First Aid Guide
There are always risks involved with any outdoor activity. Injuries can occur in a wide variety of ways in the great outdoors. Although you can never really be 100-percent prepared for every potential outcome, you can mitigate risks by being diligent and well-prepared. In this guide, we’ll cover some core fundamentals of outdoor emergency preparedness and first aid, along with some basic tips on how to stay safer.

Important Note: This guide is intended to provide an overview of basic outdoor safety and first aid information and is not a substitute for a wilderness education course or first aid training program. For information on training and certification, we recommend one of the following organizations: 1) American Red Cross, 2) National Outdoor Leadership School or 3) Wilderness Medical Associates.
  • Preparedness

    The first way to avoid potential injuries in the great outdoors is to know your limitations, including both your physical capability and experience level. The second way to increase safety is with thorough planning. If you’re prepping for a backpacking trek or ski trip in a remote area, plan your route in advance using a topographic map. Always bring a map and compass or a GPS device with you (and learn how to use them) in case you become disoriented. Research the area for information on possible hazardous terrain or animals you could encounter.

    Even if you’re packing plenty of water, take note of potential water sources in the area. In a survival situation, you may need to replenish your supply. Pack extra food. Be prepared for any weather eventuality, even if the forecast calls for mild conditions. It’s always a good idea to make a gear checklist, going through your equipment and supplies one final time before heading out for any trip. Check through the entire contents of your first aid kit to make sure nothing needs to be replaced or added. Finally, always let several people know where you’re going and when you plan to return, even if you’re traveling with a group.

    Visit our Wilderness Survival Guide for more information and tips on outdoor preparedness.

  • Getting Help

    If you or a member of your group becomes seriously injured or sick, a simple day hike could quickly turn into a survival situation. Before doing anything, stop and assess the situation. Do your best to treat any injuries and stabilize the injured person. Find shade if the weather is hot. If conditions are cold, wrap the injured person in warm clothing, a sleeping bag or an emergency blanket.

    Always carry a fully charged cell phone. When a potentially life-threatening injury or sickness occurs, someone should call for help as soon as possible. However, it’s extremely important to determine your precise location on a map or with a GPS before calling for help. Providing accurate coordinates to rescue workers will greatly increase your chances of being rescued quickly. Once help is called, it’s important to remain in that location.

    If you must leave to locate cell service, such as a nearby high point, be sure you can find your way back. Only leave an injured person unattended if there is no other option. Getting lost is easy, especially under duress, so don’t rush. If the person going for help becomes lost or injured, it could significantly diminish the chance of rescue. Always keep a headlamp or small flashlight in your gear just in case you become stuck outside after dark. The light can also be used to signal rescue workers at night.

    PLBs and Two-Way Radios

    If you’re traveling in an area far from cell phone service, a personal locator beacon (PLB) could be a life-saving addition to your gear. According to NOAA, most PLBs allow rescue teams to narrow search coordinates to a 2-3 mile radius. Some more advanced PLBs incorporate GPS technology into the distress signal, which may improve location accuracy down to a 100-meter radius. However, PLBs are expensive and should only be used to call for rescue in a serious backcountry emergency. A multi-channel, two-way radio can sometimes be used to reach help, such as a nearby ranger station, but range can be greatly reduced by terrain. Depending on power output, frequency and other factors, most two-way radios only have a distance of a few miles or less in the backcountry.

  • First Aid Kit

    When you’re miles from a hospital, a first aid kit may help you treat an injury or sickness until help arrives or until you can get back to civilization. Kits range in size from very basic kits to fully loaded expedition kits for a large group. Aside from small cuts, scrapes and other minor injuries, a first aid kit is only designed to help keep an injured person stable until medical help becomes available. The list below includes common items that are found in most basic first aid kits. Although it’s possible to build your own from scratch, brands like Adventure Medical Kits offer pre-made kits in a wide range of sizes for different types of activities.

