With the aim of 3 P’s; Preserve Life, Prevent Further Harm, and Promote Recovery, first aid provides immediate assistance to the people suffering from a minor or serious illness or injury. Whether, we are on outdoor activities or at the home, office, or any other working place, we must have a first aid kit because anything can happen accidentally. First Aid Kits include medications, tools, and other necessary kits for the first aid treatment from minor cuts to serious illness treatment like performing Cardio Pulmonary Resuscitation (CPR) while waiting for an ambulance.
First Aid treatment applies to Minor cuts, Sunburn, Blisters, Fractures, Altitude sickness, Choking, Muscle strains and sprains, Cramps, Khumbu cough, Flu, Insect bites, Dehydration, Stomachache, Fainting, etc.
During trekking, any uncertainties can happen with the trekkers, porters, guides, and other support staff. So, the trekkers or trekking organizing agency must provide first aid services with medications for the entire trek with adequate medicine. The first aid kit box should not contain only first aid items, but also some medication for instant recovery while ascending or descending on different elevations. But the medicine should have enough expiry dates. Before any treatment, one must have first aid training and have basic knowledge of medicine. With this, they must have a first aid book too.
One must be alert that, the medicine will not work for all people, and sometimes, they may get allergies or other side effects. So first aid provider should never act a doctor. With the understanding of symptoms and any other disorders, the medicine is needed to take. So, it is necessary to share what is happening in detail with all symptoms. Due to this reason, most of the trekking or travel agencies request their clients or guests to bring personal medicines that they uses regularly or often for minor illness or injury.
Before starting any trek, a trekker must be physically fit and aware of their health to walk in higher elevations or need to adapt to the new environment. They can consult with the doctors for the normal checkup of blood, urines, and other existing diseases. These first aid treatments are only temporarily treatment varies on the nature of wounds or injury.
This information can be applied for both trekking and tour. Comparison of tours, first aid treatment is necessary for trekking parts.
Here is the list of major medications and tools used in trekking in Nepal. This list is not only for the group but also for the solo travelers.
|NAME OF ITEMS/MEDICINES||DESCRIPTION / USES||DOSE/REMARKS|
|Insect Repellant (Repel 100)||Create a barrier against mosquitoes, including those that may transmit the Zika, West Nile, Dengue and Chikungunya viruses, ticks, gnats, biting flies, chiggers and fleas.||Pump Spray protects for up to 10 hours. Suitable for Nylon, Cotton and Wool clothes only. Applied on Skin, Clothes, and other surfaces.|
|Ibuprofen (200mg)||Pain relief and anti-inflammatory; fever and headache reducer. NSAID. Potential allergen.|
|Aspirin (75mg)||Heart attack prevention. Need correlates to age and health of individual(s).||Don’t use Aspirin if you’re below 19.|
|Loperamide (Imodium)||Antidiarrheal. Can be a trip-saver: improves comfort, prevents dehydration.|
Diphenhydramine (Benadryl) or Loratadine (Claritin)
|For the relief of pain, itching and swelling caused by insect bites and stings, and nettle stings|
|Antiseptic Liquid (Detol)||For cleaning wounds and hands
|Aloe Vera topical gel or cream||For burn relief||Apply on Skin|
|De-cold/Sinex||For the treatment of Common cold.||3 Times a day after meal|
|Paracetamol (500mg)||For fever, headaches, mild pains||3 Times a day after meal|
|Acetazolamide or Di-mox||Temporarily prevent and reduce the symptoms of altitude sickness.||Use before ascend higher elevation above 3500m|
|Digene||For stomach acid such as acid indigestion, heartburn and stomach upset.|
|Rehydration Salt||Replace salts and water that the body loses when you have dehydration caused by gastroenteritis, diarrhea, or vomiting.||Use after Diarrhea, vomiting.|
