have also heard that twisting the tick in a clockwise (sometimes counterclockwise) direction will remove it. A tick’s mouthparts are barbed, similar to a fishhook. Twisting off the head should be avoided because this may cause the tick’s potentially infectious body fluids to escape. It is important to remove the tick completely. This includes the mouthpart and the cement the tick secreted to securely attach itself. Improper tick removal can cause mouthparts to break off in the skin, possibly leading to a secondary infection.

So what is the proper method to remove a tick? The most commonly recommended tick-removal method is manual extraction. This can be performed with tweezers or any of the numerous commercially available tick removal devices. To remove ticks using the tweezers method:

1. Use fine-tipped tweezers to grasp the tick as close to the skin as you can.
2. Pull upward with steady, even pressure. Don’t twist or jerk the tick. This can cause the mouthparts to break off and remain in the skin. If this occurs, remove the mouthparts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.
3. After removing the tick, clean the bite area and your hands with rubbing alcohol or soap and water.
4. Dispose of the tick by flushing it down the toilet. If you would like to bring the tick to your healthcare provider for identification, put it in rubbing alcohol or place it in a sealed bag/container.

To remove ticks using a commercially available device, follow the manufacturer’s instructions. After removal, thoroughly wash the bite area and your hands with soap and water or alcohol. While having a tick attached to your skin can be an emotional experience, by preparing in advance and having the proper equipment on hand, they can be safely removed without putting yourself at risk. If you develop a rash or fever within several weeks of removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when it occurred and where you most likely acquired it.