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The objective of this Web Page is to familiarize you with basic first aid techniques in some common emergencies -
not to make you an expert in first aid

When journeying into the wilderness it is important to carry a complete
 First Aid Kit and a First Aid Book.
 It is also wise to take a first aid course. 

INTRO | ABC's | CPR basics | Common Mistakes | Cuts | Abrasions | Altitude Sickness | shock | choking | Wounds | bleeding | head injuries | Eye Injuries | spinal injuries | dislocations & sprains | fractures | Drowning | Hypothermia/severe cold | Frostbite |  | severe heat | burns | Food Poisoning | moving a victim | bites & stings  | Blisters | Trench Foot  | Swimmers Ear|  
| How To Choose A First Aid Kit |

Warning - All Contents, (including the information relating to medical, financial, construction, or other activities that could result in damage, injury, or death) is for informational purposes only. This information should not be considered complete and is not intended to be used in place of a visit, call, consultation, or advice of your physician or other professionals or any information contained on or in any product packaging or labels. The FUNdamentals of camping does not recommend the self-management of health problems or duplication of any activity or process described in the Contents.  You should never disregard professional advice or delay in seeking advice because of something in the Contents and you should not use the Contents for diagnosing a health or other problem or prescribing a medication.

The information on this site is for entertainment and personal knowledge enrichment only and is not intended to be a substitute for professional medical advice. You should not use the information on this site to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.

The information on this page is designed as a reference material only, to help people who have already taken a wilderness first aid course and CPR training. It is not a substitute for training and certification in first aid and CPR. If you have not been properly trained in these procedures, you can cause more harm to your patient by treating him or her.

If you haven't taken a first aid or CPR course, take one before you go into the backcountry! 

see terms of this site

It is your responsibility to attend a Certified First-Aid CPR Course
 (American Heart Association or Red Cross)

It's an old saying,
"An Ounce of Prevention, IS Worth a Pound of Cure",
especially in an emergency situation when seconds count. 

Here are a few selected first aid tips that may be useful in a disaster situation!! 

First aid is the immediate care given to a person who is injured or ill. Sudden illness or injury can often cause irreversible damage or death to the victim unless proper care is initiated as soon as possible. First aid includes identifying a life-threatening condition, taking action to prevent further injury or death, reducing pain, and counteracting the effects of shock, should they be present.

Because life-threatening situations do occur, everyone should know how to provide emergency care until a victim can be treated or transported to a medical facility.

First aid is not intended to replace care by a physician. Its intent is to protect the victim until medical assistance can be obtained. For any situation that appears to be life-threatening, it's important to remember to call 9-1-1 and get help on the way as soon as possible .

The primary purpose of first aid is to: 

Care for life-threatening situations
Protect the victim from further injury and complications.
Arrange transportation for the victim to a medical facility.
Make the victim as comfortable as possible to conserve strength.
Provide reassurance to the victim.

As a Rule of Thumb
 Call 9-1-1 if:

The victim has lost consciousness, is unusually confused, or is losing consciousness.
The victim has difficulty breathing or is not breathing in a normal way.
The victim has chest pain or pressure that won't go away.
The victim has persistent pressure or pain in the abdomen.
The victim is vomiting or passing blood .
The victim is having seizures or severe headache, or has slurred speech.
The victim has head, neck, or back injuries .
The victim seems to have been poisoned.

An accident can occur at any time or any place If you are the first person to arrive, there are a few basic principles you should follow to protect yourself and the victim First, CALL 9-1-1: then:

1. Survey the Scene. Before you help the victim, determine if the scene is safe. If anything dangerous is present, don't put your own life at risk to try and help the victim: you will be of no aid if you become a victim too. Summon help and wait for trained people to resolve the situation. If the scene is safe, try and determine what happened and how many victims there may be. Never move the victim unless an immediate, life-threatening danger exists, such as a fire or the threat of a building collapse.

2. Primary Victim Survey. After ensuring the scene is safe, you can turn your attention to the victim. Begin by performing a primary survey to determine if the victim:

is conscious 
has an open, unobstructed airway 
is breathing 
has a heartbeat 
is not bleeding severely 

To check for consciousness, gently tap the person and ask if they are okay. 
If there is no response, this in an indication that a possible life-threatening situation may exist. 
If the person is responsive and can talk or cry, this indicates they are conscious, breathing, have an unobstructed airway, and a pulse. 

If the victim is unconscious, kneel down next to the head and check for the ABCs: Airway, Breathing, and Circulation. To check the airway (clear and maintain an open airway), breathing (restore breathing), and for circulation (restore circulation), place your ear next to the victim's mouth and listen/feel for breath sounds while looking for a rise and fall of the chest. While doing this, check for a pulse by placing your fingers on the neck, just below the angle of the jaw, and feel for the pulse from the carotid artery. These three steps will determine if cardiopulmonary resuscitation (CPR) is needed.

 If you would like to learn how to perform CPR and First Aid, 
contact your local fire department, hospital, or the American Red Cross. 

It is your responsibility to attend a Certified First-Aid CPR Course
 (American Heart Association or Red Cross)

Head - to - toe examination
for injury 
should include:

Head, neck, shoulders, chest, arms, abdomen, back, pelvis, legs & feet

Vital signs you can check:
Level of consciousness, pupils, pulse, skin color, body temperature, respiration & response to stimulus

But First!

The Primary Survey
Establish Responsiveness

Gently tap the person and ask, 
"Are you all right!"

General Rules

Do not move the victim unless necessary 

Although each case involving injury or sickness presents its own special problems, some general rules apply to practically all situations. Become familiar with these basic rules before you go on to learn first aid treatment for specific types of injures:

The specific sequence of actions when dealing with this situation is: 

Remain calm, providing your patient with quiet, efficient first aid treatment.

Keep the victim warm and lying down motionless, head level with the body, until you have found out what type of injury has occurred and how serious it is.

If the victim shows one of the following difficulties,
 follow the rule given for that specific problem;

Start mouth-to-mouth artificial respiration immediately if the injured person is not breathing.

  Stop any bleeding.
Vomiting or bleeding from the mouth and semiconscious: If the victim is in danger of sucking in blood, vomited matter or water, place the victim on his/her side or back with their head turned to one side and lower than the feet.

  Give your patient reassurance. Watch carefully for signs of shock.

  Check for cuts, fractures, breaks and injuries to the head, neck or spine.

  Do not allow people to crowd the injured person

  Do not remove clothing unless it is imperative.

  To determine the extent of the victim's injuries, carefully rip or cut the clothing along the seams. If done improperly, the removal of the victim's clothing could cause great harm, especially if fractures are involved. When clothing is removed, ensure that the victim does not get chilled. Shoes may also be cut off to avoid causing pain or increased injury.

Decide if your patient can be moved to a proper medical facility. If this is not possible, prepare a suitable living area in which shelter, heat and food are provided.

Shortness of breath: If the victim has a chest injury or breathing difficulties place him/her on their back with their head slightly lower than the feet.

Do not move the victim more than is absolutely necessary.

The victim should not see the actual injury. You should make the victim more comfortable by ensuring the individual that the injuries are understood and medical attention is on the way.

Do not touch open wounds or burns with fingers or other objects unless sterile compresses or bandages are not available and it is absolutely necessary to stop severe bleeding.

Don't give an unconscious person any solid or liquid substance by mouth. The person may vomit and get some material into the lungs when breathing, causing choking and possibly death.

If a bone is broken, or you suspect one is broken, do not move the victim until you have immobilized the injured part. This may prove lifesaving in cases of severe bone fractures or spinal cord injuries. The jagged bone may sever nerves, blood vessels, damage tissues and induce or increase shock. Threat of fire, necessity to abandon ship or other similar situations may require that the victim be moved. The principle that further damage could be done by moving the victim should always be kept in mind and considered against other factors.

When transporting an injured person, always see that the litter is carried feet forward no matter what the injuries are. This will enable the rear bearer to observe the victim for any respiratory obstruction or stoppage of breathing.

Keep the injured person warm enough to maintain normal body temperature.

Very serious injuries may require heroic first aid measures on your behalf. The greater the number of injuries, the more you must exhibit better judgment and self-control to prevent yourself and well-intentioned bystanders from trying to do too much.


If there is no response, begin the ABC's of CPR



Seek Medical Attention! 

It is your responsibility to attend a Certified First-Aid CPR Course
 (American Heart Association or Red Cross)


The following steps for cardiopulmonary resuscitation are not meant to be an absolute guide for performing this lifesaving procedure, but rather as a reminder for those who have forgotten their skills, or an introduction for those who are interested in taking an instructional class in the future.

A person is not legally insured to perform CPR unless he has passed a written and skills exam and been certified by an organization such as the American Red Cross.
It is highly encouraged that everyone receive this basic training, even children. 

Do not perform CPR unless you are professionally trained and certified. 

CPR should not be attempted by a rescuer who has not been properly trained.
To learn CPR, consult a qualified instructor. 
Improperly done CPR can cause serious damage. 
Therefore, it is never practiced on a healthy individual for training purposes; a training aid is used instead.

Then why did I put this section on this web page?
If it was me and my Wife or one of my boys were needing CPR and we are stranded with NO WAY to get Medical Help -
I would rather take my chances in saving them than to watch them die . . .

just my opinion!

CPR Basics

NOTE: To properly learn CPR, a certified instructor must conduct the training.

Cardio - Pulmonary - Resuscitation


First - Tilt head back & lift chin up, pinch victim's nose shut

Blow 2 slow breaths into victim's mouth
(2 seconds for adults, 1-1/2 for children)

- inhale after each breath
- watch for chest to rise
- allow deflation after each breath
- reposition neck if necessary



Check pulse - put 2 fingers in groove of neck nearest you - if there is no pulse, begin chest compressions


Slide fingers up rib cage to notch in middle of chest


Put index finger in notch & slide heel of other hand next to fingers


Now put hand that found the rib notch on top of other hand & press downward with heel of bottom hand about 1 1/2-2 inches, making sure to keep your arms straight

NOTE: Use only one hand on a child or small or aged adult

Keep this procedure up, alternating breaths & compressions:

2 breaths
15 compressions
(one-and-two-and . . .) 
2 breaths - continue until victim breathes or help arrives

Check pulse & breathing regularly for any response

Repeat these steps approximately 12 to 15 times per minute.

 If treating a child, cover the nose and mouth with you mouth. Use smaller puffs of air and repeat this method 20 to 25 times per minute.

Seek Medical Attention! 

10 Common First Aid Mistakes

Picture this: You're walking through the woods behind your house and are bitten by a rattlesnake. What would you do?

John Wayne probably would have pulled out his penknife, sliced the bite wound, sucked out the venom and tied on a tourniquet. But that's the wrong approach for anyone except a silver-screen cowboy.

"The safest thing to do for snakebite is just splint the limb and go to the hospital," says Christopher P. Holstege, M.D., assistant professor of emergency medicine at the University of Virginia Health Sciences Center and director of the Blue Ridge Poison Center in Charlottesville, Va.

"Cutting the bite wound could sever tendons, nerves or arteries or increase the risk of infection, and tourniquets are risky," Dr. Holstege explains.

Dr. Holstege recommends the right approaches for the following first-aid myths.

Myth: Put butter on a burn.

Reality: If you apply butter or another substance to a serious burn, you could make it difficult for a doctor to treat the burn later and increase risk of infection.

The right approach: "It's usually OK to cool the burn with cold water, but burns with significant blistering need to be seen at a health care facility," says Dr. Holstege. Keep the burn clean and loosely covered; don't pop the blisters.

Myth: Give syrup of ipecac before calling the poison-control center.

Reality: If your child swallows something poisonous, hold off on the syrup of ipecac -- the over-the-counter treatment for inducing vomiting. "If someone ingests a hydrocarbon such as gasoline or kerosene, for example, vomiting can cause aspiration in the lungs," Dr. Holstege says.

The right approach: Immediately call your doctor or a poison-control center for advice.

Myth: Apply a tourniquet to a bleeding extremity.

Reality: When severe bleeding occurs, some people mistakenly tie a belt or shoestring around the limb above the wound to slow the flow of blood. But doing so can cause permanent tissue damage.

