In the mountains we cannot rely on luck or providence to avoid or deal with possible accidents: we must rely on ourselves, our carefulness, our skills and on the equipment. Emergency first aid equipment must never be lacking. In the event of an accident we must carry out first aid while waiting for qualified people or while being taken to hospital. A clumsy or inexperienced assistant risks causing further damage. Generosity is not the key factor, neither can we refuse help shielding ourselves behind our incompetence. We must not venture into the mountains unless there is an expert in our group or unless we have a first aid kit in our bags.
With trekking, in particular in foreign countries, an intestine infection can seriously compromise our journey. By following simple hygiene rules we can avoid annoying and sometimes serious diseases. Never drink from dubious sources without sterilising the water. Never drink anything too cold in particular if you are very hot. Eat fruit and vegetables to guarantee regular intestinal functioning. Eat easily digestible food stored in suitable containers for food. Check the expiry dates of the products. Avoid washing in stagnant water. Keep body clean to reduce the risk of infecting any wounds. Wash every time it ìs possible. Wash hands before eating and disinfect them before treating wounds. Make sure you sleep enough which is important for getting over tiredness, you can use bland, natural sleep inducers like valerian or chamomile. Carry enough medicines for the length of the hike and participants and which are suitable for the area. Have the advised vaccinations (anti tetanus is always important). Place a card with your name, address and family telephone number, blood group and valid vaccinations, any allergies, medicines and other substances in your document holder along with particular medicinal therapies undertaken. This information can be useful for rescuers in the event of an accident.
The best cure is prevention. Having snake-bite serum iny our bags doesn’t mean you should fumble around recklessly in bushes. To reduce the possibility of accidents to a minimum always be careful. Another fundamental rule is to keep calm in the event of an accident and gather ideas, consulting a first aid manual if necessary, which should always be to hand. A matter of a few seconds can mean big mistakes are avoided and further damage caused. Do not crowd around the injured party. The main aim is to save the person’s life; secondly to avoid that his/her conditions get worse; finally to ease the wait or transport.
Priority of interventions
An injured party could have more than one injury; priority is given as follows. In the event of more than one injury we should give priority to the most urgent: Blocked airways Cardiac arrest Haemorrhage Loss of conscience Wounds Fractures. Always help to recover from shock.
Priority of organs to examine
If the victim is conscious he/she can help us identify the wounds. Not always is the biggest injury the most painful. If there is more than one injured person, not necessarily is it the one who is screaming the loudest that is in greatest danger. However, if the injured person is unconscious we need to check for damage using eyes, hands (touching as little as possible), nose and ears, following the order described below: HEAD listen if the heart beat is regular at the carotid pulse. (place the index and middle finger on the artery on the neck just under the ear). Check breathing (frequency, sound..) and that there are no foreign objects in the mouth. Check both pupils at the same time. They should be the same size otherwise they could indicate cerebral compression or a stroke. The whites of the eyes mustn’t be bloodshot. Talk into his/her ears to see if is conscious. Blood or light coloured liquid form the nose or ears can indicate a cerebral lesion. If the face is pallid or blue, breathing is difficult. Check if the forehead is hot or cold and if the skin is sweaty or dry. Smell the person’s breath. Check the colour of his/her lips (if they are burnt or discoloured something corrosive has been swallowed). If the internal mucous is a blue colour there is respiratory insufficiency. Check for swelling, dips (fractures) or haemorrhages by running our hands over the scalp. If you find a tag around their neck read for any possible illnesses or allergies and information about the blood group……SPINAL COLUMN After having unbuttoned clothes check (with great care and delicacy)with your fingers any possible irregularities in the spinal column, first behind the neck, then inserting the hands in the cavity of the kidneys, check if there are any irregularities or swelling of the vertebrae. TORSO Check if the ribs are regular and without pressure. Touch the sternum, shoulders, and pelvis to see if there are any fractures. Check if there are any signs of urinal or anal incontinence. Check there are no exhaling wounds on the torso (that expire air). LOWER AND UPPER LIMBS Examine thighs, knees, ankles and feet. Look for any identity tags. Check arms, wrists, hands and fingers.