    Basic Outdoor First Aid Kit

    • CPR barrier device
    • Adhesive bandages (assorted sizes)
    • Butterfly bandages
    • Wound-closure strips
    • Sterile gauze roll
    • Sterile, non-adherent dressings
    • Trauma pad or clotting pad
    • Medical tape roll
    • Ace bandage
    • Antiseptic wipes or alcohol swabs
    • Antibiotic ointment
    • Insect bite relief
    • Antihistamine tablets
    • Pain reliever (aspirin or other)
    • Fever reducer (acetaminophen, ibuprofen or other)
    • Diarrhea treatment (loperamide or other)
    • Tweezers
    • Blunt-tipped scissors or EMT shears
    • Moleskin
    • SAM splint
    • Sling material
    • Irrigation syringe
    • Safety pins
    • Nitrile gloves
    • Mylar® emergency blanket
    • Small trash bag

    Additional First Aid Supplies

    The items below are not necessarily “essentials,” but are still good additions to any first aid kit.

    • First aid guide
    • Tubular bandages
    • Liquid bandage
    • Duct tape
    • Moldable finger splint
    • Sewing needle and thread
    • Compact thermometer
    • Iodine solution
    • Saline eye drops
    • Topical Benzoin tincture
    • Aloe Vera gel
    • Antacid tablets
    • Activated cold compress
    • Activated heat packs
    • SPF lip balm
    • Sunscreen
    • Bug repellent
    • Hand sanitizer
    • Water purification tablets
  • If an injured or sick person is still conscious, they should be able to tell you what the problem is, or at least steer you in the right direction. If they’re unconscious, you’ll need to do a visual inspection. If you spot an injury, continue inspecting the rest of the person’s body, as there may be additional injuries that need attention. Treat the most severe injury first. If you cannot see anything physically wrong, and the person is still breathing, focus your attention on getting help as quickly as possible. If a person is sick or injured but still ambulatory, you’ll have to make a judgment call on what to do next. This may involve helping the person hike out (self-rescue) or calling for help. In the following sections, we’ll cover some possible scenarios and offer advice on a potential course of action.

  • Spinal Injury

    If an injured person may have suffered a spinal injury, it’s very important not to move them unless they could sustain further harm by remaining in the current location. Moving someone with a spinal injury could cause additional damage to the spinal cord, potentially resulting in paralysis. Normally, rescue workers will immobilize an injured person’s head, neck and spine using a backboard, foam padding and straps before moving to a rescue vehicle. Since these items are most likely not available, do your best to keep the person still, calm and protected from the elements until help arrives.

    Head Injury

    A fall or blow to the head can result in several injuries, ranging from minor to very serious. Some types of head injuries include:

    • Scalp abrasion or cut
    • Bruise
    • Concussion
    • Skull fracture
    • Intracranial bleeding

    Cuts and scrapes to the scalp can bleed quite profusely, so it’s important to stop any bleeding as soon as possible. A concussion may result in a person feeling dazed, dizzy or nauseated. Other symptoms of concussion include headache, blurred vision and sensitivity to light. Have the person sit and rest, but try to keep them conscious. Call for medical help right away if the person cannot walk without stumbling, remains nauseated, slurs their speech, experiences lingering confusion or cannot remain conscious.

    Skull fracture and intracranial bleeding are potentially life-threatening injuries and may cause a loss of consciousness. Medical help should be called immediately in the event of any severe head trauma. Severe head trauma may also cause a person to go into shock.

  • A heart attack can happen anywhere and at any time. According to the Mayo Clinic, some signs of heart attack include:

    • Chest discomfort or pain
    • Pain in the left arm, shoulder, neck or jaw
    • Abdominal pain
    • Shortness of breath or lightheadedness
    • Anxiety
    • Sweating
    • Nausea or vomiting

    Some of these symptoms can also be indicative of another problem, such as dehydration, heat stroke or illness. Only a doctor or emergency medical technician can diagnose a heart attack or cardiac event. If these symptoms occur in the backcountry, have the person stop, sit down and rest in a protected area. Call for help using a cell phone or send someone to call for help if you’re not within cell phone range.

