BE IN GOOD HEALTH

To the extent possible, be in good health. You can take a number of steps to accomplish this:

BE PREPARED

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 a state of 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 mouth-to-mouth breathing, cardiopulmonary resuscitation (CPR), and the application of bandages and splints, should be practiced beforehand. Become familiar with technical rescue techniques pertinent to the environment you will be in (for example, high-angle rock, swift water, or avalanche-prone areas). Be certain to carry appropriate survival equipment, such as maps, a global positioning system (GPS) or compass, waterproof matches, a knife, nonperishable food, a flashlight, AvaLung in avalanche territory, and adequate first-aid supplies. Minimize the need for improvisation.

Be prepared for the most harsh 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 will be traveling in avalanche country, consider taking a level 1 avalanche certification course recognized by the American Avalanche Association or other reputable organization.

Before undertaking a trip where you will be far from formal medical assistance, it is wise to attend to any obvious medical problems. If you have not done so within the past 6 months, visit a dentist. Make certain that all of your immunizations are up to date (see page 449). If you have a significant medical problem, you should carry an information card, a MedicAlert bracelet or tag, or something similar.

A common question asked of wilderness medicine physicians 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 any other of numerous conditions, it is important to understand what situations are felt to be safe and what situations are felt to be risky. Preexisting conditions are sometimes classified as “unstable.” If they are unstable, they can be worsening. In general, persons with unstable conditions should not travel to high altitude, because resultant low blood oxygen levels may 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, or altitude, or travel remote from medical care, that might put you or your companions at (unacceptable) risk.

A sexually active woman of childbearing age should have a test for early pregnancy detection before a wilderness expedition. Any pregnancy under 8 weeks’ gestation has a 25% chance of miscarriage. Furthermore, it might be sensible to confirm (usually by an ultrasound examination) that the fetus is properly situated within the uterus, and that there is not a risk for an ectopic (outside-the-uterus) pregnancy (see page 133), which could rupture and threaten the mother’s life.

COMMON SENSE

Many accidents occur because people ignore warning signs or don’t anticipate problems. Swimmers are stung by jellyfish outside protective net enclosures; nonswimmers drown while participating in hazardous whitewater rafting adventures. 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, so be particularly careful. Although it may be tempting to participate in the local modes of transportation and ignore common safety rules, it is hazardous. Do not ride in the back of a truck or on the roof of a bus, always wear a seatbelt, wear a helmet when on a motorcycle or moped (if you must use these conveyances), avoid nighttime travel, and do not travel alone. If there are traffic rules, they are often not enforced. Look both ways, twice, before crossing a road or path.