The right approach: Pad the wound with layers of sterile gauze or cloth, apply direct pressure, and wrap the wound securely. Seek medical help if the bleeding doesn't stop or if the wound is gaping, dirty or caused by an animal bite.

Myth: Apply heat to a sprain, strain or fracture.

Reality: Heat gives the opposite of the desired effect -- it promotes swelling and can keep the injury from healing as quickly as it could.

The right approach: Apply ice, alternating 10 minutes on, 10 minutes off, for the first 24 to 48 hours.

Myth: You should move someone injured in a car accident.

Reality: A person with a spinal-cord injury won't necessarily appear badly injured, but pulling him or her out of a vehicle -- even removing the helmet from an injured motorcyclist -- could lead to paralysis or death.

The right approach: If the vehicle isn't threatened by fire or another serious hazard, it's best to leave the person in place until paramedics arrive.

Myth: Rub your eye when you get a foreign substance in it.

Reality: Doing so could cause a serious tear or abrasion.

The right approach: Rinse the eye with tap water.

Myth: Use hot water to thaw a cold extremity.
Hands and feet go numb when they get too cold, in which case many people try to warm them up by putting them under hot water.

Reality: Hot water can cause further damage.

The right approach: Use lukewarm water only, or use dry heat.

Myth: Sponge on rubbing alcohol to reduce a fever.

Reality: Alcohol can get absorbed by the skin, which can cause alcohol poisoning, especially in young children.

The right approach: "Take acetaminophen or Ibuprofen," says Dr. Holstege. "If a fever is very high, have it checked by a physician or treated in a hospital emergency room."

Myth: It's OK to treat at home an allergic response to a bee sting.

Reality: Delaying professional treatment could be fatal.

The right approach: For symptoms such as breathing problems, tight throat or swollen tongue, call an ambulance immediately.

Copyright 2003 Health Ink and Vitality Communications, 780 Township Line Road, Yardley, PA 19067, 1-800-524-1176

Publication: Vitality magazine
Publication Date: November 2000
Author: Polly Turner
Source: University of Virginia Health Systems
On-line Editor: Dianna Sinovic
On-line Medical Reviewer: Donald Whorton, M.D.

Date Last Modified: 8/12/03


Cuts are defined as any opening or breaking of the skin. Cuts are a common injury, and the first step in treating a cut is to determine whether it is a major or minor wound. A major wound is defined as any wound where:

  • The bleeding does not stop after five minutes of steady pressure 

  • The victim has been bitten by an animal or human or deeply punctured by any dirty object 
  • The wound has glass, dirt or metal embedded inside 
  • The wound leads to swelling, fever or problems with movement or sensation 

If any of these conditions are present, medical attention should be sought immediately.

First aid:

  • All cuts, whether a major or minor cut, need first aid. In treating any cut, caregivers should always wash their hands with soap and water before and after treatment. Breathing or coughing on the wound should be avoided in order to prevent infection.

  • The most important goal is to stop the bleeding as much as possible by applying direct pressure to the wound. In the case of a wound with an embedded object, indirect pressure should be applied. This pressure will help to close the wound, thus stopping the bleeding and limiting further contamination of the wound.

  • If it is determined that a wound is not major, it should be cleaned thoroughly with mild soap and water, then covered with an antibiotic ointment and a clean bandage. It is advised not to attempt to clean a large wound, as this may cause excessive bleeding. Instead, cover it with a clean cloth and apply direct pressure.

Even when all precautions are taken, a wound may become infected. 
Wounds that are more likely to become infected are bites, punctures, dirty wounds and wounds that do not receive proper medical attention. Symptoms of infection include:

  • A painful, throbbing sensation 

  • Swelling 
  • Pus-like drainage 
  • Heat in the area 
  • Redness 

An antibiotic should be applied to any infected wound, and professional medical attention may be needed to ensure proper healing.


It is important for the outdoor enthusiast to carry the knowledge and material for treating "road rash" for several reasons. One is they hurt, and proper treatment reduces pain, eventually. Another is that untreated abrasions leave more noticeable scars. A third reason is to prevent infection, and few wounds are more prone to infection than an abrasion.

The time it takes to properly treat an abrasion is directly proportional to the size and strength of the victim. Wimpy people can be held down while they are being vocally abusive as their wounds are thoroughly cleaned and bandaged. With large, powerful patients, you'll want to get in and get out fast.


Irrigate the wound to remove loose foreign material. Water will do fine, and any water safe to drink is safe to clean wounds. This is best done with an irrigation syringe, a device that comes in most first aid kits. Or fill a plastic bag with water and punch a pinhole in it. The idea is to create a forceful stream to wash out dirt and debris. In the process, you may, also, be washing out some of the germs.

Vigorously scrub the abrasion. Some first aid kits have cleansing pads especially made for abrasions and containing a topical anesthetic. Cleansing pads allow you to wipe the abrasion gently first, and wait about five minutes for the anesthetic to work. Warning: the scrubbing is still quite painful, but absolutely necessary for safeguarding against infection and tattooing (a unique form of scarring left by embedded material). You can scrub with any clean cloth and any soap. Scrub until nothing remains visible in the wound except raw meat.

Rinse the wound again. If the scrubbing has started some bleeding, you can just let it bleed or apply pressure with a sterile gauze pad or sponge. Letting it bleed might be a bit better since the patient is doing a little involuntary self-cleaning of the wound.

When you have a clean, non-bleeding wound, apply a thin layer of antibiotic ointment
(not cream, but ointment). 

Dress and bandage the wound. Dressings go directly on the abrasion, and any non-adherent dressing will work. Spenco 2nd Skin works really well, soothing with its coolness, protecting with its rubbery-ness, allowing you to see through to watch the wound for signs of infection. It can be left in place as long as no infection shows up. Over the dressing goes the bandage. You can tape a gauze pad over the dressing, but elastic wraps work better, being more secure. Stretch gauze is probably the best: it conforms easily to the shape of the abraded body part, it is lightweight, it is more difficult to put it on too tight
 (which can cut off healthy blood flow). 

Human skin is tough and resilient, fortunately, and abrasions, with a little pre-planning, are easy to manage. We're lucky that way . . .
er, I mean, it could be worse! 

© 1999 Buck Tilton. All Rights Reserved.

Altitude Sickness
Minimize pain & maximize fun.

Adventurers heading for the mountains hoping to experience what they pray will be ideal skiing, climbing or mountaineering conditions and with a need to cram a week's worth of adventure into an action-packed weekend are asking for trouble by forgetting that they live at sea level most of the year.
 Altitude sickness, that purveyor of nausea, headaches, insomnia and other sometimes more serious maladies is the reason.

Altitude sickness doesn't discriminate--it can affect anyone regardless of age, sex or physical conditioning. In fact, some of the best and most well-conditioned athletes suffer altitude sickness. Altitude sickness can even occur despite a history of not being susceptible. Edmund Hillary, world renowned mountaineer began experiencing altitude sickness years after he had summited Everest.

Too high, too fast appears to be a major cause of altitude sickness. Altitude sickness occurs most commonly at elevations above 8,000 feet but can certainly happen above 6,000 feet. Dehydration and overexertion are major contributing factors.

Regardless of what causes it, there are some precautions one can utilize to minimize the possibility of becoming altitude sick. Climb high and sleep low is one tried and true technique employed by mountaineers, but this is not always practical when your condo is at 8,000 feet and you are skiing or climbing at 9,000 feet.

Keeping your ascent under moderation is another technique, but again, when skiing the point becomes somewhat moot since lift lines shoot you up and down several thousand feet throughout the day.

"The classic avoidance technique is to acclimatize by not ascending more than 1,000 feet per day above 7,500 feet," says Dr. Paul Auerbach, Chief of Emergency Medicine at Stanford University Medical Center.

Jumping into the car at sea level and leaping out at 9,000 feet to play blows any acclimatization plan clean out of the water and really opens the door for altitude sickness. Auerbach suggests spending some time with the feet up in the tent, condo or lodge before adventureing out. If that means adding a day to your weekend in the name of health, so be it.

"Dehydration is a causative and a worsening factor when it comes to altitude sickness," says Auerbach. "It is critical that a person stays well hydrated so that urination is frequent and clear or light colored."

Auerbach also recommends laying off the coffee and tea since both are diuretics (causes your body to lose vital fluids). Liquor, aside from the fact that it is also a diuretic and clouds judgment is even worse for the body since symptoms of a hangover mimic those of altitude sickness confusing diagnosis.

Acetazolamide (Diamox) is a prescription drug that does appear to be a factor in enhancing a person's ability to acclimate to altitude, and is used in reducing the effects of altitude sickness. Like any drug, it does have side effects and is not for everyone. It is a sulfa derivative so persons allergic to sulfa drugs should not take it and it is also a mild diuretic so maintaining a regular fluid intake is essential. Seek the advice of your physician before using the drug.

"Although it is recommended in higher doses, we are finding that doses of 62.5 or 125 mg twice per day beginning upon ascent to altitude and continuing for a day after the highest altitude has been reached are sufficient," says Auerbach.

How do you know if you have altitude sickness? An early morning headache that doesn't go away is one fairly sure sign. Low levels of energy, insomnia, shortness of breath, nausea and loss of appetite are all symptoms that can, either alone, or in combination indicate altitude sickness.

Descending and reducing your level of activity are the standard remedies once you feel altitude sick. Do not push it! While mild symptoms are more a nuisance than a health threat, they are a definite warning to acclimatize.

Levels of altitude sickness can progress to moderate and then severe which may result in required hospitalization or death in extreme cases. Confusion, vomiting, difficulty walking a straight line or severe shortness of breath are signs of impending severe high altitude illness. In such a case, the victim should be immediately brought to medical attention for the administration of oxygen and rapid descent to a lower altitude.

© 1999 Michael Hodgson; All Rights Reserved

The Silent Killer

Straighten victim's legs & elevate above heart 8" to 12"

Shock is a life-threatening secondary condition wherein the body's vital physical and mental functions are seriously impaired due to an inadequate supply of oxygenated blood reaching the lungs, heart or brain. This is the body's reaction to a serious injury, illness, or other traumatic event.

Shock is a depression of all of the body processes and may follow any injury regardless of how minor. Factors such as hemorrhage, cold and pain will intensify shock. When experiencing shock the patient will feel weak and may faint. The skin becomes cold and clammy and the pulse, weak and rapid. Shock can be more serious than the injury itself.

Characteristics of shock include: 

1. Anxiety (usually the earliest sign), weakness, paleness, sweating, and thirst; 
2. Pulse may become rapid and weak; 
3. Patient may become dizzy and pass out; 
4. The more severe the injury or illness, the more likely shock will set in; 
5. Shock can result in death if not treated rapidly.


To treat shock, check your "ABC's," then,

Use the following method to prevent and control shock: 

1. Handle the patient gently, and only if necessary; 

2. When treating injuries: 

i. restore breathing
ii. stop bleeding 
iii. treat breaks and fractures

2. If conscious and if there are no head or chest injuries place the patient on his/her back with the head and chest lower than the legs. This will help the blood circulate to the brain, heart, lungs and other major organs.
If the patient is unconscious, place face down, with the head to one side, to prevent choking on blood, vomit or the tongue.
But only if no neck injury is suspected;

3. Except in the case of a head injury or suspected neck fracture, lower the head and shoulders and elevate the feet approximately 15 inches;If severe head and chest injuries are present elevate the upper body. If chest injuries are present, elevate the injured side to assist in the functioning of the uninjured lung.

4. Make sure there are no broken bones before straightening the patient out; 

5. Protect the patient from becoming cold, especially from the ground below; 

6. Continue to reassure the patient.

Shock is a life-threatening condition that requires immediate medical treatment. 
Some degree of shock can accompany any medical emergency.
 Shock can get worse very rapidly. 
Be prepared to begin rescue breathing or CPR as needed. 


First Aid

1. Check the victim's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.

2. If the victim is conscious and does not have a head, leg, neck, or spinal injury, place the victim in the shock position by laying the victim on the back and elevating the lower extremities about 12 inches. Do not elevate the head. However, if the victim has sustained an injury in which raising the legs will cause pain, leave the victim flat.

