First Aid

Possible injuries encountered when Hiking, and how to treat them.

Whether you like to hike long distances or in short spurts, you can encounter hazards along the way. Hiking trails are often located in parks and wooded areas where rocks, tree limbs, insects and lack of fresh water can all create problems for hikers.
Some common injuries include :

• Blisters
• Skin Injuries (cuts & grazes)
• Sprains
• Insect Bites
• Sunburn
• Dehydration

Here I will cover prevention and treatment basics. As in all cases, if you have an injury and treat it yourself, make sure you see a doctor at the earliest opportunity.
Remember the old saying……..Prevention is better than cure.

The Injuries listed above, are the most common amongst hikers. Obviously other Injuries can occur, some a lot more serious. Serious injuries are not as common, but are a sure fire reason to think long and hard before hiking alone. More serious Injuries would include :

• Broken Bones/Dislocations
• Hypothermia
• Hyperthermia/Heat Stroke
• Burns
• Unconsciousness
• Eye Injuries (branch impalement)

Blisters

Even the most experienced hikers can get blisters on their feet. Unfamiliar terrain and inclines add more stress to footgear. Blisters often form on heels, anklebones and on big toes when going downhill. Carry a small sheet of moleskin to cut into shape and apply to the blistered area. This action will allow you to continue your hike without undue discomfort.
What causes blisters? Friction or rubbing of the skin is one of the most common causes of blisters. Blisters caused by rubbing and friction can occur after walking, running or hiking long distances, especially while wearing ill-fitting shoes, or after performing other repetitive motions over an extended period of time.
There are several steps you can take to prevent blisters. The main goal is eliminating or, at least, minimising friction to blister-prone areas. The first step to preventing blisters on your feet is selecting the correct shoes. But there are other ways to help prevent blisters, including socks, lubricants and taping the area of your foot that you know is prone to blisters using medical tape. Even drinking more water!
Early Treatment of Itchy Foot Blisters
Blisters develop over a period of time and often you can already feel one coming up. Early detection and treatment is the key to preventing full grown Blisters. If you feel a sore place on your foot or irritation, do the following:

• Take off your boots and socks immediately and remove any sand or gravel from your feet.
• Let your feet dry and cool down.
• Cover the sore area with surgical tape, band-aid, or even better special Blister moleskin. Moleskins are artificial skin that you can cut to shape and stick to your own skin.
• Remove the moleskin once you stop hiking and let the skin recover during the night. The next morning, you can judge for yourself to apply a new cover or not. In general, take precautions and apply moleskin even if the area is only moderately irritated.

Treating Blisters

• If the Blisters are at the surface and filled with fluid, you should take a sterilised needle and pierce the blister. Pierce from the side close to the base of the Blister and let all the liquid flow out. If the affected skin is still intact then do not remove it. Instead, cover the drained Blister with moleskin. If the affected area is ruptured then carefully cut it away and clean the underlying new skin with rubbing alcohol or an antiseptic. If you have the time, you should allow the new skin to harden in the open air. If you need to move on again, apply moleskin and use gauze to keep the moleskin from directly contacting the tender new skin. Once the new skin has hardened a bit, you can apply benzoin or rubbing alcohol to further toughen up the new skin. Keep the new skin clean and sterilise it to prevent infection.
• If the blisters on the foot are buried deep in your skin and does not hold a lot of liquid then do not try to puncture them. Instead, just cover them with moleskin.
  

Skin Injuries

• Stop the bleeding by applying gentle pressure with a clean cloth or sterile bandage. If possible, elevate the wound. Don’t lift the bandage to check on the wound or you may break the blood clot that is forming, and bleeding may start again.
• Clean the wound with clean, clear water. Use soap and water to clean the area around the scrape, but try to use only clean water on the actual wound.
• Apply an antibiotic cream or ointment – such as Neosporin or Polysporin – in a thin layer to the wound.
• Cover the scrape with a bandage.
• Deep wounds will require stitches. It’s best to get stitches in the first few hours after the injury occurs.
• Watch for infection. See a doctor if the scrape isn’t healing, or if you see redness, drainage or swelling or it feels warm or the pain increases.
• Get a tetanus shot if the scrape is deep or dirty and your last one was more than five years ago.
  