|Sancho Balm||For cold, cough, rheumatism, stuffy nose, fatigue, body-ache, muscular-ache, headache, neuralgia, sprain and itching.||External uses only|
|Strepsils Lozenges||Relieve discomfort caused by mouth and throat infections|
|Vicks Inhaler (Nasal Stick)||For the effects of allergic reactions and infections such as a cold and the flu.||Inhale by Nose only|
WOUNDS & INJURIES TOOLS
|NAME OF ITEMS OR TOOLS||DESCRIPTION/USES|
|Medical Adhesive Tapes / Cloth Tapes||To attach bandages, gauze, and other dressings to skin around wounds.|
|Antiseptic or alcohol wipes or Betadin||Cleaning wounds and prevent bacterial skin infections from minor cuts or scrapes|
|Cotton swabs||To clean the skin around a wound in preparation for treatment.|
|Wound closures strip / Butterfly closures / Band Aid||Close small wounds and treat the laceration in a manner which pulls the skin on either side of the wound together.|
|Moleskin||To apply to blisters or hot spots|
|Polysporin||To treat minor wounds (e.g., cuts, scrapes, burns) and to help prevent or treat mild skin infections.|
|Sterile Gauze Pads (3”x3” or 4”x4”)||Used as a temporary absorbent dressing over open wounds|
|Disposable First Aid Gloves (Sterile)||Protection for both the victim and the rescuer while treating open wounds, providing A germ-free barrier between the two. Avoid Latex gloves because someone may have latex allergy.|
|Non-adhesive wound pads||Allows dressing to absorb without adhering to the wound.|
|Elastic Bandages||To treat muscle sprains and strains by reducing the flow of blood to a particular area.|
|Safety pins (large and small)||To secure a bandages over a wounded and bleeding arm or leg.|
|Scissors||To cut bandages, tapes to fit wounds and help remove dressings so bandages can be changed, reducing the risk of infection.|
|Digital Thermometer||To measure temperature of body.|
|Tweezers||To remove debris such as glass, dirt, or splinters from a wound|
|Surgical Masks||Reduce the transmission of infections.|
|Hand Sanitizers||To kill the vast majority of viruses/bacteria/microorganisms on the hands.
Washing hands with soap is preferred if possible.
|Moov Spray or Jel||Used for Ache, Muscle pain, Muscle strain, Muscle ache, Gingivitis, Sprain, Inflammation, Pain, Pyorrhea, Nerve pain and other conditions.|
Guidelines for First Aid Treatment
First Aid is given to someone with the major goals of 3P’s; Preserve life, prevent further harm and promote recovery. When someone’s got injury or illness, first aid assistance will be given with no panic to the victims and save them from mental unconsciousness.
Before you provide help to an injured person, you must check the scene for danger. If you get injured, you won’t be able to help someone else who’s injured. So before you rush to help someone, take a moment to analyze the area and spot anything that could injure you.
After analyzing the situation and condition, proceed for the first aid treatment as soon as possible. For this, first aid providers must have gained first aid training. Almost all the trekking guides of Nepal have attended the basic course of first aid. If you wish to have self-treatment, you must understand the procedure.
Reference to the famous saying, ‘Prevention is better than cure, we must be alert about the trekking route, weather, elevation of places and climatic condition of destinations and must be prepared accordingly. Despite this, sometimes we may encounter challenging situations although having proper knowledge. So, we must be prepared for the uncertainties that may occur before starting the trek in the Himalayas.
The most common injury and illnesses in the Himalayas are as follows:
1. Altitude Sickness
Symptoms of altitude sickness usually develop between 6 and 24 hours after reaching altitudes more than 2,500m above sea level.
Symptoms are similar to those of a bad hangover and include:
- Feeling and being sick
- Loss of appetite
- Shortness of breath
The symptoms are usually worse at night.
