Ten tips to avoid or treat common medical problems in the outdoors

"Good fortune favors the well prepared," says Paul S. Auerbach, MD, a founder and past President of the Wilderness Medical Society and editor of Wilderness Medicine, 6th Edition, recently published by Elsevier. With some advance reading, individuals planning vacations or outdoor excursions can become familiar with adverse situations and be prepared to handle them.

"Severe weather, wild animals, rugged terrain, and equipment failure all conspire to create or complicate medical hardships that must be diagnosed swiftly and remedied with certainty," says Auerbach, the Redlich Family Professor of Surgery at Stanford University School of Medicine.

Through his work as a volunteer physician in Haiti, Nepal and Guatemala, as well as his many hours exploring the outdoors, Auerbach has faced a myriad of emergency medical situations without the benefit of access to a hospital. Wilderness Medicine has been the go-to textbook for physicians since its debut in 1983, while his paperback, Medicine for the Outdoors, is written for the lay reader and offers a succinct yet comprehensive reference guide that is also available in electronic format.

Auerbach offers these ten useful tips for avoiding or treating common medical problems in the outdoors:

1. Know First Aid: 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 the rescue techniques pertinent to the environment in which you will be traveling.
2. Use Common Sense: Many accidents occur because people ignore warning signs or don't anticipate problems. Pay attention to rangers, posted warnings, weather reports, and the experience of seasoned guides.
3. Carry the right equipment: Be prepared for foul weather conditions. Always assume you will be forced to spend an unexpected night outdoors. Carry warm clothing and waterproof rain gear. Carry survival equipment such as maps, a GPS or compass, waterproof matches, a knife, nonperishable food, a flashlight and first-aid supplies.
4. Stay hydrated: Most people underestimate their fluid requirements. The average minimum recommendation for an adult man is 2 to 3 liters of liquid a day, but this requirement can double in hot temperatures, during heavy exercise, or in high altitudes or in cold, dry air. Carry supplies for water disinfection if natural sources of safe drinking water will not be available.
5. Protect Your Skin: Sunscreen should be applied to cool, dry skin for optimal absorption, and at least 10 minutes before swimming. In general, most sunscreens should be re-applied every 20 minutes to 2 hours. Be aware that use of insect repellent containing DEET lowers the effectiveness of sunscreen by a factor of one third. On the other hand, taking aspirin or ibuprofen 6 hours before sun exposure may help protect the sun-sensitive person.
6. Avoid altitude sickness: When hiking in the mountains, avoid sudden or direct ascent to a sleeping altitude above 9,020 feet; the rate of ascent should not exceed 1,500 feet per day at altitudes above 8,000 feet. Adjusting to high altitude requires gradual exposure to the lower oxygen content of the air. When traveling at high altitudes, avoid the use of alcohol, stay warm, stay hydrated, avoid exhaustion, keep out of the wind, and eat regularly to avoid weight loss. 
7. Anticipate ocean stings: Stings from contact with jellyfish, fire coral, hydroids or anemones can range in severity from mild burning to severe pain with generalized illness. Make sure your beach bag includes a small bottle (labeled) of half vinegar, half rubbing alcohol that can be used to decontaminate wounds and provide pain relief. Seawater can also be used to rinse a sting, but fresh water or ice can worsen the effects of sea life venom. Also, adults and children can both use a combination sunblock and jellyfish protective lotion to help prevent the stings of many species.
8. Manage motion sickness: Most boaters and divers adapt to motion after a few days, but may require treatment until they do. If you become nauseated on board a ship, stay on deck. Splash your face with cold water and keep your eyes fixed on a steady point in the distance. Anti-nausea medications can be taken as a preventive, and wristbands that apply pressure or electrical stimulation to acupuncture points can be used before or after symptoms begin. 
9. Prevent blisters: Foot blisters have probably ended more outings than all major illnesses combined. To minimize the friction generated by walking, reduce the load you are carrying. Use a padded insole or arch support to evenly distribute pressure over the bottom surface of the foot. Make sure shoes fit properly and are broken in, and try on new shoes in the evening because feet tend to swell during the day. Wearing a synthetic liner sock under an outer sock can wick moisture away from the skin surface and prevent friction on the skin.
10. Check for ticks: Search the skin and scalp thoroughly for ticks after hiking in wooded areas or walking through grassy fields, and remove any ticks with a tweezers by grasping the tick close to its mouthparts and pulling it straight out. Even if you are dressed appropriately for "tick country" tiny ticks may sneak under gaps in clothing protection and latch on to their human hosts.

"The art of outdoor medicine absolutely depends on observation, anticipation, and resourcefulness," Auerbach says. "The cardinal rule is to act conservatively and not take unnecessary risks when making the decision to continue a journey or to postpone travel and seek formal medical attention."