This is a guide to the first aid knowledge and techniques required for safe and comfortable hiking. It is intended as an adjunct to proper training in basic first aid, conducted by a suitably qualified instructor. First aid is a practical skill which can only be learned well under supervision and personal instruction.
These notes assume that the reader is acting as first aider within a group of hikers. It would also be helpful for the reader to hold a current first aid certificate at the level of First Aid at Work (UK) or EMT-Basic (USA).
First Aid nominally has no regional differences; ill people are ill in a certain way, no matter whether they come from London, San Francisco or Pretoria. However, different countries have different approved protocols for a variety of conditions, most noticeably in the matter of resuscitation. The reader is referred to the American Heart Association or European Resusciation Council publications for the most recent information on this topic.
The terminology used in this guide is primarily British. Measurements are given in Imperial and metric measures. Note that British pints and gallons are used rather than American ones; a British pint is about 550ml, so a British gallon weighs 10 pounds (4.5kg). Sick people are referred to as 'casualties' rather than 'patients'.
An experienced hiker, he has hiked the English and Welsh moors and
mountains, in addition to the puys of the Massif Central,
the Catskills and Adirondacks, southern Sierra Nevada peaks, and
Mojave desert. He has personally experienced blisters, hypothermia,
heat exhaustion and altitude sickness, and does not intend to repeat
The author has endeavoured to make this information as accurate and
helpful as possible. However he is not a healthcare professional,
practises differ from country to country, and it is impossible to cover
all eventualities of environment, casualties and circumstances. This
information is best used as an adjunct to existing training and
The author welcomes corrections and additional material, and will
give credit where due in future releases of this document.
Principles And Practise
The basic principles of first aid are:
These are given in descending order of priority. A first aider's primary concern must ALWAYS be for his or her own safety. The ideal first aider is a selfish lazy coward. Ask any experienced paramedic or EMT (who always seem to be the opposite of these qualities, yet approve of them.)
Within a hiking group, the first aider acquires extra priorities. The safety of the whole group is affected by illness of or injury to any member of the group. The distance from professional help does not affect the priorities of treatment, but may affect the action required to address them.
If you are taking action as a first aider, and the action does not fall within one or more of the above categories, you should carefully consider whether the action is in fact necessary.
The main hazard while hiking is the environment. It is sometimes
dangerous for the party to be halted for a significant time, due to cold,
wet or windy conditions chilling all members of the party. It is very
easy for one hypothermia case to turn into four or five when the party
stops to look after the first casualty. Be aware of the rest of your
party if one of them becomes ill or injured.
The best way to provide first aid for your party is to prevent them
getting into trouble in the first place. This section makes general
points about avoiding trouble.
You may come across other groups or individuals who are in need of assistance. Remember that the safety of your party is paramount; do not give up any food, drink or equipment which your party needs. Once this is ensured you can try to help the injured parties.
To call out an organisation such as the Mountain Rescue (in the UK) you should be able to provide the following information:
It is almost always worth taking 5 minutes to secure this information
before you send a party out for help.
Hypothermia usually comes on slowly, over a matter of an hour or longer. It is generally caused by the hiker's clothing being insufficient to retain heat and block wind in the hiking environment. Sudden hypothermia may result from the hiker falling into cold water, but is not common and it is usually obvious that the affected person may be in trouble.
One common mechanism for hypothermia is hill walkers who wear a cotton T-shirt next to their skin. During walking this will become saturated in sweat, though still stay warm. However, as soon as the walker stops walking (and thus stops generating so much heat) the T-shirt will rapidly cool down, aided by any wind that is blowing. This cooling will make the shirt feel icy cold, and can quickly chill a walker to the point of hypothermia. Avoid it by wearing a polypropelene shirt as your innermost layer, and polypropelene long johns under your walking trousers in cold conditions.
Other ways to protect against hypothermia are to eat well before and during the hike, wear layered clothing to trap air between layers, to wear a windproof (and ideally breathable) fabric as the outer layer of clothing, to wear a hat, and to keep talking with the rest of the party so that they can detect if you're getting cold.
The signs and symptoms of hypothermia vary from casualty to casualty. There are general features which are almost always present. The skin of the casualty is usually pale and cold to the touch, even in the warmer parts of the body like the armpit. The pulse will normally slow down as hypothermia progresses.
The most noticeable feature of hypothermia is a change in the casualty's behaviour. They generally become more withdrawn, less willing to spontaneously talk, and may be less sunny in nature than normal. As the hypothermia progresses they may lag behind the rest of the party, be reluctant to move on once stopped, or even sit down and refuse to move.
