Outdoor First Aid for Hikers

Overview

Most hillwalking days go fine. Most hikers never need to use their first aid kit. But UK hills are remote enough and weather harsh enough that when an incident happens, the walking group is usually the first responder — sometimes the only responder for hours. Basic first aid competence turns manageable incidents into stories; lacking it turns minor issues into emergencies.

This guide covers the practical first aid relevant to UK hillwalking and outdoor activity. It assumes you're not a medic and doesn't try to train you to that level — but it gives you the 80% of knowledge that handles the 80% of incidents. For more serious training, take a proper outdoor first aid course (Mountain Training, St John Ambulance, or Red Cross run outdoor-specific courses).

Golden Rule: In the outdoors, the first priority is preventing things getting worse. Second priority is treating the immediate issue. Third priority is getting to professional help. Don't confuse this order.

The First Aid Kit — What to Actually Carry

For day hikes (any grade):

Item	Why
Assorted plasters (various sizes)	Small cuts, blisters
Compeed or blister plasters	Heavy-duty blister treatment
Medical tape	Secure dressings, tape ankles
Steri-strips or butterfly closures	Cuts that need holding together
Sterile gauze pads	Wound dressing
Triangular bandage	Sling, pressure dressing
Elastic bandage (crepe)	Sprains, support
Painkillers (paracetamol + ibuprofen)	Manage pain, reduce inflammation
Antihistamine tablets	Allergic reactions
Small scissors or multitool with scissors	Cut tape, clothing
Tweezers	Splinters, thorns
Latex-free gloves (2 pairs)	Hygiene
Hand sanitiser	Pre-treatment cleanliness
Foil blanket	Hypothermia treatment
Small torch or headtorch	Night incidents
Whistle	6 blasts = distress signal
Notebook + pencil	Record vitals for rescuers

Fits in a sandwich bag. Weight: ~200g.

For multi-day / remote hikes, add:

• Larger wound dressings
• Saline for wound cleaning
• Emergency shelter / group bothy bag
• Spare medication (your own + partner's)
• Body wrap / insulation layer
• SAM splint (flexible aluminium splint)

The Big Six Incidents

These cover 80% of what happens in UK hills. Know them cold.

1. Blisters

Prevention: sock choice (merino), well-fitted boots, tape hotspots BEFORE they become blisters.

Treatment:

• If unbroken: cover with Compeed or thick plaster. Don't pop.
• If broken: clean with hand sanitiser or saline, sterile dressing, non-stick pad (not cotton wool — sticks), tape over.
• If under toenail (painful): DO NOT drain in the field — high infection risk. Apply soft padding, walk out, see a pharmacist/GP.

2. Ankle Sprains

Most common hill injury. Symptoms: pain, swelling, difficulty bearing weight, bruising.

Assessment:

• Can they bear any weight at all? If yes, possibly a walking-out sprain.
• Is the ankle grossly deformed? If yes, possible fracture — immobilise and call for rescue.
• Severe pain over bone (medial or lateral malleolus)? Possible fracture.

Treatment (for non-fracture sprain):

• RICE: Rest, Ice (if available — cold stream water works), Compression (elastic bandage), Elevation
• Walking aids: trekking poles, improvised stick
• Assist the casualty — don't let them walk out alone if it's serious
• If descent is very long or severe, consider calling Mountain Rescue even for "walkable" sprains

3. Hypothermia

Recognition (mild to severe):

• Shivering, cold extremities
• Confusion, poor decision-making
• Slow speech, stumbling
• Shivering stops (severe — bad sign)
• Unconsciousness (life-threatening)

Treatment:

• Shelter immediately — emergency shelter or bothy bag
• Replace wet clothes with dry (if available)
• Add insulation layers
• Warm sweet drink if conscious and able to swallow
• Body-to-body warming if severe and shelter available
• Call 999/112, ask for Mountain Rescue

Do NOT:

• Give alcohol (vasodilation worsens it)
• Apply direct heat (heating pads, fire — can cause further damage)
• Rub limbs
• Let them "walk it off" (exercise can cause cold blood to rush to core, triggering cardiac arrest)

4. Cuts and Bleeding

Small cuts:

• Clean with water or saline
• Apply pressure if bleeding
• Close with steri-strips if gaping
• Sterile dressing, tape

Heavy bleeding:

• Direct pressure with anything clean
• Elevate if possible
• Maintain pressure — don't keep lifting to check
• Apply second layer if blood soaks through (don't remove first)
• Call 999 if arterial bleeding (spurting) or heavy

Never use tourniquets unless absolutely necessary — improper application can cost a limb.

5. Hyperthermia / Heat Exhaustion

Less common in UK but not impossible on hot days.

Recognition:

• Hot, dry skin OR profuse sweating
• Headache, nausea
• Dizziness, confusion
• In severe: body temperature rises dramatically, loss of consciousness

Treatment:

• Move to shade
• Cool the body: wet cloth on neck, arms, groin; fan; immersion in cold water if possible
• Hydrate if conscious — water with electrolytes
• Call 999 if symptoms don't improve quickly

6. Allergic Reactions / Anaphylaxis

Mild (hay fever-type): antihistamine tablet.

