Wilderness and Adventure Travel Preparation
There is no substitute for preparedness. Adherence to this basic rule will prevent or ease the majority of mishaps that occur in the wild. Proper education before situations of risk allows you to cope in a purposeful fashion, rather than in fear and panic. At least two, and preferably all, members of a wilderness expedition should understand first aid and medical rescue. On a casual family outing, at least one responsible adult should be skilled in first aid. Manual skills, such as tourniquet application, cardiopulmonary resuscitation (CPR), and the application of bandages and splints, should be practiced beforehand.
Be certain to carry appropriate survival equipment, such as maps, a global positioning system (GPS) or compass, satellite messenger and personal locator beacon (e.g., Somewear Global Hotspot), avalanche transceiver, waterproof matches, fire-starter materials, a knife, nonperishable food, a torch/flashlight, AvaLung in avalanche territory, and adequate first aid supplies (stored in a waterproof container).
Technology, especially mobile phone and its applications, are rapidly being developed to aid with wilderness navigation and outdoor medicine topics. If you are going to use such technology, be sure to have a backup navigation/resource system, as well as update and review these applications before you might need them. Be prepared for the harshest environmental conditions you might expect to encounter. To the best extent possible, become familiar with the setting and possible survival scenarios, particularly should you become stranded or lost.
If you have a significant medical problem, you should carry an information card, a MedicAlert bracelet or tag, or something similar. If you will be traveling abroad, be certain to have insurance that will cover you for medical evacuation from the location and specific environment in which you plan to adventure.
A common question asked of wilderness medical practitioners is whether a person can engage in certain activities or travel in a particular environment, depending on the person’s state of health and medical history. Given the number of persons with preexisting conditions, especially those who are part of a growing senior population, these are very important considerations. Whether a person has coronary artery disease, diabetes, rheumatoid arthritis, sickle cell anemia or trait, or any other of numerous conditions, it is important to understand what situations are considered to be safe and what situations are risky. Pre-existing conditions are sometimes classified as “unstable.” If they are unstable, they can worsen. In general, persons with unstable conditions should not travel to high altitude, because resultant low blood oxygen levels might impair or prevent recovery from the condition. If you have a preexisting condition, consult with your physician before undertaking any activity, such as that in extreme cold, heat, high altitude, or remote environments that might put you or your companions at (unacceptable) risk. People with specific medical disabilities, such as chronic severe lung disease, might be advised by a physician to avoid certain stressful environments, such as high altitude.
Have an emergency action plan to protect people and property. Consider the likelihood of being exposed to risks and try to determine likely outcomes of accidents and illnesses, so that you can respond appropriately to danger, communicate effectively, treat people, have access to all necessary equipment, and be prepared to travel and transport. Train and practice until you are reasonably confident.
Many accidents occur because people ignore warning signs or do not anticipate problems. Pay heed to rangers, posted warnings, weather reports, and the experience of seasoned guides. Prepare for situations of risk by developing your skills in less challenging conditions. Wear recommended personal safety equipment, such as a flotation jacket, safety harness, or climbing helmet. Do not tolerate horseplay in dangerous settings.
When abroad, remember that most injuries occur while traveling on roadways. Although it might be tempting to utilize the local modes of transportation, this might be hazardous. If you are a driver or passenger in or on a motor vehicle, remember that roadways in developing nations are often dangerous.
If there are traffic rules, they often are not enforced. Here are important safety rules:
Do not ride in the back of a truck or on the roof of a bus.
Always wear a seatbelt. For children, have them travel in the back seat in correctly positioned age- and size-appropriate restraints. All infants and toddlers should ride in a rear-facing car safety seat (CSS) until they reach the manufacturer’s allowed height or weight limit. After that point, they should use a forward-facing CCS with a shoulder harness until they reach the manufacturer’s allowed height or weight limit. After that point, they should use a belt-positioning booster seat until they fit properly into the vehicle’s lap belt and shoulder harness configuration.
Wear a helmet when on a motorcycle or moped (if you must use these conveyances).
Avoid nighttime travel.
Do not travel alone.
Watch for pedestrians and animals in the roadway, particularly when visibility is low.
Do not exceed the posted speed limit.
Slow down at intersections and crosswalks. Do not pass another vehicle at an intersection or crosswalk.
Here are important safety rules for pedestrians:
When possible, walk on paths or sidewalks. Stay off roads that prohibit pedestrians.
Wear bright or reflective clothing.
If you must walk on the road, walk on the shoulder facing traffic. Be careful if you are on unstable ground or next to a drop-off. Try to make eye contact with the driver approaching you.
Look both ways, twice, before crossing a road or path. Try to do so at crosswalks or intersections.
Cross in good lighting.