3. If the victim has sustained a possible spinal injury, keep the victim in the position in which he or she was found.
Do not place the victim in the shock position. 

4. Give appropriate first aid for any wounds, injuries, or illnesses.

5. Keep the person warm and comfortable.
 Loosen tight clothing.
 Don't give the victim anything to drink or eat. 

6. If the victim vomits or is drooling, turn the head to one side so vomits can drain (as long as there is no suspicion of spinal injury). If spinal injury is suspected and the victim vomits, "log roll" him or her by supporting the neck and spine to keep head position neutral with body position while turning the victim onto his or her side.

7. Call for immediate medical assistance and continue to monitor the victim's vital signs
(temperature, pulse, rate of breathing, blood pressure)
until help arrives. 


Do Not

DO NOT give the victim anything by mouth. 

DO NOT move the victim if a spinal injury is suspected. 

DO NOT wait for milder shock symptoms to worsen before calling for emergency medical assistance. 


Call immediately for emergency medical assistance if

You suspect a person is in shock.
Try to determine the cause of shock.
 Check for a medical alert tag.
 Shock requires immediate treatment to prevent damage to vital organs and tissues. 


Preventing shock is easier than trying to treat it once it happens. 
Prompt treatment of the underlying cause will reduce the risk of developing severe shock. 
Early first aid can help control shock. 

Major classes of shock include: 

cardiogenic shock 
(associated with heart problems)
Cardiogenic shock is a disease state where the heart is damaged enough that it is unable to supply sufficient blood to the body.

Causes, incidence, and risk factors  

Shock occurs whenever the heart is unable to pump enough blood for the needs of the body. Cardiogenic shock can be caused by disorders of the heart muscle, the valves, or the heart's electrical conduction system.

Some related disorders include heart attack, heart failure, cardiomyopathy, rupture of the heart, abnormal heart rhythms, and heart valve disorders (especially leaky valves).


rapid pulse 
pulse may be weak (thready) 
rapid breathing 
anxiety, nervousness 
skin may feel cool to touch 
weakness, lethargy, fatigue 
decreased mental status 
loss of alertness 
loss of ability to concentrate 
restlessness, agitation, confusion 
skin color pale or mottled 
profuse sweating, moist skin 
decreased urine output (or none) 
poor capillary refill 


Cardiogenic shock is a medical emergency!
 Treatment requires hospitalization. 
The goal of treatment is to save the patient's life and treat the underlying cause of shock

hypovolemic shock
(caused by inadequate blood volume)
A condition where the heart is unable to supply enough blood to the body because of blood loss, or inadequate blood volume.

Causes, incidence, and risk factors

Loss of approximately one-fifth or more of the normal blood volume produces hypovolemic shock. The loss can be from any cause, including external bleeding (from cuts or injury), bleeding from the gastrointestinal tract, other internal bleeding, or diminished blood volume resulting from excessive loss of other body fluids (such as can occur with diarrhea, vomiting, burns, and so on). In general, larger and more rapid blood volume losses result in more severe shock symptoms.


rapid pulse 
pulse may be weak (thready) 
rapid breathing 
anxiety or agitation 
cool, clammy skin 
pale skin color (pallor) 
sweating, moist skin 
decreased or no urine output 
low blood pressure 


Obtain professional medical care immediately! 

Limited measures to help include: 

Keep the victim comfortable and warm (to avoid hypothermia). 

Have the victim lie flat with the feet elevated about 12 inches to increase circulation. However, if the victim suffers from a head, neck, back, or leg injury, leave the victim in the position in which they were found unless doing so poses other immediate danger.

Do not give fluids by mouth. 

If victim is stung or suffering an allergic reaction, treat the allergic reaction. 

If the victim must be carried, try to maintain the flat, head down, feet elevated position.
Stabilize the head and neck before moving a victim with a suspected spinal injury. 

anaphylactic shock
(caused by allergic reaction)
Anaphylaxis is a life-threatening type of allergic reaction

Causes, incidence, and risk factors

Anaphylaxis is an acutesystemic (whole body) type of allergic reaction. It occurs when a person has become sensitized to a certain substance or allergen (that is, the immune system has been abnormally triggered to recognize that allergen as a threat to the body).

On the second or subsequent exposure to the substance, an allergic reaction occurs. This reaction is sudden, severe, and involves the whole body.

Tissues in different parts of the body release histamine and other substances. This causes constriction of the airways, resulting in wheezing; difficulty breathing; and gastrointestinal symptoms such as abdominal pain, cramps, vomiting, and diarrhea.

Histamine causes the blood vessels to dilate (which lowers blood pressure) and fluid to leak from the bloodstream into the tissues (which lowers the blood volume), resulting in shock. Fluid can leak into the alveoli (air sacs) of the lungs, causing pulmonary edema.

Hives and angioedema (hives on the lips, eyelids, throat, and/or tongue) often occur, and angioedema may be severe enough to cause obstruction of the airway. Prolonged anaphylaxis can cause heart arrhythmias.

Some drugs (polymyxin, morphine, X-ray dye, and others) may cause an anaphylactoid reaction (anaphylactic-like reaction) on the first exposure. This is usually from a toxic or idiosyncratic reaction rather than the "immune system" mechanism that occurs with "true" anaphylaxis, though the symptoms, risk for complications without treatment, and therapy are the same.

Anaphylaxis can occur in response to any allergen. Common causes include insect bites/stings, horse serum (used in some vaccines), food allergies, and drug allergies. Pollens and other inhaled allergens rarely cause anaphylaxis. Some people have an anaphylactic reaction with no identifiable cause.

Anaphylaxis occurs infrequently. However, it is life-threatening and can occur at any time. Risks include prior history of any type of allergic reaction.


Symptoms may include the following:

Difficulty breathing 
Abnormal (high-pitched) breathing sounds 
Slurred speech 
Rapid or weak pulse 
Blueness of the skin (cyanosis), including the lips or nail beds 
Fainting, light-headedness, dizziness 
Hives and generalized itching 
Sensation of feeling the heart beat (palpitations) 
Nausea, vomiting 
Abdominal pain or cramping 
Skin redness 
Nasal congestion 

Note:  Symptoms develop rapidly, often within seconds or minutes.


Anaphylaxis is an emergency condition
immediate professional medical attention.
 Assessment of the ABC's (airway, breathing, and circulation from Basic Life Support) should be done in all suspected anaphylactic reactions.

CPR should be initiated if indicated. 
People with known severe allergic reactions may carry an Epi-Pen or other allergy kit, and should be assisted if necessary.

septic shock
(associated with infections)

Septic shock is a serious, abnormal condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. Vital organs, such as the brain, heart, kidneys, and liver may not function properly or may fail. Decreased urine output from kidney failure may be one manifestation.

Causes, incidence, and risk factors

Septic shock occurs most often in the very old and the very young. It also occurs in people with underlying illnesses. Any bacterial organism can cause septic shock. Fungi and (rarely) viruses may also cause this condition. Toxins released by the bacteria or fungus may cause direct tissue damage, and may lead to low blood pressure and/or poor organ function. These toxins also produce a vigorous inflammatory response from the body which contributes to septic shock.

Risk factors include underlying illnesses, such as diabetes; hematologic cancers (lymphoma or leukemia); and other malignancies and diseases of the genitourinary system, liver or biliary system, and intestinal system. Other risk factors are recent infection, prolonged antibiotic therapy, and having had a recent surgical or medical procedure.


Fever, chills 
Feeling light-headed 
Shortness of breath 
Cool, pale extremities 
Elevated temperature 
Restlessness, agitation, lethargy, or confusion 

Some physical findings may be easily detected:

Rapid heart rate 
Low blood pressure, especially when standing 
Low urine output 


Septic shock is a medical emergency, 
and patients are usually admitted to intensive care. 

neurogenic shock
(caused by damage to the nervous system)

Shock is a life-threatening condition that requires immediate medical treatment. 

Some degree of shock can accompany any medical emergency.
 Shock can get worse very rapidly. 
Be prepared to begin rescue breathing or CPR as needed. 

Causes of Shock

Bleeding (hypovolemic shock)
Dehydration (hypovolemic shock)
Heart attack (cardiogenic shock)
Heart failure (cardiogenic shock)
Trauma or serious injury 
Infections (septic shock)
Allergic reactions (anaphylactic shock)
Spinal injuries (neurogenic shock) 
Toxic shock syndrome 



What to look for:

Unable to speak, breathe or cough

Clutching neck with one or both hands

Wheezing, gurgling noise in throat

Skin turning blue or ashen color


Heimlich Maneuver

Stand behind victim with arms around victim's torso. 
Clench one hand over the other; thumb side of fist pressing between the waist & bottom of ribs. 
Apply pressure & jerk quickly upwards 4 times.

If alone, use your own fists & arms - or push down against any blunt projection.

Sometimes objects can be dislodged by a finger sweep. (Caution: When inserting your finger in any patient's mouth, be extremely careful of the risk of being bitten.) Grasp victim's jaw & tongue & lift upward - use hooking motion inside mouth from one cheek to other.(Be sure victim is choking & not experiencing a seizure.)


Caring for a Minor Open Wound 

Blood color in a minor wound is dark red/purple and is the result of venous bleeding. 

Stop the bleeding by applying direct pressure with a clean, absorbent cloth, if a cloth is not available, use your fingers.
If the blood soaks through, apply a second bandage on top.

 remove the first bandage because it will disturb the clotting which has already occurred.

If the bleeding still does not stop, elevate the wound higher than the heart.
Once the bleeding stops, clean the wound gently to get all the debris and dirt out.
Apply an antibiotic ointment if necessary.
Wrap the wound firmly in a cloth or bandage. DO NOT cut the circulation off.

Caring for a Major Open Wound

External Bleeding

To control bleeding, elevate the wounded area above the heart and apply pressure using either gauze, clean cloth, dried seaweed or sphagnum moss. Use pressure at the pulse point between the injured area and the heart if bleeding fails to stop. If bleeding still persists, use a tourniquet between the injury and the heart. This method should only be used in extreme situations. After bleeding has been controlled, wash the wounded area with disinfectant and apply a dressing and bandages. 

Most bleeding can be stopped by the following techniques: 

Direct Pressure Most bleeding can be controlled by applying direct pressure to the wound.
Use a gloved hand (to protect the rescuer from diseases the patient might be carrying) and a piece of sterile gauze (if available) and apply firm pressure to wound. It may take up to 15 minutes before the bleeding is stopped completely. It is essential that the site of the bleeding be located exactly when applying direct pressure, otherwise blood will continue to flow past the piece of gauze and the bleeding won't be stopped.
In some cases, you may have to cut away clothing, and/or wiping away blood until the wound can be seen clearly. Remember, if you can't see the wound, you can't control the bleeding.
If bleeding continues, it is because direct pressure is not being completely directed on the entire wound. You may have to remove your hand, reassess where the wound is, and reapply direct pressure.

Elevate the wound above the heart. This will decrease the local blood pressure.

Other Techniques
In many cases, especially in severe wounds, direct pressure and elevation will not stop bleeding.

For these situations, use the following techniques in addition: 

Pressure Points 

 Direct pressure stops most bleeding. Place sterile gauze or clean cloth over wound & apply pressure. If bleeding doesn't stop in 5 minutes, replace cloth and continue to apply direct pressure to wound while adding pressure to pressure points (below).

