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Accidents Happen. Especially to people like me who tend to be a bit on the clumsy / reckless end of the scale. If you are away from home, and more especially, away from civilisation, it’s important to know how to deal with common medical emergencies.
This article is not a substitute for first-aid training. Treat this article as a starting point.
Doing a first aid course, like the one offered by St John is a great idea, even if you never leave home, but if you routinely roam around in remote and unfamiliar parts, then it is essential.
C.P.R. and E.A.R. resuscitation are skills that take a few hours to learn, but could save someone’s life.
Handy Info.
The first thing to do, as a well prepared first-aider is have information at hand. We are lucky to live in an era when you don’t need to lug around a paper first-aid manual, so heavy it could give you a spinal injury. Get all the basic info you need by downloading a first aid app for your smartphone.
My Custom First-Aid Kit.
There are plenty of first aid kits available from camping stores and pharmacies. It’s important to settle on a compromise between having the stuff you really need and keeping the weight down. I have made a little kit of my own. It’s got exactly what I need and it was a lot cheaper to put together than a pre-packed one. I’m going to include some items in this list that I use all the time, which are typically not included in a pre-packed kit. Some stuff in this list, like my swiss army knife, serves multiple purposes. Why carry around the extra weight of a special pair of scissors in your first-aid kit, when you can use your pocket knife?
First Aid Kit:
Swiss Army Knife
needle and thread
single use antiseptic swabs
fabric self adhesive bandage
generic paracetamol tablets (for mild pain and headache)
small roll of gauze bandage
emergency foil ‘space blanket‘
photocopies of important documents: passport, ID, insurance, birth certificate, credit card, etc
baby powder (for chafing and heat rash)
generic diarrhea tablets (active ingredient tiliquinol)
disposable latex gloves x2
DEET based insect repellant
water purification tablets (antibacterial)
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Improvised Equipment.
There are plenty of situations which will call for equipment not included in the list above. In many first-aid situations improvisation is the key to success, and you can use what you find in the environment. American soldiers in the south pacific famously resorted to using coconut milk as a substitute for blood transfusion during WWII. That’s an extreme example, but it illustrates the point. What if, for instance, you need to splint a broken arm and make a sling? A straight tree limb can serve as a splint. Bind it with your neck scarf, and make a sling from the floor sheet of your tent.
Responding to an Emergency
In all emergency response situations, the first priority is to summon assistance. If you can phone or radio for emergency services, do so. If there is another person present who can handle the call while you give your attention to the casualty, better yet. It’s good to know the emergency phone numbers for the part of the world you are in. There is an app, eCall, that makes this relatively easy.
Remember the first-aid golden rule:
DR ABC
Once you have summoned assistance, run through the following procedure.
D: Check for Danger:
Ensure you can assist the casualty without becoming a casualty yourself, or making the situation worse. Observe your surroundings and look for environmental threats such as traffic, fire, electrical hazards and flooding.
R: Check the Casualty’s Response:
Is the person conscious or unconscious? Speak loudly and clearly to them. No response means that the casualty is unconscious and it is important to get help as quickly as possible as this is a life-threatening condition.
If they are conscious ask them what their name is. Gently shake the casualty’s shoulder or ask them to squeeze your hand.
If a response indicates that the casualty is conscious and they can be left in the position in which you found them then follow the steps below:
1. manage any life-threatening injuries that need immediate attention
2. manage other injuries
3. get help
If the casualty is unconscious, proceed immediately to the next step: A.
A: Make Sure the Airway is Clear:
Is the patient’s airway clear of blockages?
Turn them onto their side, into the recovery position, with one knee bent, and the head resting on it’s side.
Ensure the neck is well supported if a neck or spine injury is suspected.
To clear the airway, open the mouth and probe inside for foreign objects with your fingers.
If the casualty has an open airway, place your hand high on their forehead, support the chin with your other hand and gently tilt the head backwards, to bring tongue away from back of throat. Lift the jaw forward and open the casualty’s mouth slightly.
With an unconscious casualty, ensuring the airway is open takes precedence over any other injury. However, it is important to handle them gently with minimum of movement.
