First let me say that you may work an entire career as a Paramedic and never see a systemic reaction to a brown recluse bite. By far, most reactions seen by medics in the pre-hospital environment are local reactions from bites that have occurred shortly before we have been summoned. This is precisely why it is so important that we know that the bite of the brown recluse, like many poisonings, can be a metabolic time bomb.

Let me explain where I am going with this. As mentioned earlier, It has been my experience that many patients who have been bitten by a brown recluse (or anything for that matter) have the good sense to call EMS but then decide that they do not wish to be treated or transported by us. Often I have arrived at the home of a patient that is well aware that they have been bitten, but do not want to go to the hospital because they had no symptoms in the 15 minutes or so after the bite. Like many people, they believe that because they didn't immediately drop dead or become violently ill, they are in no danger. I once had a patient who had been bitten by a very large copperhead. When I arrived on the scene, there was the snake, which my patient had killed after he was bitten, laying on the ground. The patient had definite fang marks on two separate locations of his leg. He wanted to refuse transport saying that it had been 20 minutes since he was bitten and "nothings happened yet". Many patients take this view.

It is the patients right to refuse transport, but we as Paramedics have a duty to inform the patient, in the strongest terms necessary, of the dangers of their decision. In order to do this, we need to know the progression of possible events in the envenomation process even though we probably wont see these events during our time with the patient. This is also important that we know what may happen and when it may happen so that we may make an intelligent estimation of how far along in this process the patient is. Knowledge of the often-subtle signs and symptoms of systemic envenomation, and the probable sequence of events yet to happen will help prevent overlooking or underestimating a potentially deadly situation for our patient.