Response to stimuli of an unconscious person
If a person who has lost consciousness responds to stimuli his/her condition is not worrying, if he/she responds with difficulty it is more serious; if he/she doesn’t respond at all it’s dangerous. Things to check: auditory response: talk into his/her ears. Reaction to touch: observe the reaction when we gently shake him/her and the reflexes of the eye lids when we touch the eyelashes. Response to pain: pinch a hand. If the injured person has lost consciousness put him/her into the safety position (see more) if, however, he/she is not breathing carry out artificial respiration. (see more) If his/her heart is not beating carry out cardiac massage (see more). If the person is unconscious, look in his/her wallet or pockets, better if with a witness, for anything that can indicate if he/she suffers from any disturbances and their possible therapies or any allergies. A diabetic patient has sugar cubes with him/her.
Request for aid
If there is more than one rescuer, after having ascertained the damage, at least one can stay with the injured person, better if two, and if there is no phone or it is impossible to get a signal in the area, help can be sought. The others need to communicate to 112 the exact location of the accident, the nature and seriousness of the injury, the type of wounds, special requests if poisoning is suspected, heart attack or anything else, the sex and age of the injured person, the telephone number from which they are calling and the name of the caller to help the rescuers find the place of the accident and any further useful information. Do not hang up until the speaker has confirmed that all is understood clearly. Wait for the rescuers and help them reach the injured person. If you are alone in assisting an injured person, after having carried out first aid and sheltering the victim, leave him/her water and food and go for help (if of course you have no mobile or radio or there is no signal. It is not always possible to get a signal in the mountains).
Place your ear over the person’s mouth. If you hear breathing and you can see his/her chest and abdomen moving (place a hand on the sternum) then it is ok, otherwise carry out artificial respiration. First, however, the person needs to be prepared. Free the airways. With two fingers positioned as a hook and covered with a tissue, remove any foreign bodies from the mouth (vomit, prosthesis, food..). Tilt the head backwards. After having laid down the person, with one hand under the back of the neck and the other on the forehead, tilt the head back a little. Lift the chin up. These movements are necessary to bring the tongue forward. Mouth to mouth respiration consists in blowing air that we have inspired into the lungs of the injured person; this contains 16% oxygen when only 5% is necessary. Prepare the person as described above. Close his/her nose with one hand while the other is under the neck. Place your mouth, sealed over his/hers and blow. The first three respirations need to be quick. Then proceed with 16 respirations a minute. Raise your head after every breath to observe the chest. Also check the pulse to ensure the heart is still active. If it is not, carry out cardiac massage. If the chest does not expand, free the airways better and tilt the head back again. We can also carry out mouth to nose respiration (blow air into both the nose and mouth at the same time). This method should not be carried out in the event of poisoning, so as not to get intoxicated; when poison is in or around the mouth; when vomiting continues.
(do not carry out if the patient’s heart is functioning, even if slowly, the cardiac massage would stop it). Normally it is necessary to carry out cardiac massage with artificial respiration. Place the patient on a rigid base. Kneel beside and place the palm of your hand on the lower part of the sternum, right above the appendix. Put the other palm on top of the first and, with extended arms, move your chest forward pressing on the patient’s chest until your arms are vertical. We need to lower the chest by 3cm (for an adult), with the rhythm of 50/60 times a minute. (be careful not to break any ribs). If you are alone, every 10 pushes tilt back the head and carry out two respirations. Every minute check the pulse. If there are two of you for every five pushes of the first helper, the second carries out one respiration (the second helper will kneel beside the patient on the opposite side to the first). Interrupt the cardiac massage as soon as the heart starts beating. Continue with artificial respiration until breathing is not autonomous. Once oxygenated blood starts to circulate the patient’s face will regain colour. WITH CHILDREN insufflations must be 20 a minute. Pushes should be carried out with one hand only, with a rhythm of 80 a minute, with a displacement of 2.5cm. WITH BABIES from 20 to 30 insufflations and 100 compressions carried out using two fingers, placed higher than normal, with a displacement of 1.5 – 2 cm.
We can feel if the heart is beating by placing our fingers in some places of the injured person’s body, where arterial circulation is nearer the surface: the neck, the groin, the wrist on the thumb side, on the inside of the elbow. Use the index and middle finger to check for the heart beat (if you use your thumb, you hear your own beat and that will surely be active!!).