B: Check if the Casualty is Breathing:
Is their chest rising and falling?
Can you hear breathing?
Can you feel breath on your cheek?
If the casualty is breathing, leave them in the recovery position and check regularly for continued breathing.
If the casualty is not breathing, turn them onto their back and start Expired Air Resuscitation (E.A.R.).
(E.A.R. (like C.P.R.) is best learned from a professional instructor, first hand, so I’m not going to go into a lot of detail here. The basic principle is to force air into the patient’s lungs, by breathing out, directly into their mouth. This technique can also be combined with C.P.R. compressions of the ribcage.)
With the patient on their back, and their head tilted back, the first-aider exhales forcefully into their mouth. You should be able to observe their chest rising and falling with each breath. It is vital to pinch the nostrils closed during this procedure, otherwise the air will simply go straight out of their nose.
There are plenty of pages on the web showing basic instructions on Expired Air Resuscitation, but actual hands on experience is the only way to master the technique.
C: Check for Circulation:
Can you feel a pulse?
Can you see any obvious signs of life?
To assess for signs of circulation follow these steps:
1. Check if carotid (neck) pulse is present
2. Look for any movement, including swallowing or breathing
3. Observe colour of skin on face
To feel for a pulse:
Use the pads of your fingers (NOT the thumb or fingertips). To find carotid pulse place your fingers in the groove on either side of the windpipe (neck), but not on both sides at the same time.
If there are signs of circulation, continue E.A.R. and recheck for signs of circulation about every sixty seconds.
If the patient starts to breathe sufficiently, turn them back onto their side, in the recovery position.
Check their condition and be ready to turn onto back and restart E.A.R. if their breathing stops.
If there are no signs of circulation (or you are unsure), Start C.P.R. (cardiopulmonary resuscitation).
Once again; ressusitation techniques should be learned hands-on with a qualified trainer. Many community organisations offer one day courses, free of charge.
C.P.R. Training Saves Lives.
Common accidents like choking, drowning and shock, as well as incidents such as cardiac arrest may put you in a situation where another person’s life is in your hands. We all want the people around us to know how to care for us in an emergency. C.P.R. or Cardio Pulmonary resuscitation, is a simple technique that can turn a life threatening emergency into a manageable one.
There is no substitute for doing an accredited CPR training session, but the basic techniques are covered in an excellent video, produced by St John.
Chronic or Known Medical Conditions.
If you suffer from a chronic illness, especially one that requires daily medication, make sure you have sufficient stocks of medicine to deal with it, and top up your supply before you run out. You can’t always rely on being able to find a pharmacy that has what you need. Diabetes, epilepsy, asthma, or a mental health issue such as bipolar disorder are manageable as long as you have the drugs you need.
Consult your doctor and be prepared with stocks of medicine. Make a list of the drug’s active ingredients (written on the packaging) so you can find substitutes for your known brands when you are in unfamiliar territory. In many countries generic pharmaceuticals are the only ones available, so knowing what the actual ingredients are, is vital.
Recognising and Treating Hypothermia.
Hypothermia is a shock reaction caused by very low body temperature. Typically caused by exposure to cold weather conditions, hypothermia can set in very rapidly and incapacitate the sufferer.
A hypothermia victim will become tired and apathetic, complain of feeling cold and will shiver violently. Advanced hypothermia will affect physical coordination. The victim will be clumsy and have difficulty walking and performing manual tasks. Speech may also be affected. Typically a person suffering from hypothermia will be inarticulate: mumbling, slurring and grumbling.
To treat hypothermia, get the patient into warm, dry clothes and keep them in a sheltered area like a tent. Wrap the sufferer in a sleeping bag, blanket or extra clothing. This is the time to use your foil space blanket as an outer protective layer.
Keep the patient hydrated by giving them water, ideally warm water. Do not let them drink alcohol. Get them to eat some simple carbs like sugar or chocolate, but only small quantities at a time to avoid vomiting.
Stopping Heavy Bleeding.
Bleeding is a potentially life threatening emergency. Puncure wounds and bleeding caused by broken limbs are common first-aid emergencies.