- Avoid flying directly to areas of high altitude, if possible
- Take 2 to 3 days to get used to high altitudes before going above 2,500m
- Avoid climbing more than 300m to 500m a day
- Have a rest day every 600m to 900m you go up or rest every 3 to 4 days
- Day trips to higher altitudes with returns to lower altitudes for sleeping will aid in acclimatization
- Make sure you’re drinking enough water
- Avoid smoking and alcohol
- Avoid strenuous exercise for the first 24 hours
- Eat a light but high-calorie diet
- If you think you have altitude sickness:
- stop and rest where you are
- do not go any higher for at least 24 to 48 hours
- if you have a headache, take ibuprofen or paracetamol
- if you feel sick, take an anti-sickness medicine, such as promethazine
- make sure you’re drinking enough water
- do not smoke, drink alcohol or exercise
- Acetazolamide can be used to reduce the severity of your symptoms, but it will not completely get rid of them.
- Tell your travel companions how you feel, even if your symptoms are mild – there’s a danger your judgment may not be clear.
- You can continue going up with care once you feel you have fully recovered.
- If you do not feel any better after 24 hours, go down by at least 500m (about 1,600 feet).
- Do not attempt to climb again until your symptoms have completely disappeared.
- After 2 to 3 days, your body should have adjusted to the altitude and your symptoms should disappear.
- See a doctor if your symptoms do not improve or get worse.
- Wear comfort and fit sock
- The boot should be fit to prevent the foot from moving or rubbing inside. (Avoid very tight or lose fit boots)
- Always keep your feet dry.
- Carry spare socks and change every day
- Apply Vaseline is also very useful toward preventing and treating chafing while walking long distances.
- Clean the blisters with soap and water.
- Pop and drain the blister with the small safety pin. (Always use the new one and avoid if it seems to rust)
- Don’t cut or peel the skin.
- Apply antibiotic ointment (Polysporin). Bandage with a donut-shaped piece of moleskin, Duct Tape, etc.
- Cover the Tape
3. Muscle Strains and Sprains
Strains affect muscles while sprains involve ligaments and tendons (for hikers, which usually means ankles and knees). Either way, expect pain, swelling, or restricted range of motion, often after a snap or pop. Because they require rest to heal, these injuries can be trip-enders.
- Always wear fit and comfortable hiking or trekking boots.
- Prefer a pair of trekking poles for stability while walking.
Sprains are part and parcel of hiking, no matter how cautious you are.
Control Swelling With RICE Therapy
RICE stands for:
- Rest the sprained or strained area. If necessary, use a sling for an arm injury or crutches for a leg or foot injury. Splint an injured finger or toe by taping it to an adjacent finger or toe.
- Ice for 20 minutes every hour. Never put ice directly against the skin or it may damage the skin. Use a thin towel for protection.
- Compress by wrapping an elastic (Ace) bandage or sleeve lightly (not tightly) around the joint or limb. Specialized braces, such as for the ankle, can work better than an elastic bandage for removing the swelling.
- Elevate the area above heart level if possible.
Apply Moov Spray or Jel over the injury but no in the cut or scrapes. All but the most minor strains and sprains should be evaluated by a doctor. Consult a doctor as soon as possible if there are symptoms of a possible broken bone like popping sound and significant swelling, pain, fever, or open cuts. Continue RICE for 24 to 48 hours, or until the person sees a doctor. Take medicines for pain relief.
4. Cuts and Scrapes
- Watch slowly and be careful at narrow trails and footsteps on rocks.
- Be careful with knives, tools, and other sharp objects.
- Apply direct pressure on the cut or wound with a clean cloth, tissue, or piece of gauze until bleeding stops.
- If blood soaks through the material, don’t remove it. Put more cloth or gauze on top of it and continue to apply pressure.
- If the wound is on the arm or leg, raise the limb above the heart, if possible, to help slow bleeding.
- Apply a thin layer of an antibiotic ointment or petroleum jelly to keep the surface moist and help prevent scarring. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.
- Apply a bandage, rolled gauze, or gauze held in place with paper tape. Covering the wound keeps it clean. If the injury is just a minor scrape or scratch, leave it uncovered.