Sprains:
Pain in your knees makes for quite an unpleasant hike. Knee injuries can happen doing practically any activity, but the constant pounding of hiking for hours can really wear out your joints. You may get a serious injury such as a torn ligament if you twist wrong or take a fall while hiking, but chances are your knees will just get tired out and inflamed from too much work. Just like a mechanical device, the joints in your body can wear out if they are overworked and not allowed to be repaired.
Downhill hiking is the major cause of knee problems. When hiking uphill, the muscles work hard to lift your weight, but when coming downhill, gravity is pulling your weight down so muscles don't work so hard. Unfortunately, your joints absorb the impact of your weight being pulled down the mountain and too much stress on ankles, knees, and hips can cause irritation and inflammation.The faster you hike downhill, the higher you raise the risk of injury. You are in less control, have less reaction time, and have more inertia to arrest if a mis-step occurs. And, to top it off, the impact to your body is amplified as you hike faster. So, slow down! Taking your time going downhill is safer and less damaging to your knees and other joints.
Treatment :   Rest: The most important part of treating a knee injury is resting your knee. You may be told to keep weight off your knee. This means that you should not walk on your injured leg. Rest helps decrease swelling and allows the injury to heal. When the pain decreases, begin normal, slow movements.

•  
• Ice: Ice causes blood vessels to constrict (get small) which helps decrease swelling, pain, and redness. Put crushed ice in a plastic bag or use a bag of frozen corn or peas. Cover it with a towel. Put this on your knee for 15 to 20 minutes, 3 to 4 times each day. Do this for 2 to 3 days or until the pain goes away.
   
• Compress: You may need to wear an elastic bandage. This helps keep your injured knee from moving too much while it heals. You can loosen or tighten the elastic bandage to make it comfortable. It should be tight enough for you to feel support. It should not be so tight that it causes your toes to be numb or tingly. If you are wearing an elastic bandage, take it off and rewrap it once a day.
   
• Elevate: Lie down and raise your knee to a level above your heart to help decrease the swelling.  
   
  
  
  Ankles can easily be turned, especially on rocky surfaces. This why I always wear boots rather than shoes when hiking, and always have at least 1 hiking pole. An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged and how many ligaments are injured. With a mild sprain, the ankle may be tender, swollen, and stiff. But it usually feels stable, and you can walk with little pain. A more serious sprain might include bruising and tenderness around the ankle, and walking is painful. In a severe ankle sprain, the ankle is unstable and may feel "wobbly." You can't walk, because the ankle gives out and may be very painful.
  Treatment again for Ankle Sprains, as will all sprains is…… R.I.C.E.
  
  
  Insect Bites :
  Unfortunately, you can never tell when you will run into a stinging insect on hiking trails. Bees, wasps, mosquitoes and flies are just a few of the creatures that can deliver painful, itchy stings. Ensure that the first-aid kit in your backpack also contains an anti-sting medication to reduce discomfort from insect bites. These medications are available in individual dose packets and easy-to-pack pens. Always rinse and dry the bite area before applying medications. Remove stingers if necessary.
  Removing a sting
  As soon as you have been stung by a bee, remove the sting and the venomous sac if it has been left in the skin. Do this by scraping it out, either with your fingernails or using something with a hard edge, such as a bank card.
  When removing the sting, be careful not to spread the venom further under your skin and do not puncture the venomous sac.
  Do not pinch the sting out with your fingers or a pair of tweezers because you may spread the venom. If a child has been stung, an adult should remove the sting.
  Wasps and hornets do not usually leave the sting behind, so could sting you again. If you have been stung and the wasp or hornet is still in the area, walk away calmly to avoid being stung again.
  Basic treatment
  Most insect bites and stings cause itching and swelling that usually clears up within several hours.
  Minor bites and stings can be treated by:
  
• washing the affected area with soap and water
• placing a cold compress (a flannel or cloth cooled with cold water) over the affected area to reduce swelling
• not scratching the area because it can become infected  
    Additional treatment
  If the bite or sting is painful or swollen, you can also:
  
