The very basics to consider for your adventures. First-aid kit I bring with me and basic techniques that I used to teach when working as a lifeguard.

When leading a group I usually bring a small dry sack (2L or 3L Sea to Summit, depending on if I am going to put more valuables and electronics inside) with the following:

Bottom to top, left to right

  • Emergency blanket. An impermeable metalized sheet that helps prevent heat loss. In case of a serious accident and you need to wait for rescue. How to use them correctly.
  • Resuscitation Face shield. A bit “cleaner” CPR.
  • Rehydration salts.
  • Pain killers. In case anyone has sudden pain. Girls with really painful menstrual pain for example. I do not allow anyone to take them to be able to continue on a long route, as some trail runners do with Ibuprofen… Pain is a good indicator for the body to avoid you hurting it further unnecessarily.
  • A rescue whistle.
  • Band-aids and gauzes. For scratches, cuts, and more serious wounds.
  • CrampFix shot. I have a friend that tends to cramp pretty easily. Bought to give it to her next time 😉
  • Blister and burn dressing
  • Cleaning wipes, for the aforementioned wounds
  • Personal locator beacon. Allows you to ask for help anywhere in the world meanwhile you have unobstructed visual access to the sky, i.e. connection with satellites. It is a quite expensive gadget, but really useful if going to remote areas without cell signal. Fully explained in the adventure tech post.
  • Elastic bandage. Mainly used for dressing bigger wounds and first treatment of ankle sprains and alike. It can be used also for, really unlikely, snake bites (not to apply to bamboo vipers’, everything explained on the link)
  • Tiny multi-tool knife. The smallest I was able to find. Minuscule scissors, knife, screwdriver, toothpick, and tweezers. The latter might be the handiest, to remove urchin spikes or plant thorns.

The total weight, 3L bag included, is approx 450g of which the PLB takes the biggest part at 150g.

Treatments

Usual disclaimer. I am not a doctor. So this is simply what I would do according to my experience and my long ago learned lifeguard and first aids “technician” classes. Readers discretion advised too. Below are pictures of wounds and others.

Wounds

For small ones, the goal is to try to clean them and keep them that way till the end of the day out. Wipes and water, gauze and band-aid could do it.

For coasteering routes, I bring extra gloves to cover cuts in fingers while we finish. As mentioned before tweezers can be really handy to remove “foreign objects”: spikes, thorns, small rock particles, etc. If the wound is more open you can try to use a soft flask or water filter to throw water with some pressure for cleaning. Once completely clean cover with gauze and bandage.

If the cut is deep and there is a lot of bleeding, do not tourniquet the limb. If it is a clean-cut, put the gauzes and additional clean clothes on and press the wound with your hand or similar for ten minutes. If blood soaks through add more clothes on and continue pressing. When stops use the bandage to hold everything in place. An urgent visit to a hospital is required, so assess if you can move him or need to ask for a rescue.

Do not try to remove any impaled object. Trying to pull it out can damage nerves, blood vessels and make the wound even worse. Just try to put as many clean clothes as possible above to prevent too much blood loss and stabilize it so that does not move and create more damage. In the hospital, they will be able to remove it a lot easier and safer.

You might want to add a pair of clean latex gloves to your bag for handling wounds and others. Above all, if you go out with big groups and you do not know well all participants

Sprains

Twisting your ankle is one of the most common mishaps while outdoors. If it is not very severe you will have some time (in my case, it has been approximately half an hour) before the swelling does not allow you to move. How to use the bandage:

Knee and other joints are not so frequently sprained but have significantly more complicated initial treatment. Same with fractures. Try to immobilize and help the person out only if you are experienced and the fracture is not big. If complicated, or, even more, if you have an open fracture, obviously ask for rescue. Pic by Paul on his own rescue (full article in scmp).

Cramps

Find a nice place for the person who cramped to lie down or sit. In most of the cases I needed to help, the reason for cramping was not proper rest before the activity or the person going well above its physical capabilities. Dehydration, not eating during the activity and others could also let to cramping. Help them stretch. Provide them something like the mentioned shot, a power gel, or similar and water. Find a simple exit back to civilization.

Fainting

Find a safe place for the person who fainted to lie down. Try to put his feet higher than the rest of the body and loosen tight clothing. Check that he is breathing and try to reanimate him. A bit of water or a gentle shake worked most of the times. The reasons for fainting could be similar to cramping or more serious conditions. Increasing sugar levels (giving them a power gel and water) worked with some. An immediate exit is necessary in any case.