  • Respiratory Emergency

    Shortness of breath or difficulty breathing may be caused by chest or abdominal injury, asthma, bronchitis, allergic reaction, heart attack and other medical conditions. Treatment for respiratory emergency can only be performed by a doctor or emergency medical technician. However, if a person is having difficulty breathing, they should stop all activity and rest in a protected area. If the person is asthmatic, they may be carrying a rescue inhaler. If the person’s breathing does not return to normal after using an inhaler or after several minutes of resting, call for medical help right away.

    Rescue Breathing and CPR

    If a person has stopped breathing but still has a pulse, rescue breathing is usually performed until medical help arrives or until the person has resumed breathing on their own. If the person is not breathing and has no pulse, CPR should be performed until help arrives or until the pulse has returned. However, do not perform CPR unless you have been properly trained. Incorrect CPR could cause additional harm to an injured person.

    For information on rescue breathing and CPR, you should enroll in a reputable certification course, which involves hands-on instruction with a trained professional. The American Red Cross offers some good resources on finding a local program.

  • Shock

    According to Dr. John Cunha, DO, FACOEP, shock is a potentially life-threatening condition resulting from insufficient blood flow throughout the body. Shock can be caused by a severe injury, infection, blood loss, heart failure, anaphylaxis and other causes. When a person goes into shock, their circulatory system is no longer able to supply enough oxygenated blood to the brain and internal organs. Possible symptoms of shock include:

    • Below-normal blood pressure
    • Slow, shallow breathing or very rapid breathing
    • A weak or very rapid pulse
    • Confusion, anxiousness, extreme fatigue or unconsciousness
    • Cool and clammy skin, which may appear pale or gray
    • Nausea or vomiting

    Aside from using first aid to treat any injuries that may be causing shock, it’s important to treat the shock itself. In hot weather, get the person to shade quickly. In cool or cold weather, wrap them in a blanket or sleeping bag, especially if the skin is cool to the touch. Once they are lying down, elevate the legs slightly above heart-level to help concentrate blood flow to the lungs, heart and organs. Call for medical help immediately.

  • Fractures, Sprains, Strains and Dislocations

    Broken bones, sprains and dislocations are painful injuries that should receive medical attention as soon as possible. When these injuries occur in the backcountry, first aid techniques may be used to help immobilize or support the injury until medical help becomes available.

    Fractured Bones

    The adult human body contains just over 200 bones, all of which could become fractured during an accident. The severity of a bone fracture can vary from a small hairline fracture to a severe compound fracture. First aid varies for different types of bone fractures. Usually, to treat a broken bone in the field, the injured area should be immobilized or supported. For most arm and leg fractures, a splint may be used. A SAM Splint is one example of a customizable splint that can be molded or cut to support several different injuries. Most first aid courses will cover several techniques that can be used to splint or support broken bones. Fractures to the vertebra and skull are very serious injuries. If you suspect a potential spine injury or a fractured skull, do your best to keep the person immobilized until help arrives.

    Sprains

    A sprain is caused by trauma to one or more ligaments in a joint. Common sprains include ankle, knee, wrist, finger and toe sprains. Symptoms of a sprain include pain and mobility loss at the affected joint. Swelling and bruising are also common. First aid for sprains typically includes immobilizing or supporting the affected area, similar to treating a fracture.

    Tendon Injuries

    An inflamed, torn or ruptured tendon can be a very painful and debilitating injury. Common tendon injuries occur at the shoulder, elbow, wrist, knee and ankle. An injured tendon will typically cause pain and loss of mobility at the affected area. In the field, these injuries should be treated just like sprains.

