Doing a Tick Check and Removing a Tick Correctly

Why this matters

The daily tick check is the single habit that does the most to keep an outdoor crew from getting Lyme disease, because most tick-borne infections need the tick to stay attached for a long time before they transfer (the owner card on ticks covers which diseases and how long). The check only works if it is thorough enough to find a nymph the size of a poppy seed, and removal only works if it gets the whole tick out quickly without squeezing it. Most techs were taught removal by a relative with a lit match. This is the version CDC actually recommends, with the reason behind each step.

What you need on the truck and at home

• Fine-tipped tweezers, the pointed kind. Flat-ended household eyebrow tweezers grip too wide and tend to squeeze the tick's body. A purpose-made tick removal tool works too.
• Rubbing alcohol or soap and water, for the bite and your hands.
• A small zip bag or a pill bottle, and tape.
• A hand mirror, or a crew member willing to check your back and scalp.
• A phone for the photo and the note.

Keep a set in the truck's first aid kit and a set at home. A tick found at 9:00 at night is removed with whatever is in the bathroom, and if that is a pair of flat tweezers, the job gets harder.

The procedure

1. Do the check at the right time, in good light. Check right after the last outdoor job or within two hours of getting home, before or during a shower, in a well-lit room with a mirror. Why: ticks crawl for hours before biting, so an early check often catches them still loose on skin or clothing, where removal is just a matter of picking them off. If skipped: a check done the next morning is a check on a tick that has had a whole night to attach and feed.

2. Check your clothes and gear before you check your skin. Shake out and look over outer layers, especially pant cuffs, socks, the inside of the waistband, and gloves. Take brush clothes off in the garage or laundry area, not the bedroom, and put dry clothes in the dryer on high heat for 10 minutes. Check the lunch bag, the jacket that was on the truck seat, and the dog if it rode along. Why: a tick on a sock is a tick that has not bitten anyone yet. If skipped: it bites you on the couch at 10:00, or it bites someone else in the house.

3. Work the body in a fixed order, low to high. Ticks land low and climb until something stops them. CDC's list of where they hide matches where clothing creates a barrier or skin is thin: behind the knees, between the legs and in the groin, around the waist and belt line, in the belly button, under the arms, in and around the ears, and in and around the hair and along the hairline. Do the feet and ankles first, then legs, groin, waist, belly button, armpits, chest, back with the mirror, neck, ears, and scalp last, parting hair with your fingers. Why: a fixed order means nothing is skipped on a tired evening. If skipped: people check their arms and legs, the places that are easy to see, and miss the waistband and scalp, which is where crews actually find them.

4. Feel as well as look. Run your fingertips over the scalp, behind the ears and along the waistband. An attached nymph often feels like a tiny raised scab or a grain of sand stuck to the skin. Why: in hair and on freckled skin, touch finds what eyes miss. If skipped: a nymph in the hairline stays there for days.

5. Confirm it is a tick before you go at it. Look closely, ideally with a magnifier or the phone camera zoomed in. A tick has legs at the front, is attached at its head end, and does not brush off. A freckle, a scab or a skin tag does not have legs. Why: digging at a mole with tweezers is its own injury. If skipped: you either attack your own skin or decide a real tick is a scab and leave it.

6. Grab it at the skin and pull straight up, steadily. Grip the tick with fine-tipped tweezers as close to the skin's surface as you can, at the mouthparts rather than the body. Pull upward with steady, even pressure. Do not twist or jerk. Expect resistance; ticks cement themselves in, and it may take several seconds of steady pull. Why: gripping at the skin pulls the whole tick, and steady pressure lets the mouthparts let go. If skipped: grabbing the swollen body squeezes the tick's gut contents toward the bite, and twisting or jerking snaps the mouthparts off in the skin.

7. If the mouthparts break off, try once, then leave them. CDC's guidance is to remove remaining mouthparts with the tweezers if you can do it easily; if you cannot, leave them alone and let the skin heal. Why: the mouthparts do not transmit disease the way the feeding tick does, and digging opens the skin to ordinary infection. If skipped: the mistake here is doing too much, not too little. A tech who gouges at it with a pocketknife ends up with an infected wound on top of a tick bite.

8. Clean the bite and your hands. Wash the bite area and your hands with rubbing alcohol or soap and water. Why: it reduces ordinary skin infection and cleans anything off your fingers. If skipped: low consequence, but it takes ten seconds.