X Denotes spot to apply pressure if bleeding
persists in indicated body areas

Temple or scalp

Face below eye

Shoulder or upper arm


Lower arm



Lower leg 


DO NOT Use direct pressure on eye, embedded objects or open fractures

Pressure Bandages
 Pressure bandages are used in rare situations when the rescuer has difficulty holding sustained direct pressure to a wound such a severe laceration. In the event that this happens, use a circumferential gauze dressing, and tie the gauze dressing around the leg if the wound is on the leg, on the arm if the wound is on the arm, etc.. It must cover a wide area so the bandage does not cut off blood flow to the lower parts of the limb and cause ischemia. I recommend using a triangle bandage for this. The ends of the triangle bandage are small and can easily be tied together, and the middle of the bandage has lot's of fabric and a wide area to cover the wound properly. To make a triangle bandage, simply cut a clean cloth (old bed sheets work well) in a 45,45,90 degree triangle with the long end being about 3 feet long. With the longest side facing away from you, fold the 90 degree corner in. Depending on how big the wound is, is how for you fold in the corner. I recommend folding the corner 2 inches more than the size of the wound (if the wound is 5 inches long, fold the corner 7 inches). DO NOT fold the corner any less than 3 inches, because the bandage could cut off circulation when tied around the wound. Continue to fold the folded corner over itself until it is aligned with the opposite edge. You should now have a long trapezoid consisting of a height that equals the length of the wound plus 2 inches, and a length of about 3 feet, depending on how long you cut your bandage. Place to middle of the bandage over the wound, and wrap the bandage around the leg, and tie the ends of the bandages together with a square knot. You tie a square knot by tying the first part of a shoelace knot, and then tying the first part of the shoelace knot again, only this time backwards the first time. A common rhyme for this knot is "right over left, left over right".

Tourniquets are rarely necessary except in situations of amputation. The only time a tourniquet should be used if all other techniques have failed and continued blood loss will cause death. To tie a tourniquet, use a piece of rope, or a tightly rolled triangle bandage above the wound. Tie the tourniquet tight enough to stop most, or all blood from flowing into the limb with the wound. Write the exact time the tourniquet was applied on the patients forehead, so that when the patient is evacuated, the EMT's, doctor's, etc. will know the duration of time the tourniquet was applied. This is critical when it comes to deciding whether the limb can be saved or if it needs to be amputated. Any time a tourniquet is applied, you run the risk of ischemia, and potential loss of limb. If it's "life or limb", consider a tourniquet.

*Use a tourniquet
 as last resort
never apply below the elbow or knee


DO NOT Use direct pressure on eye, embedded objects or open fractures

DO NOT Rinse wound with full strength medicines

DO NOT Close wounds with tape

DO NOT Breathe or blow on a wound

Head Injury

A head injury is any trauma that leads to injury of the scalp, skull, or brain. 
These injuries can range from a minor bump on the skull to a devastating brain injury.

A concussion may result when the head strikes against an object or is struck by an object.
 Concussions may produce unconsciousness or bleeding in or around the brain. 

Head injury can be classified as either closed or penetrating.

 In a closed head injury, the head sustains a blunt force by striking against an object.
 A concussion is a type of closed head injury that involves the brain.

In a penetrating head injury, an object breaks through the skull and enters the brain.
(This object is usually moving at a high speed.)



Injuries to the head are so common that almost everyone will sustain some form of trauma to the head at some point during their lifetime. Learning to recognize serious head injury, and implementing basic first aid, can make the difference in saving someone's life.
Medical advances in detecting and treating these injuries, however, have improved the outlook for many of these injuries.

Every year, approximately two million people sustain a head injury.
 Most of these injuries are minor because the skull provides the brain with considerable protection -- thus symptoms of minor head injuries usually resolve with time. However, more than half a million head injuries a year are severe enough to require hospitalization.



The signs and symptoms of a head injury may occur immediately or develop slowly over several hours. If a child begins to play or run immediately after getting a bump on the head, for example, serious injury is unlikely. However, the child should still be closely watched for the 24 hours, since symptoms of a head injury can be delayed.

When encountering a victim of a head injury, try to find out what happened. If the victim cannot tell you, look for clues and ask witnesses. In any head trauma victim that appears to have any serious injury, always assume that there is also injury to spinal cord.

The following symptoms suggest a more serious head injury that requires emergency medical treatment:

Altered level of consciousness
Decreased rate of breathing
Fracture in the skull
Facial bruising and fractures
Fluid drainage from nose, mouth, or ears (may be clear or bloody)
Headache (may be severe)
Increased drowsiness
Initial improvement followed by worsening symptoms
Loss of consciousness
Personality changes
Slurred speech
Stiff neck
Swelling at the site of the injury
Blurry vision
  Scalp wound
Vomiting or nausea
Pupil changes
 Unequal pupils

Note! The signs & symptoms of brain injury may be observed immediately (as listed above)
 or may slowly develop over several hours.

Check out the victim by asking personal questions: name, birthday, home address, where they are, etc.
 If the victim can't answer these questions, it could indicate a concussion or closed head injury.

First Aid 

Treatment varies according to the severity of the injury, type and location of injury, and development of secondary complications. For mild head injury, no specific treatment may be needed other than observation for complications, although an initial medical evaluation should still be done.
Over-the-counter analgesics may be used for headache. 
Aspirin is usually discouraged because prolonged use increases the risk of bleeding.


For moderate to severe head injury, where the victim is comatose or if symptoms are severe, urgent treatment is required.

 Take the following first aid treatment steps:

1. Call the local emergency number (such as 911) before you begin treating someone with a severe head injury.

2. Check the victim's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.

3. If the victim's breathing and heart rate are satisfactory but he or she is unconscious, treat him or her as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the victim's head, keeping the head in line with the spine and preventing movement. Wait for medical help.

4. Unless there has been a skull fracture, attempt to stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the victim's head. If blood soaks through the cloth, don't remove it, just place another cloth over the first one.

5. If you suspect a skull fracture, do not apply direct pressure to the bleeding site, and do not remove any debris from the wound. Cover the wound with sterile gauze dressing and get medical help immediately.

6. If a victim is vomiting, remember you must always suspect a spinal injury and roll the head, neck, and body as one unit to prevent choking. (Children often vomit once after a head injury. But even if the child does not vomit again and is not behaving differently, contact a doctor.)

7. Apply ice packs to swollen areas.


For patients with mild or moderate head injury and no loss of consciousness, a full medical evaluation should still be sought. If the patient is not hospitalized, you will receive instructions to observe the victim for any signs of a serious head injury over the next 24 hours. These instructions may include waking the patient every 2 to 3 hours during the night to check for alertness; you may be told to ask the victim specific questions, such as "What is your address?"

If the patient becomes unusually drowsy, develops a severe headache or stiff neck, vomits more than once, or behaves abnormally, get medical help immediately.

Do Not

DO NOT remove the helmet of a victim if you suspect a serious head injury. 

DO NOT wash a head wound that is deep or bleeding profusely. 

DO NOT remove any object sticking out of a wound. 

DO NOT move the victim unless absolutely necessary. 

DO NOT shake the victim if he or she seems dazed. 

DO NOT pick up a fallen child with any sign of head injury. 

DO NOT consume alcohol within 48 hours of a serious head injury. 

Call immediately for emergency medical assistance if 

There is severe head or facial bleeding.

There is a change in the victim's level of consciousness (such as confusion or lethargy).

There is any cessation of breathing.

You suspect a serious head or neck injury.

Eye Injuries

The eyes are one of the most vulnerable parts of the human anatomy, and injuries to the eye should be taken seriously. Injuries to the eye include eyeball scratches, small foreign bodies in the eye, larger objects stuck in the eye, chemical exposure, burns, cuts and blows to the eye. Washing your hands with soap and water should always precede treatment of any eye injury.

In the case of an eyeball scratch, do not apply pressure to the eye and get medical help.

If a small foreign body like sand or dirt enters the eye, normal blinking and tearing will usually remove the object. Do not allow yourself or the victim to rub the eye. If pain and redness continues, try to locate the foreign object by doing a visual search in a well-lighted area. If found, try to wash out the foreign object with water, or try to brush out the object by pulling the upper eyelid over the lashes of the lower eyelid. Do not use a cotton swab or tissue to lift out the object. If the object cannot be removed, or if it is removed and pain continues, cover the victim's eye with a clean cloth or sterile pad and seek medical help.

If a large object is sticking out of the eye, do not attempt to pull it out. This will likely do much more damage than good. Instead, bandage the eye on either side of the object and tape a paper cup or cone over the object so that it cannot be touched. Also cover the uninjured eye to discourage eye movement. While emergency medical attention is being sought, reassure the victim, keeping him or her as calm as possible.

If a harmful chemical substance has entered the victim's eye, use water to flush it out while waiting for medical help. Turn the victim's head on its side with the injured eye down and pour fresh water into the eye for at least 15 minutes. You may have to force the eye to remain open. If chemicals are in both eyes, have the victim flush out the eye by taking a shower. Contact lenses should be removed only after the eye has been thoroughly flushed out. After flushing the eye, cover both eyes with a clean cloth, even if only one eye is afflicted, as this discourages eye movement.

If an eye gets burned, flush it with water if it is not too painful for the victim. Lightly apply a cool compress without putting any pressure on the eye. Seek medical help.

If the eye has either been cut or received a hard blow, lightly apply a cool compress without putting any pressure on the eye, even if the eye is bleeding. If blood is pooling in the eye, cover both eyes with a clean cloth to deter eye movement and seek medical help.

Spinal Injury


If victim is sitting up, support their head between your arms & gently lean them backward - making sure you keep their head & neck immobilized - if you must go for help, stabilize the head on both sides with objects

Tell victim not to move

Note: Spinal injuries can be difficult to evaluate.
 If you suspect one ( pain over neck or spine, inability to move arms or legs, tingling or numbness in arms or legs, inability to wiggle toes or to feel your touch on soles of feet . . .)

Do not move victim unless it is absolutely necessary for safety reasons
(victim is in dangerous place).

In most cases, you should just stabilize the victim & wait for professional help to arrive.

Dislocations and Sprains

What to do

 It is unwise to treat a dislocation unless you are a trained professional as permanent damage may occur.
The affected extremity should be supported using a sling or other device and pain controlled with aspirin or other suitable drugs.


A dislocation is displacement of a bone end from its normal position at the joint, allowing the movement of the bone from its socket.

Example: Displacement of humerus (upper arm bone) from shoulder socket


Can cause a deformed looking shoulder


Prepare a splint with a thin board or foam board & wrap with bandages or clean cloth (t-shirt, etc.)



Arm & shoulder joints can be additionally stabilized by fashioning a sling & swathe as shown here

Seek medical attention as soon as possible!

Splint with boot on





If you suspect an ankle sprain, use the RICE procedures listed at left. Do not apply heat until at least 48 hours after the injury - If swelling & pain don't decrease with in 48 hours, seek medical attention


Sprains are a sudden or violent twist or wrench of a joint beyond its normal range that results in a stretching or tearing of the joint's ligaments. Sprains are a common injury, and the most frequently sprained part of the body is the ankle. It is estimated that there are 27,000 ankle sprains in the United States everyday. Other areas commonly sprained are the wrist, knee, finger and toe.

Sprains can happen while playing sports or as easily as landing awkwardly while stepping off a curb. Even though sprains are often quite painful, they usually do not require professional medical attention to heal properly. When giving aid to a person with a sprain, call for emergency medical assistance if a broken bone is suspected or if there is an audible popping sound and the victim has difficulty in using the joint.

The first aid procedure for treating sprains can be summarized by the acronym R.I.C.E., which stands for rest, ice, compression and immobilization, and elevation.


 When someone sprains a part of their body, the person should immediately rest the injured part. Further exertion could result in more damage to the sprained area.

To help reduce swelling, ice should be applied immediately to a sprained area, either by a cold compress or wrapped in a towel or piece of clothing.

and immobilization
The sprained area should be securely wrapped. Wrapping the area too tightly, however, could restrict circulation.

The sprained part of the body should be elevated above the level of the heart. This is particularly true when sleeping.


If you are hiking & sprain your ankle - Construct a splint over your boot until you return to camp or vehicle - Once boot is removed, hiking is finished - Don't push an injured ankle!


There are to two types of fractures:

1. Closed Fracture, which is a break or crack in a bone that does not puncture or penetrate the skin.

2.Open Fracture, where there is a break in the skin caused by a protruding bone, or there is an open wound in the area of the fracture. Open fractures are more serious than closed fractures.