    Strains

    A strain occurs when muscle fiber is damaged as a result of overstretching or overexertion. Pain, bruising and discoloration are three indications of a muscle strain. Hamstring and groin injuries are two common types of strains suffered by athletes. Depending on the severity of the strain, an injured person may remain ambulatory long enough to self-rescue. If necessary, help by supporting some of the person’s weight and by periodically stopping to rest. If the person is unable to walk with aid, call for help right away.

    Dislocation

    A dislocation injury is caused by an abnormal separation within a joint. This may also damage surrounding tendons, ligaments, muscle fiber and nerves. Joints that can be dislocated include the shoulder, elbow, knee, hip, foot, fingers, toes and jaw. Symptoms of a dislocated joint include pain, reduced mobility, deformation, bruising and swelling. Dislocated joints should only be set back into place by a doctor or trained medical professional. This type of injury should be immobilized or supported in a similar manner to a sprain until medical aid becomes available.

  • Bleeding

    Wounds like cuts and scrapes will usually cause bleeding. The amount of blood loss depends on the severity and location of the wound. Superficial wounds typically damage the capillaries, causing minor bleeding. Damage to veins will cause venous bleeding, which flows more steadily. Arterial bleeding, which occurs when an artery is cut or damaged, is the most severe type of bleeding injury.

    To stop bleeding, apply firm, steady pressure to the wound using a sterile pad or trauma pad. Once the bleeding has stopped, leave the pad or cloth in place. Wrap the injury with gauze or tape to secure the dressing. Be sure not to wrap too tightly, as this could cut off blood circulation.

    If the bleeding does not stop or reduce after several minutes of steady pressure, this could indicate a serious injury. If possible, elevate the wound above the person’s heart. Continue to apply firm, steady pressure. Have someone call for medical help immediately. If a pad or dressing becomes soaked through with blood, do not remove it, as this may damage any clotting that has already occurred. Apply an additional dressing over the existing one and continue applying pressure until the bleeding has subsided.

    Internal bleeding can occur from trauma beneath the skin and damage to internal organs. This can be a life-threatening injury and requires immediate medical attention. Do your best to keep the person comfortable and protected from the elements. Watch for signs of shock and monitor breathing.

    Cuts

    Small cuts can usually be treated without the help of a medical professional. Once any bleeding is stopped, gently clean the wound with an antiseptic swab or soap and water. Before dressing a deep or gaping wound, you may need to apply wound-closure strips to prevent the wound from re-opening. Seek medical attention as soon as possible, since deeper lacerations may require stitches and are more prone to infection. Periodically check the wound to make sure bleeding has not resumed.

    Abrasions

    Scrapes and abrasions should be treated in a similar manner as cuts. First, stop any bleeding with a sterile pad. Next, clean the wound with antiseptic wipes, doing your best to remove any dirt or debris. Apply a small amount of antibiotic ointment to the bandage or dressing. Use gauze and medical tape to keep the dressing secure.

    Punctures

    When applying first aid to a puncture wound, stop any bleeding first. Next, clean and dress the wound. Anyone who has suffered a puncture wound should strongly consider getting a tetanus booster as soon as possible, unless they’ve already received one within the past 10 years.

    Infection

    An infected wound is very dangerous, so it’s extremely important to seek medical attention right away if you suspect an injury may be showing signs of infection. According to WebMD, warning signs include:

    • Redness and/or swelling of the surrounding tissue
    • Increased pain
    • The wound feels warm or hot to the touch
    • Fever
    • Drainage or puss
    • Red streaks emanating from the wound

    A dirty wound is more likely to become infected, so it’s a good idea to clean superficial injuries with antiseptic wipes or warm, soapy water before applying bandages. It’s also important to change dressings and bandages on a regular basis, especially for weeping wounds. Severe injuries that bleed excessively should not be cleaned, as this could reopen the wound. Once the bleeding is stopped, leave the dressing in place and seek medical attention.

  • Dehydration

    According to the American Heart Association, staying well-hydrated is crucial to an individual’s overall health and wellbeing. Rigorous activities like hiking and cycling in hot weather without proper hydration can quickly lead to heat stroke or dehydration.