Many health hazards of wilderness travel, such as falls, can be avoided by a reasonable degree of fitness, which can be acquired only by conditioning. Every expedition member should begin from a state of maximum fitness (aerobic exercise capacity, agility, muscle strength, power, and endurance). Conditioning might make a person more capable in a situation of rescue, including performing CPR. Other health hazards, such as temperature extremes and high altitude disorders, can in certain circumstances be avoided by acclimatization to the environment. Acclimatization is a physiologic adaptation that is often different from, and might be unrelated to, physical fitness. For instance, see the discussion on acclimatization to high altitude HERE.
Equipment
Be prepared for all weather conditions. Always assume that you will be forced to spend an unexpected night outdoors. Carry warm clothing and waterproof rain gear (with patches for easy repair). Know how to dress properly for all types of weather using a layered approach. Break in all footwear and take care to pad rough edges and exposed seams. Consider carrying a compact emergency position-indicating radio beacon (EPIRB).
Persons who wear glasses with multifocal (bifocal, trifocal, or progressive) lenses tend to be elders. Wearing lenses with appropriate single-distance focus decreases the incidence of falls during outdoor activities. This might be because multifocal eyeglasses diminish depth perception and cause blurred contrast.
Before each use and after any collision or impact, a safety helmet of any sort (ski, bicycle, etc.) should be inspected for integrity. If there are cracks, dents, or other damage, the internal structure of the helmet can be altered in such a way as to lessen its ability to protect the wearer. If that is the case, replace the helmet. Helmets should fit comfortably and snugly and be worn properly. Pads should contact the cheeks and forehead, and the back of the helmet should not contact the nape of the neck. The edge of the forehead opening should rest approximately two fingers-breadth above the eyebrows. The chin strap should be tightened to the point that one finger can slide between it and the underside of the chin. If extra insulation is needed under the helmet for thermal protection, use a thin garment, not a thick hat. When wearing goggles, size them so that the top edge rests snugly and comfortably against the edge of the helmet forehead opening.
All expedition leaders should carry safety and first aid supplies (in a waterproof container) for the most likely mishaps. Medical supplies must be arranged so that they can be rapidly located and deployed and be available during all phases of the expedition, including travel to and from the adventure area. Each person on an adventure trip or expedition should carry a personal medical kit, including essential medications. Recommended first aid items can be found HERE.
Become familiar with the safety profile of all equipment. For instance, be aware of the flammability of tents, clothing, sleeping bags, and so forth if you will be in the vicinity of a campfire. Certain inflatable air mattresses might be comfortable and convenient but pose a suffocation hazard for small children if they become entrapped between the mattress and the fabric sides of a tent. Knives with spring-loaded actions and/or without a safety latch must be handled with great caution.
Trip plans
Prepare a trip plan (itinerary) and record it in a location (trailhead, ranger station, marina, or the like) where someone will recognize when a person or party is overdue and potentially lost or in trouble. Similarly, determine beforehand a plan for getting help in an emergency, whether it involves radio communication, ground-to-air or ship-to-shore signals, cellular telephone, or knowing the location of the nearest pay telephone, ranger station, or first aid facility. If mobile rescue-grade equipment is to be used, it should be checked and double-checked before departure, and regularly scheduled communications should be prepared.
At least two members of any expedition should be able to fashion standard ground-to-air distress markers. Make sure children wear an item of bright clothing and carry a whistle that they know to blow if they are frightened or lost. If you carry a radio, know how to tune in to a weather information channel. The National Weather Service issues a “watch” when conditions may develop a concerning weather pattern, and a “warning” when its arrival is imminent.
If you will be traveling within an area with telephone or radio communication, whether on land or at sea, carry precise instructions for persons to be able to communicate in an emergency. For instance, a diver should know how to contact the Divers Alert Network. An expedition might wish to establish a relationship with an organization such as Global Rescue for medical consultation or evacuation.
In most stories of miraculous ocean or wildland survival, the first chapter includes the account of how the victim lost their way. All wilderness travelers should carry maps, be proficient with a GPS or compass routing, understand how to signal for help, and know in advance where they intend to explore. If you are traveling in snow country, you should know how to avoid being caught in an avalanche and consider carrying an avalanche rescue beacon (transceiver) that operates on the frequency of 457 kilohertz (kHz). The signal carries 30 to 46 m (100 to 150 ft) and is received by the rescuers’ units. In avalanche country, also carry a shovel and a collapsible probe pole. Consider wearing an AvaLung or an ABS Avalanche Airbag System. A technology for locating an avalanche victim is the RECCO harmonic radar-based detector.
Medicines
There is no need to carry a drugstore on a day hike. In general, it is best to avoid administering new (to the user) drugs in a wilderness setting unless they are absolutely necessary because unknown side effects might be more difficult to manage when distant from urban medical care. On the other hand, drugs necessary to treat established medical problems, such as nitroglycerin tablets or spray for a person with angina (chest pain) should always be on hand.