• wrap an ice pack (such as a bag of frozen peas) in a towel and place it on the swelling
• take painkillers, such as paracetamol or ibuprofen (children under 16 years old should not be given aspirin)
• use a spray or cream that contains local anasthetic, antihistamine or mild hydrocortisone on the affected area to prevent itching and swelling
• take an antihistamine tablet to help reduce swelling  
     
  Blisters
  If you develop blisters after being bitten by an insect, do not burst them because they may become infected. Blisters do not often cause pain unless they burst, exposing the new skin underneath. If possible, use an adhesive bandage (plaster) to protect the blistered area.
  If (like me) you are allergic to bee/wasp stings, I would advise that you carry an EpiPen in your first aid kit.
  
  Ticks :
  Most ticks do not carry diseases, and most tick bites do not cause serious health problems. But it is important to remove a tick as soon as you find it. Removing the tick completely may help you avoid diseases such as Lyme disease that the tick may pass on during feeding, or a skin infection where it bit you.
  When you return home from areas where ticks might live, carefully examine your skin and scalp for ticks. Check your pets, too
  

  How to remove a tick
  

  Use fine-tipped tweezers to remove a tick. If you don't have tweezers, put on gloves or cover your hands with tissue paper, then use your fingers. Do not handle the tick with bare hands.
  
• Grab the tick as close to its mouth (the part that is stuck in your skin) as you can. The body of the tick will be above your skin.
   
• Do not grab the tick around its swollen belly. You could push infected fluid from the tick into your body if you squeeze it.
   
• Gently pull the tick straight out until its mouth lets go of your skin. Do not twist the tick. This may break off the tick's body and leave the head in your skin.
• After the tick has been removed, wash the area of the tick bite with a lot of warm water and soap. A mild dishwashing soap, such as Ivory, works well. Be sure to wash your hands well with soap and water also.
  
• Put the tick in a dry jar or ziplock bag and save it in the freezer for later identification if necessary.  
    NOTE : If you can't remove a tick, go and see your Doctor.
  What not do do :
  
• Smother a tick that is stuck to your skin with petroleum jelly, nail polish, gasoline, or rubbing alcohol.
   
• Burn the tick while it is stuck to your skin.
• Smothering or burning a tick could make it release fluid-which could be infected-into your body and increase your chance of infection.
  There are some tick-removal devices that you can buy. If you are active outdoors in areas where there are a lot of ticks, you may want to consider buying such a device. (Tick Key, see pic #2)
  

Sunburn

Sunburn is always a danger on long hikes in hot weather. You may have to hike through long, open area with no shade. Always apply sunscreen before you begin your hike, and re-apply the sunscreen periodically during the day. Pay special attention to re-application after sweating a lot or getting wet in streams or waterfalls. Small, easy-to-carry tubes of sunscreen are available that fit easily into backpacks and do not add extra weight.
If you have sunburn, you should avoid direct sunlight by covering up the affected areas of skin and staying in the shade until your sunburn has healed. However, protecting your skin from the sun using sunscreen is better than treating it.
Water
Cool the skin by sponging it with lukewarm water or by having a cool shower or bath. Applying a cold compress, such as a cold flannel, to the affected area will also cool your skin. A Bandana soaked in water will work well whilst still out on the trail.
Drinking plenty of fluids will help to cool you down and will replace water lost through sweating. It will also help prevent dehydration (when the normal water content in your body is reduced, causing thirst and light-headedness).

Moisturiser

For mild sunburn, apply a moisturising lotion or aftersun cream. Aftersun cream will cool your skin and moisturise it, helping to relieve the feeling of tightness.
Moisturisers that contain aloe vera will also help to soothe your skin. Calamine lotion can relieve any itching or soreness.

Painkillers

Painkillers can help to relieve the pain and reduce the inflammation caused by sunburn.

Severe sunburn

Severe cases of sunburn may require special burn cream and burn dressings. Ask your pharmacist for advice. You may need to have your burns dressed by a nurse at your GP surgery.

