• How to give First Aid

    When at high altitude where professional care is difficult to reach it is important to be trained in basic first aid. Along with a good first aid kit this section should help to prepare you for most emergencies.

    Mouth to Mouth Resuscitation

    Breathing can be stopped by many conditions, notably a heart attack, drowning, electric shocks and suffocation. It may be tricky to diagnose for certain, but the tell-tale signs are a blue-grey tint to the skin, particularly the face, and no ‘rise and fall’ chest movement. If a person’s breathing has stopped, mouth-to-mouth resuscitation is needed. The method has different types for different situations, as shown below:

    Adults

    Mouth to Mouth

    • Open the mouth and if necessary remove and blockages from the airway carefully with a finger.
    • Using two fingers under the chin and hand on the forehead tilt the person’s head back.
    • Hold their nostrils closed, breathe in and place your mouth on theirs.
    • Breathe out until their chest rises.
    • Remove your mouth to allow the chest to fall.
    • Give 10 breaths then check for a pulse. If there is no pulse then give CPR.
    • Continue method at 10 breaths per minute.

    Mouth to Nose

    This method can be used when it is difficult to breathe into the mouth.

    • Use steps 1-2 from above.
    • Hold the persons mouth closed, take a deep breath and place your mouth around the person’s nose.
    • Breathe into their nostrils quite forcefully until the chest rises.
    • Remove your hand and mouth to allow the air to escape.
    • Continue at 10 breaths per minute.

    Children

    Mouth to Mouth and Nose for a Baby (under 1 year)

    • Open the mouth and gently remove any blockages with a finger.
    • Place your mouth around the baby’s nose and mouth.
    • Gently blow air into the baby’s lungs whilst watching its chest.
    • As soon as the chest rises, stop and let the air escape.
    • Repeat to give one breath every 3 seconds.
    • After 20 breaths check the pulse.
    • If the heartbeat is lower that 60 bpm then start CPR, and if it is above this then continue ventilation until help arrives.

    Mouth to Mouth for a Child (over 1 year of age)

    • Use steps one 1-2 from mouth to mouth for adults.
    • Blow gently into their lungs until you see their chest rise.
    • Stop, and let the air escape.
    • Repeat to give one breath every 3 seconds.
    • After 20 breaths check the pulse.
    • If absent, start CPR, and if present continue mouth to mouth until help arrives.

    Cardio-Pulmonary Resuscitation

    When the heart stops it can often be made to start again using CPR. This involves a series of chest compressions coupled with the ventilation techniques described above.

    Adults

    • Give two breaths as described above.
    • Position the heel of your hand slightly above where the breast bone and the ribs meet.
    • Interlock your fingers with your other hand.
    • Keep your arms straight and press down firmly, then release but keeping your hands in the same position.
    • Repeat 15 times.

    Children

    Baby (under 1 year of age)

    • Ensure the baby is on a firm surface.
    • Place two fingers slightly below the nipple line in the middle of the chest.
    • Press down and release 5 times, at a rate of twice per second.
    • Continue mouth to mouth for one breath as described above.
    • Repeat steps 3-4 until help arrives.
    • If a pulse appears and is above 60 bpm stop the chest compressions but continue ventilation.

    Child (over 1 year)

    • Place one hand slightly above where the breast bone and ribs meet.
    • Use the heel of your hand to press down firmly and release.
    • Repeat 5 times at a rate of 2 per second.
    • Blow air into the lungs once, as described above.
    • Repeat steps 3-4 until help arrives.
    • If a pulse is present stop compressions but continue ventilation.

    Severe Bleeding

    Blood can be lost very quickly from a severed artery, not least because it is highly pressurised. Extensive blood loss can easily lead to shock, unconsciousness or death. This is considered to be anything more than a litre in an adult and a third of a litre for a child. If the injury is in a limb, treat as below:

    • Lay the person down and try to raise the injured part, which will reduce blood flow to the area and so slow down blood loss.
    • Using a clean dressing or, if unavailable, a clean item of clothing, keep firm pressure on the wound.
    • If the wound has glass or small stones in then only apply pressure to the side of the wound until it has been removed.
    • With a clean dressing over the wound, firmly apply a bandage to the whole arm. If a bandage is not immediately available a scarf can

    be used as a substitute until one can be found.

    • If the binding becomes soaked in blood then do not remove it. Instead continue pressure for another 10 minutes.
    • Descend and seek medical help if bleeding does not stop.

