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Wilderness First Aid

wilderness first aidI know we don’t like thinking about bad things happening, but we also know that sometimes they do! We reckon it’s better to know what to do that to not, so here are some useful First Aid and wilderness safety tips you can apply to prevent or at least improve a painful situation:


Ankle & Knee injuries

When hiking on uneven terrain we’re only ever one misplaced step away from disaster so it’s important to wear adequately supportive shoes and to put some effort into training your ankle strength to avoid an injury in the first place.


Dealing with a sprained/twisted ankle - Sometimes if you’re lucky the pain of a twisted ankle isn’t all that long lasting and a few minutes rest with the leg elevated is all you need, however if the pain doesn’t seem to be easing then you may have to bandage the ankle for support. Keep reading for how to size up and properly apply a bandage.


A couple of Ibuprofen tablets can help take the edge off of the pain as well as helping to reduce inflammation (always read the enclosed leaflet on medication for advice on possible side effects and when NOT to use it).


Sometimes a turned ankle can do more damage than initially thought and there may be ligament damage or a fracture involved. Keep reading for advice on broken bones below.


TIP: A wetted cloth can cool and soothe the area and help to reduce any swelling, a covered ice pack would be better but is a luxury not often available in the wilds. This might be the difference of getting your shoe back on if you have no choice but to hike home!


Knee Injuries: It’s not just your ankles that are at risk of a painful twist injury, or perhaps you’ve been particularly unlucky and fallen onto your knee(s) on hard rocks.

An overloaded pack can also pile on the pressure causing knee pain that can come on gradually until it just becomes too much to bear. It is important to do some training with your pack on shorter walks before a big hike to make sure your legs are up to the task, start with a lighter load and gradually increase the load weight until it contains everything you will be bringing on your trip. Check out our article on packing light here>

If despite taking steps to avoid it, you sense that this is becoming a problem for you, it’s only likely to get worse so don’t be a hero and ignore it! Bandaging your knees for support before they blow out can be your day’s saving grace – discuss the issue as soon as you can with your fellow hikers and see if you can find a way to rearrange your supplies that make the load easier to carry.


How to size up and properly apply a bandage

The size of bandage you need depends on the size of the person and the limb, to measure which size bandage is most suitable hold the roll across the limb. Ideally the bandage should be wider than the limb you are to be bandaging.

Before you start take a moment to remove any jewellery from the area if it is safe to do so (it’s always wise to remove rings from a hand that might later swell up!). Unwrap the bandage from the wrapper and remove the securing clip if it includes one, alternatively have a safety pin or roll of tape out ready.

Always begin at the part of the limb that’s FURTHEST from the heart. Lay the end of the bandage on your starting point (just above the toes for ankles, mid shin for a knee, above the wrist for elbows and the centre of the palm/around the fingers for a hand) with the rest of the roll on TOP.

Holding the end of the bandage in place with one hand, carefully unroll around the limb with the other hand until it passes over your starting point where it will help hold itself in place. As you begin the second pass around the limb you can begin to angle the roll so that it climbs higher, overlapping each layer halfway over the last.


For more awkward body parts like ankles and hands you will need to skip the heel and thumb on the first pass, angling the roll back downwards after making one turn above to cross over the area beneath at least once before to can continue upwards. Depending on the injury you may need to repeat this back and forth action until you have built up enough layers to give enough support to give comfort.


In order to maintain good blood flow it is important not to apply the bandage too tightly, though of course there’s no point in putting it on so loose that it’s not providing any support at all or falls off! While annoying if you’ve spent a long time winding it on, if the casualty feels an uncomfortable amount of pressure or tingling in the limb beyond the bandage you may need to take it off and reapply it with slightly less tension (don’t pull too hard as you pass the bandage around the limb, the fabric of the bandage should NOT be stretching to it’s limits as it is applied).

It is wise to check on the level of blood flow at regular intervals after bandaging in case further swelling has caused it to become too tight. Firmly squeezing a finger or toe nail and watching for the colour to return is a good way to see that all is still well (the colour should return almost immediately), cold weather can make blood flow trickier to monitor.