- Get a tetanus shot. Get a tetanus shot if you haven’t had one in the past five years and the wound is deep or dirty.
- Do not apply a tourniquet unless the bleeding is severe and not stopped with direct pressure.
- See a doctor
- If you see signs of infection on the skin or near the wound, such as redness, tenderness, or a thick discharge, etc.
- Consult for Medical treatment if,
- The wound has dirt or debris that won’t come out.
- Red streaks from around the wound.
- The wound is a result of an animal or human bite.
- If there are any foreign objects in the wound.
- Apply SPF 30 sunscreen and wear a wide-brimmed hat.
- If you have sensitive skin, consider wearing pants and a long-sleeved shirt. And check your outdoor store for SPF-rated hiking clothes designed for alpine treks and people with fair skin.
- Use a lip balm that has sun protection.
- Get extra attention for special care, especially between 10 a.m. and 4 p.m. when ultraviolet rays are strongest.
- Heed the above advice with extra care when 1) traveling on snow or water, as reflected rays increase your exposure; and 2) hiking above 5,000 feet, where the strength of UV rays intensifies by 5 percent with every 1,000 feet of elevation gain.
- Apply a wet cloth (cold if possible) to the sunburned area to relieve pain and minimize swelling.
- Take a painkiller such as ibuprofen (if needed).
- Gently wash blistered skin with cool water to prevent infection.
- Keep burned areas out of the sun.
- Smear on Aloe Vera or a sunburn cream, but choose one without alcohol, which can sting and dry the skin.
- It’s only necessary to leave the trail and see your doctor if you have blisters on your face, which can sometimes lead to scars.
6. Insect bites
- Use insect repellent: To deter mosquitoes, flies, and ticks.
- Move to a safe spot: If you’re stung and are near a wasp nest or beehive, retreat to a place where you won’t get swarmed.
- Remove stingers or ticks: Keep out additional toxins by removing a bee stinger as quickly as possible; with ticks, use fine-tip tweezers to gently dislodge the mouth.
- Clean the wound: Use antiseptic soap.
- Use a cold compress or ice: To reduce swelling, and relieve pain and itching.
Dehydration occurs when someone loses fluid from the body and does not replace it. If untreated, someone with dehydration can develop heat exhaustion.
Signs and symptoms
- a headache or light-headedness
- dizziness or confusion
- a dry mouth and dry eyes
- dry or cracked lips
- reduced amounts of dark urine
- Muscle cramps, etc.
- Reassure the casualty and help them to sit down.
- Give them plenty of water. You can also use an oral rehydration solution.
- If they have any painful cramps, encourage them to rest. Help them to stretch and massage the muscles that are affected.
- Monitor the casualty’s level of response.
- If the casualty appears to be unwell, seek medical advice.
Signs and Symptoms
- Nausea and vomiting
- Painful urination
- Avoid overeating or eating right before going to sleep
- Never share utensils, cups, straws, etc.
- Get plenty of fluids and fiber-rich foods like fruits and vegetables
- Reduce fatty, greasy foods like fries and burgers
- Wash hands well, especially before eating and after going to the bathroom
- Eat several smaller meals instead of three big ones
- Chew your food slowly and well
- Stay away from foods that bother you (spicy or fried foods, for example)
- Ease stress with exercise, meditation, or yoga
- Drink plenty of clear fluids so your body has enough water.
- Gas pain – take a medicine that has the ingredient Simethicone can help get rid of it. Peppermint tea may help with gas.
- For Heartburn from gastroesophageal reflux disease (GERD), try an antacid or acid reduction.
- For constipation, a mild stool softener or laxative may help get things moving again.
- Cramping from diarrhea – take a medicine that have Loperamide (Imodium) might make you feel better.
- Immunization- a good idea for everyone, but advisable for those most at risk for serious flu complications.
- Get plenty of sleep
- Eat a healthy diet
- Exercise regularly
- Avoid people you know are sick
- Wash your hands frequently and keep them away from your face and eyes.
