Emergency First Aid for Remote Outdoor Accidents

Start With the Scene, Not the Casualty

The hardest part of remote first aid is resisting the urge to sprint straight to the injured person. Take five seconds. Look up, look around, and ask yourself what put them there and whether it can hurt you too. Loose rock, fast water, an unstable bank, a loose dog, a second walker sliding down the same muddy gully — any of these can turn one casualty into two.

Make the area as safe as you reasonably can, then approach. If you are in a group, say out loud who is doing what: one person with the casualty, one person managing kit and shelter, one person preparing to go for help. Vague good intentions go nowhere when everyone assumes someone else has called for rescue. If you are alone, accept that you may have to do everything yourself, in order, slowly.

The Primary Survey: Breathing Before Bones

Kneel beside them and work through the basics without skipping steps.

• Response: Speak loudly, squeeze their shoulders. If they do not wake, they are at risk of a blocked airway.
• Airway: Tilt the head back gently and lift the chin. Sweep out anything obvious with a finger — do not dig blindly.
• Breathing: Look, listen and feel for up to ten seconds. If they are not breathing normally, start CPR immediately and send someone to raise the alarm.
• Catastrophic bleeding: Check for blood soaking through clothing or pooling on the ground. This is dealt with before anything else.

Only once breathing and major bleeding are handled should you start examining for fractures, head injuries and everything else. In a remote setting, the priorities are always the same: airway, breathing, bleeding, then everything else.

Controlling Serious Bleeding

For most wounds, firm direct pressure with a dressing, a clean T-shirt or your bare hand if that is all you have, will control things within a few minutes. Press hard, keep pressing, and do not lift the dressing to check. If blood soaks through, add another layer on top rather than removing the first.

If bleeding will not stop from a limb and pressure has failed, a tourniquet may be necessary. Use a commercial one if you carry it; otherwise a wide strap — a triangular bandage, a webbing belt, a rolled scarf — placed 5–7 cm above the wound, tightened with a stick or bar until bleeding stops. It must be wide and tight, never a thin cord, which can cut into tissue. Write the time it was applied on the casualty's skin or a strip of tape, and tell the rescue team exactly when. Once a tourniquet is on, it stays on.

For a nosebleed, pinch the soft part of the nose and lean them forward. For an amputated part, wrap it in clean material, seal it in a bag, and keep it cool — but never place it directly on ice.

Calling for Help When the Signal Is Poor

In the UK, 999 works from any network, even one you are not subscribed to, and even with no credit. If you have a faint signal, hold the phone still and high, keep the call short, and do not wander while talking. Ask for the police if it is a mountain, moorland, coastal or rural rescue — they coordinate the appropriate team.

If calling fails, texting is possible but requires registering your phone in advance, so set that up before your trip, not during it. Otherwise:

• Move to high, open ground. A summit ridge, a hilltop or a shoreline often has signal when a valley does not.
• Send two people if you can spare them, with written details: location, number injured, injuries, weather, and your route. Never send someone alone.
• Give a precise location. GPS coordinates from a phone or watch are ideal. A grid reference from a paper map is excellent. A description like "the third stile past the ruined barn" is better than nothing.
• Use six loud blasts on a whistle, repeated at intervals. It is the international distress signal and carries further than a voice.
• Make yourself visible: bright clothing on a stick, a head torch at night, anything that catches a helicopter's eye.

Keeping Them Warm While You Wait

Evacuation may take hours, and cold is what turns a survivable injury into a serious one. Get the casualty off the ground — rucksacks, bracken, branches, a sleeping mat — because ground conduction drains heat faster than cold air. Insulate above and below, cover the head, and shield them from wind and rain with a bothy bag, tarp or jackets.

Handle them gently. Rough movement increases pain and can worsen internal bleeding. Do not give food or hot drinks to anyone who is drowsy, vomiting or likely to need surgery; small sips of water are usually fine for someone fully alert. Reassure them, keep talking, and check breathing and responsiveness every few minutes. Write down times and changes so you can hand over accurate information.

Moving Them — Usually a Last Resort

Leave a casualty where they are unless staying put is more dangerous than moving them: rising water, an active rockfall, a fire, or a location where nobody will ever find you. Moving someone with a suspected spinal, pelvic or leg injury can do real harm, so it is a judgement call made only when the alternative is worse.

If you must move them, support the head and neck, keep the spine as straight as you can, and use a rope, sling or improvised drag sheet rather than lifting alone. Go slowly, stop often, and remember that the rescue team would rather walk an extra mile to a stable casualty than treat a worsening one.