Identifying and dealing with broken bones

In some instances it is very obvious what you are dealing with, yet at times it can be difficult to know for sure if someone is suffering from a break or a soft tissue injury.

Signs to look out for is a clearly misshapen limb, lumps under the skin, the sound of grating bone ends and severe and immediate bruising. A break will often be far more painful than a sprain or bruise and the person will likely insist you not move or even touch the body part, though this isn't always the case. People often report hearing a snap or cracking noise on recollection of the fall. 

If you suspect that there is be more going than initially meets the eye it is important not to make anything worse so do not move the person any more than is absolutely necessary. Certainly do not encourage them to walk if you suspect a broken bone, though it is unlikely that they would want to! Although someone with a broken arm may be able to walk assisted they may go on to develop shock due to the pain or unseen internal blood loss which can mean they blackout and fall risking worse injuries.

Do not straighten or move the injured limb unless you are trained to do so, the best thing to do is to simply support the area however is most comfortable by tying on a sling or surrounding it with rolled up blankets and other soft items until help arrives. 


If a broken bone is involved you will be needing the assistance of a rescue team so phone for help as soon as possible, giving your exact location and map grid reference where you can. Make yourself as visible as possible and if you can tidy up anything that may be blown about by the downdraught of a helicopter.

In low visibility it is unlikely that a helicopter will be able to reach you so rescue will probably be arriving on foot, if you can’t be seen then find a way to make your location heard – a three second blow on an emergency whistle repeated three times, or alternatively using the light of a torch or reflected mirror, is a universally recognised distress call.


Blisters and sores

A blister is a bubble of fluid that forms under the top layer of skin in response to repetitive friction, and a sore forms when layers of skin are literally rubbed away by a rough edge. Everyone will have suffered a blister at some point or another, and while they aren’t exactly a life threatening scenario they can at least ruin an otherwise good day or go on to become a problematic infection later on. Blisters aren’t just confined to your feet and can happen on your hands too. An overloaded or poorly fitting pack, even a rough trouser hem, can also rub painfully leading to a miserable day indeed!


Like most scenarios the best technique is in prevention; always wear new boots, bags and clothes on several tester hikes before the big one so you can get used to to the fabric and know if anything is likely to cause a problem (even seemingly soft fabrics can cause sores when combined with extreme repetition!). Also be sure to wear comfortable walking socks and base layers designed for hiking and with good sweat wicking abilities as damp skin is more likely to suffer blisters.


If you feel a blister ‘hot spot’ developing it’s worth stopping to address the issue before it properly forms. If the offending rubbing item cannot be moved or removed, applying a strip of adhesive mole skin, a plaster, or even a strip of tape can save your skin from the continuing abuse. Do not apply tape to an open sore or directly onto a blister bubble which will likely tear open as you try to remove it later! We make sure to carry several blister plasters in our kit which are specially designed to be that bit tougher than standard plasters and to stay on for several days to help protect as well as cushion the blister until the fluid is reabsorbed into the surrounding tissue.


Once a blister bubble has formed things get a bit trickier and you’ll likely have to ask the question, to burst or not to burst? It is NEVER advised to forcibly burst or lance a blister since it then becomes a point of entry for bacteria (which is naturally occurring on our skin) to infect the raw skin below. Sometimes though, we understand that a blister can become so large and so painful that you really have no choice but to relieve the pressure – in order to even be able to get a shoe back on or because it’s very obviously going to burst or tear in a bad way anyway.

If you do decide to burst it is wise to do so with a needle from your emergency sewing kit rather than a safety pin or knife. It is also worth taking a moment to sterilise the needle (with a flame or boiling water) and to clean the skin around the blister to limit the bacteria that can be introduced to the wound. Take care not to stab the skin below the bubble, wipe away the fluid with a clean tissue or sterile gauze and cover immediately with a plaster.


Burns & scalds

A toppled pan or gas stove, errant sparks from a camp fire onto tent fabric or flammable clothing, or an unfortunate trip into either can land you with a nasty burn or scald. Be sure to check out our article on Fire Safety and always take great care when picking up or adjusting pans of hot water on a camping stove. While you’ll likely live if you singe your pinky finger, larger burns and especially those close to airways can be extremely serious. Also beware of burns that encircle a limb as the swelling can cut off blood flow to the area beyond leading to complications.