Stroke

It is caused by partial or total interruption of blood supply to the brain. It can happen anywhere and be fatal, so it is important to be able to early detect it. If someone faints, or starts to feel dizzy + flaccid facial muscles, sometimes with only half of the face showing it, unequal pupil size, strong and fast pulse; time to ask for a rescue.

Heatstroke

One of the common reasons for fainting in Hong Kong can be a heatstroke. Untreated, a serious case can quickly damage your brain, heart, kidneys, and muscles. The damage worsens the longer the treatment is delayed, increasing the risk of serious complications or death. High body temperature, headache, blurred vision, the person not answering coherently to your questions are the usual symptoms. You need to be able to cool the overheated person as soon as possible. Getting them into the shade or, even better, into a stream worked best. I have helped quite some people with this. Most of the times with non-prepared hikers in too strenuous routes or even trail runners going hard on a hot day. A helicopter rescue was necessary with some that were not responsive. One of the trail runners just arrived at the hospital previous to full kidney failure. A really close safe…

Hyponatremia or water intoxication

I think only once a friend suffered something similar to hyponatremia. But it is good to keep it in mind as an option. Abnormally low concentration of sodium in the blood. For those who start dehydrated (due to alcohol the night before for example) + are sweating a lot + are drinking too much water in a long day out. So do not force yourself to drink above your thirst level. All those old sports drinks commercials were incorrect, thirst is a very good indicator of how much you should drink. If you are drinking just plain water you should eat salty foods too. Otherwise, go for sports drinks. Learn how much you sweat depending on circumstances (weather, route type, intensity) and bring sufficient liquids/nutrition accordingly. Nutrition post.

Respiratory failure

The person is unconscious and when you get next to them (get your ear next to their mouth and nose) you realize that they are not breathing. If he has not suffered any fall that could have injured his cervical spine, tilt the head backwards by applying pressure to the forehead and the chin. This way you might be able to open the airways in case the tongue was obstructing it.

Check again if (s)he is able to breath now. If not, check if there could be other obstruction mechanism (he was eating before and choked or others). In that case try to remove it with a finger without pushing it further in. If still not breathing + you are not a trained professional go for simplified CPR.

CPR

Cardiopulmonary resuscitation for untrained people has been simplified and the general recommendation is just to focus on chest compressions. Approximately 100 to 120 compressions per minute, approx 5cm deep. Your arms should be straight and use your body weight on the chest. It is exhausting. So ideally there should be at least a couple of people taking turns. Your main goal is to keep oxygen flow to brain and heart to avoid permanent damage before the pros arrive with the defibrillator. When training lifeguards we use to teach them to chest compress 30 times before 2 ventilations for adults.

Drowning

The first priority is to move the person out of the water safely and fast. Check if breathing. If not check obstructions. If the person has get too much water in you might need to start CPR compressions. Hopefully they might open partly the airways and allow the person to vomit the rest in the way. It was the case in the rescues I was involved in. Once breathing on his own we put him in recovery position. Example, pic from Wikipedia and sourcece.

Nevertheless, the patient needed immediate transfer to hospital and painful removal of water from the lungs and others for several days.

Coda

This post does not try to cover all the situations you could encounter in your outings. Just provide a general view. Hopefully will make some more cautious and a few interested to join basic CPR and first aid courses. A very good investment for you, your loved ones and general public you can help.

Updates 2021

I have explained a lot of time this to several people, so adding a bit more info. This liquid plaster is the best find so far.

It is able to hold long periods of time in the water. Whenever I have a cut not yet healed and we are going coasteering I put a thick layer of it above and keeps full route waterproof. Sea water slows a lot the healing process. So if you want the wounds to recover fastest and have as little a scar in the future as possible, you know.

Lately I’ve been recommending them a lot. So here in the post too for my easier reference. If you are looking for a traumatologist, Christopher Tong. I like his approach, unlike several other doctors in Hong Kong. He is an avid triathlete and wants his patience to continue being active for long years. His advice therefore tends to be more conservative and less surgery ($$$) focused.

For physiotherapist I like Charles Wang from hongkongsportsclinic. Specialised in trail runners, but also with customers that enjoy coasteering and others explained in this web. So he knows what are the movements we do.