It is the responsibility of the trip leader to be aware of any significant medical problems and to insist that people in obviously poor physical condition not undertake activities that might endanger themselves or others. Any person with allergies, diabetes, epilepsy, or special medical instructions should wear an identification bracelet or carry a medical information card. Anyone who takes medications should carry a list of drugs and doses. If you travel abroad, it is wise to carry an adequate supply of routine medications, as well as a note from a physician stating their necessity, should you be questioned or need refills. Ensure your immunizations are up to date, including specific requirements for particular countries.
Nutrition
Anyone who undertakes vigorous physical activity should consume adequate calories in a well-balanced diet. A debilitating weight-reduction program should not be continued in the wilderness, where a rescue might depend on extraordinary effort and endurance. Similarly, an unfamiliar diet (e.g., keto diet, intermittent fasting) should be well tolerated in a non-stressful setting before it is put to the test when energy, strength, endurance, and alertness might become important for survival.
To avoid dehydration and exhaustion, take adequate time to eat, drink, and rest. Do not plan to live off the land unless you are a survival expert. Most adult men require 3500 to 5000 food calories each day to sustain heavy physical exertion. This can add 2 to 3 lbs for each day’s food to your backpack. Women require 2000 to 3500 calories. A nutritious diet for any activity can easily be maintained with proper planning.
For instance, for backpackers, it has been suggested that the diet should be composed of 50% carbohydrates achieved by constant “carbohydrate snacking,” 35% fat, and 15% protein. To calculate the number of calories worth of food to carry, multiply your ideal body weight in pounds times 22. For example, a 150-lb (68 kg) person would carry 150 × 22 = 3300 calories, divided into the food group ratios mentioned previously. Consider carrying a supply of energy bars or gel, but do not count on food bars alone to maintain you.
People who become patients need to maintain a decent nutrition status. This is important for medical and psychological reasons. Here are some factors to consider during a rescue:
Plan ahead. Everyone needs to eat.
Even if a victim is not hungry, they need nourishment. They should consume at least 30 g of carbohydrate every 30 minutes if they are physically active. This is necessary to maintain blood sugar in an acceptable range for continued exertion. Common symptoms of low blood sugar are shakiness, hunger, sweating, sudden moodiness or behavior changes, confusion, headache, pale skin color, dizziness, and fatigue.
During sustained exercise, such as a long hike, eat sufficient protein to avoid losing muscle mass. Eat three or more servings of high-quality protein sufficient to achieve an overall daily intake of 1 g per kg of body weight.
Food and drink can be emotionally reassuring.
Fluid requirements
Fluid requirements have been well worked out for all levels of exercise. They are highlighted in the section on heat illness (see page 341). Most people underestimate their fluid requirements. Although there is variation, the following is a hydration requirement based on an average minimal recommendation of 2 to 3 liters of liquid per day for an adult man: minimal water loss—2300 mL; water loss in hot environmental temperature—3300 mL; and water loss during heavy exercise with significant sweating—6600 mL. Other factors that increase fluid loss are activities at high altitude or in cold, dry air (increased loss during breathing), anything that increases sweating, and ingestion of drugs (e.g., alcohol or diuretics) that increase urinary losses.
Encourage frequent rest stops and water breaks. If natural sources of drinkable water (springs, wells, ice-melt runoff) will not be encountered, you should carry at least a 48-hour supply. Carry supplies for water disinfection (see page 433). Inspect your urine to be certain that it is light-colored, rather than dark-colored. Dark coloration usually indicates that you are not adequately hydrated.
Personal hygiene and bodily waste disposal
Personal hygiene can influence preventing disease transmission and should be maintained on wilderness expeditions. The most obvious activity is washing hands effectively before eating or preparing foods. Soap and water scrubbing, followed by an application of an alcohol-based (at least 60%) gel, is the most effective technique. To wash hands properly, wet them with clean water, then lather with soap.
Take care to wash bottom and top of hands, between the fingers, and under the nails. Scrub for at least 30 seconds, then rinse with clean, running water before completely drying with a dry , clean cloth or towel or air (sun) drying. Sharing a contaminated towel can spread germs, so if conditions and time permit, consider air drying. If a person is known to be ill, they should have their own personal towel that is used and laundered apart from other clothing and towels. Do not dry hands on one’s pants or shirt.
Doing so might re-contaminate the skin. Washing skin in bacteria-laden areas, such as underarms, in the groin, and around genital areas, might decrease infections in these locations. If hands are washed often enough to cause skin irritation, chapping, and cracking, follow drying with a moisturizing cream or lotion. Tampons should not be retained in place for prolonged periods of time, in order to avoid toxic shock syndrome. Brushing teeth and flossing will diminish dental decay and gum infections.
Defecation is a common cause of spreading infections, in particular, diarrheal diseases. If an outhouse is available, use it. If provision has not been made to carry wastes out of wilderness areas, they can be buried in holes (minimum depth 6 in [15 cm]) and covered tightly with soil, sand, or leaf litter, at least 100 yards from natural water sources. Toilet paper should be carried out, be biodegradable and buried, or carefully burned. Urinate far from camp and trails, preferably on rocks or bare ground. Treat animal waste like human waste.