If you’ve suffered a burn or scald cool the area immediately with cold and preferably clean running water – in the wilderness this may of course be a limited resource! While rivers are certainly not considered clean to drink from they are running and may be the only option. You’re in better luck if surrounded by snow or in the worse case scenario, in dry areas where survival depends on having that water to drink, you may have to make do with wetting a cloth to lay over the area. Cool the burn for at least 5-10 minutes before covering and seeking further medical help. Always give the skin and circulation some time to recover between applications of ice.


For deeper burns that have broken the skin and created a wound the risk of infection is extremely high, applying ice or water (especially dirty river water) directly to the flesh may cause more damage than good. It is advised to cover the wound as soon as possible and help to manage their pain. If clothing is already stuck to the wound do not attempt to remove it, cut around the clothing if necessary.


It is not advised to bandage a fresh burn as swelling is likely to occur for a while afterwards and a bandage will soon become too tight. Ideally do not apply anything with loose fibres or that will stick to an open burn wound as it will prove difficult and be extremely painful to remove, possibly even causing further damage – cling film or a layer of plastic is recommended, laid over the wound not bound tightly. If the casualty is still in a lot of pain after covering the wound you can continue to apply water on top of the dressings, and unless there is reason not to allow them to take Ibuprofen (always read the leaflet before giving medications).


Cuts & bleedinglightweight camping knife - Buy now!

A fall onto sharp rocks, littered glass, or most commonly a simple slip using a knife or other cutting tool (all part of the learning process...) and now you or your hiking companion is bleeding!


Sit or lay the person down and after quickly checking that there is nothing sharp still in the wound itself (like broken glass) and ideally wearing gloves, apply firm pressure to the wound and raise it above the level of the heart. If there is something stuck in the wound you should not attempt to remove it yourself, instead apply equal pressure around the object to slow bleeding without pushing it in and causing further injury.


Depending on the severity of the wound several minutes of pressure and elevation may be enough, in which case you can go on to clean the area and cover with a plaster to prevent infection. If the bleeding is not stopping (or seems arterial ie. spurting!) you will need to apply a pad and bandage to maintain pressure and seek emergency help as soon as possible. Do not attempt to tie off the blood flow to a bleeding limb unless you are trained to do so.


Blood is often a scary sight for both casualty and those dealing with the situation so it is important to stay calm. A higher panicked heart rate will also mean faster blood loss so do everything you can to relax everyone involved. Take deep slow breaths and encourage them to copy you.


Dealing with Shock & Thirst

Shock is caused by not having enough blood flow to serve the body’s needs, either due to dehydration and the loss or restriction of blood. It can progress quickly and is recognised by pale and cold/clammy skin, a fast weak pulse and breathing rate, dizziness and confusion.

Treat shock as for fainting by laying the casualty on their back and raising their legs slightly to encourage better blood flow to the heart and vital organs, either hold their legs comfortably in place or use rucksacks and other equipment to prop them up (don’t move an injured leg!). Fear and panic increases the amount of oxygen needed so keeping the person calm is an important step.


Thirst is a common reaction to an injury or other fear inducing event however it is not advised to give water to someone with a head injury or other serious injury since it can alter blood pressure and increase the risks associated with vomiting. If surgery is likely to be required any additional stomach contents can put them at risk of complications on the operating table.


For less serious scenarios and when treating burns or scalds you may give water to drink providing that the person is fully conscious and does not have any restriction to the airway.


Temperature complications

Our bodies operate best within quite a narrow internal temperature range and have many clever adaptations in order to stay within that range dependent on the outside temperature but can only so so much before our health is at risk.


Hypothermia – low body temperature.

Natural responses to the cold include a reduction in surface blood flow and an increase in heart rate, followed by shivering - a last ditch attempt at manually heating the muscles before hypothermia kicks in. The body can quickly tire from shivering if not properly fuelled or sheltered leading you to become sleepy and disorientated – neither good things to happen in a wilderness environment where you need your wits about you!