Lateral safety position
An unconscious person who is breathing and whose heart is beating regularly needs to be put into the safety position, if it is believed there is no damage to the vertebral column. Undo tight clothing (belts, shirt necks..). Tilt the head backwards and open the mouth. Remove any foreign bodies. Align the patient’s arm to the side of his body, on your side. Bend the other arm onto his/her chest. Bend the leg on your side. Grasp the patient’s hip and shoulder on the opposite side and turn him/her over towards us. Tilt the head back a little and position the limbs so that the body is stable.
Shock is caused by the reduction of blood supply to the brain, by a haemorrhage or excessive vasodilation following a trauma, an injury or excessive loss of liquids. It intensifies with pain and exposure to the cold. If not treated it can lead to death. The person is pallid, yawns, is breathless, has cold skin, feels week, is thirsty, is cold, can be sick. You need to react immediately! Only haemorrhages and cardiac or respiratory arrest have precedence. Shelter the patient. Lay him/her on the ground with his/her legs raised. (We can always lay a chair down under the patient’s legs). If there are particular injuries place the patient in the most suitable and comfortable position. Loosen any tight clothing without letting him/her feel cold. Relieve the pain as much as possible and treat any injuries. Cover the patient without over heating him/her or making him/her sweat. If internal haemorrhages are not suspected give something to drink, little but often, water or tea and reassure him/her. Avoid noise and help him/her to overcome any states of panic. Check breathing and heartbeat, ready to intervene. Take to hospital.
Loss of consciousness
A person can lose consciousness for various reasons: heart attack, asphyxia, cerebral stroke, shock, cranial trauma, fainting, poisoning… it is important to discover the cause, react quickly and call for help. Check breathing and heart beat and free the airways. If the patient is breathing put him/her in the safety position and cover him/her with a cover. Examine the injured person to understand the cause. Every 10 minutes check he/she responds to stimuli. Do not give the patient anything (no liquids) if unconscious. Do not leave him/her alone.
It is a momentary loss of consciousness due to a lack of blood supply to the brain following a strong emotion or to low blood sugar caused by fasting etc.: lay the patient down, free the airways, raise his/her legs a little. Calm the patient and do not give alcohol, do not slap the patient and do not throw water in his/her face.
Injuries can cause danger of haemorrhages and infection. They can be simple which we can cure ourselves, or serious which require medical intervention. There are many types: CUTS: caused by a blade; they can bleed a lot. FROM A POINTED OBJECT: caused by nails, scissors etc. The deeper they are the greater the risk of infection; they can cause internal lesions. LACERATIONS: with the skin lacerated by claws or animal bites, metal wire; they bleed less but they are easily infected. LACERATIONS AND BRUISING: caused by a fall or a blunt object; can be associated with bruising and fractures. ABRASIONS: mainly caused by a fall, the skin is grazed; they can get infected due to the presence of sand or other foreign bodies. FROM WEAPONS: cause serious lesions and internal haemorrhages; the bullet creates an entrance hole and, if it comes out, a larger exit hole, from which there can be a haemorrhage.
Wash and disinfect hands. Widen the edges of the wound to check for any detritus which needs to be removed using gauze or pincers disinfected over a flame and with a lot of water. Clean the wound moving from the inside out using a sterilised gauze. Disinfect with a non-alcoholic disinfectant without using creams or antibiotic powders. If the wound is deep or very open it needs to be stitched by a doctor. We can carry out emergency stitching joining the edges and fixing them with butterfly plasters. Cover the wound with a sterile gauze and cotton wool placed over the wound (never directly on it so as not to get fluff in it), then bandage it. If it is a small wound use a sterile medicated plaster. If the patient is not vaccinated he/she must be taken to the doctor’s to get an anti-tetanus.
