Life-or-Death Decisions - Injury - Backpacker

Life-or-Death Decisions - Injury

Learn how to plan and react when and unexpected injury creeps up on you.



You're lying at the bottom of a steep scree slope, clutching your leg in agony. A moment ago, you were scrambling across the hill above–but one wrong step on a loose rock knocked you off balance and sent you careening down the slope. Could this have been prevented? And what do you do now?

Planning | Encountering an Obstacle/Recognizing a Problem | Reacting to Injury/Deciding to Stay or Go

1. Planning

WRONG: Head out without considering the conditions you might encounter, such as exposed scrambling, icy terrain, loose rock, or difficult river crossings.

RIGHT: Research the area to find out which skills are necessary, and call rangers to make sure snow or high water hasn't turned a standard trail into a dangerous route. Make sure you're in good shape before you go–physical fitness improves your ability to stay balanced in tricky terrain and to avoid injury caused by fatigue.

2. Choosing partners

WRONG: Go with your competitive, stubborn friend who just took a mountaineering course and wants to "show you the ropes."
RIGHT: Pick knowledgeable companions who won't get summit fever and push beyond your limits. First-aid training doesn't hurt, either.

3. Thinking ahead

WRONG: Hit the trail without thinking about what you'll do if you encounter an unexpected obstacle, like a raging river or icy traverse.

RIGHT: Settle on a plan B with your companions before you leave–what happens if trail conditions are worse than you expect?



Planning | Encountering an Obstacle/Recognizing a Problem | Reacting to Injury/Deciding to Stay or Go

4. Encountering an obstacle

WRONG: Press on at all costs. This is your one shot!

RIGHT: Carefully assess the risk before you try to get past it. Ask yourself: What's the worst thing that could happen if I attempt this? If the answer is unacceptable, don't proceed. "Make decisions conservatively, with the idea that you can always come back and do it when the conditions are better," suggests Anderson.

Rushing river: Turn back if the water is more than knee-deep, you can hear rocks tumbling underwater, or there are hazards (such as downed trees, boulders, or a waterfall) downstream.

Exposed scramble: Avoid wet, mossy, or loose rocks, and never ascend anything you don't think you can downclimb. Climb without a rope only if doing so requires easy moves, and test each hold before putting your full weight on it.

Snow slope: Retreat if the snow is too hard to kick steps in (or wait for the sun to soften it). Be alert in areas with avalanche potential (generally, 30- to 55-degree slopes), especially after storms, when high winds can create unstable snow layers.

How to cross a river

Keep boots dry by crossing in sandals or sneakers. Unbuckle your pack's hipbelt and sternum straps. Facing upstream, slowly sidestep across, leaning into the current and angling slightly downstream. Use trekking poles or sticks for balance. If water is swift, link arms with a partner or form a tripod shape with two others.

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How to traverse a snow slope

When ascending, make a platform for your foot by kicking steps into the snow before you step forward. Switchback up steep slopes and plant a trekking pole or stick in front of you with each stride for balance. Dig into the snow with your heels on the way down.

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How to spot avalanche hazard

Look out for leeward slopes, cornices, and gullies that can funnel snow. Avoid areas that show signs of previous slides, such as knocked-down trees. Evaluate slopes using the ruler on your compass and a 7.5-minute topo: If two or more contour lines appear within one-sixteenth of an inch, the slope exceeds 33 degrees.

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5. Recognizing a problem

WRONG: Ignore the early signals of serious conditions–like hypothermia, heat exhaustion, or altitude sickness–and hike on. You'll probably be fine, and it's just a few miles to camp.

RIGHT: Know the warning signs of outdoor illnesses and stop to administer first aid as soon as they appear. Continuing to travel will just make things worse, and will impair your ability to deal safely with any challenges ahead.

Hypothermia: Watch for shivering, loss of coordination, confusion, numbness, and apathy.

Heat exhaustion: Look out for thirst, heavy sweating, flushed skin, a rapid pulse, nausea, and a headache.

Altitude sickness: Early signs include headache, appetite loss, nausea, fatigue, dizziness, and irritability (typically above 8,000 feet).



Planning | Encountering an Obstacle/Recognizing a Problem | Reacting to Injury/Deciding to Stay or Go

6. Reacting to injury

WRONG: Panic. The last thing you want to do is let a surge of adrenaline lead to hasty decisions.

RIGHT: Sit down, breathe slowly, and focus on small, right-brain tasks (setting up the tent, applying a bandage). Think positive: Remind yourself of your skills, think of family and friends, or repeat encouraging phrases to yourself. Treat your injury or condition:

Hypothermia: Put on warm, dry layers and get in your sleeping bag. If you don't have a bag, sit on top of your pack with your arms curled around your knees. Drink hot liquids and snack on something with fat and carbs. Do jumping jacks or squats to generate heat.

Heat exhaustion: Get out of the sun, remove restrictive clothing, and spray yourself with cool water. Drink cool liquids and rest.

Altitude sickness: Drink a liter of water and do light exercise to bring more oxygen into your body. Take an ibuprofen tablet. If you don't feel better within two hours, descend 1,000 to 2,000 feet.

Injured ankle: Apply a bladder or zip-top bag filled with cold water or snow for 30 minutes. Wrap with an elastic bandage or tape and take ibuprofen. If it's very painful, can't bear weight, or you heard a popping sound, it's a more serious injury. Splint your ankle with a sleeping pad, clothes, and backpack straps or bandannas.

Bleeding: Apply direct pressure with a clean bandage, adding extra bandages on top of the first without removing it. When the bleeding stops, irrigate the wound with a stream of water from a bladder or zip-top bag, then close with a butterfly bandage or 1/4-inch strips of duct tape, leaving space between for drainage.

How to tape a sprained ankle

First, apply tape in a stirrup pattern: down one side of the ankle, under the heel, up the opposite side. Next, tape several figure 8s: Bring tape across the arch, under the foot and around the back of the ankle to return to starting position.

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7. Deciding to stay or go

WRONG: Drag yourself across dangerous terrain with a serious injury.

RIGHT: "If the injury impairs mobility, like a bad sprain or a broken leg, you're probably better off staying put and waiting for rescue," advises Anderson. "Walking out will be extremely painful and maybe even hazardous." Don't try to move anyone with a head or neck injury, heavy bleeding, or loss of consciousness. The exception: If you're alone and nobody knows where you are–or even that you went hiking–consider self-evacuating.