Safety & Emergency Response · 9 min
The injuries and illnesses that happen here
Why this matters
New York guiding has a short list of predictable problems. Hypothermia and heat illness dominate, ankles and knees are the common injuries, and ticks and anaphylaxis are the two that follow clients home.
By the end of this lesson you will be able to
- Recognise and treat hypothermia at each stage
- Distinguish heat exhaustion from heat stroke and act accordingly
- Manage sprains, bleeding, anaphylaxis and tick exposure in the field
Hypothermia
The first-order guide problem in this state, and it happens at 40°F and raining far more often than at 10°F and clear.
| Stage | Signs | Action |
|---|---|---|
| Mild | Shivering, clumsy hands, the "umbles": stumbles, mumbles, fumbles, grumbles | Stop. Shelter from wind and wet. Dry layers. Insulate from the ground. Warm sweet drink, food. They can still rewarm themselves |
| Moderate | Violent shivering giving way to none, confusion, apathy, slurred speech, poor decisions | Handle gently. Hypothermia wrap: vapour barrier, insulation all round, especially underneath. External heat at the trunk. No alcohol. Evacuate |
| Severe | No shivering, rigid, barely responsive, pulse and breathing very slow and hard to detect | Extreme care: rough handling can trigger fatal cardiac arrhythmia. Horizontal. Wrap. Evacuate urgently. Nobody is dead until warm and dead, so continue resuscitation efforts |
Shivering that stops without the patient warming up is a deterioration, not an improvement. That is the single most misread sign in the field.
Heat illness
| Heat exhaustion | Heat stroke | |
|---|---|---|
| Mental state | Normal, if miserable | Altered: confusion, aggression, collapse, seizure |
| Skin | Pale, sweaty, cool | Hot; may be sweaty or dry |
| Temperature | Near normal | Very high |
| Action | Shade, rest, fluids with electrolytes, cool the patient. Usually recovers | Medical emergency. Cool aggressively and immediately: water, fanning, ice at neck, armpits, groin. Evacuate urgently |
The distinguishing sign is mental status. A hot, confused patient is heat stroke until proven otherwise, and cooling cannot wait for the evacuation.
Musculoskeletal
- Ankles and knees are the bread and butter. RICE, then decide: can they walk out with poles and a lighter pack, or is this a carry?
- Splint in the position found if there is no circulation problem, and immobilise the joints above and below. Check circulation, sensation and movement before and after
- Blisters are the injury that most often ends a trip. Treat the hot spot, not the blister. Tape at the first complaint, and ask about feet at every break, because clients will not volunteer it
Bleeding
Direct pressure, hard, for long enough. Most bleeding stops with it. For life-threatening limb bleeding a tourniquet is appropriate: high and tight, note the time, do not loosen it. Modern practice does not treat a tourniquet as a last resort.
Anaphylaxis
Rapid onset after a sting, a food or a medication: hives, swelling of the lips, tongue or throat, wheeze, difficulty swallowing, collapse. Epinephrine is the treatment, given early into the outer thigh, and a second dose may be needed. This is why you asked at booking, why you know where the client's auto-injector is, and why a second person knows too. Evacuate every time, even after a good response.
Ticks
Blacklegged (deer) ticks carry Lyme disease and are established across New York, worst in the Hudson Valley and downstate but present in the Adirondacks and the west. Brief clients: light clothing, trousers tucked, repellent, permethrin on clothing, and a tick check at the end of every day. Remove with fine tweezers, gripping close to the skin, steady straight pull, no burning and no petroleum jelly. Note the date and tell the client to watch for a spreading rash or flu-like illness for the next month.
From the field
Mile four, 43°F, steady rain, and a client who was chatty is now monosyllabic and dropping things. That is mild hypothermia. You stop the trip there: tarp up, wet layers off, dry fleece on, insulation underneath, hot sweet drink. Twenty minutes later she is talking again and you walk out. Pressing on to the summit would have made this a rescue.
This lesson is part of the NYS Licensed Guide Exam course. Open it in the course to answer the retrieval checks that go with it, track what you have read, and quiz the whole unit. Lessons, quizzes and the glossary are free.