Dehydration

Dehydration is the hikers worst enemy. A long strenuous hike can use up fluid reserves in the body quickly in hot weather. Sometimes, hikers miscalculate their water needs and find themselves running out of water on the trail. Bring enough water to allow you to quench your thirst every 30 minutes. Drink before you are thirsty to prevent fluid loss. Tuck a few water purification tablets into your backpack in case you run out of water and are forced to refresh yourself from a stream or creek. Signs of dehydration include increased thirst, dry mouth, dry skin, light-headedness, weakness dark-colored urine and headache. Dehydration can lead to heat stroke, a serious medical problem. Be aware of signs such as vomiting, headache, cramps, rapid pulse or confusion. Get into the shade and seek medical attention immediately

• Stop and rest
  
• Get out of direct sunlight and lie down in a cool spot, such as in the shade or an air-conditioned area.
  
• Prop your feet up
  
• Take off any extra clothes
  
• Drink cool water, juice, or sports drink to replace fluids and minerals. Drink 2ltrs of cool liquids over the next 2 to 4 hours.
  
• On returning home, Rest and take it easy for 24 hours, and continue to drink a lot of fluids. Although you will probably start feeling better within just a few hours, it may take as long as a day and a half to completely replace the fluid that you lost.
  
• Severe Dehydration, Children and adults who are severely dehydrated should be treated by emergency personnel arriving in an ambulance or in a hospital emergency room, where they can receive salts and fluids through a vein (intravenously) rather than by mouth. Intravenous hydration provides the body with water and essential nutrients much more quickly than oral solutions do — something that's essential in life-threatening situations.
  
• My personal advise……..DO NOT wait until you are thirsty to drink !!!!
  
  

More Serious Injuries
 

• Breaks and Dislocations
  A fracture can generally be diagnosed by the patient's symptoms, by the signs of appearange of the part, and the history of the accident or injury. When characteristic signs are absent, the diagnosis may be made from a history of sudden severe pain, followed by deformity and local tenderness on pressure.  
     
  The chief symptom of a fracture is generally pain at or near the site of the injury, with tenderness on pressure. There is also disability of movement or use of the part, with pain on attempted movement. Swelling and deformity may be seen, but are not necessarily present in all fractures. In some cases swelling may mask the deformity, especially at the ankle.
  The limb or part may be misshapen or held in an unnatural position, or there may be obvious shortening. If the fractured bone is near the surface of the skin it may be seen to be irregular in outline or shape.
  Treatment :
  
• Apply a cold pack to the area of fracture or dislocation to decrease swelling and to relieve pain.
   
• Flush open wounds associated with compound fractures with clean, fresh water and cover them with a dry dressing.
   
• Splint the injured area to keep it from moving. Support a broken limb by using the best material available for a splint, such as sticks, part of a backpack frame, or other stabilizing device. Wrap tape around the splint and the extremity affected. For example, if a forearm is broken, the splint should run from the wrist to the upper arm and support the arm without repositioning it.  
    Splints should be firm, and sufficiently long to support the joints above and below the fracture. They should be light and strong, and at least as wide as the limb. Sticks gathered from the surrounding trees or Hiking poles may be used as temporary emergency substitutes. Whatever form of support is used should be well padded on the surface next to the limb with a soft material. When no splint is available for first aid, an injured arm may be very carefully bound to the body; a fractured leg should always be tied to its fellow for additional support, with wide bandages round the thighs, above and below the knees, at the ankles and round the feet. Use your hat (or helmet if you're rock climbing) to put over the feet for support. Remember MOVE THE GOOD LEG TO THE INJURED LEG.
  Great care must be used when applying the splints and bandages so that the injured part is kept well supported and the bones are not further displaced. Bandages must be applied firmly but not too tightly, to hold the splints in position. The upper bandage should always applied first.
  A Stretcher may be improvised in an emergency by passing two poles through the sleeves of two or three coats turned inside out. The coats are buttoned up. Strips of wood bound to the ends of the poles complete the stretcher.
  A stretcher of some sort must be obtained as soon as possible and should be covered with padding, blankets or garments; the stretcher should be gently slid beneath, and the patient laid on it by a sufficient number of people to raise him easily from the ground. The stretcher should then be carried by four people, two at each end, moving steadily with great care, and keeping exact step with each other. If these persons take hold of the ends of two poles fixed under the stretcher, they will find they can carry it much more easily.
  DO NOT……..Under any circumstances try to push back protruding bones, or bones in a dislocation. For protuding bones in an open fracture, make a ring bandage to encase the bone, before applying the bandages.
  