To treat bleeding, apply direct pressure to the wound until the bleeding stops, or is significantly reduced. Pack the wound with gauze, or any clean absorbent fabric. Apply direct pressure onto the dressing, and elevate the injury above the casualty’s heart.
If blood soaks through the dressing, add more gauze on top and continue to apply pressure. When the bleeding stops completely, clean the wound thoroughly with water. Apply antibiotic or antiseptic ointment to a sterile dressing and completely cover the wound, securing it with tape or a bandage.
For very large, or gaping wounds, press the edges together gently and hold the wound closed with wound closure strips, tape or a bandage. Place a sterilised dressing on top, and then apply pressure as above. Seek medical assistance.
After immediate treatment, and cessation of bleeding, regularly check all wounds (including burns and abrasions) for symptoms of infection such as:
1. increasing pain or sensation of heat
2. redness or dark discolouration
3. swelling
4. large amounts of white pus
5. red or dark streaks just under the skin near the wound
6. fever
If any of these symptoms appear and grow steadily worse, seek medical assistance immediately.
Do not close wounds caused by animal bites or crushing injuries.
Do not close wounds involving damaged joints, tendons, ligaments, or bones.
Do not close heavily contaminated wounds, that are impossible to clean thoroughly.
The above wound types carry a high risk of serious infection. Pack these sorts of wounds with moist gauze, cover with dry bandages, and evacuate the casualty. Seek immediate medical attention.
Damaged Joints and Limbs.
Sprained ankles and broken limbs are common traveller injuries. Medical attention should be sought for any injury that impedes normal movement, but good first aid can speed recovery and reduce the casualty’s pain and anxiety.
Remember the acronym R I C E:
Rest – Ice – Compression – Elevation
Repeat the process outlined below up to four times a day until pain and swelling are alleviated.
1. Rest.
A broken limb or damaged joint should be immobilised as soon as possible.
2. Ice.
In the case of sprains and joint injuries, apply ice to the site of the wound to prevent excessive swelling. If ice is not available apply fabric soaked in cold water, or snow if possible.
After half an hour, let the injured area warm up naturally for 10 minutes before useing the limb again.
3. Compression.
Compress the injury with a bandage or tape wrapping.
4. Elevation.
Raise the injured area, keeping it above the level of the heart to reduce swelling. Use blankets, rope, or any other means of supporting the elevated limb.
Broken and Fractured Bones.
Breaks can be tricky to identify. If the injury is painful and swollen or the casualty doesn’t want to use the injured limb, treat it as a break, and splint it.
Splinting should support and immobilise the injured body part. Use even and firm pressure, but don’t impede normal blood circulation with escessive pressure. Jumpers, blankets, etc, can be used as pads between the limb and the splint. Use the patient’s discomfort level as a guide to how much pressure to apply.
Keep splinted limbs supported and elevated. In the case of a broken leg or ankle, keep the patient on the ground, and elevate the leg.
Observe the patient’s responses and check for tactile sensation in splinted limbs. If they are experiencing swelling or loss of sensation in the fingers or toes, ease the pressure on the bandages.
Seek immediate medical attention for all suspected breaks and fractures.
Get Help.
All serious medical emergencies require attention from a doctor. Always make it a priority to get a casualty to hospital. If there is more than one person at the scene of an emergency, keep the most competent first-aider with the casualty and send others to seek help or evacuation.
Do not attempt to move seriously injured or very ill people on foot. Get help from emergency services and request evacuation.
Send clear information detailing the nature of the emergency, the location and current condition of the patient, and any means of contact available such as phone numbers, or GPS coordinates.
Prevention is the Best Cure.
Stay safe and take care. Educate yourself about the potential hazards in the area you are going to travel in.
Disease and injury can often be avoided with basic self education.
It’s good to get home in one piece, but it’s even better if you can avoid having to put yourself back together.
>> Questions? Check out the Q and A page, or email me.
>> See the world on a shoestring – read the Hitchhiking 101!
>> Great gadgets and handy equipment: pack your bag for adventure!
>> Free accommodation! Read my rookie guide to urban camping.