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How to Handle Medical Mishaps

How to avoid mishaps—and what to do if an accident happens | by Doug Diekema

You’re out on the trail with a friend. Suddenly she stumbles, tumbles down a slope and impales her leg, leaving a bleeding wound on her shin. Would you know what to do?

Most of us plan our hikes and think about the fun but we don’t give much thought to injury or illness. The truth is that the drive to the trailhead may be more dangerous than the hike, but stuff happens: twisted ankles, falls, getting lost in dense fog. And when things happen, getting help can be difficult. Common sense, preparation and adequate training become important when help may be hours or days away.

Students practicing potential scenarios in a wilderness first-aid course. Photo courtesy Aerie Backcountry Medicine.


The best medicine is the medicine you don’t need. In addition to leaving plans with a trusted individual along with a note in your vehicle, make it your practice to ask everyone accompanying you about their medical history. Do they have asthma and their inhaler? Do they have any history of serious allergic reactions? And if so, do they have their EpiPen? Familiarize yourself with the trail and the terrain before you leave, and carry a map and compass (and know how to use both) along with the other Ten Essentials. The biggest threat for many people who get lost or suffer an injury is getting cold and wet while awaiting rescue, which could take days. Bringing extra clothes and rain gear is essential.

While many minor injuries are unavoidable, most life-threatening mishaps could have been prevented if the victim had recognized a dangerous situation and avoided it. Know your limits and be aware of risks like steep slopes, ice and river crossings.

Finally, check the weather forecast before any outing, and adjust your plans accordingly. If thunderstorms are predicted, hiking in the mountains is too risky. Fog can be disorienting, snow can cover trails and rain makes everything slippery.

General approach: STOP

So what do you do when, despite your best efforts, you still encounter a medical issue? A useful acronym for any emergency is STOP: stop, think, observe and plan.

Think and Observe: These two go together. Perform a careful assessment of the situation, your surroundings and what resources (people and gear) you have available. Establish priorities, starting with anything that requires immediate action to prevent harm. Secure the area—keep the victim, yourself and others safe (get out from under falling rocks, etc.). Identify what resources you have available (in your pack or even in the wilderness around you). If someone is injured, assess their injuries, what supplies you have to treat those injuries, whether you need additional aid, what will be required to get that assistance and how long it will take for help to arrive. After stabilizing any life-threatening issues (trouble breathing, profuse bleeding), the next priority is to keep the victim, yourself and others warm and dry by creating a shelter. Exposure and hypothermia are the biggest threats to those who are lost or injured.

Stop: Don’t panic. Take a deep breath. If possible, sit down. Reacting quickly and carelessly can make matters worse. Get your panic under control and set yourself up to think clearly.

Plan: Once you have done all the above, make a plan. First, do no harm. In general, avoid moving a victim who has fallen and may have injured their neck or back. Don’t give medications or perform procedures without the knowledge to do so safely. For medical emergencies, the victim can often tell you what they need. Can the victim walk to the trailhead? If so, that is your quickest way to definitive medical care. If you are unable to safely transport the victim to a car, and other people are available, assign someone to call for help (which may require hiking to the car) and someone else to work on keeping the victim and others warm and dry. 

Take a first-aid course

A medical kit isn’t worth much if you don’t know what to do with it. The best way to learn is to sign up for a wilderness first aid course like those offered by Aerie Backcountry Medicine, NOLS (in collaboration with REI) and The Mountaineers. Such courses are oriented toward outdoor recreational emergencies. It’s also important to take a refresher course every couple of years. Preparation and training are essential to safer trips.

Managing basic injuries

Fortunately, major injuries are rare on the trail, but even minor medical issues can be debilitating, so every hiker should have some basic knowledge of how to manage blisters, burns, cuts and scrapes.

Blisters: Blisters may be the most common medical issue you will face hiking and backpacking, but don’t underestimate their potential to ruin a trip. Left unattended, blisters can become exquisitely painful, impacting your ability to walk. Ideally, blisters should be treated before they occur (while they are still friction “hot spots”). The key to early and late treatment is to prevent rubbing. A hot spot should be addressed promptly. Cover the area with a barrier between the skin and the object that is rubbing. This barrier must adhere to the skin, so that it doesn’t also rub. It can be almost any kind of tape, including a Band-Aid, athletic tape, moleskin, blister pads or duct tape. I usually apply a layer of moleskin over the hot spot and then cover the Moleskin with tape or a Band-Aid. An intact blister can be treated by cutting a blister-sized “doughnut-hole” in Moleskin and placing it around the blister. Then place a patch of 2nd Skin into the doughnut hole to directly cover the blister. Next, place a second layer of Moleskin over both the original Moleskin and the doughnut-hole. Finally, cover all of this with a layer of tape (or a large Band-Aid). An open blister can be treated with 2nd Skin, a layer of Moleskin and a layer of athletic tape.

Burns: Get away from the heat source, immediately cool the burned area (cold-water immersion of burn or a cool, wet compress), apply an antimicrobial cream and apply a nonstick layer over the burn (like 2nd Skin), followed by a dry gauze, then secure with tape. A very small burn can be covered by a Band-Aid. Ibuprofen will help with the discomfort.

Cuts and scrapes: Managing cuts involves four steps:

  1. Control the bleeding.  
  2. Clean the wound.
  3. Close the wound.
  4. Cover the wound.

Once bleeding has been controlled, the most important aspect of managing any wound is to cleanse it thoroughly and as soon as possible to reduce the chances of infection (the exception is a wound that exhibits massive bleeding, which requires immediate transport to an emergency department). Use clean (ideally filtered or treated) water, use lots of it and ideally apply it in a forceful stream. Carrying a syringe can be helpful for this purpose. Alternatively, a resealable sandwich bag punctured with a safety pin, then filled with water and closed, can create an improvised cleaning tool. A gaping cut can often be closed with tape closures using Band-Aids (butterfly bandages work great) or strips of tape.

Remember: never handle blood or other potentially hazardous materials without proper bodily substance isolation (BSI) such as gloves. Photo courtesy Aerie Backcountry Medicine.

What rescuers need to know

 Search-and-rescue calls are coordinated through the county sheriff’s office by calling 911. The more information you can provide to emergency personnel, the better they will be able to do their job. Here are a few essential pieces of information to be prepared to pass on. (Consider clipping this checklist and leaving it in your medical kit.)

  • Detailed location of accident (GPS info if possible)
  • Victim’s age
  • Nature of the injury
  • First aid rendered
  • Whether the victim can stay warm and dry
  • Any area hazards present
  • Photos (taken with your phone) of the injury, accident site and any aid rendered
This article originally appeared in the July+August 2017 issue of Washington Trails Magazine. Support trails as a member of WTA to get your one-year subscription to the magazine.