Sprains - Dislocations - Fractures
Sprains are the so called “twists” which involve the joints and affect muscles and tendons. Pain makes it difficult to move the limb; bruising and swelling can occur (for blood spilling). There can be damage to the tissue (pulled muscle). Put ice or material soaked in cold water onto the area for about half an hour. Bandage it using an elastic bandage after having applied a cream. We can give the patient an anti-inflammatory and, if necessary, a pain killer. If we are unsure about the damage treat the lesion as a fracture. Dislocations occur when the bone comes out of its socket. There is an obvious deformation of the body. The area swells and there is bruising. The pain is intense and the limb cannot be moved. Immobilize the affected area without trying to put it back into position. Place a rolled jumper under the armpit (if the shoulder has dislocated).Take the injured party to the hospital. Fractures are breaks in the bone and can be caused by a trauma. They can be closed if the bone does not break the skin, and exposed when the bone sticks out or when a wound reaches the fractured bone. The latter are dangerous because they easily get infected and can infect the soft tissue inside the bone. Both types of fracture can be complicated when they damage a blood vessel, a nerve… The most dangerous fractures are in the vertebral column, the head and complicated ones in the chest. Symptoms: intense pain; swelling and bruising (can occur later); deformation of the limb; sound or crack heard by the patient due to the rubbing of the surface of the fractured bone; possible state of shock. Some of these symptoms are not always present. Intervention: we can intervene only if qualified help is late in arriving and in extreme cases. Observe the injured area without moving it and compare it to the healthy limb. Immobilize the fractured part with precaution so as not to provoke pain, without moving it and without stopping the blood from circulating. Between the stick and the limb there must be some padding. Treat shock and give something to drink. Take to hospital. We can give a pain killer (to a conscious patient). If there is the risk of death (fires…) we must move the patient before immobilizing the limb. In the event of exposed fractures, before immobilizing the limb, cover the bone and wound with a sterile gauze, protecting it with a ring shaped object (made with a clean rolled scarf placed on the bone) and bandage with care. If breathing stops or there are haemorrhages or unconsciousness first deal with these. Immobilization: if a foot is involved and we suspect it is not bleeding we can immobilize it with the shoe, after having loosened it, using the healthy foot. If however it is a hand or forearm or arm, after having positioned a stick, bandage with a scarf and block the limb to the chest. Vertebral column fracture: the spine is made up of a series of bone rings in which there is the spinal cord, made up of nerve fibres, which transmit nerve impulses to various parts of the body. A lesion to the vertebrae can damage the spinal cord causing paralysis of some or more of the surrounding areas. Considering paralysis is definitive, if we suspect this type of injury, we absolutely must not move the patient, to avoid further damage. Symptoms are: intense pain in the back; impossibility to move arms and legs (tell him/her to move fingers and ankles); insensibility (cannot feel when we touch his/her limbs). Gently touching we can feel some irregularities. Call for assistance immediately specifying that suitable equipment is required (stretcher, etc…). In the meantime cover and keep warm, placing clothes around the body to prevent movement and keep head still. Only expert people can move the patient. If we are forced to move him/her we must not let his/her back bend and there must be at least three of us. One can hold the head, placing one hand under the nape and the other can hold the shoulders. One can hold the legs: a forearm under the calves and the other under the thighs. The third, astride the patient can hold the body placing his/her hands under the waist. Lift the patient with care and, at the same time, with force. The two holding the head and legs should pull towards themselves to keep the patient’s back still. Place the body on a rigid surface (a plank, a door..). put a scarf under the neck and in the lumbar cavity. If we suspect a fracture of the cervical vertebrae loosen clothing and apply an emergency collar, without moving the neck, using a newspaper or scarf. Treat as a vertebral column fracture.