  
• Hypothermia
  Hypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as 35.0 °C (95.0 °F). Body Temperature is usually maintained near a constant level of 36.5–37.5 °C (98–100 °F). If exposed to cold and the internal mechanisms are unable to replenish the heat that is being lost, a drop in core temperature occurs. As body temperature decreases, characteristic symptoms occur such as shivering and mental confusion.
  Hypothermia most often occurs because of prolonged exposure to cold weather. Inadequate clothing for conditions may not provide enough insulation for the body to prevent heat loss. Immersion in water hastens hypothermia, and just a few minutes in cold water may be fatal.
    The body starts to slow as the temperature drops. Aside from the cold that is felt and the shivering that may occur, mental function is most affected initially. A particular danger of hypothermia is that it develops gradually, and since it affects thinking and reasoning, it may go unnoticed.
     Initial hunger, an urge to urinate and nausea will give way to apathy as the core body temperature drops. This is followed by confusion, lethargy and slurred speech, loss of  consciousness, and eventually coma. Often the affected person will lie down, fall asleep, and die. In some cases, the patient will paradoxically remove their clothes just before this occurs.
  Treatment :
  The patient should be removed from the cold environment and placed in a warm shelter away from the wind. Wet clothing should be removed and replaced with a warm, dry covering including head covering.
  The patient's breathing should be monitored, and if it becomes dangerously slow or stops, CPR should be initiated.
  Rewarming should be started by applying warm compresses to the chest, neck and groin. Hot water should not be used. Because there may be associated frostbite, direct heat should not be applied to the body. Instead, warm blankets and body to body contact may be needed as a first aid measure. Space blankets are good as they reflect body heat back to the patient, if you have one big enough, get in with them and use what we in the military used to call the "Buddy buddy system". Climbing into any shelter/sleeping bag with the patient gives them warmth from your body so get in with them where possible.
  The severity of hypothermia and the patient's mental status and ability to function will determine what further treatment is necessary. Passive rewarming with warm clothing in a warm environment may be all that is required for a conscious person who is shivering.
  
  
• Hyperthermia / Heat Stroke:
   