The casualty will almost always feel cold and may shiver uncontrollably. If this shivering stops without intervention then this may well mean that the casualty is getting worse rather than better. They may realise that they are getting cold but not be bothered to tell anyone.
The casualty's mental faculties may be diminished. I have known a hypothermia victim want to eat a Mars Bar she was given, but be unable to work out how to open it. They will be at greater risk of stumbling while walking.
If you suspect that someone in the party may be hypothermic, get into shelter if feasible and stop hiking. Make sure that all other members of the party are warm enough and protected from the elements. Assess the level of hypothermia of the casualty by talking to them, checking vital signs and feeling their body temperature.
If the casualty is still coherent but feels cold, get extra warm clothing onto them. If they are not wearing a hat, get one for them. A warm drink to sip may help, as may chocolate if they are happy to eat it. Don't stay static too long; get moving again and stay with the casualty at all times. If they recover then that's great; still, you should seriously consider getting out of the cold and wind, descending off the heights if possible. If they don't get better, or get worse, stop and consider the next move.
It is generally not safe to make an ill hypothermic casualty move under their own steam, especially if ascent or descent is involved. The first aider will have to make a judgement, in conference with the party leader, about trading travel distance for shelter. Once the stop is reached the casualty should be fully dressed and put into a survival bag with another (fit and warm) member of the party to warm passively. The party must then send people for help. It is recommended that a minimum of people are left with the casualty, and these people should be well clothed with a good store of provisions.
The golden rule in the treatment of hypothermia is to warm the casualty up at the same speed that they cooled down. For this reason, applying hot water bottles or similar sources of heat to hypothermic casualties is normally a bad idea; it draws blood to the skin surface instead of keeping it in the body core where it is needed.
For the unusual circumstance of rapid hypothermia onset, get the
casualty into dry, warm clothes, give high-energy food and warm drink,
and exercise them as soon as possible. Only do this if they are still
coherent and complaining of cold. Otherwise, restrict treatment to
Hyperthermia is the condition which occurs when the body's core becomes
too warm. It manifests in two principal conditions: heat exhaustion and
Heat exhaustion is caused by exercise in a warm environment without adequate rehydration. The body loses water through the process of sweating, which it uses to cool itself down. If this water is not replaced then the body will run short of water. This is heat exhaustion.
To prevent heat exhaustion you should carry and use the appropriate amount of water for the hike. Walking in a warm climate requires at least one pint (550ml) of water per hour of hiking. Higher altitudes require more water than lower altitudes. You should wear clothing which can be put on or taken off in layers so that you can control how warm you get. Light coloured clothing and a wide-brim hat reflect sunshine and protect you against sunstroke (irritation of the coverings of the brain by the sun's radiation).
You should drink your water whenever you feel thirsty, not trying to ration it. If you reach your halfway water level, you should carefully consider whether you have enough to make it safely to your destination, or whether you should abort the hike. Carry at least a litre of your water in a shatterproof and leakproof container such as a Sigg aluminium flask, and drink this last of all.
Signs and symptoms of heat exhaustion include the person feeling thirsty, sick, dizzy, and generally ill. Their skin may be warm and sweaty. As heat exhaustion progresses they may become unable to walk further and collapse.
The first priority in treating heat exhaustion is to stop it getting worse. Get the person covered up with a hat and light loose clothing if they are not already so covered. Put them into any available shelter from sunshine. Give them frequent sips of water (optionally mixed with a small amount of salt, or a sachet of electrolytes such as "Rehydrat") and assess their condition. If it starts to improve then see how they feel about proceeding. If they do not improve, or feel unable to proceed, the party should decide whether and how to get professional help.
Casualties who are not conscious enough to drink water themselves should not be given water as they may choke on it.
If the body loses its ability to control its own temperature then the casualty has developed heat stroke. When this happens the casualty may run a temperature of 40C (104F) or greater. The body ceases to sweat, so the skin becomes hot and dry. The increased heat affects the ability of the brain to function, causing the casualty to lose consciousness. This condition can easily be fatal, and must be treated as soon as possible.
Since the body cannot cool itself any more, the first aider must do
the cooling instead. The casualty should be moved into shade, have all
outer layers of clothing removed, and soaked in cold water. This may be
difficult if no water source is available; the key point to remember is
that the casualty must be cooled or they will die. Anyone suffering
from heat stroke needs urgent medical attention.
