Paddling / Mountain First Aid & Medical Issues

-by Jay Murdock, SDKC Safety Editor                                                                                                                              

While I compiled this condensed list of treating the most common first aid issues in the mountains, most of it also applies to situations on the water. This info can be put on an 8.5 x 11 sheet of paper (do a copy/paste and change the font size if needed) and carried with your first aid kit.

SHOCK – Rapid & shallow breathing, disorientation, sweating, pale/grey/clammy skin, nausea, vomiting, thirst. Maintain body temperature, elevate arms & feet, make comfortable, reassure with positive talk, and stay with person. Treat underlying cause of the shock (stop bleeding, etc).  No food or liquids. 

CPR – Check for alertness, check for breath, check for pulse. Look for cause and make person safe. Maintain body temperature, and insulate from cold ground if possible, or shade person if in hot sunlight. Send for help. Open airway, but don’t move person if there are signs of trauma (broken bones, internal injuries). Give 2 quick breaths, followed by 30 fast compressions (1 per second). Place heel of hand 1 inch up from the apex of lower rib cage. Continue for up to 60 minutes if needed. Hypothermic victims have been revived to 3.5 hours applying CPR. Make sure there is no pulse & no breathing before you begin CPR in all cases. Use eyeglasses under nose to check for breath fog.

SEVERE HEAD INJURY – Life threatening. Bleeding may not be present. Person may be unconscious, delirious, confused. Look for nausea, vomiting, slurred speech, deformity, unequal pupils, headache, dizziness, convulsions, staggered walk, breathing problems, sleepiness, loss of memory, blue lips or nails. If unconscious, suspect spinal cord injury also, and do not move except to protect life (to stop bleeding, choking on blood, or move from rock fall area, etc). Treat for shock and monitor breathing, keeping airway open. Keep head higher than the body if conscious.  Avoid over-pressure when stopping bleeding. If open wound and brain protrusion, cover with dressing without applying pressure. Even if person states/acts/looks ok, suspect brain injury. Have person sit, and do not give aspirin, food or waterSend for help fast, with all observed info and location. Person must be air lifted out if possible, even if they act/look ok.

HEADACHE – When there is a headache only, take acetaminophen with 1 liter of water. If headache is gone quickly, it is not mountain sickness (AMS).

HEART ATTACK – Shortness of breath, pressure in the chest, pain in upper abdomen/neck/left shoulder and arm, nausea, dizziness, sweating. Have person sit and give aspirin or Excedrin Extra Strength. Loosen clothing, make comfortable. If unconscious, give CPR. Send for help fast.

BLEEDING – Profuse bleeding can cause death within 5 minutes. Internal bleeding will cause shock.  External bleeding must be stopped before CPR is started, if you are the only person giving aid.  Send for help.  Treat for shockDo not give aspirin. Use direct pressure and initiate immediately. Apply your hands, one on top the other over a cloth it you have that, and keep the pressure applied without letting up for 5 minutes. Use a loose tourniquet if needed. A tight tourniquet should not be on for more than 1 hour to avoid the loss of a limb. Check on the under-side of the person, even if you suspect severe trauma. You must stop all the external bleeding, or death will result.

BEE / WASP STING – Anaphylactic shock if a reaction, and is life threatening.  Difficult breathing, swelling of the face, eyes, tongue. Treat with an antihistamine spay, and/or Benadryl tablet (crush and dissolve in a few drops of water and immediately put under the tongue). Apply endotracheal tube if breathing stops. **     

BROKEN BONES – Person will “guard” the broken area. A “compound fracture” will have bleeding and bone protrusion. Treat for bleeding and shock. Stabilize the area, and do not allow it to move. Cover open wound with clean cloth/bandage. A broken rib can penetrate the lung. Listen for air escaping, and tape a plastic bag over the hole. Do not give aspirin.

BURNS – First Degree top layer only. Apply cool water. Take Acetaminophen or Ibuprofen for pain. Second Degree two skin layers with blisters. Do same as First and apply triple antibiotic, then loose gauze. Third Degree is an emergency with no pain. Keep area clean, away from clothing, raise area above heart. Evacuate.