We can be poisoned by a toxic substance we ingest , breathe or absorb through our skin or it can be transmitted to us through an animal bite. Some poisons block some vital organs (heart, lungs) working on the nervous system, others prevent oxygen form being transported. Symptoms depend on the type of poison and its diffusion through the body. There can be nausea, vomit, diarrhoea and abdominal pain, burns around the mouth, if a caustic substance has been ingested. Damage to the nervous system, headaches, asphyxiation symptoms. The most serious poisoning is when the effects are delayed and the symptoms appear after 12-36 hours. This is the case with some deadly mushrooms or botulin (a germ found in food preserved in tins, in oil or sausage meat). Intoxication from botulin, as well as the normal symptoms, manifests an interruption in salivation, paralysis, loss of voice. Poisoning from mushrooms also causes paleness, cold sweating, thirst, confusion, vertigo, delirium, tremors, collapse leading to coma. Prevention: throw away tinned food that has a raised lid, do not eat high meat, only gather mushrooms and berries that are known. Intervention: if breathing stops or there is cardiac arrest intervene with reanimation, being careful that any remains of poison around the mouth do not intoxicate us. If the patient is unconscious put him/her in the safety position. Try to find out what poison you are dealing with by gathering as much information as possible from witnesses and by observing the objects around the patient or from him/herself. Gather any samples of the poison and vomit. If can be taken to hospital in a short time do not provoke vomit. Contact a poison centre. Only if transport to a hospital or medical care is delayed should we follow the procedure described here. Ingested poison: do not make person vomit if caustic poison has been ingested (bleach, muriatic acid, caustic soda…) or derivatives of petrol (petrol, diesel, mixes…), as the regurgitated substance could cause further damage. Provoke vomit for other poisons (including mushrooms and poisonous plants) if there are symptoms a few hours after ingestion. Stimulate the pharynx with a finger or make the patient drink 200 cc of warm water with two spoons of salt. Antidote: for both caustic poisons and the others we can give the patient a drink of ½ a litre of water or milk mixed with 4 beaten egg whites, or ½ a litre of milk or even just water.
Frostbite hits the parts of the body exposed to cold with temperatures below 0, in particular hands, feet and the face. Tissue appears pale and hard, the injured party feels pins and needles, burning and numbness. Subsequently the limb swells, becomes marbled and blisters appear. Finally some areas become dark and gangrene develops on the limb. We can proceed with first aid only when we are sure we are in a sheltered and safe place. The person, in fact, once assisted, must not continue walking and can only be transported if well protected. It is not necessary to expose the affected area to intense heat (fire, hot water…), we need to massage it. Once the area has been carefully exposed, put it in warm water until it has not regained its normal colour. We can also keep the limb in close contact with the person’s body or our own. Heat their face with your hands. Finally cover the area with hot dry cloths. Do not burst the blisters but treat them with alcohol free disinfectant. Give hot drinks to the person. Do not whatsoever give alcoholic drinks as they facilitate frostbite.
Is an increase in body temperature caused by prolonged exposure to the sun in hot periods. It is dangerous as the cerebral cells cannot survive above a certain temperature. You should avoid prolonged exposure to the sun’s rays. The effects can be serious: nervous disorders, increased sweating, tiredness, light and frequent pulse, headache, vomiting, state of shock, increased body temperature, and if measures are not taken promptly, loss of consciousness and coma. Place the person in a half sitting position in a cool place in the shade and take off his/her clothes. If he/she loses consciousness put in the safety position. Fan his/her face. Wipe the whole body with a cool damp sponge or cloth. In these cases alcohol is ok. As soon as he/she comes round give him/her cool water to drink with a dash of salt and a spoon of sugar. He/she must drink as is suffering from dehydration. Check the temperature. Take to hospital.
The lack of oxygen and the drop in pressure at a height are the main reasons for the general feeling of unease known as mountain sickness. Our bodies adapt by increasing the number of red blood cells which transport oxygen and by intensifying respiratory and cardiac activity. Until we are used to these new environmental conditions we should not undergo stress. We need a few days to get used to it. When we find ourselves unexpectedly above 2500 metres certain disturbances appear: lack of breath and palpitations, headache, vertigo, tiredness, nausea, paleness. With rest and getting used to it the situation improves. Give warm stimulating drinks like tea. Serious syndromes can appear with lack of breath even when resting, coughing, nervous disorders, mental confusion, blood in spit, cyanosis, fever and finally coma. In these cases the patient is put in a semi sitting position and transported down the mountain to hospital as quickly as possible. Inhaling oxygen helps.
The bite of any animal can produce a wound which can easily be infected and some (from foxes, dogs…)can transmit rabies (a deathly disease). Wash the wound with soap and water and disinfect it with a non-alcoholic substance. Try to capture the animal and take it to a vet’s, or if it is a domestic animal, get in touch with the owner to find out what vaccinations it has had. If in doubt or we have no information about the animal we must take the patient to casualty to get anti rabies treatment.