  Hyperthermia is the opposite of Hypothermia, and is elevated body temperature due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates. Extreme temperature elevation then becomes a medical emergency requiring immediate treatment to prevent disability or death. Amongst the most common causes is heat stroke. Hyperthermia is defined as a temperature greater than 37.5–38.3 °C (100–101 °F), depending on the reference used.
  The normal body temperature in a healthy person can be as high as 37.7 °C (99.9 °F) in the late afternoon. Hyperthermia requires an elevation from the temperature that would otherwise be expected. Such elevations range from mild to extreme; body temperatures above 40 °C (104 °F) can be life threatening.
  Signs and symptoms are, Hot, dry, skin as blood vessels dilate in an attempt to increase heat loss. An inability to cool the body through sweating may cause the skin to feel dry.
  Other signs and symptoms vary. Accompanying dehydration can produce nausea, vomiting, headaches, and low blood pressure and the latter can lead to dizziness and fainting, especially if the standing position is assumed quickly.
  In severe heat stroke, there may be confused, hostile, or seemingly intoxicated behavior. Heart rate and respiration rate will increase as blood pressure drops and the heart attempts to maintain adequate circulation. The decrease in blood pressure can then cause blood vessels to contract reflexly, resulting in a pale or bluish skin color in advanced cases.
  Heatstroke in also known as sunstroke, thermic fever or siriasis, It happens when the body's mechanisms for controlling temperature fail. Heat stroke is a life-threatening emergency needing immediate treatment. While many people feel sick and faint during heat waves, most of these people are suffering from heat exhaustion, a related condition usually less serious than heat stroke.
  Working and excercising in hot conditions without taking in enough fluids, is the leading cause of heatstroke. You can get heat stroke by not replacing lost fluids over days or weeks, or you can bring it on in a few hours by exercising strenuously on a hot day without drinking plenty of liquids first.
  Liquids help to cool us down by allowing the body to produce sweat. However, liquids are also necessary for bodily functions, such as keeping up blood pressure. You can lose large amounts of body fluid in the form of sweat without noticing any effects, but at a certain point the body will reserve the remaining fluid for vital functions and stop sweating. The body's core temperature then shoots up, and cells start dying.
  Sweat evaporates more rapidly in dry weather, cooling the body more efficiently than in humid weather. When working in humid conditions, the core temperature rises more rapidly. This is why weather forecasts add a humidity factor or heat index to represent how you will actually feel outdoors.
  Treatment :
  Everything must be done to cool the heat stroke victim immediately. The best solution is to remove them from the sun, immerse the body in cold water, such as a river or stream. Otherwise, remove most of their clothes, douse them with water, and fan them vigorously. Wrapping in wet sheets can help increase the rate of heat loss. If the person is conscious and alert, offer him or her water or other fluids. Avoid caffeinated or alcoholic drinks because they dehydrate you.
  If the victim starts shivering, slow down the cooling treatment because shivering raises core temperature. Take the person's temperature every 10 minutes if you have a thermometer handy. You should not let the core temperature fall below 38°C (100°F), as this can result in an uncontrollable slide towards dangerously low temperatures (hypothermia). All the while you should be making arrangements to get the victim to an emergency room. Watch for signs of respiratory arrest (breathing failure) and be ready to give mouth-to-mouth resuscitation
  Place the victim in a cool place, somewhere in the shade, lay them down and give small gulps of liquid every few minutes. "Sports" drinks are best but water is often more readily available. You should watch carefully for signs of deterioration, but there's no need to rush to a hospital for a normal case of heat exhaustion.
  
  Burns :
  To distinguish a minor burn from a serious burn, the first step is to determine the extent of damage to body tissues. The three burn classifications of first-degree burn, second-degree burn and third-degree burn will help you determine emergency care.
  1st-degree burn
  The least serious burns are those in which only the outer layer of skin is burned, but not all the way through.
  
• The skin is usually red
• Often there is swelling
• Pain sometimes is present
  Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin or buttocks, or a major joint, which requires emergency medical attention.  
    2nd-degree burn
  When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned, the injury is called a second-degree burn.
  
• Blisters develop
• Skin takes on an intensely reddened, splotchy appearance
• There is severe pain and swelling.
  If the second-degree burn is no larger than 3 inches (7.6 centimeters) in diameter, treat it as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin or buttocks, or over a major joint, treat it as a major burn and get medical help immediately.   3rd-degree burn
  The most serious burns involve all layers of the skin and cause permanent tissue damage. Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn.
  Treatment :
  For minor burns, including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7.6 centimeters) in diameter, take the following action:
  
• Cool the burn. Hold the burned area under cool (not cold) running water for 10 or 15 minutes or until the pain subsides. If this is impractical, immerse the burn in cool water or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don't put ice on the burn.
• Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, or other material that may get lint in the wound. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burn, reduces pain and protects blistered skin.
• Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others).  
  Caution
  
• Don't use ice. Putting ice directly on a burn can cause a person's body to become too cold and cause further damage to the wound.
• Don't apply egg whites, butter or ointments to the burn. This could cause infection.
• Don't break blisters. Broken blisters are more vulnerable to infection.
  For major burns, call for emergency medical help. Until an emergency unit arrives, follow these steps:
  
• Don't remove burned clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat.
• Don't immerse large severe burns in cold water. Doing so could cause a drop in body temperature (hypothermia) and deterioration of blood pressure and circulation (shock).
• Check for signs of circulation (breathing, coughing or movement). If there is no breathing or other sign of circulation, begin CPR.
• Elevate the burned body part or parts. Raise above heart level, when possible.
• Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist cloth towels.  
     