Closed fracture

skin & muscle intact


Open Fracture - skin broken, bone open to contamination

*Do not apply traction, cover wound & splint as is


 Some symptoms of a fracture are:

Signs that a fracture is present include: 

1. Pain at the affected area. 

2. The injured part appears deformed; 
The area may or may not be deformed. 

3. Pain is present when attempting to move the part; 

4. The victim is unable to place weight on the area without experiencing pain.

4. A grating sensation or sound may be present during any motion of the injured area.

5. Absence of feeling when touched; 

6. Bluish color and swelling in the area of the injury.

What to do




 If body part is bent or deformed, apply gentle traction & apply a splint



You can fold a triangular bandage into a sling

Seek medical attention as soon as possible with ANY broken bone 

Examples of Leg Splints


To treat a fracture; 

1. If in doubt, treat the injury as a fracture.

2. Splint the joints above and below the fracture. 

3. If the limb is grossly deformed by the fracture, splint in place, and do not try to straighten it; 

4. Be sure to pad your splints and place it so that it supports the joint above and below the fracture. Immobilize a leg fracture by splinting the fractured leg to the unbroken leg if no other materials are present;

5. Check the splint ties frequently to be sure they do not hinder circulation. 

6. Cover all open wound with a clean dressing before splinting. 

3. 4. Elevate and use indirect (not on skin) ice packs if available.

First Aid for Drowning

When someone is drowning, get help immediately, but do not place yourself in danger. Do not get into the water or go out onto ice unless your own safety can be assured. Rescue options may include extending a long pole or branch to the victim, or using a throw rope attached to a buoyant object, such as a life ring or life jacket. Toss it to the floundering person, then pull him or her to shore.

Keep in mind that victims who have fallen through the ice become hypothermic very rapidly and may not be able to grasp objects within their reach or hold on while being pulled to safety.

If a person is still floundering in the water and you are appropriately trained to attempt rescue yourself, do so immediately if conditions do not pose undue risk to your own safety.

If there is any likelihood of spinal injury, care must be taken to stabilize the victim's head and neck at all times during the rescue and resuscitation.

If the victim's breathing has stopped, begin rescue breaths as soon as you safely can. This often means starting the breathing process while still in the water.

Continue to breathe for the person every few seconds while moving them to shore. Once on land, check for a pulse (or other signs of circulation, such as spontaneous breathing, coughing, or movement) and administer CPR if needed.

For step-by-step instructions on rescue breathing, see CPR and rescue breathing first aid.

The Heimlich maneuver should not be used routinely in the rescue of near-drowning victims.
It should be used only if the airway is blocked with debris or vomit, and you are unable to successfully ventilate the victim (unable to get air into the the lungs with proper rescue breaths).
 Since most drowning victims do not breathe in large quantities of water, immediate rescue breaths are effective without first draining the lungs. Furthermore, performing the Heimlich maneuver unnecessarily may increase the chances that an unconscious victim will vomit, and subsequently choke on the vomitus.

Always use caution when moving a drowning victim. Always assume that the victim may have a neck or spine injury, and avoid turning or bending the neck. Take appropriate steps to immobilize the head and neck during resuscitation and transport. Either tape it to a backboard or stretcher, or secure the neck by placing rolled towels or other objects around it. It is important to keep the victim calm and to keep them immobilized. Seek medical help immediately.

In order to prevent hypothermia, remove any cold, wet clothes from the victim and cover him with something warm, if possible.

Once the victim is stabilized, administer first aid for any other serious injuries.

As the victim revives, he may cough and experience difficulty breathing. Calm and reassure the victim until you get medical help. All near-drowning victims should be seen by a health care provider. Even though victims may revive quickly at the scene, lung complications are common.

Hypothermia - Severe Cold

Signs & Symptoms: 


Shivering begins
Slurred speech
Stiff fingers
Strange behavior


Obvious mental deterioration


Hypothermia Chart
(In Water)

If the Water Temp. is (F.) . . .

Exhaustion or Unconsciousness 

Expected Time of Survival is . . .


Under 15 Min

Under 15-45 Min.


15-30 Min.

30-90 Min.


30-60 Min.

1-3 Hrs.


1-2 Hrs.

1-6 Hrs.


2-7 Hrs.

2-40 Hrs.


3-12 Hrs.





For Hypothermia danger on land:


Treatment in Field:

Raise victim's body temperature with dry clothing, shelter, insulation
(sleeping bag, blankets etc.)
applied heat 
(hot water bottles, your own warm body) 

Caution! Be careful not to burn skin with hot water.
 Give warm liquids to drink only if you are sure victim is conscious and can swallow


Frostbite is the freezing of a part of the body, most often the nose, ears, cheeks, fingers or toes.

Causes of frostbite:

Cold stress
Low temperatures
Wind chill
Poor insulation
Tight-fitting clothing or boots


Clear blisters


discolored skin on extremities




Most common areas found

Remove victim from cold exposure, remove clothing from affected body parts.
 If warm water is available, put parts in warm water until thawed & numbness decreases 
- Wrap parts in dry, clean gauze & seek medical attention as soon as possible. 

Do not rub affected areas!

Once you warm a body part you must keep it warm.
 If you cannot protect it from freezing again, it is better to leave it frozen until you can.

Heat-Related Emergencies

If it is hot, you may be the victim of heat cramps, heat exhaustion or, in extreme cases, heat stroke.

(Note: An ounce of prevention is worth a pound of cure - drink plenty of liquids to avoid heat-related emergencies.)

Heat Cramps: These are the least serious & usually occur in the leg muscles due to loss of body salts from heavy perspiration - Move to a cool place, rest, affected muscle & drink water (cold water if available).

Heat Exhaustion: This can become serious & is indicated by cold, clammy skin, slightly elevated temperature & possibly loss of consciousness - Move immediately to cool place & elevate legs, give cool water, and seek medical attention ASAP.

Heat Stroke: This is the most serious heat-related problem, & the typical symptoms are hot, dry or wet skin, 105° temperature or higher, usually loss of consciousness - Move immediately to cool place & elevate head & shoulders. After victim is cooled, transport immediately to nearest medical facility -

Heat Stroke is life-threatening!

Be careful not to give liquids orally 
if victim is unconscious or cannot swallow.

Compare heat stroke symptoms with those of heat exhaustion in the figure below:

Children are more likely than adults to be affected by heat and sunlight. 
They can more quickly lose body fluid and become dehydrated or develop heat stroke. Their sensitive skin also can be burned more easily by the sun's ultraviolet rays.
 Children can also be burned by objects or surfaces, particularly metal surfaces, that have been heated by the sun.

Overexposure to the sun's harmful rays during childhood has been linked to skin and other cancers later in life. To reduce injuries caused by heat and sun:

Limit the time that children spend outdoors during the hottest part of the day
( 10:00 A.M. to 2:00 P.M.) 

Parents should provide sun block lotion with a sun protection factor (SPF) of at least 15 if children will be spending more than a few minutes in the sun.

Provide drinks for children before, during, and after playing outdoors.

Require that children wear protective clothing if they will be exposed to the sun for extended periods, such as on a field trip outdoors.
 Hats or sun visors, long-sleeved shirts and pants, and sun block lotion will prevent burns to sensitive skin. 

Keep children under 1 year of age
out of direct sunlight. 

Do not use sunscreen on babies
 under 6 months of age
 (a baby is likely to absorb more of the product through its skin than an older child would).


Most burns in the woods are thermal (heat) burns, caused by fire, over-exposure to sunlight, certain chemicals & hot surfaces or substances.

and COOL

STOP immediately where you are.

DROP to the ground.

ROLL over and over and over, covering your face and mouth with your hands
(this will prevent flames from burning your face and smoke from entering your lungs). 
Roll over and over and over until the flames are extinguished. 

COOL the burn with cool water for 10-15 minutes.
If needed, see a doctor. 



For measuring body surface, the palm of your hand is about 1% 

What to do:

Determine the severity of burn (first, second & third degree burns increase in amount of skin layers destroyed)

1st degree - Red/pink, hot skin
2nd degree - Red/skin blisters
3rd degree - Deep layers/charred skin

Remove clothing from burned area
 (if burns aren't severe) 

Douse with cool water until pain stops


The product above is a ointment that my wife's family introduced to us from England, it is now found in the states.

Cover with dry, nonstick, sterile dressing, keep area clean

Watch for signs of infection & dehydration

If burn is over more than 15% of body, or appears to be deep
(second or third degree)
 - seek medical attention immediately

Do not:

Do not Apply ice

Do not Break blisters if it can be avoided

Do not Apply any type of salve, ointment, sprays or creams

Do not Pull or cut away clothing around deep burns

Food Poisoning

The Unwelcome Dinner Guest
by Mike Yudizky

North Texas Poison Center


"It must be something I ate". When you think of a hamburger, what comes to mind? Is it a delicious treat - hot, juicy and fresh from the grill? Or do you imagine "Montezuma's Revenge" or some other unwelcome gastrointestinal upset? The prime causes of food-borne illness are a collection of bacteria with tongue-twisting names like Campylobacter jejuni, Salmonella, Staphylococcus aureus, Clostridium perfringens, Vibrio vulnificus, and Shigella just to name a few. These organisms can become unwelcome guest at the dinner table. They're in a wide range of foods, including meat, milk and other dairy products, coconut, fresh pasta, spices, chocolate, seafood, and even water.


Egg products, tuna, potato and macaroni salads, and cream-filled pastries harboring these pathogens also are implicated in food-borne illnesses, as are vegetables grown in soil fertilized with contaminated manure.

Poultry is the food most often contaminated with disease-causing organisms. It has been estimated that 60 percent or more of raw poultry sold at retail probably carries some disease-causing bacteria. Bacteria are also often found in raw seafood such as oysters, clams, mussels, and scallops.


But that doesn't mean you should stop eating. Just be smart about how you buy, store, prepare and serve food, and you'll reduce the risk of food-borne illnesses. Careless food handling sets the stage for the growth of disease-causing "bugs." For example, hot or cold foods left standing too long at room temperature provides an ideal climate for bacteria to grow. Improper cooking also plays an important role in food-borne illness.


Foods may be cross contaminated when cutting boards and kitchen tools that have been used to prepare a contaminated food, such as raw chicken, are not cleaned before being used for another food such as vegetables.

Be wary of food poisoning.
 Contaminated food can cause nausea, vomiting and diarrhea. Food poisoning usually resolves itself within 24 hours without medical treatment. Drink lots of fluids (mostly water for 12 hours and then add juices, broth . . .). Seek medical attention if symptoms lasts longer than 2 days, if watery diarrhea occurs every 10-15 minutes, if diarrhea contains blood or mucus or if abdominal pain or fever is constant.

When camping, remember the following;

  - wash your hands thoroughly before handling food

  - smell the food first. If it doesn't smell right, don't cook it and don't eat it.

  - it is better to "overcook" than "undercook" food (surface bacteria are killed at 212°F)

  - once meat has thawed, cook it 
 don't refreeze it!

  - serve cooked food immediately

  - avoid food that nourish bacteria (custard, mayonnaise, custards, bologna  . . .)



Common symptoms of food-borne illness include diarrhea, abdominal cramping, fever, headache, vomiting, and severe exhaustion. However, symptoms will vary according to the type of bacteria and by the amount of contaminants eaten. Symptoms may come on as early as a half-hour after eating the contaminated food or they may not develop for several days or weeks. They usually last only a day or two, but in some cases can persist a week to 10 days. For most healthy people, food-borne illnesses are neither long lasting nor life threatening.


When symptoms are severe, the victim should see a doctor or get emergency help. For mild cases of food poisoning, liquid intake should be maintained to replace fluids lost through vomiting and diarrhea. Sport drinks (or Pedialyte for small children), are especially good because they contain much-needed electrolytes.

Prevention Tips

The idea that food on the dinner table can make someone sick may be disturbing, but there are many steps you can take to protect your family and dinner guest. It's just a matter of following basic rules of food safety.

Prevention of food poisoning starts with your trip to the supermarket. Don't buy food in cans that are bulging or dented or jars that are cracked or have loose or bulging lids. Look for expiration dates and never buy outdated food. Check the "use by" or "sell by" date on dairy products and pick the ones that will stay fresh longest in your refrigerator. Choose eggs that are Grade A or better and that are refrigerated in the store. Make sure that none are cracked or leaking.