A viper bite can be recognised by the two small holes made by the snake’s teeth. The victim will manifest oedema around the bite and profound pain. After about 20 minutes the following symptoms gradually appear: headache, vertigo, general discomfort, fall in blood pressure, stress, vomiting, diarrhoea with blood, difficulty breathing and finally cold sweating and salivation. After two hours symptoms get worse. The victim is in a severe state of shock. For an adult one bite is not fatal, even if it can have effects on the nervous system. It can be deathly if it is a child, a heart patient, if the bite is on the neck or face, if the venom if injected into a blood vessel. The cure is to administer snake-bite serum under medical care, therefore take the patient immediately to the hospital trying to move the bitten area as little as possible. Our task is to slow down the diffusion of the venom till the patient arrives at the hospital. Temporarily place a tourniquet (a folded tissue), not too tightly, a few cms above the bite towards the heart; the tourniquet should be removed every 15 minutes and replaced further up. It must not stop the arterial blood from circulating (pulse); a finger must fit between it. Clean the bite with a lot of water, try to get some blood out of the bite to get the venom out. Disinfect the bite with a non-alcoholic solution (alcohol is dangerous as it can fix the venom). Neutralize the venom with potassium permanganate or bleach, if you have it. Having done this take the tourniquet off. Bandage the area and the whole limb as for a fracture. In this way you slow down the diffusion of the venom. Treat the state of shock. Place an ice bag on the area. Do not move the patient and calm him/her down, so as not to speed up the diffusion of the venom. Give strong tea of coffee to drink or administer a cardio tonic.
Scorpion bites can cause profound pain, reddening and swelling. It Italy scorpion venom is not deathly, however the trauma is serious in particular for children.
Bee, wasp, hornet stings all cause profound pain, swelling and reddening, but considering the amount of venom injected is minimal they are not dangerous, apart from some exceptions. Not serious cases: after having extracted the sting using tweezers, apply an anti-histamine cream or some ammonia diluted in water on cotton wool. Stings in the throat: give ice to suck and cold very salty water to gurgle to reduce swelling. Be ready to intervene with artificial respiration. Keep the airways free. Take the victim immediately to a doctor.
Transporting the injured party.
The decision to transport the injured party is very delicate and must be assessed carefully. The best thing to do with injured or seriously ill patients is to wait for qualified assistance, for the ambulance or helicopter. Sometimes, however, the patient needs to be moved. In these cases we must transport him/her with care and method, and, if necessary, place him/her on a stretcher (even an improvised one). Work quickly if the patient is in danger of death and it is not possible to wait for medical help (viper bites, haemorrhage..) and only if there are enough people to do so. If the victim has a fracture on the vertebral column we must only move him/her to save from immediate dangers, like a fire, taking care to lift him/her and place on a rigid stretcher without moving the vertebral column. Simple techniques: when the patient is able to walk we can help by supporting him/her. For short distances, in the event of an emergency, if the conditions of the patient allow, we can drag him/her by the forearms, the shoulders or give a “piggy back”. A fireman’s lift is the technique used for carrying light people and if we need a free hand.
First aid kit
The container must be strong and waterproof, such as plastic ones used to store food in the fridge, and of the right size so as to fit in your bag. It is better to divide the material according to the type of intervention: wounds, sprains, various pills. Register and check regularly the expiry dates of the products. Disinfect the equipment before use and before putting away. The amount of material and medicines depends on the length of the hike and number of people. In the first aid kit there should be: some disinfecting wipes for hands or some neutral soap, a thermometer, tweezers, scissors with rounded tip, 2 razor blades, safety pins, mono use gloves, 2 triangles of material (1m side), 1 tourniquet, absorbent cotton, 2/3 packets of sterile gauze (10x10), 1 plaster roll, 1 packet of plasters of different sizes, 1 metre of elasticated net for medication, 1 bottle of non-alcoholic disinfectant, 1 bottle of hydrogen peroxide, 1 elasticated bandage, 1 tube of cream for sprains, 1 synthetic ice spray, 1 tube of anti-histamine cream (for insect bites), 1 tube of cream for burns, aspirin, some small packets of sugar, cooking salt. Minimal indispensable material: bottle of disinfectant, absorbing cotton, a packet of sterilised gauze, 1 5cm bandage, medicated plasters, aspirin, 1 elastic bandage, pain killers, 1 tube of anti-histamine cream (for insect bites).
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