    Head Injury

    A head injury may not always be obvious. Sometimes there is no wound so you must look out for other signs, even though a serious head injury may be present without any signs. Signs may include:

    • Blood or any liquid seeping from the ear
    • Unconsciousness
    • Dizziness
    • Nausea
    • Headache

    To treat, follow instructions below:

    • In the case of a wound, try to put skin flaps back in place.
    • Using a clean dressing press firmly on the wound.
    • Bind the dressing in place with a bandage.
    • If the person is conscious lay the down but raise their head and shoulders.
    • If they have fluid leaking from an ear, secure a dressing over it and tilt the person’s head to allow free drainage.
    • If condition worsens then descend and seek medical help.

    Chest Injuries

    • Immediately cover the wound with a palm.
    • Place a clean dressing over the wound, then cover it with a clean plastic bag or tin foil.
    • Bind this with a bandage or similar to form an airtight seal.
    • Descend immediately. Breathing is far more complex at altitude and with a puncture wound it could be made worse.

    Internal Bleeding

    Internal bleeding is the result of ruptured blood vessels which allow blood to leak into cavities within the body. It can be caused by a fracture or a sprain, or a blow to the body which is strong enough to rupture a blood vessel but not the skin. It can also be caused by a chest or abdomen injury. These are quite likely when climbing, so you should watch out for the signs:

    • Pain in the area
    • Cold, clammy skin
    • Fainting
    • Loss of colour
    • Nausea
    • Dizziness
    • Dilated pupils
    • Being out of breath
    • An irregular pulse
    • Swelling or bruising at the site

    To treat:

    • Begin mouth to mouth resuscitation as above if necessary
    • Descend immediately
    • Don’t give the person anything to drink

    Dislocation

    A dislocation is where one or more bones at a joint, most commonly the shoulder, finger, thumb or jaw become removed from its socket. This is recognisable by:

    • Swelling
    • Out of place bones
    • Pain and tenderness
    • Change in skin colour

    To treat, follow these instructions:

    • Apply a splint to the joint to prevent movement (see below)
    • Keep the joint elevated

    Broken Forearm

    • If the person can hold the arm across their chest then apply a splint and help position it with a wide sling. The person’s fingers should be positioned above their elbow.
    • If the arm cannot be bent, splint it in the straight position then secure it to the side of the body.
    • Descend and seek medical help.

    Fractures

    A fracture is a broken or cracked bone. There are two types of fracture; simple and compound. A simple fracture does not pierce the skin, but if it is left untreated it can develop into a compound fracture. This is where the bone pierces the skin and causes serious bleeding. Other than this obvious sign, others include:

    • Pain and tenderness
    • Difficulty moving
    • Difficulty breathing
    • Swelling
    • Bruising
    • Change in skin colour

    To treat, see below:

    • Take care of any bleeding.
    • Lightly cover an open wound using a clean dressing.
    • Secure the injured limb to a solid part of the body. Fractured arms should always be supported by the body using a sling, usually made from a triangular bandage.
    • Watch for signs of shock.
    • Keep the person warm.
    • Apply a splint (see below).

    The Splinff

    A splint is a method of keeping movement in a fractured bone to a minimum. They are easy to fit, just follow these guidelines:

    • Examine the suspected fracture to determine whether is simple or compound.
    • Check the circulation above and below the fracture, and movement of fingers/toes if appropriate.
    • Remove any constricting jewellery (watches, bracelets, rings).
    • Control bleeding by applying a dressing if necessary.
    • Administer pain medication if necessary.
    • Apply the splint above and below the injury.
    • If possible, prepare the splint on an uninjurd body part, and then transfer it to the injured area. This minimises potentially damaging movement of the injured part and minimizes the pain associated with splinting.
    • Splints can be created from sticks, cardboard, foam pads, ski poles, tent poles or other similar objects.
    • Fasten using belts, triangular bandages, tape, shirtsleeves, and blankets. Slings can be made from triangular bandages, sheets, and ropes.
    • When applying the splint, be sure not to interfere with circulation.
    • If the fracture is simple and there are no signs of decreased circulation, it is advisable to apply ice packs/snow to the swollen area, but be sure not to apply ice directly to the skin.
    • After the splint is applied, check the limb every 15 minutes to make ensure that swelling inside the splint has not cut off the circulation. This is particularly important to remember in cold weather, where numbness can be a confusing factor.
    • Elevate the injured part to minimize swelling.
    • Depending on which bone is affected, descend and seek medical help. e.g. it may be possible to continue with a fractured toe, but not a broken leg.

    Insist that all victims seek medical evaluation when they return home, to be certain that all bones are properly aligned and that no further intervention is needed.

    Try to avoid:

    • Moving the person. Movement can move the broken bones further, which may damage internal organs.
    • Applying pressure to a compound fracture to stop bleeding – it may cause extreme pain and can move bones.