Hypothermia can come on gradually through poor clothing or laying on cold ground, or suddenly as a result of falling into icy water – either way you need to act fast before you’re too cold to be able to do anything at all. Put on whatever extra layers you have available, and if it’s a serious enough situation climb into a sleeping bag and tent if you have those with you.


If clothes are wet it is important to get out of them and into a dry set as soon as possible since heat is conducted and lost much faster through wet fabric than dry.


A reflective foil emergency blanket is a magical lightweight addition well worth a space in every kit – they take the heat naturally being given off of the body and reflects up to 90% of it making a massive difference that is noticeable almost immediately! If you have any more layers to add put them over the top of the foil.


It is important to drink plenty of water and to refuel vital lost energy with high energy foods as long as the person is conscious enough to safely do so without putting their airway at risk. If someone is losing consciousness NEVER attempt to feed them or make them drink!


Remember that the weather doesn’t need to be particularly wintry to be at risk of Hypothermia, especially if injured. It is important to have an additional layer in your pack even if the temperature seems quite comfortable and you’re only planning a short walk, whilst your moving you may be sweating but can very quickly chill when forced to sit on the ground with an ankle injury for any length of time! Be sure to wrap up well before you begin shivering if you are awaiting rescue.


Hyperthermia – high body temperature.

When overheating due to the environment or exertion the body has several ways it uses to get rid of excess heat such as dilating (widening and raising) the blood vessels to enable heat to be convected away, panting and heavy breathing to ventilate, and sweating to utilise the surface cooling effect of evaporation. As clever as our bodies are, sometimes the system can be overwhelmed leading to a medical emergency. Hyperthermia usually occurs in humid environments where the rate of evaporation is low and so sweating has little to no effect on cooling the skin.


Heat exhaustion is the first serious stage in Hyperthermia and is generally recognised a headache, fast and weak pulse, irritation, confusion, nausea and dizziness – all common symptoms in dehydration. Fainting is increasingly likely if the person has not taken the time to sit or lay down and rest which can cause further injury in a rocky environment.


Heat stroke is the final stage of Hyperthermia and is characterised by hot but dry skin as sweating has ceased. A person suffering from heat stroke can initially appear intoxicated, become delirious and even hostile but will quickly collapse without intervention as their blood pressure drops. While those suffering from heat exhaustion can often recover well after cooling and rehydrating, if someone has reached the extreme stage of Heat Stroke you should call for emergency assistance!


Treatment of the initial stages can be as simple as resting in some cool shade; set up a tarp/emergency blanket or other cover to create a shaded area (hiking poles can be incorporated to make a decent tent!) preferably slightly raised from the ground to allow good air flow. Wetted cloths laid on the forehead and body, or wetting their clothes, can be helpful and soothing - a wet sheet in a doorway is a good trick for utilising the cooling effects of evaporation to cool an entire space (provided it’s not so humid that nothing is drying).

As symptoms progress the removal of clothes may be necessary, as well as actively fanning their body along with applying cool water. If it is possible to do so safely (without risk of drowning ether them or yourself!) they could benefit from being immersed in a cool stream or river – arguably this can cause the veins to constrict leading to the possibility of less heat loss but studies have shown that despite this response, immersion is still the most effective cooling technique.


It is important to stay well hydrated and to include electrolytes when exercising especially in hot weather, even is nausea is a concern sipping water every few minutes should be encouraged. If you begin to notice the beginning symptoms yourself such as a headache, take the time to take a break and put in some self care – don’t try to be a hero, you certainly won’t make your hiking target for the day of you need to be airlifted out!


Also to note: Taking a painkiller may help to ease a headache brought on by dehydration but remember that it is NOT a solution, if anything it will be adding to the workload of your liver and kidneys so don’t make it the first thing you reach for.


Heart Attacks, Anaphylaxis and Asthma

Sometimes an emergency scenario is more serious and more unexpected than a simple trip or slip which is why it is important to receive proper First Aid training and knowing how to correctly perform CPR (Cardio Pulmonary Resuscitation).