Blisters can turn an enjoyable hike into utter misery. Do not
underestimate their effect. This section tells you how blisters form,
how to prevent them, and what to do about them when they do arise.
Blisters are the result of persistent rubbing on an area of skin. Typically they occur on the foot or ankle. There is a loss of fluid (serum) into the potential space between two skin layers, resulting in a "bubble" on the skin surface. If this bubble bursts, as can happen easily, raw and sensitive skin is exposed and made susceptible to infection. In any case, further pressure on the blister is painful.
You are almost always going to get at least one blister on any long hike. However, you can delay the onset of blisters by preparation and the use of good kit. There are three factors in blister formation; feet, socks and boots. We address each in turn.
Your feet should be acclimatised to walking long distances, building up tough calloused skin to protect their soft parts. As well as walking lots in the weeks before the hike, rubbing your feet with surgical spirit for one or two weeks before can apparently help to toughen them. I have not tried this personally. Don't get your feet wet if you can possibly help it; dabbling your bare toes in a stream may be very refreshing, but your feet should go back into your socks dry.
Choice of socks is very important. Cotton socks retain moisture, keeping the skin wet, and wet skin is halfway towards blistering already. Use thin polypropelene or silk inner socks under a thicker outer socks. "Thor-Lo" padded socks are what I use, with extra pads around the toes, ball of the foot and ankle. Changing inner socks at least every day is vital; changing halfway through the day's hike may help those with sensitive feet.
Finally, your boots should be really well broken in. This doesn't just mean wearing them around town for a few days; they should be worn on a few short day hike, ideally with the kind of backpacked load that you'll be carrying normally. Ensure that they're properly waterproofed with G-Wax or whatever is appropriate.
If a blister appears, you should treat it as early as possible. Get the boot and sock off and expose the affected area so that you know where the blister is and how big it is. There are two possibilities: it is still intact, or it has burst. In either case it will be painful if pressed.
The dressing of choice for a blister is Compeed. This comes in packs of 5 normally, each dressing being about 1 inch wide and 1.5 inches long. Make sure that the blistered area is dry. Remove the protective backing from the Compeed, apply squarely onto the blister with the adhesive side down, and hold it on there with your hand for 60 seconds. I personally favour securing the Compeed with zinc oxide 2cm tape; run the tape along the line of friction if you can, rather than across it. Tape over each edge of the Compeed. This should secure the dressing for several days even if you are hiking each day, and should reduce pain considerably. For blister pain in the short term, paracetamol helps.
Once the hike is over, you can remove the Compeed, wash the blistered
area with clean water, and allow it to heal naturally. As with any wound,
if the blister appears to be infected or fails to heal then consult a
As you ascend from sea level, the amount of oxygen available to breathe
decreases. Technically, the air pressure decreases and so the partial
pressure of oxygen decreases with it; it's harder to get a certain
volume of oxygen to cross into the blood from the lungs. This lowered
level of oxygen gives rise to altitude sickness.
The effects of altitude are most easily noticed after a sudden ascent, for instance in a cable car from sea level up to 8000 feet. The body is unable to sustain a flow of oxygen to the muscles at the usual rate. This manifests itself in people being short of breath after even moderate exercise, for instance climbing up a flight of stairs.
To avoid the effects of altitude it helps to acclimatise. Ascending slowly, over several days for an ascent of around 8000 feet, helps the body adapt to the new level of oxygen. Keeping a high rate of fluid consumption also helps as this aids the body in circulating what oxygen it has.
Altitude sickness arises from this decreased oxygenation, usually combined with strenuous activity. It is basically hypoxia, a reduced amount of oxygen for the body, and has the same basic signs and symptoms. The onset of mild altitude sickness may be detected from headaches, sickness, an increased level of anxiety, and aggravated effects of other conditions such as hypothermia. As the sickness sets in the casualty may collapse, hyperventilate, or even stop breathing.
Treating altitude sickness is difficult. Medication such as Diamox
can help to attack the symptoms, but the only way to stop it is to
attack the cause and descend to where the partial pressure of oxygen
is greater. If the casualty is severely ill then this may be difficult.
The best way to deal with altitude sickness is to avoid it by
Being attacked by animals is much rarer than popular myth suggests.
Nevertheless, fiction usually has a basis in fact. Know the dangerous
animals in your hiking environment, and how to deal with them. In
national parks, check with the park ranger about seasonal hazards.
If someone is bitten, try to identify the snake by size, colour, markings etc. Keep the injured person still with the bitten part lower than the rest of their body, and seek professional help.