Moderate (hives, some swelling): antihistamine + monitor carefully.

Severe (throat swelling, breathing difficulty, rapid pulse, loss of consciousness):

• Administer EpiPen if available (carried by someone with known allergies)
• Call 999 immediately
• Keep patient calm and still — decrease circulation of allergen
• Monitor breathing, be ready for CPR

When to Call Mountain Rescue

Dial 999 or 112, ask for Police, then Mountain Rescue.

Call when:

• Serious injury (suspected fracture, head injury, severe bleeding)
• Hypothermia or severe cold exposure
• Loss of consciousness
• Severe illness (cardiac symptoms, stroke symptoms)
• Lost with no way to self-rescue
• Benighted (caught out in dark without lights)
• Group member missing

What to tell them:

• Location (grid reference from OS map, GPS coordinates, or landmarks)
• Nature of injury or emergency
• Number of people
• Weather conditions
• Your phone number
• Keep phone on, await callback

After calling:

• Stay where you are (easier to find)
• Display anything bright (foil blanket, bright jacket)
• Use 6 whistle blasts per minute as distress signal
• At night, flash torch 6 times per minute

Mountain Rescue is a volunteer service in the UK and does not charge for services. Don't hesitate to call — they'd rather come out and be unneeded than not come when needed.

Navigation When Things Go Wrong

A surprising amount of first aid is navigation-prevention:

• Getting lost → hypothermia/exhaustion is a common chain
• Twisted ankle → night descent → further injury is another

If you realise you're lost:

• Stop, shelter, think
• Read the map, locate yourself (visible features, grid reference)
• Decide: go back the way you came, or forward with confidence
• If neither is possible, shelter and call for help before conditions worsen

Specific UK Conditions

Scottish Winter

• Cold exposure risk genuine
• Navigation in whiteout is life-or-death
• Avalanche risk on steeper terrain (check SAIS reports)
• Sunset very early, limited daylight
• Wetter snow = higher hypothermia risk

Lake District / Welsh Hills

• Weather shifts rapidly
• Steep ground falls possible
• Poor mobile signal in valleys
• Remote corries far from roads

South Downs / Rolling Hills

• Lower consequence but heat in summer can matter
• Dehydration on longer routes
• Blisters from firm paths

Moorland (Peak District, Yorkshire Moors)

• Exposure — no shelter from wind
• Bog hazards
• Navigation on featureless terrain is HARD
• Lightning exposure in thunderstorms

Group First Aid Etiquette

When you're leading or in a group where someone is injured:

• Stay calm. Panic spreads. Calm spreads too.
• Assess before acting. Don't rush treatment.
• Keep the casualty informed. Let them know what you're doing.
• Assign roles. Someone calls rescue, someone stays with casualty, someone provides shelter.
• Don't make promises you can't keep. "You'll be fine" is not a guarantee.
• Protect yourself. You're no use injured too.

Post-Incident

After any significant incident:

• Review what happened. What caused it? Could it have been prevented?
• Update your kit. What did you wish you had?
• Report serious incidents to the landowner, Mountain Rescue, or authorities as appropriate.
• Psychological aftermath. Witnessing serious injury is affecting. Talk about it; seek support if needed.

Training Beyond This Guide

For serious UK hillwalkers, investing in training is worth it:

• Basic First Aid (16-hour course): St John Ambulance, Red Cross. Good foundation.
• Outdoor First Aid (2-day course): Specifically for outdoor environments. Highly recommended.
• Remote First Aid (4+ day courses): For serious expeditions, extensive remote time.
• Mountain Leader / Winter Mountain Leader awards: Include significant first aid component.

Costs: £50-£500 depending on course. Time commitment: 1-5 days.

Personal Medical Information

Carry (or have a partner carry):

• Your own condition / allergy information in a card in your wallet
• Emergency contacts
• Medications you take regularly
• Blood type if known
• GP details

If you have specific conditions (epilepsy, diabetes, severe allergies), consider a medical alert bracelet.

Common Mistakes

• Forgetting the first aid kit. It's in your kit list for a reason.
• Using out-of-date supplies. Replace annually.
• Heroics without training. Don't attempt complex interventions you're not trained for. Basic care + call for help beats improvised surgery.
• Refusing to call rescue. Embarrassment is not a valid reason to risk further harm.

What's Next

Pair with Scottish Munros & UK Mountain Days for mountain-specific preparation, and Winter Hiking for cold-weather-specific considerations.

Take a formal outdoor first aid course within the next year if you haven't. It'll improve your confidence on every hill day, and could save a life.

Good first aid is a small investment for a peace of mind that makes every hike safer. You'll probably never need most of what you've learned. If you ever do, you'll be glad you have it.