If you suspect a heart attack have the casualty chew on an Aspirin tablet which will help thin the blood easing it’s passage, as long as the person is conscious and able to do so. Sit the person down with their knees raised, against a wall or a propped up backpack and try to keep them calm – call for emergency help as soon as possible.


Anaphylaxis is a severe allergic reaction to certain foods or to Bee or Wasp stings, and begins with a tingling irritation to the throat and skin, developing very quickly to a rash, itching and severe swelling (which can obstruct the airway). It is an extremely serious situation that requires medical intervention as soon as possible – do not delay in calling the emergency services!

People with a previously known allergy will often carry an EpiPen (an emergency injection of epinephrine), it will be your responsibility to locate and help them to apply the injection (good information to know before you set out if someone in your group is at risk). It is important to remember that using the pen does not cure the issue, only buys the casualty more time until medical help arrives.


Asthma attacks can also occur due to any number of airborne and environmental irritants and much like Anaphylaxis are extremely serious and will require medical help. Most Asthma sufferers will carry an inhaler which they may need your help in finding and administering, though are usually used only to ease symptoms of breathlessness and not to completely stop a full blown attack.

Any airway obstruction is a terrifying experience so do your best to encourage the person to remain as calm and to breathe deeply along with you. Have them sit down, preferably leaning forward slightly to maximise the chest area – holding their hand and having the casualty open their eyes to look at you can be reassuring as you talk them through the ordeal.


Hyperventilation or Panic Attacks can also occur at higher elevations or with extreme exertion - experienced that one myself on a Welsh mountain side! It can happen to anyone and be both confusing and very frightening. It generally begins with a high heart rate and a strong sense of not getting enough air; continuous yawning or taking deep breaths progressing to an excessive rate; dizziness; tingling in the fingers and face and/or muscle clenching.

Treat by sitting the person down and speaking calmly as for an Asthma attack, DO NOT get them to breathe into a bag! With some time to rest and a few minutes of calm the symptoms will ease and the person will generally be able to continue without medical assistance - a slower pace is obviously recommended though it may be wiser to end the hike there and head home.

First Aid really comes down to knowing your ABC’s; check the Airway is clear and unobstructed (know how to correctly lift the chin), Breathing (can you see their chest move or feel or hear regular breath?) and Circulation (are they bleeding or lack a pulse?). If a casualty is not breathing or has no pulse you will need to call for emergency assistance immediately and perform CPR until they arrive. In the UK dialling 999 or 112 both work to connect you to the emergency services – follow their instructions and answer each question in order.

CPR is performed by placing the heel of one hand in the centre of the ribcage with the other on top, and with straight arms vertically compressing the chest by at least 2 inches – aim for approximately 100 compressions per minute. CPR can be a tiring exercise, it is advised to lean into the action using the weight of your body and not your arm muscles. While a properly trained First Aider is trained to provide rescue breaths as well as chest compressions it is not currently recommended for those without training to attempt since it can be tricky to get right and trying can mean valuable compression time is lost. Each time the chest is compressed and released there is a natural transference of air that balances the benefits lost from ceasing movement to attempt a failed rescue breath.


Be the difference with St John AmbulanceSarah served 6 years as a volunteer for the charity St John Ambulance, training in a wide range of advanced First Aid techniques and helping to deliver their renowned quality care. Visit the website to book a training course for yourself where you can gain vital emergency knowledge and certification along with hands on practice, and stock up your First Aid Kit via their online store to help support their valuable ongoing work.


Mountain rescue teams along with the Air Ambulance save many lives across the British Isles every year without government funding, and need your support as they rely on charitable donations to continue operating.


SUPPORT Mountain Rescue (England & Wales)>

SUPPORT Mountain Rescue (Scotland)> 

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See also what’s in our lightweight Hiking & Motorcycle Touring First Aid Kit>


We hope you found this article useful, and we also hope you never need it! Tell us your wilderness survival stories or any tips of your own in the comments below...

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Sarah is a UK artist and writer with a lifetime interest in camping and survival techniques.

Living the #vanlife since before it was a hashtag and touring on two wheels with her husband Ryan, they have a wealth of camping and motorcycling knowledge to share, and know a thing or two about packing light! read more

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