   
  
  Unconciousness :
  When a casualty is unconscious, their muscles become relaxed, including their swallowing muscles, and if the casualty is not placed on their side, they can choke on their own fluids.  If an unconscious casualty is left on their back, their tongue may fall back and block the airway. An unconscious casualty is still breathing and has a pulse, but may not respond to gentle shouting and stimulation.  They look like they are in a deep sleep, but cannot be woken up.  They may not respond to verbal or painful stimuli.
  Treatment :
  If you come across an unconscious person for whom the nature of the accident or the positioning indicates that she may have broken her back (for example, a bystander tells you the casualty fell,) your priority remains to check the airway.
  
• Ask a question to find out if the casualty is conscious. Do not shake the casualty.
• Carry out your ABC checks, taking care to tilt the head gently. If the head is already extended a suitable way, do not move it any further. lnstead, just use the chin lift and carefully check the mouth.
• If the casualty is not breathing, give rescue breaths and full CPR as needed. Make an early call for an ambulance.
• If you have to roll the casualty on to her back to resuscitate, then you should aim to keep the casualty's head, trunk and toes in a straight line. If possible, get bystanders to help move the casualty over, but do not waste time looking for help because the casualty needs air as soon as possible.
• If the casualty is unconscious and lying in such a way that the head is extended and she is on her side, allowing fluid to drain from the mouth, then leave them alone.
• Hold the casualty's head still by placing your hands over the ears and your fingers along the jawline. Ensure that the airway is monitored.
• If the casualty is unconscious and either the head is not extended or she is not lying on her side, you need to move her into the recovery position. Ideally, with enough bystanders, you should use the log roll. lf not, be prepared to roll the casualty into the recovery position yourself.  
    Recovery positioning : Put the arm that's closest to you at right angles to the casualties body, with the palm facing upwards. Put the palm of their other hand against their chest. Lift the knee that's furthest from you so that their leg is bent and their foot is flat on the floor. Pull the bent knee towards you, and the person's body should roll onto their side. Put the free hand (the one that was on the chest) under the head, so that the palm is on the floor, and the person's cheek is on the back of the hand.
  
  Continue monitoring the casualty, and Never leave them alone.
  Eye Injuries :
  Common causes of abrasions to the eye's surface (corneal abrasions) are getting poked in the eye or rubbing the eye when a foreign body is present, such as dust or sand. Corneal abrasions are very uncomfortable and cause eye redness and severe sensitivity to light.
  If you know something has scratched your eye, it's very important to see your eye doctor to seek treatment for your eye injury.
  Scratches also can make your eye susceptible to infection from bacteria or a fungus. Certain types of bacteria and fungi can enter the eye through a scratch and cause serious harm in as little as 24 hours. Even blindness can result. This is especially true if whatever scratched your eye is dirty or contaminated.
  Remember also that infections from eye injuries such as scratches can originate from unexpected sources such as tree branches.
  If you have a scratched eye, don't rub it. And don't patch your eye, either. Bacteria like dark, warm places to grow, and a patch might provide the ideal environment. Simply keep the eye closed or loosely tape a paper cup or eye shield over it. See your doctor as soon as possible to check out this type of eye injury.
  
  