    Signs of dehydration include:

    • Thirst
    • Dry mouth and tongue
    • Fatigue, dizziness or light-headedness
    • Decreased need to urinate

    Signs of heat stroke include:

    • Headache
    • Nausea and/or vomiting
    • Cramps
    • Little or no sweating, despite feeling very hot
    • Elevated body temperature
    • Irregular heartbeat
    • Fatigue, dizziness or light-headedness
    • Unconsciousness

    If a person is showing symptoms of either heat stroke, dehydration or both, get them out of the sun and into the shade as quickly as possible. Continue to give the person small sips of water. Remove any unnecessary clothing. If symptoms persist or worsen, seek medical attention.

  • Altitude Sickness

    When a person has not been properly acclimated to a higher elevation or their body is having difficulty acclimating, they may begin to suffer from altitude sickness. The effects of altitude sickness occur when a person is unable to get enough oxygen into the bloodstream. Air becomes thinner at higher elevations, which is why alpine climbers frequently spend several days at a base camp, giving their body time to acclimate to thinner air before attempting to reach the summit.

    Common symptoms of altitude sickness include:

    • Headache
    • Fatigue
    • Dizziness
    • Difficulty sleeping
    • Decreased appetite
    • Nausea and/or vomiting

    Altitude sickness may take several days to subside, depending on the elevation and other factors. It’s important to drink plenty of water and avoid strenuous activities during acclimation. However, prolonged altitude sickness is a serious condition. If symptoms persist for too long or become increasingly worse, reduce elevation as soon as possible and seek medical attention.

  • Exposure

    Wearing the proper clothing in cold conditions and being prepared for changes in weather are very important for any outdoor activity. Exposure to cold without enough protection can lead to frostbite, hypothermia or both.

    Frostbite

    When the extremities (fingers, toes, nose, etc.) are exposed to cold for an extended period of time, they can begin to lose circulation and slowly freeze. In the early stages, frostbite affects the outer layer of skin. However, if exposure continues, frostbite may grow steadily worse, potentially leading to permanent tissue damage and possibly gangrene. People with diabetes or circulatory problems have a higher risk of getting frostbite.

    When fingers, toes or other extremities begin to feel numb from cold, it’s very important to get out of the elements as soon as possible, warm the affected areas and allow circulation to return. If you are traveling in an area where shelter may not be readily available during the winter, consider carrying portable heat packs and an emergency shelter.

    Hypothermia

    When a person’s body is exposed to cold conditions without adequate protection, heat loss will occur, eventually reducing a person’s core body temperature. As the core temperature drops, the body will often begin to shiver. This is an early indication that additional clothing or shelter is needed to prevent further heat loss. Hypothermia can occur in above-freezing conditions, especially if a person’s clothing is damp or wet. Infants, young children and the elderly are more susceptible to exposure.

    If heat loss continues unabated, a person will begin to show signs of hypothermia, which include:

    • Shivering
    • Fatigue
    • Increased heart rate
    • Confusion and/or difficulty speaking
    • Diminished coordination
    • Drowsiness

    Hypothermia is very dangerous. Advanced stages will eventually lead to unconsciousness, organ failure and death. If you suspect an individual may be suffering from hypothermia, seek shelter as soon as possible. If the person’s clothing is damp, help them change into dry clothing or get them into a warm sleeping bag. Skin-to-skin contact can also be used to provide core warmth. For more information on winter dangers and how to prepare, check out our Winter Clothing Guide.

  • Wildlife

    Researching an area you plan to visit is the best way to prepare for potential animal encounters and learn how to reduce risk. When camping in certain outdoor locations, it’s important to keep all food and scented toiletries outside of camp and far from your tent, especially at night. Using a bear bag or bear canister to keep food protected is recommended for some areas in North America, particularly the Rocky Mountain region, Appalachian region, Canada and Alaska. Some national parks in these regions require a bear-proof container for all primitive camping. Carrying bear spray is also a recommended safety measure in several popular hiking and backpacking destinations. Check out the Alaskan Department of Natural Resources for more information on bear safety.