- Throw used tissues in the trash immediately
- Drink plenty of chicken soup- it replaces the sodium that your body has lost.
- Take acetaminophen to reduce the fever
- Ensuring the patient is kept well-hydrated.
- Constantly monitoring temperature to accommodate any sudden changes.
- Reinforce hygiene practices such as washing hands and having showers to minimize the chance of picking up other germs in addition to spreading the virus through contact.
- Minimizing contact to others for both the patient’s wellbeing and the wellbeing of others who could contract influenza.
As cramp can happen when you are least expecting it, it’s always best to be prepared.
- Regular stretching of the muscles, not just before and after exercise.
- Regular massages in order to keep the muscles soft and supple.
- Stay hydrated.
- Review your sodium intake with a view to increase if required.
- Reduce fatigue.
- Stay well fueled with adequate carbohydrate intake.
- Practice mental relaxation techniques in preparation for big events such as controlled breathing to remain focused.
During a cramp attack
- Stay calm.
- Stretch the affected area.
- Try and walk it off, slowly putting pressure on the affected area in order to relieve muscle tension and shortening.
After a cramp attack:
- Drink plenty of fluids
- Continue to stretch the affected area by using resistance bands for light resistance.
- Reach for the First Aid Kit for essential items that may help with the onset of muscle soreness such as hot and cold packs, heat and freeze spray
You should seek medical advice if your cramps last longer than 10 minutes, they are disturbing your sleep or you have any numbness or swelling as medication may be prescribed for prolonged attacks.
11. Fractures Bones
- Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth, or a clean piece of clothing.
- Immobilize the injured area. Don’t try to realign the bone or push a bone that’s sticking out back in. If you’ve been trained in how to splint and professional help isn’t readily available, apply a splint to the area above and below the fracture sites. Padding the splints can help reduce discomfort.
- Apply ice packs to limit swelling and help relieve pain. Don’t apply ice directly to the skin. Wrap the ice in a towel, piece of cloth, or some other material.
- Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.
Someone who is choking may be clutching at their chest or neck and won’t be able to speak, breathe, or cough.
- If someone is choking, encourage them to cough.
- Bend them forwards and give up to 5 back blows to try and dislodge the blockage.
- If they are still choking, give up to 5 abdominal thrusts: hold around the waist and pull inwards and upwards above their belly button.
- Call for medication emergencies – Repeat the steps until they can breathe again or until help arrives
13. Khumbu Cough
The Khumbu Cough is a cough caused by the low humidity and temperatures associated with high altitudes.
- Dry, persistent cough
- A running nose
- Expulsion of a clear/white phlegm when you cough
- Wear a buff to cover the mouth and nose while you are trekking in the high altitude (Over 3,500m) like the Khumbu region
- As you get higher up (over 5,000m), switch out your buff to an insulated mask or balaclava.
- When spending the night at a high altitude try using a balaclava to sleep
- In case of fast breathing, take regular breaks and inhale oxygen if needed.
- Walk smoothly with full acclimatization.
- If you notice these symptoms then the best treatment involves trying to keep your bronchi moist by:
- Drinking as much water as possible, ideally warm water as the steam helps moisten the bronchi
- Avoid over-exerting yourself as this will only increase your breathing rate and hence expose your lungs to more dry air
- Suck on throat lozenges
- Wear an insulated mask or balaclava during the day and during the night, if you can. This keeps the throat area warm and prevents cold air and particulates from irritating your lungs
- If the cough is really bad, then inhaling oxygen can help
For more information about Khumbu Cough, please visit the site: https://www.mountainiq.com/khumbu-cough/
These are the basic guidelines for first aid treatment. If you know first aid treatment, then only assist your friends or group members. Otherwise, we don’t recommend you to provide first aid treatment based on above information only. You can get training of Wilderness First Aid Training Course for effective and safe first aid treatment. Online training is not so effective, so we don’t recommend you online first aid training. If you know survival techniques, you can treat yourself only.