Save to the last frozen foods and perishables such as meat, poultry or fish. Always put these products in separate plastic bags so that drippings don't contaminate other foods in your shopping cart. Take an ice chest along to keep frozen and perishable foods cold if it will take more than an hour to get your groceries home.

Safe Storage 

The first rule of food storage in the home is to refrigerate or freeze perishables right away. Refrigerator temperature should be 40 to 45 degrees Fahrenheit and the freezer should be zero. Refrigerate or freeze leftovers in covered shallow (less than 2 inches deep) containers as soon as possible and always within 2 hours of cooking. Arrange items in the refrigerator or freezer to allow cold air to circulate freely. "When In Doubt, Throw It Out"


Wash hands with hot soapy water for at least 20 seconds before preparing, serving and eating food. People with open cuts, sores, vomiting or diarrhea should not handle food. Clean all food preparation surfaces that will come in contact with food. Wash fresh fruits or vegetables with plain water before eating or cooking. Wash hands, utensils, plates, cutting boards and countertops after contact with raw meat or poultry. Use plastic cutting boards rather than wooden ones where bacteria can hide in grooves. Serve cooked food on clean platters with clean utensils. Keep dishwashing sponges clean. Thaw frozen meat or poultry in the refrigerator or microwave, not on the countertop. Bacteria can grow on the outer layers of the food before the inside thaws. Always marinate food in the refrigerator.


Cook at recommended temperatures to kill bacteria: poultry-180 degrees F, beef-160 degrees F and pork-160 degrees F. Don't taste meat, poultry, eggs, fish or any other food of animal origin when it is raw or during cooking. Cook eggs until the yolk and whites are firm. Cook foods as close to serving time as possible to limit bacterial growth. Cover and reheat leftovers to 165 degrees F before serving.

Moving A Victim

When faced with the problem of rescuing a person threatened by an emergency, 
do not take action until you’ve determined the danger. 

Sometimes it is necessary to move a victim to safety or to a medical facility. Moving a victim can be done in a variety of ways. The safest way is to carry the victim on a stretcher fashioned from poles and blankets.

Log roll if you need to turn the victim over. 
Support the neck in case of a spinal cord injury. 

Do not pull the body sideways 
Do not twist the body when turning the victim over.


 If the victim can walk, put one arm around their waist and with your other arm hold their arm around the back of your neck.

This can also be done with two people supporting the victim.

 If the victim cannot walk . . .

Do not move a victim with a suspected spinal injury unless it is necessary to get the victim out of danger.
 If this is necessary, stabilize the injured part so that it does not move and make the injury worse.


Do not make injury worse by moving victim 

Do not move a victim with spinal injury 

Do not leave unconscious victim alone 

Do not move victim without stabilizing the injured part


Moving a Victim

Moving a victim can be done in a variety of ways, some of which are shown here:

Improvised Stretchers

Standard stretchers should be used whenever possible to transport casualties. If none are available, it may be necessary for you to improvise. Sometimes a blanket may be used as a stretcher. The casualty is placed in the middle of the blanket on his or her back. Four people kneel (Fig. 1) on each side and roll the edges of the blanket toward the casualty. Stretchers may also be improvised (Fig. 2) by using two long poles (approx. 7 feet long) and a blanket. Most improvised stretchers do not give sufficient support in cases where there are fractures or extensive wounds of the body!

Blanket used as improvised transport stretcher.


Stretcher made from poles and a blanket.


Fireman's Carry 

The Fireman's Carry (Fig. 3) is one of the easiest ways to carry an unconscious casualty.

1 .Place the casualty face down. Face the casualty, and kneel on one knee at the casualty's head. Pass your hands under the armpits; then slide your hands down the sides and grasp them across the back.
see Fig. 3-1

2. Raise the casualty to his knees. Take a better hold across the casualty's back. 
see Fig. 3-2

3. Raise the casualty to a standing position and place your right leg between the casualty's legs. Grasp the right wrist in your left hand and swing the arm around the back of your neck and down your left shoulder.
see Fig. 3-3

4. Stoop quickly and pull the casualty across your shoulders and, at the same time, put your right arm between the casualty's legs.
see Fig. 3-4

5. Grasp the casualty's right wrist with your right hand and straighten up. The procedure for lowering the casualty to the deck is also illustrated. Do not attempt if the casualty has an injured arm, leg, ribs, neck, or back!
see Fig. 3-5








Placing The Victim Back Down from a Fireman's Carry

Tied-Hands Crawl 

The tied-hands crawl may be used to drag an unconscious casualty for a short distance. It is particularly useful when you must crawl underneath a low structure, but it is the least desirable because the casualty's head is not supported.

1. Place the casualty face up. Cross the casualty's wrists and tie them together. 

2. Kneel astride the casualty and lift the arms over your head so that the casualty's wrists are at the back of your neck.

3. When you crawl forward, raise your shoulders high enough so that the casualty's head will not bump against the deck.

 Blanket Drag

The blanket drag can be used to move a casualty who, due to the seriousness of the injury, should not be lifted or carried by one person alone.

1. Place the casualty face up on a blanket, and pull the blanket along the deck. 

2. Always pull the casualty head first, with the head and shoulders slightly raised, so that the head will not bump against the deck.

Pack-Strap Carry 

The pack-strap carry can be used to move a heavy casualty for some distance. 

1. Place the casualty face up. 

2. Lie down on your side along the casualty's uninjured or less injured side. Your shoulder should be next to the casualty's armpit.

3. Pull the casualty's far leg over your own, holding it there if necessary. 

4. Grasp the casualty's far arm at the wrist and bring it over your upper shoulder as you roll and pull the casualty onto your back.

5. Rise up on your knees, using your free arm for balance and support. Hold both of the casualty's wrists close against your chest with your other hand.

6. Lean forward as you rise to your feet, and keep both of your shoulders under the casualty's armpits. 

Do not attempt if the casualty has an injured arm, ribs, neck, or back! 

Arm Carries

There are several kinds of arm carries that can be used in emergency situations to move a casualty to safety. 

The one-person arm carry
should not be used to carry a casualty who is seriously injured.
Unless the casualty is considerably smaller than you, you will not be able to carry the casualty very far. 

The two-person carry 

 1. Two rescuers kneel beside the casualty at the level of the hips, and carefully raise them to a sitting position.

2. Each rescuer puts one arm under the casualty's thighs; hands are clasped and arms are braced. 

3. Both rescuers rise slowly to a standing position. 

Do not attempt if the casualty is seriously injured! 

Bites & Stings

Click Here for


Animal Bites

Extreamly rare while camping. 
But if you are bitten & skin is broken, 
wash wound with soap & water.
Apply pressure to control bleeding.

If the attack was unprovoked, consider the possibility of rabies.
Notify authorities as soon as possible. 
Seek medical attention if needed.

Hornets, bees, wasps and yellow jackets
 are the bane of many an outdoorsperson.

Just when you thought you were sitting down for a nice picnic lunch or a mid-hike snack, in come the buzzing squadrons.
The fear of a sting motivates most to swing and swat wildly, and yet that is the worst thing that you can do.

Avoid attracting undue attention by following a few simple guidelines. 

  • Dress in light-colored clothing. Studies have shown that black, red and blue are more attractive since bees and their other stinging cousins see in ultraviolet.

  • Do not wear perfume or cologne as the sweet smell seems to attract insects of all kinds. 

  • When planning a picnic, keep in mind that fruit, red meat, sodas and food packed in heavy syrup are like ringing the dinner bell for hornets, yellow jackets, bees and wasps.

  • Should a stinging insect make frequent fly-bys through your personal space, resist the urge to wave wildly and swat blindly. Instead, use a gentle pushing or brushing motion to deter the incursion. Wasps, bees, hornets and yellow jackets don't react kindly to quick movements.

What should you do if stung?

Cool the sting area with a cold compress. 

If you were stung by a bee, scrape the stinger out with the edge of a knife (don't cut yourself) or your fingernail. A product called the Sawyer Extractor works very nicely here as it uses suction to remove the bee venom and stinger.
Do not attempt to grab the stinger and pull it out as you will only inject more venom into skin by compressing the venom sack.

If the pain persists, add a topical ointment such as benzocaine to the site to numb it. 
An over the counter antihistamine such as Benadryl will alleviate some of the swelling and itch as well.

If the allergic reaction goes beyond mild swelling, or if there are numerous stings to the face and hands, then seek medical attention quickly.
A serious allergic reaction with massive swelling is life-threatening and should be treated as such.


Blisters are actually localizing second degree burns caused by heat or friction.
 They are mostly found on the feet and are the most common cause for evacuation on backcountry trips. If people are aware and take care of their feet, then blisters can easily be avoided, or at least caught soon and treated before they become a serious problem.


Always make sure your footwear fits properly and is broken in to YOUR foot.
 I know someone who bought a used pair of boots that were in real good condition from someone else, but didn't wear them at all before a backpacking trip. He thought that because they were already broken in he wouldn't get blisters. Boy was he wrong. You need to get your boots broken in so that they are molded to your foot before you go on any trip that requires hiking. If your are one of those people that get blisters no matter what you do to prevent them, I have the perfect solution: duct tape. Just take a piece of duct tape, and stick it to the spot on your foot where you get blisters, and voila, no more blisters! The duct tape acts as sort of a lubricant for your foot, kind, of like what oil does for your car. Your boot slides against the duct tape, not your foot, so therefore, there is no friction between your foot and the boot, and therefore, no blisters. But if your one of those duct tape haters, or for whatever reason you won't put duct tape on your feet, there are other ways of preventing blisters. One of those ways is to wear more than one pair of socks. The best combination of socks is a thin polypropylene liner sock, with a thick wool or synthetic outer sock. The polypropylene wicks moisture away from your feet, keeping them nice and toasty and dry, and the wool or synthetic outer sock will absorb the moisture, and then eventually, the moisture will be evaporated. The two layers of socks also transfers the friction from your feet to the socks, which reduces the chance of blisters. The only drawback, is on a hot summer day, your feet will get a little too hot for comfort. That's when I call on the duct tape. To keep your sock from bunching up in the toes of your boots, keep your boots laced up snugly against your foot to prevent your foot from sliding forward in your boot.

Treatment for Hot Spots 

A hot spot always comes before a blister. So if you feel a hot spot, STOP! You need to stop, and treat the hot spot before it forms into a nasty blister. This is easily done by placing a piece of duct tape over the hot spot. One way to pack duct tape with you on a backpacking trip where packing space is limited, is to wrap your water bottle in duct tape. This not only keeps you from lugging around that giant roll of tape, but it insulates your water bottle keeping the water cool in the summer and not frozen in the winter. To keep the duct tape from peeling up on the corners as all tape usually does when it is placed on the bottom a foot and walked on, just round the edges so that there are no corners to peel up. The ingenious of it all.


Treatment for Blisters 

First of all, if you get a blister, you are foolish for not preventing it easily with duct tape, or treating the hot spot that occurred only moments before, so you probably deserve the blister. Remember, no blister is good blister. But now that you have a blister, it must be treated properly so that it doesn't pop and become infected. Here's your chance to redeem yourself from that foolish nickname you acquired. First off, the liquid in the blister is sterile, and as long as the blister has not been popped, it is a closed wound, and therefore, infection is impossible. To keep the wound closed, you need something thicker than ordinary duct tape. Moleskin works great for this (partly because blister treatment is what moleskin was invented for). Cut a square of moleskin large enough so that it covers the blister, and has an extra inch to two inches of moleskin surrounding the blister. Fold the moleskin in half. On the folded edge, cut a half circle the size of the blister. Open the moleskin up, and pee off the adhesive back. Place the moleskin over the blister so that the blister is in the hole of the moleskin. Do this again with a second piece of mole skin of the same proportions, and stick on top of the first piece for extra padding.

