A new book called Outdoor First Aid aims to educate fans, such as mountaineers, hill walkers, and off-road runners outdoors, on basic medical skills if the worst does happen.
Do you know what to do if a medical emergency arises in the mountains?
The author, Katherine Wills, is a qualified Specialist Physical Education teacher and runs Active First Aid Training. She is also a keen mountaineer and a member of the Llanberis Mountain Rescue team in north Wales. She wanted to write a book that would offer easy-to-understand but useful information for a wide range of people who are active in the UK’s mountains.
The book, published by Pesda Press, is not meant as a substitute for attending a first aid course, but it does offer useful tips and advice.
First things first
There are so many different kinds of accidents that can happen in the mountains. For example, a walker might fall and break their leg, someone may suffer a heart attack or be bitten by an adder.
It is also difficult to generalise about what to do should any of these incidents arise, but some points of advice are worth keeping in mind.
It’s not rocket science: Keep a casualty breathing, stop the bleeding and keep it warm. Then call for emergency help.
Help for the conscious casualty
Give support: A casualty is likely to be shocked and confused, so take control of the situation and offer support. Hold their hand and keep them calm.
Consent is vital: You must ask the casualty’s permission to help them. Even if they clearly need first aid, they are rightfully allowed to refuse help. Most people won’t, but if they seem to be of sound mind and they are still refusing assistance, you must back away.
Monitor vital signs: There are five basic vital signs, including the level of response (AVPU), breathing, pulse, skin colour and temperature. It is important to keep a note of all of these signs, and if emergency help is then required, you can report the signs to the medics.
Getting off the mountain: Take a common-sense approach. If the casualty is conscious and able to walk with assistance – and their evacuation will not put others in danger – then you can proceed. But be realistic.
Aid for an unconscious casualty
ABC: Check Airway, Breathing and Circulation. This will help the first aider to determine how life-threatening the injuries are. To be able to assist an unconscious casualty, it is recommended that you attend a first aid training course. This will include exercises on checking, clearing and opening the airways, among many other skills.
Position: Place the casualty in the Safe Airway Position, what many people will know as the recovery position.
Monitor vital signs: As above.
Not breathing: Some first aiders will carry a small AED (Automated External Defibrillator) that can deliver an electric shock that may, in certain circumstances, restore a normal heart rhythm. Sometimes AEDs are kept at mountain cafes, although the chances of a first aider being able to access the gadget could be slim. Instead, call emergency assistance on 999 or 112.
CPR: Again, this is a handy skill to know, and it is worth signing up to a first aid training course.
Call for emergency help: The chances of survival of an unconscious casualty will depend on a chain of events taking place, including emergency help, early CPR, early defibrillator, rapid transfer to hospital. Know what to do and how to help.
How to make emergency contact
If you have a signal on your mobile phone, you can call 999. Ask for the police (not ambulance services) and give them your information as requested. If appropriate, the police will contact mountain rescue, who will call you back.
If you don’t have a phone signal, you can use Relay UK, by using their mobile application. This service is useful because it can often relay a text message when voice calls are not possible.
Download the app:
There are some injuries and conditions that you should know about. For further information, it is a good idea to attend a first aid training course, specifically one that trains people outdoors.
Broken ribs: While not usually life-threatening, broken ribs can be incredibly uncomfortable and cause difficulties with breathing.
Treatment is limited to pain relief and getting the patient off the mountain quickly. Monitor for signs of shock.
Collapsed lung: Severity depends on how much of the lung has collapsed. Be aware of casualties who have a history of an injury to the chest, shortness of breath and worsening chest pain. In severe circumstances, the casualty may complain of not being able to breathe, look pale and clammy and have fast worsening circumstances.
In all cases, sit the casualty down, and if breathing is not too difficult, you might be able to form the hill self-assist. If serious, immediately dial 999/121 and keep the casualty warm and supported.
In remote settings, the triggers tend to be bee or wasp stings, or some plants. Signs may include itchy skin, running eyes and nose, rash, facial or limb swelling, difficulty swallowing, wheezing or shortness of breath, anxiety, abdominal pain, nausea and vomiting. In severe cases, where the casualty is suffering an anaphylactic reaction, they may start to lose consciousness and stop breathing.
Remove the cause of the allergic reaction, such as the insect or bite. Further treatments include antihistamines. In severe cases, adrenaline may be required. Some first aiders may carry adrenaline, but if not speedy emergency help will be required.
