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3.0: First Aid and Health Considerations

Cold weather seriously degrades first-aid work. Injured or sick people are more susceptible to cold injuries, and at the same time the cold weather can constrain field medical treatment and evacuation. Furthermore, the incidence of disease and injuries is increased during cold weather.

Table 8: Treatment For Shock:

1. Keep warm by placing in sleeping bag or substitute.
2. Raise legs above head level, unless patient's head is injured.
3. Loosen clothing without compromising protection from cold.
4. If conscious, provide warm drinking fluids.
5. Minimise discomfort and provide reassurance.

Understanding the Problems

1. Cold weather seriously affects care of injured or sick people.
   • Medical equipment, medications and medication containers (e.g. drug ampoules) may freeze. Cold-weather clothing can make it more difficult to check the person for wounds or injuries and initiate treatment.
   • Shock may develop more rapidly and more severely when casualties are exposed to cold weather. Blood loss and shock increase susceptibility to frostbite and hypothermia. Sick or injured persons are often unable to sense the development of frostbite.
2. The widespread use of stoves and heaters in tents, other types of shelters and vehicles during cold-weather operations poses a risk of burns and injuries from unventilated exhaust fumes.
   • Burns result from contacting hot surfaces, fires or explosions of stoves and fuel sources. Improper fuelling and lighting techniques, or inadequate ventilation can result in the accumulation of flammable fumes into the tent or shelter. When ignited, these gases may cause potentially fatal fires.
   • "Tent eye" is an inflammation and irritation of the eyes caused by exposure to fuel fumes which can accumulate in poorly ventilated shelters. Rubbing "itchy" eyes can subsequently lead to eye infection.
   • Carbon monoxide (CO) is a poisonous gas which cannot be seen or smelled, and is contained in exhaust from stoves and vehicles. CO can build up in closed spaces without being noticed. Witches seeking shelter from the cold in poorly ventilated shelters or vehicles with the engine idling often become victims of CO poisoning. Early signs of CO poisoning are headache, confusion, dizziness or drowsiness. The lips and skin can become bright red. Victims will lose consciousness, and eventually die. Any person found unconscious in a closed tent or vehicle should be suspected of possible CO poisoning.
3. Proper field sanitation is very difficult to maintain during cold-weather campouts and excursions. However, poor sanitation can lead to outbreaks of disease. Frequent close contact with others in confined quarters, combined with increased individual susceptibility due to fatigue, also contributes to the spread of disease.
   • Digging latrines and garbage pits can be difficult or impossible when the ground is frozen and covered with snow and ice.
   • Witches (like most other people) are not inclined to walk far to use the latrine or garbage pit when it is cold outside.
   • Improper food storage or garbage disposal will attract wildlife which can destroy clothing and equipment and bring disease.
   • The limited availability of hot water and the discomforts associated with undressing in the cold may discourage Witches from maintaining proper personal hygiene.
   • It is difficult to maintain dish or hand washing water hot enough to keep it sanitary in cold weather, which can contribute to the spread of disease.
   • Untreated drinking water obtained by melting snow and ice can contain disease.
4. Accidents due to slipping, sliding, falling and vehicular accidents will be more frequent during cold-weather operations.
   • Paths, walkways and roads are frequently muddy or frozen. Heat escaping from the entrances of tents and buildings can cause cycles of thawing and freezing of the ground surface which makes these areas particularly hazardous.
   • Fatigue, the hobbling effect of clothing, and the effect of hoods and hats on vision and hearing will also contribute to accidents and falls.

Table 9: Immediate First Aid for Burns:

1. Move casualty away from fire, remove burning or smouldering clothing.
2. Cut away clothing over and around the burn unless it is stuck to the wound.
3. Cover burn with dry, sterile dressing, tied at edge, not over, the burn.
4. Do not apply ointments, snow or ice to the burn, and do not break blisters.

Table 10: First Aid for Carbon Monoxide Poisoning:

1. Move casualty to fresh air.
2. Administer CPR if needed.
3. Refer to medical treatment facility for evaluation and care.

Avoiding the Problems

1. Keep liquid medications and first aid equipment from freezing.
   • Store medications in heated areas of vehicles and shelters whenever possible to prevent freezing.
   • Some liquid medications can be carried inside clothing where body heat will prevent freezing.
   • Extra clothing and blankets should be available for use by patients during treatment and evacuation. Check patients awaiting treatment and evacuation for cold injuries frequently.
2. Proper precautions will prevent injuries associated with use of stoves and heaters.
   • Only properly trained and responsible people should be permitted to set up, light, refuel and maintain stoves.
   • When a stove is being used, a fire guard should be posted, horseplay in the tent, caravan or cabin should be prohibited and doorways should be kept clear to allow easy escape.
   • The stove pipe should be kept clean and be tall enough to draft properly. Air intake to the stove should be unobstructed.
   • Shelters and tents should not be sealed so tightly that ventilation is completely blocked.
3. The principles of proper sanitation and housekeeping are the same as in warm weather, but their application during cold weather may require some modification of procedures.
   • Locate latrines and garbage pits at minimum allowable distances from the food service sites (100 metres / 100 yards, downwind) and water supply points (30 metres / 100 feet), and clear snow and ice from paths leading to these areas making them more accessible. Provide latrines with as much shelter as possible. Leaders should prohibit indiscriminate waste disposal, and insist that people use only properly designated latrine and garbage areas.
   • Snow and ice covering the ground may disguise the natural slope, and extra attention is required to ensure drainage from latrines and garbage pits is away from living areas. Freshly fallen snow can hide ice patches or other hazards.
   • If the ground is too frozen to dig latrines and garbage pits, and other facilities are not available, use above-ground containers (such as an empty cardboard box lined with a plastic bag) to collect refuse. Ensure these containers are clearly marked to indicate the contents for proper disposal.
   • Garbage pits, and to a lesser extent latrines, may attract scavenging animals and birds. In the interest of human health and animal health, consider securing garbage pits and latrines in such a manner that scavengers cannot gain access to them - this is the reason why most wilderness parks use 'bear-proof' rubbish containers.
   • Leaders should ensure that warm water is frequently made available, in order to encourage personal hygiene. People should wash hands, feet, face, and groin daily, whether or not heated water is available. A heated shower or sauna bath is worth the effort of arranging it.
   • Food handlers should wash hands before serving and wear serving gloves when serving food. Provide larger sizes of food serving gloves for food handlers to wear over glove liners, if food must be served out-of-doors.
   • Chlorine or iodine purification of cold water requires twice the usual amount of chemical and an extra 15 minutes waiting period before the water is safe to drink. Flavour enhancers (such as lemonade powder) should be added just before consuming the water.
4. Snow should be removed from the ground before tents are set up. Slippery paths and walkways should be marked with warning signs (or warning lights of a particular colour in the case of night- time use), and sand, grain or straw should be spread to increase traction - grain has the singular advantage of being edible by many birds and animals.

edited by: Brigantia Stone
updated: October 15, 1998; minor corrections 1998 November 12
document: WM216PT3
GWI: WM 21-6-0/3

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