9. Photograph the tick, then dispose of it. Photograph it next to a coin or a ruler for scale before getting rid of it. Dispose of a live tick by putting it in alcohol, sealing it in a bag or container, wrapping it tightly in tape, or flushing it. Never crush a tick between your fingers. Why: the photo lets a clinician identify the species later, which tells them which diseases to think about. Crushing it puts its fluids on your fingers. If skipped: a month later, when a fever shows up, nobody can say what bit you or how engorged it was. Some people keep the tick sealed in a bag in the freezer for that reason, which is fine, but CDC does not recommend testing the tick itself as a way to decide on treatment, so the photo and the date are what matter.

10. Write it down, then watch for 30 days. Record the date, the body site, where you worked that day, how long it could have been attached, and whether it was flat or swollen. A small red bump at the bite right after removal, like a mosquito bite, is common and is not itself a sign of infection. What you are watching for over the next 30 days is a rash that expands over several days, or fever, chills, headache, aches or fatigue. If either appears, get medical care and bring the record. Why: tick-borne illness shows up days to weeks later, long after anyone remembers the bite. If skipped: the clinician hears "I might have had a tick sometime" instead of a date, a place and a photo.

What not to do, and why each one is folklore

CDC is blunt that the goal is to remove the tick as quickly as possible, not to wait for it to detach. Every one of these delays removal:

• A hot match or lighter on the tick. It does not make the tick back out. It burns you, and it may cause the tick to release more saliva into the bite.
• Nail polish, petroleum jelly or oils to "smother" it. Ticks breathe so slowly they can sit for hours under a coating, attached and feeding.
• Squeezing it off with fingers. Same problem as gripping the body with tweezers, and your fingers are now contaminated.
• Waiting until you get home tomorrow. The removal tools fit in a first aid kit for this reason.

Worked example: a fence installer working alone

A fence installer in southern Minnesota spends a July day setting posts along the wooded back line of a property, in grass and brush up to the knee, alone. Permethrin-treated pants, no repellent that day. Last post set at 3:30, home at 5:15.

Steps 1 and 2. Brush clothes come off in the garage at 5:20 and go in the dryer on high for 10 minutes. Shaking out the socks first, he finds one tick crawling on the outside of the left sock, not attached. It goes into a pill bottle of rubbing alcohol.

Steps 3 and 4. Shower check, feet to scalp, with the bathroom mirror for his back. Nothing on the legs, groin, waist or back. Running his fingers behind the right ear along the hairline, he feels a raised speck.

Step 5. Phone camera, zoomed: legs at the front, head end down in the skin. A tick, small and flat, not swollen.

Step 6. Fine-tipped tweezers from the bathroom kit, gripped at the skin, steady upward pull. The body comes away; a dark fleck stays in the skin.

Step 7. One easy try with the tweezers does not get the fleck. He leaves it.

Steps 8 and 9. Alcohol on the bite and his hands. Photo of the tick beside a coin, then into the same pill bottle.

Step 10. The note on his phone, forwarded to the office so it lands in the day's job record:

TICK BITE RECORD
Date found:     Thu Jul 17, 5:40 pm
Body site:      behind right ear, hairline
Job:            Lindqvist fence, wooded back line
Earliest pickup 8:00 am (first post)
Max attached:   about 9.5 hours
Condition:      flat, not swollen
Mouthparts:     fleck left in skin, one try made
Second tick:    on left sock, not attached
Photo:          yes, beside a coin
Watch until:    Sat Aug 16

The maximum attachment is the time from the first possible contact to removal: 8:00 am to 5:40 pm is 9 hours 40 minutes, about 9.5 hours. The watch date is 30 days from July 17.

Day 2. A pink bump the size of a pea at the bite, itchy, the same size on day 4 and fading by day 7. That is the common local reaction, and it did not expand.

What would have changed the answer: a red patch that started small around day 8 and was the size of a palm by day 11 is the expanding rash step 10 watches for. That is a same-week doctor visit with this record in hand, whatever the bump looked like at first.

The failure this prevents: the version where he finds the speck, decides it is a scab, goes to bed, and finds a swollen tick behind his ear on Saturday morning with no idea when it got there.

How to know you did it right

• The tick came out in one steady pull, or you made one easy try at the mouthparts and stopped.
• You have a photo, a date, a body site and a job written down.
• You know your 30-day watch date and what an expanding rash looks like.

References

• CDC, Removing a Tick (fine-tipped tweezers, steady upward pull, mouthparts guidance, cleaning, disposal, folklore remedies to avoid)
• CDC, Preventing Tick Bites (where ticks hide on the body, showering within two hours, dryer on high heat)
• See related: Ticks and Tick-Borne Disease for Outdoor Crews
• See related: Treating Work Clothes with Permethrin