Snakebites : 
Deaths from snakebites are rare. More than one-half of the snakebite victims have little or no poisoning, and only about one-quarter develop serious systemic poisoning. However, the chance of a snakebite in a survival situation can affect morale, and failure to take preventive measures or failure to treat a snakebite properly can result in needless tragedy.
The primary concern in the treatment of snakebite is to limit the amount of eventual tissue destruction around the bite area.
A bite wound, regardless of the type of animal that inflicted it, can become infected from bacteria in the animal's mouth. With non venomous as well as venomous snakebites, this local infection is responsible for a large part of the residual damage that results.
Snake venoms not only contain poisons that attack the victim's central nervous system (neurotoxins) and blood circulation (hemotoxins), but also digestive enzymes (cytotoxins) to aid in digesting their prey. These poisons can cause a very large area of tissue death, leaving a large open wound. This condition could lead to the need for eventual amputation if not treated.
There are two kinds of snake venom out there – hemotoxic (affects blood) and neurotoxic (affects nervous system). Rattle snakes, Copperheads and Water Moccasins (Crotalinae, or Pit Vipers) are hemotoxic and can cause problems with clotting. Cobras and Coral snakes (Elapids) are neurotoxic and their venom can stop nerve signals and cause organ failure. Their venom also leads to convulsions or immobilisation.
Shock and panic in a person bitten by a snake can also affect the person's recovery. Excitement, hysteria, and panic can speed up the circulation, causing the body to absorb the toxin quickly. Signs of shock occur within the first 30 minutes after the bite.
Before you start treating a snakebite, determine whether the snake was venomous or non venomous. Bites from a non venomous snake will show rows of teeth. Bites from a poisonous snake may have rows of teeth showing, but will have one or more distinctive puncture marks caused by fang penetration. Symptoms of a venomous bite may be spontaneous bleeding from the nose and anus, blood in the urine, pain at the site of the bite, and swelling at the site of the bite within a few minutes or up to 2 hours later.
Breathing difficulty, paralysis, weakness, twitching, and numbness are also signs of neurotoxic venoms. These signs usually appear 1.5 to 2 hours after the bite.
Whether a venomous snake bite is hemotoxic, neurotoxic or both, treatment with an injection of antivenin, or antivenom as soon as possible is absolutely necessary to neutralise the poison. Typically, hospitals will carry the antivenin of all of the venomous snakes found within their region. Giving the victim the proper amount of the antivenin is crucial for proper treatment. The severity of the venomous snake bite depends on the health and size of the victim. Children and the elderly tend to be particularly sensitive to the effects of snake venom.
In order to treat a snakebite, if you determine it to be venomous, you will then need to determine whether it is Hemotoxic or Neurotoxic as the treatment differs slightly.
Treatment :
Non Venomous :
Although not life threatening, bites from non venomous snakes can still be painful and lead to infection.

• You need to clean the wound carefully, and stay calm, use alcoholic swabs from your first aid kit if you have some available. If not use clean water.
• If you have any available, use some antibiotic ointment to treat the wound.
• Bandage the wound, this will protect it and help to discourage infection. Pay attention to the wound as it heals for redness or streaking or other signs of infection.

Hemotoxic Venom :

• Remove clothing or constricting items. Bites from venomous snakes can cause rapid and severe swelling. Remove clothing or jewellery from the area.
• Minimise your activity. Higher levels of activity will increase blood flow and increase the spread of venom throughout your body.
• Do not cut the bite site or use your mouth to suck out the poison. These are likely to be ineffective and can increase the likelihood of infection.
• Clean the bite with clean water and soap if you have any with you.
• Wrap a tight, but not uncomfortable elastic bandage two to three inches above the bite site. You can use something like an Ace bandage for this, or can fashion one from a stretchy shirt or other article of clothing. The elastic bandage should not be uncomfortable as that will lead to the person unconsciously flexing their muscles, undoing the purpose of immobilising the limb. The intent of this step is to slow drainage from the lymphatic system, not to slow or impede blood flow. Blood on average makes a complete circuit through the body around once a minute, and cannot be significantly slowed down via compression without risking cutting off circulation. The lymphatic system, on the other hand, drains much more slowly and can be influenced by an elastic compress above the site of the wound.Check for a pulse below the over wrap. It should be present. NOTE: Some experts disagree with this step of using an elastic compress. Doing so may cause a rapid release of venom when the bandage or other material is removed. Leaving it on is not an option, however, because any administered anti venom will not be able to reach the affected area. Additionally, people not trained in first aid will often make the mistake of making the compress to tight, much like a tourniquet, which risks cutting off circulation and worsening the condition. In the case of hemotoxin, the use of a material to restrict blood flow may result in the loss of limb.
• Splint the bitten limb to prevent motion. Lie down and keep the splinted extremity at heart level.
• Keep the casualty calm. Let them rest until you can get them medical attention. If the victim is conscious, make them drink fluids.

Neurotoxic Venom :

• To treat a bite from an Elapid (Neurotoxic venom) do the same as above, however in this case you need to wrap and constrict the bite to prevent the spread through your lymphatic system.
• Keep calm and try not to panic.

Some snakes can look very similar indeed, remember the rhyme in the picture below, in order to tell the difference between a venomous Coral snake, and a harmless King snake. Remember though, the best way to avoid being bitten in the first place, is to leave snakes alone.