The only indigenous poisonous snake in the UK is the adder. This is the way to treat a bite from an adder, and not other snakes that have been kept domestically and escaped into the wild. Signs are pain and swelling around the bite area, anaphylaxis, throat and tongue swelling, breathing problems, feeling tired and weak, falling unconscious.
Identify the snake, note time of the bite, keep casualty calm, DO NOT BANDAGE or interfere with the bite wound, offer pain relief such as paracetamol, immobilise limb with a splint, dial 999/112. Do not: Cut or suck the venom out, tie a tourniquet around the wound or apply a compressive dressing. And do not kill the snake, as they are a protected species.
In simple terms, a shock is a problem with the circulatory system – the heart, blood vessels and blood – which results in insufficient oxygen reaching the body’s tissues and vital organs. The most common cause of someone going into shock is life-threatening bleeding. Potential fatal bleeding injuries are most likely when a thigh bone or pelvis is broken, or when the spleen, liver or chest are injured. It is very difficult to know if someone has gone into blood loss shock. Some signs include pale and cold skin, fast heart rate (over 100 bpm), fast breathing, thirst and altered mental state.
Dial 999. Treat any bleeding you can see. Lie the patient down and keep them warm and reassured.
A first aider will usually carry a variety of dressings and bandages. There are ways in which to create an “improvised” dressing, too. Read Outdoor First Aid and attend a first aid training course to find out more. Knowing how to use a dressing for best effect, especially when a wound is deep, could save someone’s life.
Spine and back injuries
The concern for most first aiders in this situation is making the injury worse. If an accident occurs where it looks as though the spine or back is injured, it is important to keep the patient still – do not allow them to move. After this, you should take hold of, and support, the head and neck. The head needs to be returned to the “neutral” position.
However, if the casualty complains of increased pain, numbness or tingling while realigning the head, stop what you are doing. If you are not confident about the head mobilisation, simply support the head in the position that you find it. The advice is NEVER to move a spinal injury casualty unless they are in serious danger. Find out more at a first aid training course.
Severe central chest pain and/or pain that travels into the jaw, neck or arms. The person may also suffer breathlessness, dizziness, nausea, vomiting, blushing, sweating and look very ill.
Call 999. Get the casualty to sit down, often in a semi-reclined position, to make them comfortable. If they usually take medication for angina, get them to take this. A first aider may also administer aspirin for heart attack casualties. Soluble aspirin tablets can be chewed and swallowed and may increase the heart attack victim’s chance of survival. You could carry an ASPOD, which is a handy little keyring that carries two aspirin tablets.
This occurs when someone has an abnormally low core temperature in the outdoors and is much more common in winter conditions. Symptoms will be similar but increasingly extreme for various levels of hypothermia, from mild to severe.
Signs of mild hypothermia are shivering, fast breathing, tiredness and mumbling, cold and pale skin. Help the person on the mountain by providing shelter and warmth. Give the casualty extra clothes, hot drinks, high energy foods and then walk them off the mountain.
People with moderate hypothermia may display violent shivering, cold and pale skin and blue lips, confusion, drowsiness, slurred speech and disregard for the cold (such as removing a jacket). Treat as for mild hypothermia, but if you can’t re-warm them call 999.
Signs are shivering that stops, unconsciousness, cold and bluey tinged skin and lips, muscle stiffness, shallow breathing, weak and irregular pulse, dilated pupils. If they look dead, they may well be severely hypothermic. Handle the casualty gently and move them as little as possible, provide shelter, insulate from the ground and place in the Safe Airway Position. Call 999.
Outdoor first aid kits
Your first aid kit will depend on your level of expertise. There is no point in carrying adrenaline, for example, if you do not know how to administer it. The advice in Outdoor First Aid is first to attend a first aid training course.
Core first aid kit items
Examination gloves, tape, support bandage, scissors, triangular bandage, plasters, wound dressing, medical wipes, group shelter, medications (such as painkillers, aspirin, antihistamines and asthma inhaler), glucose gels or tablets, wound closure strips, blister plasters, duct tape, casualty report form, gauze swabs, saline, rehydration tablets, catastrophic bleed dressing, clinical waste bags, tick tweezers and splint.
Outdoors First Aid is published by Pesda Press, £15.00. Look in your local book shop or pick up a copy via Amazon. There are lots of outdoors first aid training courses in Scotland. Have a search on Google.