If the blister is so severe that you absolutely cannot walk on it, even with moleskin, and evacuation is not available at the current time, then you will need to pop the blister to continue your trip. Take a sterile needle, and pop the blister at the blister's edge where the blister meets the foot, not in the middle of the blister. Gently squeeze the liquid out of the blister. Because you have just popped the blister, you have upgraded the blister from a closed wound, to an open wound. Dry the surrounding skin, and bandage the blister to keep out bacteria and to prevent infection. To bandage a blister on the bottom of your foot is slightly different from bandaging other wounds. There is no other liquids being secreted by the wound, so extra padding is not necessary. Simply place a piece of gauze over the wound, and then wrap tape around your foot and over the gauze. Make as many wraps as necessary to keep the gauze in place. If possible, change into polypropylene socks, for they will wick away moisture from your feet, keeping them dry. Change the bandage twice a day.

Trench Foot

The name "trenchfoot" came from World War I, when the troops stood in cold, wet trenches for days without relief. It is sometimes, today, called "immersion foot," nerve and muscle damage that results from prolonged exposure to moisture and/or cold without ice formation (as in frostbite) in the cells of the affected area.

Trenchfoot is encouraged by poor nutrition, dehydration, wet socks, inadequate clothing, and the constriction of healthy blood flow in the feet by too-tight shoes and socks. People who sweat heavily are more susceptible, but everyone can prevent trenchfoot by paying attention to their feet. Keep a dry pair of socks on hand at all times, preferably packed in a plastic bag to make sure they stay dry. Make sure your boots fit with plenty of room for the socks you choose to wear. Don't add more socks if your feet get cold--get bigger boots, or boots with more insulation, or add insulation to the outside of your boots with gaiters.

Trenchfoot is divided into three phases.

Phase one is the period of time when blood vessels are contracted by the cold and wetness inside the shoe or boot, and too little oxygen is carried to the cells of the foot. The foot is cold to the touch, slightly swollen, slightly discolored, numb, maybe a little tender to touch. When the foot is rewarmed, the damaged tissue usually looks red, and feels sensitive, and the discomfort may last from hours to days.

Phase two is the period when the cells of the foot have become damaged by the lack of adequate circulation. When the blood vessels open back up, the tissue swells with excess fluid. Patients complain of tingling pain that never lets up. A foot check will reveal swelling. On rewarming, blisters form, and, later, ulcers where the blisters have fallen off revealing dead tissue underneath. In severe cases, gangrene will result. Suffering may last from 2 to 6 weeks, and medications for pain are often prescribed.

Phase three may last weeks to months. The swelling subsides, and the foot takes on a normal appearance once again. During this phase, the patient may complain of increased perspiration in the foot, increased sensitivity to cold, and varying degrees of pain, itching, and paresthesia (a creeping, tingling, prickly feeling). The damaged foot may be more susceptible to cold injury in the future.

Here's what should be done if you think you, or a companion, is developing trenchfoot. Stop and carefully dry the cold foot or feet. If the foot looks dirty, carefully wash it before drying it. Keep it elevated above the level of the foot-owner's heart while you gently rewarm the foot with passive skin-to-skin contact. No rubbing or placing the foot near a strong heat source such as a fire or stove, both of which can damage the tissue of the cold foot. Start the patient on a regimen of over-the-counter anti-inflammatory drugs (aspirin or, even better, ibuprofen), following the directions on the label.

Remember it will probably take 24 to 48 hours before the severity of the damage is fully apparent. If you end up with a painful, obviously swollen foot that develops blisters, that patient needs the attention of a physician. Whether or not that patient can walk out to a physician will be determined by the patient. If they can do it, let them.

© 1999 Buck Tilton; All Right Reserved

Otitis externa
(also called swimmer's ear or ear ache)

Otitis externa is an inflammation, irritation, or infection of the outer ear and ear canal.

Causes, incidence, and risk factors

Swimmer's ear is an infection of the ear canal.
Normally, if you were to stick your finger in your ear, you would feel a little of the ear canal. But if you have swimmer's ear and you stick your finger in your ear - YOW!

Let's find out more about this painful ear infection, which very often affects swimmers.

Swimmer's ear (Otitis externa) - is different from a regular ear infection. Usually, when people say a kid has an ear infection, they mean otitis media, an infection of the middle ear.
(otitis media (also known as glue ear) is an inflammation of the middle ear segment of the ear. It is usually associated with a buildup of fluid and frequently causes an earache. The fluid may or may not be infected.
This might happen when the kid gets a cold.

But swimmer's ear happens when bacteria grow in the ear canal, which leads to the eardrum. In that canal, you'll find delicate skin that's protected by a thin coating of earwax. Most of the time, water can run in and out of the ear canal without causing a problem. For instance, you don't usually get swimmer's ear from taking baths or showers -
 however it is possible to contract swimmer's ear from water trapped in the ear canal after a shower, especially in a humid climate.

Bacteria get a chance to grow when water stays in the ear canal and it washes away the protective coating of earwax. A lot of swimming can wash away that wax protection and lead to these wet conditions in the ear canal. Bacteria grow and the ear canal gets red and swollen.

swimmer's ear is fairly common, especially among teenagers and young children. Swimming in polluted water is the most common way to contract swimmer's ear.
Using objects such as cotton swabs or other small objects to clear water trapped in the ear canal is usually the cause, however . . .
the condition can be drastically enhanced by scratching the ear or an object stuck in it. Trying to clean wax from the ear canal, especially with cotton swabs or small objects, can irritate or damage the skin.

How Do I Know if I Have Swimmer's Ear?


Ear pain - may worsen when pulling the outer ear
Itching of the ear or ear canal
Drainage from the ear - yellow, yellow-green, pus-like, or foul smelling
Decreased hearing or hearing loss

Swimmer's ear may start with some itching, but try not to scratch because this can worsen the infection. Ear pain is the most common sign of swimmer's ear. Even touching or bumping the outside of the ear can hurt. The infection also could make it harder to hear with the infected ear because of the swelling that happens in the ear canal.

If a doctor thinks you have swimmer's ear, he or she will help you get rid of the infection. To do that, the doctor will probably prescribe eardrops that contain an antibiotic to kill the bacteria. Sometimes, the doctor may use a wick. Not the wick on a candle! This kind of wick is like a little sponge the doctor puts in your ear. The medicine goes into the sponge and it keeps the medicine in contact with the ear canal that's infected.

Use the drops as long as your doctor tells you to, even if your ear starts feeling better. Stopping too soon can cause the infection to come back. If your ear hurts, the doctor may suggest that your parent give you a children's pain medication. This can help you feel better while you're waiting for the antibiotic to work.


The goal of treatment is to cure the infection. The ear canal should be cleaned of drainage to allow topical medications to work effectively. Depending on how severe the infection is, it may be necessary for a doctor to aspirate the ear as many times as twice a week for the first two or three weeks of treatment.

Effective medications include eardrops containing antibiotics to fight infection, and corticosteroids to reduce itching and inflammation. Use of antibiotics to treat ear infections may result in treatment of the wrong cause of the infection because not all ear infections are bacterial; some are fungal, and it is possible to have both a bacterial and fungal ear infection.

Ear drops should be used abundantly (four or five drops at a time) in order to penetrate the end of the ear canal. If the ear canal is very swollen, a wick may be applied in the ear to allow the drops to travel to the end of the canal. Occasionally, pills may be used in addition to the topical medications. Analgesics may be used if pain is severe. Putting something warm against the ears may reduce pain.

Do note that it is imperative that there is visualization of an intact tympanic membrane before any curretage or drops are used. This often requires a health professional, as the inflammation can obscure the view. Use of certain medications with a ruptured tympanic membrane can cause tinnitus, vertigo, dizziness and hearing loss in some cases.

Protect ears from further damage. Do not scratch the ears or insert cotton swabs or other objects in the ears. Keep ears clean and dry, and do not let water enter the ears when showering, shampooing, or bathing.

Swimmer's ear is not usually a dangerous infection and often heals itself within a few days. If the infection is mild, alternative methods of treatment may be beneficial.

Swimmer's ear is easily preventable by drying the ear canal after swimming or showering. There are a number of solutions sold in drug stores that will accomplish this, but perhaps the easiest and least expensive is isopropyl alcohol.

To remove water from the ear canal after swimming; 

1.Tilt your head to the side and place approximately 5 drops of isopropyl alcohol (rubbing alcohol) into the ear canal. You should experience the sensation that your ear is "full of water".

2.Bring your head back upright and the solution in the ear will run out. The remaining moisture in the canal will quickly evaporate.

3.Repeat this process for the other ear.

NOTE: This process should NOT cause pain or burning. If it does, stop - it is possible that you already have inflammation or an infection in the ear canal.


This may pack ear wax down onto the ear drum, traumatize the ear canal (leading to pain or infection), and/or damage the ear drum. Q-tips are meant to clean only the external parts of the ear that you can see.

Herbal remedies

Native Americans used mullein (Verbascum thapsus) oil to treat minor inflammations. To ease the discomfort of swimmer's ear, 1-3 drops of a mullein preparation may be placed in the ear every three hours.

Garlic (Allium sativum) has been shown to be effective in treating swimmer's ear. As a natural antibiotic, garlic is a useful herb for inflammation of the outer ear. Equal parts of garlic juice and glycerin are added to a carrier oil, such as olive or sweet almond. One to three drops of this mixture may be placed in the infected ear every three hours.

Home remedies

The inflammation and pain of otitis externa may be eased with the following home remedies:

The infected ear canal may be washed with an over-the-counter topical antiseptic. A homemade solution using equal parts white vinegar and isopropyl alcohol may be placed, a few drops at a time, into the ear every two to three hours. The vinegar-alcohol drops should be kept in the ear for at least 30 seconds.

A warm heating pad or compress may be placed on the ear to relieve pain. 

Pain may also be eased by taking aspirin or another analgesic. 

To assist the healing process, the infected ear canal should be kept dry. When showering, the patient should use earplugs or a shower cap.


Otitis externa responds well to treatment, but complications may occur if it is not treated. Some individuals with underlying medical problems, such as diabetes, may be more likely to get complications such as malignant otitis externa.


Chronic otitis externa
Malignant otitis externa
Spread of infection to other areas of the body


Dry the ear thoroughly after exposure to moisture.
Avoid swimming in polluted water.
Use earplugs when swimming.

Consider putting a few drops of a 1:1 mixture of alcohol and white vinegar in the ears after they get wet. The alcohol and acetic acid prevent bacterial growth (alcohol is a sterilizing agent, and many bacteria and fungal agents are reduced by the slight acid environment of weak organic acids such as vinegar).

There are several products on the market with such ingredients to cure Otitis externa (swimmer's ear)

When Can I Go Back in the Pool?

The question every kid wants to know is: "When can I swim again?" You'll have to ask your doctor, but be prepared to wait a little bit. It could be as long as a week to 10 days before the doctor says OK. That's a bummer in the summer, but it's better than having that awful ear pain again!

If you have a big problem with swimmer's ear or you're a kid who's always in the water, the doctor may suggest ways for you to protect yourself. For instance, your mom or dad can get some special drops to put in your ears after swimming to dry up the water in there. It's an extra step that just might keep your ears in super shape all summer!

CAUTION: If you already have an ear infection, or if you have ever had a perforated, punctured, ruptured, or otherwise injured eardrum, or if you have had ear surgery, you should consult an ear doctor before you go swimming and before you use any type of ear drops. If you do not know if you have or ever had a perforated, punctured, ruptured, or otherwise injured eardrum, you should consult your ear doctor.

For pool swimmers who swim to keep fit

Buy an empty bottle with an eye dropper from a drug store.

Fill the bottle with a solution made from 1 part alcohol and 1 part white vinegar. 

Keep that bottle in your locker or gym bag. 

Forget the earplugs. 

After your swim, draw out ALL water from your ears thus:

Stand still.
Don't jump.
Tilt your head to one side.
Use the eardropper to put enough of the alcohol and vinegar solution to fill one ear.
Keep the alcohol and vinegar in your ear for 30 seconds.
To drain the alcohol and vinegar, tilt your head to the opposite side, and use a tissue to catch the effluent.
The solution may burn slightly; it's not intense.
The water in your ear will drain out with the alcohol and vinegar.
Repeat for the other ear.
Verify that no water remains in either ear by tilting your head from side to side and front to back. If any fluid remains inside your ears, you'll hear it.
Repeat the steps above if necessary.