DEHYDRATION – Nausea, headache, confusion, dizziness, thirst, weakness. Altitude and low humidity will contribute.  Seek shade, sit down, drink plenty of water or Gatorade, and rest for a while. No salt or food, except for high-energy foods in moderation. After recovery, stay away from spicy foods that day. Diarrhea, burns, or vomiting caused dehydration causes low blood sodium levels. Water and salt is then needed. A low salt level can lead to unconsciousness and death.

HEAT EXHAUSTION – Caused by high humidity and high temperatures. Humidity will not allow for sweating to be effective. Not life threatening.  Cool person down, drink water/Gatorade, get plenty of rest. Don’t eat, except snacks.

HEAT STROKELife threatening. Person cannot cool down. Red face, lack of sweating, breathing difficulty. Severe vomiting, headache and diarrhea, leading to convulsions and unconsciousness.  Cool person down and give plenty of water or Gatorade. If near water, immerse 2 limbs in water to aid cooling. Treat for shock and send for help.

HYPOTHERMIA – Disorientation, sluggishness, dizziness, weakness, uncontrolled shivering, desire to lie down and sleep.  Often brought on by dehydration and exhaustion. Get person dry, give warm liquids, or food/drink with sugar, but NO caffeine (unless cold water immersion). Warm in sleeping bag, and get in with person if going unconscious. Don’t let person go to sleep, and stay upbeat. Do not let person “give up”. Overt fear will cause the situation to become worse.

ACUTE MOUNTAIN SICKNESS – Nausea, dizziness, severe headache, disorientation, weakness, thirst, coughing, breathing difficulty and gurgling sound, difficulty sleeping. Can be life threatening. Give plenty of water, and get person to lower altitude. Do not leave unattended. You must get person down the hill. If headache or breathing difficulty persists, get medical help FAST, as this could be cerebral or pulmonary edema. Give aspirin or Ibuprofen.  HAPE & HACE. Test for HACE: “Walk the Line”.  Three “Golden Rules”: 1. If sick at altitude, it is AMS until proven otherwise. 2. Never ascend with AMS. 3. If you are getting worse, go down at once. Any delay can result in death. If person has HACE (high altitude cerebral edema), get medical help, even if feeling better.

LIGHTNING STRIKE – Can kill within 30 ft on land, 300 ft on water. Divide number of seconds by 5 to get distance. Get off exposed areas and get low by squatting. Stay away from tall trees. If in your tent, sit up, and place all your clothes under you, including your feet. Drink lots of water.  First Aid: treat for trauma, broken bones, and burns. Treat for shock.  

HANTAVIRUS – Deer mice droppings breathed in from dust or transferred by contaminated kitchen gear or food.  Pick up your feet as you walk. Protect all kitchen gear and utensils. Check food for signs of mice. Wash hands after contact with those items if you see droppings, or holes in food wrappings.   

INFECTION / POISONING – Caused by air-borne or water-borne protozoa or virus. Can contaminate eating and drinking items. Protect and clean those items, especially after a rain. Dig down 3 inches from surface when using snow for water. Treat all drinking water, wiping the opening of the container after treatment. Be careful when washing face or swimming.

IMPALED OBJECTSLeave in place, unless obstructing the airway. Treat for bleeding and immobilize the object. Hold on & walk person out, or send for help.

GOING FOR HELP – After assessing situation, send 2 walking out, with your location on a map, staying on a trail, not cross-country.  They need to carry map, compass, rain gear, warm clothes, two headlamps, food and water. Make sure they have all pertinent information about victim’s condition.  


**- Applying an endotracheal tube requires training. If you are serious about leading a group in remote areas, you should do that. I took EMT training at the Balboa Naval Hospital, first aid training as a volunteer fire fighter, and Red Cross Instructor classes. I also taught wilderness first aid at the college level, and took part in a rescue of a fallen climber on the face of Mt Whitney, who had severe injuries and hypothermia.

Note: Before each trip you should go over the above info to refresh your memory, then go over it with the group at the start of each trip. You can never over-prepare for this.