    Although animals like bears and mountain lions are often first on people’s minds when venturing into the wilderness, it’s important to be aware of other threats. Game animals like adult deer, elk and moose can also be dangerous. Venomous snakes are another potential threat in many areas. Raccoons, mice and other rodents can quickly pillage an unprotected bag of food during a backpacking trip, so take proper precautions.

  • Poisonous Plants

    Insect Protection

    In certain parts of Asia, Africa and South America, disease-carrying mosquitos cause more deaths annually than any other animal or insect. In parts of North America, mosquitos can transmit West Nile Virus and some types of encephalitis. Ticks are known to transmit Lyme disease, Rocky Mountain Spotted Fever and several other harmful pathogens.

    These days, insect protection is available in several forms, from bug repellent sprays to clothing infused with permethrin. According to cdc.gov, the most reliable and longest-lasting protection from mosquitos and ticks is a spray repellent containing at least 20% DEET. Permethrin-treated clothing can provide additional protection, but should be used in combination with a spray for best results. In extremely buggy territory, a hat and mosquito net may be needed. To stay protected at night, a tent or shelter with bug-resistant mesh offers the best barrier.

    Poisonous Plants

    In some regions of North America, poison ivy, poison oak and poison sumac pose another hazard in outdoor settings. These plants excrete an oily compound called urushiol. Following contact with the skin, urushiol is known to cause allergic reactions in many people, which include itching, redness and inflammation of the skin (dermatitis). Fluid-filled blisters may also form. According to the Mayo Clinic, reactions usually manifest between 12-48 hours after contact and may last up to three weeks.

    It’s important to avoid itching skin dermatitis as much as possible. Scratching can break the skin and may introduce bacteria into the wound, potentially leading to infection. Some remedies include applying a corticosteroid cream or calamine lotion to affected areas, but you should consult a doctor or pharmacist before using any of these. If you may be hiking or camping in an area that contains poison ivy, oak or sumac, learn how to identify these plants, so they can be avoided. If you must travel through dense vegetation in the backcountry, long pants and a long-sleeved shirt can minimize skin exposure. However, urushiol can remain on clothing and footwear, and may transfer to skin through secondary contact.

    Allergic Reaction and Anaphylaxis

    Different compounds can cause various levels of allergic reaction in some people. A handful of people are severely allergic to certain foods or stings from bees, wasps and hornets. Anaphylaxis is a type of severe allergic reaction that can be life-threatening. Signs of anaphylaxis include:

    • Hives or flushed, red skin
    • Swelling of the face, eyes, throat and tongue
    • Difficulty breathing or swallowing
    • Elevated or decreased heart rate
    • Nausea, dizziness or vomiting

    People with a severe allergy may be prescribed an epinephrine injector by their doctor, which can be carried and used in case of an allergic reaction. If you believe someone is having a severe reaction or may be experiencing anaphylactic shock, call for medical help immediately. If the person is carrying an epinephrine injector, use as indicated and get help as soon as possible.

  • Lightning

    In the outdoors, lightning strikes can be a very serious threat, especially at higher elevations. If you plan on doing any activities outside, check the weather forecast and plan accordingly. Of course, weather patterns can change suddenly. If you become stuck outside during a lightning storm, there is no “safe” place. However, you may be able to reduce your risk by avoiding high, exposed areas. Check out noaa.gov for more information on lightning safety.

    Important Note

    The information contained in this guide is not comprehensive and not intended as a substitute for professional medical advice. You should never delay seeking medical attention or advice from a medical professional. This information is published solely as a general introduction to first aid principles and products. It is highly recommended that anyone planning to practice first aid should enroll in a reputable first aid training or certification program.