Let the remnants of the alcohol and vinegar air dry on your outer ear.

Pool swimmers have very clean, wax-free ears because pool water dissolves ear wax. 

If you have an ear itch, use the alcohol and vinegar mixture. Itching is a sign that something foreign is in your ear and that it needs the alcohol and vinegar treatment.



A well equipped first aid kit should be kept in both your home and your car, and should accompany you on trips whether they be civilized tours or backcountry camping.

A first aid kit is one of the most important items to have when doing any sort of outdoor activity.
A fisrt aid kit is ranked up there with toilet paper. 
Neither of these should be at left home when out in the wilderness. Always carry a first-aid kit designed for the number of people in your group.

Weight and space considerations are significant to your purchase decision and an increasing number of kits come in a variety of sizes and shapes designed with a sport-specific intent. For example, a soft triangular shaped kit for cyclists that fits securely between the bike's top and down tube with Velcro fasteners. Most cases are soft, making them more convenient to pack and lighter weight. Those for car and home use frequently have a hard case.

Size is determined by the number of people it supports and the types of products included. There are individual, family, and group kits designed to equip you for basic home and car needs, or for remote locations and travel.


The most common problems are insect bites, wounds, blisters, sunburn, asthma, allergic reactions and lacerations.

Proper management of abrasions and open wounds involves three steps; 

1. Stop serious blood loss 
2. Clean adequately to prevent infection 
3. Maintain an environment around the wound that will prevent further damage and promote healing.

Strains and sprains are best treated with the easy to remember formula RICE; which stands for rest, ice, compression, and elevation.


There is nothing in a prepackaged first aid kit that you cannot buy separately.
Starting with a good kit will save you money but you will still have to purchase additional items.
All kits are not created equal! 

FIRST AID MANUAL - a guide to the treatment of the most common and serious emergencies. Almost everything in your first-aid kit is designed to ease the pain and speed the healing, of relatively simple problems,
but unless you know how to use the products, 
they are useless. 

If you are not up to date with first aid treatment, a handbook on first aid would be useful
A good resource for first aid is the Boy Scout first aid merit badge book. It can be found at any scout supply store or at most of your neighborhood craft stores, or sometimes at army navy surplus stores. It's cheap and has a lot of useful information for the medically illiterate folk.

It is important to know how to use everything in your first-aid kit beforehand.
You won't have time in the middle of an emergency to read an instruction manual.

When an accident occurs, ... 
you need to be prepared.
 Often very basic first aid knowledge can help to save a life. Completing a First Aid Course is a sensible investment for your family and it's really interesting and fun too.

DISPOSABLE GLOVES - when treating anyone, bleeding or not, gloves keep your germs out of the wound and the other person's germs out of you. Vinyl gloves are less expensive, but prone to leaking, so Latex gloves are still the best choice.

CPR SHIELDS - protect a person while administering artificial breathing (mouth to mouth). They are compact and lightweight with a one-way valve that protects from infection.

THERMOMETERS - to monitor an illness and determine its severity. A special thermometer is necessary to register low temperatures as experienced during hypothermia.

RESEALABLE PLASTIC BAGS - hold ice, snow, or cold water for cooling strains and sprains.

MINERAL ICE - topically applied, cold-inducing gel for reducing pain and swelling caused by a strain, sprain, fracture, or other injury.

PAIN RELIEVERS - treatment for pain, inflammation, and fever. Ibuprofen is the preferred choice for inflammation reduction. Tylenol will reduce fever and relieves pain, but it does nothing for decreasing inflammation that can occur from a sprain or strain. Ibuprofen (Nuprin, Motrin, Advil) is the preferred choice for inflammation reduction. Benadryl is often included in today's kits as a treatment for mild allergic reactions, but medical doctors assert that if you are a frequent traveler in the backcountry you would be wise to add epinephrine in the form of an Epi Pen to treat more serious allergic reactions that might otherwise be fatal.

Try to avoid Aspirin as it tends to produce upset stomach

ORAL REHYDRATION SALTS - a combination of electrolytes and sugar that is ideal for replenishment of lost body fluids. It must be mixed with water and is far superior to salt tablets that are impossible to digest and frequently induce vomiting.

Salt tablets were the standard for oral re-hydration needs, but what a lousy standard. Salt tablets are virtually impossible to digest and frequently induce vomiting--
not what you want when it is re-hydration you are trying to achieve. 

World Health Organization oral re-hydration salt packets for treating diarrhea and dehydration are the standard in most good kits.

SCISSORS, TWEEZERS OR NEEDLES - tools to alter bandage size, remove splinters and cut delicately to get at a deeply embedded splinter.

IRRIGATION SYRINGES - cleanse a wound via high-pressure using a normal saline solution, diluted Betadine (1%), or purified water.

SOAP SCRUB SPONGES - clean dirty abrasions, where the grime is ground into the wound and the irrigation syringe is not fully effective. Use the sponge and aggressively scrub the wound clean. Follow the scrubbing with a clean water flush.

IODINE OINTMENT - topical disinfectant to wipe wounds clean after flushing with water from a water bottle or irrigation syringe. Iodine can also be dissolved in unsafe water to create a disinfectant flush. Wait 20 minutes after putting it into the water to ensure full disinfecting action.

ANTISEPTIC TOWELETTES - for cleaning very minor wounds. Also for wiping your hands clean before, and after, treating open wounds.

EYE CUPS - flush the eye of foreign particles or liquids. They are fine for home kits, but are too heavy and bulky for backpacking.

TOPICAL ANTIBIOTICS - topical antibiotics have minimal effect on the lives of germs, but do help and keeping a dab on open wounds helps maintain a moist environment around the would speeds healing significantly.

TINCTURE OF BENZOIN - very sticky and can be swabbed anywhere tape is used to ensure that the tape stays in place.
Benzoin is an irritant and should be kept out of open wounds.

FABRIC BANDAGES (Band-aides) - cover small wounds after they have been cleaned.

KNUCKLE BANDAGES - cover small and difficult-to-bandage scraped knuckles. This bandage allows an almost full range of motion after application.

MICRO-THIN BANDAGES - similar to a piece of sterile Gore-Tex, it "breathes" while it protects and lets moisture from the wound escape. Once the wound is clean and prepared with the antibiotic ointment, this see-through "window" bandage allows you to monitor the wound for signs of infection. It is important to watch very carefully for these signs or for an excess of fluid buildup. The bandage functions at a slow rate and if fluid builds up underneath, the chances of further skin damage and infection will increase.

ELASTIC BANDAGE (usually ACE) - for wrapping sprained wrists and ankles, although the support is not ideal unless you use athletic tape as well. Also for holding splints, large bandages and ice packs in place.

TRIANGULAR BANDAGE (with safety pins) - to sling and swathe upper extremity injuries, such as severe sprains or even fractures. Also used to tie splints and to hold large wound dressing in place. Serves as an excellent pressure bandage, and will work as a tourniquet (as long as you fully understand when and how to do it).

BUTTERFLY CLOSURES OR PROXISTRIPS - pull the edges of a gaping wound somewhat together before bandaging and until a physician can suture the wound. Proxistrips are thinner and breath better than the old-fashioned butterfly bandages.

GAUZE PADS, COHESIVE & ADHESIVE TAPE - used to create a very effective cover for larger open wounds. Remember to touch only the edges when you're handling sterile material. A dab of triple antibiotic ointment on the wound first helps prevent the gauze from sticking to the wound. Adhesive tape can also be used on hot spots to prevent blisters.

Since the old days of traditional 4x4 gauze pads, wound dressings have gotten more sophisticated and feature non-adherent designs and hydrogel dressings such as Spenco 2nd skin. Cleansing a wound is now best performed via high-pressure irrigation utilizing an irrigation syringe.
Gone too are the butterfly bandages, replaced by more effective wound closure strips.
To eliminate sticking problems, be sure that your kit has tincture of benzoin in it which, when spread on the skin on either side of a wound, serves to help tape and bandages adhere better-
useful when the skin is sweaty and dirty. 

NON-ADHERENT DRESSINGS - designed for wounds that tend to weep excess fluid, they help prevent sticking.

2ND SKIN DRESSING - 97% water held together in a gel. It can be used to cover small burns after cleaning, and for the treatment and prevention of blisters. It is best to leave an intact blister alone since it is nature's way of cushioning the raw area and, if still intact, provides a sterile environment.

Build up the surface around the blister with a piece of moleskin by cutting a hole (the size of the blister) in the middle. Apply the second skin to the blister inside this cutout, and then apply tape or a bandage to hold it all in place. Most blisters on hard surfaces, withstanding abrasion (such as on your heel when hiking) will pop anyway. Once this happens, or before if you wish, a blister is best managed by taking the entire top off the blister, washing the area with a mild antiseptic, and applying the 2nd Skin. The 2nd Skin is then held in place with tape.

SAM SPLINTS - for nearly every type of orthopedic injury, they can be cut and molded to fit any extremity, can be fashioned into a usable cervical collar, are reusable, aren't affected by temperature extremes, and are X-ray permeable.

POISON OAK/IVY SOAP - helps to breakdown the oily resin, making it easier to rinse away. Plain soap, used within 30 minutes after contact, is sometimes effective. Regardless, the sticky resin clings to almost anything and, though you may not have reacted to it last time, a sensitivity can be developed at any time. Handle contaminated clothing, shoes and gear carefully and wash them immediately. The resin can stay active for years!

ALLERGY MEDICATIONS (like Benadryl) - help alleviate the pain and itch of bug bites and mild allergic reactions. For backcountry trekking, add epinephrine (by prescription only) to treat more serious, possibly fatal reactions.

SAWYER EXTRACTORS - a hand held suction pump that creates powerful suction to remove venom and toxins from insects, snakes, marine, and plant life. No cutting is necessary and it is reusable! The best first aid for a snake bite is to get the victim to a hospital where antivenin can be safely administered.

Ice, electric shock treatment, constriction and those tiny kits with razor-sharp blades and miniature rubber suction cups are not safe, according to wilderness medical experts, and can do much more harm that good when treating for a snake bite.
The Sawyer Extractor is the only snake bite kit that is actually acknowledged as useful in certain situations.

The recommended first aid? 
Get the victim to a hospital where antivenin may be given safely. 






Inspect the contents before every trip and make sure the tools are clean and supplies in good condition.
 Replace expired medicines and add items you wished you had brought on the last trip.

Tips to consider regarding child-specific needs in the outdoors:

Standard first aid kits carried by families must be adapted to meet infants' and children's special needs. Actual items carried will vary depending on the ages of the children, preexisting medical conditions, length of travel, specific environment traveled in, and the first aid knowledge of the parents.

Infants can develop infections and become hypothermic, hyperthermic, and dehydrated more rapidly than adults or older children. Carry a digital thermometer and the appropriate lubricant for monitoring rectal temperatures. Temperatures 100 degrees F and over require immediate medical attention in a child younger than four months of age. A bulb syringe is also useful because not only because it can be used to suction mucus from the throat and nasal passages of infants, but also because it may be used to flush foreign bodies from ears and administer enemas.

Blisters bother all ages. Feet should receive attention the minute friction or irritation is noticed. Always leave blisters intact unless infection is suspected. A fluid, gel-laminate (Spenco 2nd Skin) and an adhesive pad is very effective in prevention and treatment of blisters.

Most children under five cannot swallow pills. Chewable medications are preferred. If chewable is not available, liquid will work, but they add excess weight and can leak. Most children can chew tablets once their first molars are present--usually around fifteen months. For children who cannot chew, chewable medications may be crushed between two spoons and mixed in with food.

Reduction of weight and bulk is a primary concern in any first aid kit. One way to do that is to select medications and items that have multiple uses. For example. Desitin, best known for helping to prevent diaper rash is also an excellent sun block as it contains 40-percent zinc oxide.

Review of Important Principles

Do Not Panic - Stay Calm! 

Call for help. 

Do not put yourself in danger! 

Do not move the victim unless he/she is in danger and the situation is stable for you to enter/help.

Administer necessary first aid. 

Reassure the victim and make as comfortable as possible. 

Stay with the victim until help arrives. 

Be prepared!
 Take a CPR course. 

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