Why mountain first aid makes the difference
Mountain first aid is the set of immediate actions to protect, assess and stabilise an injured person until help arrives or until the group can leave on their own.
In the mountains, cold, altitude and distance work against you. The wind cuts like a knife when you stop, and acting well and in time changes the outcome.
This article is aimed at hikers, mountaineers and guides who want to carry just enough, know how to act calmly and decide when to call for rescue. You will find clear steps, practical lists and reminders applicable in real terrain. At the end, we propose a plan that the group can train with before the next outing.
Real risks and why you need to respond quickly
In the mountains, most incidents start with something small: a fall, a sprain, a bleeding wound. Added to that are heatstroke and hypothermia, which appear when the body stops regulating its temperature.
There are less visible problems that also carry weight: exhaustion, dehydration, hypoglycaemia and disorientation due to fog or bad weather. Many of them do not show clear signs until the person is already walking poorly or responding slowly.
The weather is in charge. A storm can block a helicopter and turn one hour of waiting into four. Narrow paths, loose terrain and the lack of signal condition the response and force you to simplify.
Acting quickly means prioritising life over comfort: stopping massive bleeding, maintaining the airway and protecting from the cold. In remote places, assistance can take longer than in the city, so your role is to gain time with simple and effective decisions.
Speak clearly, take notes of what you are doing and decide whether it is better to move or wait. Mountain first aid does not seek to cure: it seeks to stabilise and prevent the situation from worsening.
What you are going to learn and how it will serve you today
This guide gives you criteria to act safely when help is slow to arrive.
First, you will learn to identify priorities and to take control of the situation safely. Afterwards, you will see how to put together a basic and lightweight first aid kit with judgement, without overloading your backpack.
The practical part reviews concrete steps for haemorrhages, fractures, burns, stings and loss of consciousness. You will also see how to use the ABCDE protocol without advanced equipment and with improvised material.
Finally, you will learn to decide when to ask for help, what to say by radio or telephone and how to prepare the evacuation. And you will know where to train and what to carry in the mountains depending on the activity and the season.
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Key principles before touching the injured person
Your safety comes first: if you get injured, the problem multiplies. Before approaching, assess the scene (loose rock, rockfall, electrical risk due to storms, unstable snow or track traffic). If it is not safe, withdraw and rethink the access.
In the mountains, resources are limited: poor coverage, low light and low heat force you to prioritise and improvise with what you have. A mat can serve as a splint, a handkerchief as a sling and a t-shirt as a pressure bandage.
Hygiene matters. Put on nitrile gloves if you can and use hand sanitiser to reduce infections, especially in open wounds. Ask for consent if the person is conscious; if they are not and there is a life-threatening risk, consent is presumed.
In Spain, there is a reasonable duty to assist: call 112 and help without putting yourself at risk or performing techniques for which you are not trained. Apply a basic triage (first those with the greatest life-threatening risk) and minimal intervention until help arrives: protect from the cold, control bleeding and avoid unnecessary neck movements.
Note down key times: onset of symptoms, the time a tourniquet was applied and any analgesics administered. When asking for help, communicate clearly and concisely and prepare the ground to facilitate access for professional teams (GREIM, firefighters, rescue groups).
Plan before you head out. Check the weather (AEMET), define the route and alternatives, share your return time and carry redundant communication means: a mobile phone with battery and SOS mode, a PLB device or personal beacon. The essential mountain first aid kit is not large: it must be relevant, checked and known by the person carrying it.
Respect the territory and those who look after it: mountain refuge wardens, mountain clubs and local volunteers.
Initial assessment: apply the ABCDE without wasting time
Before touching anyone, look around: rocks, ice, track traffic and storms can turn you into the second casualty. When the environment is safe, introduce yourself, ask for permission and ask what has happened. Assess the response using AVPU: if they are Alert, responsive to Voice, only to Pain or if they are Unresponsive.
If there are several of you, divide tasks from the first minute: one protects and speaks with the casualty, another prepares the thermal blanket and another calls 112. Then follow the ABCDE protocol adapted to the mountains: A, airway; B, breathing; C, circulation; D, neurological; E, exposure and environment.
In A, check if they speak or cough. If they do not, open the airway with the head-tilt chin-lift manoeuvre, unless you suspect cervical trauma: in that case, use the jaw thrust. Remove visible foreign bodies with a hooked finger protected by a glove, never blindly.
In B, count breaths for 30 seconds, observe thoracic symmetry and listen for noises. If they are short of breath, place them in a semi-Fowler position, upright, and loosen tight clothing. Undress, assess and re-cover: do not expose them to the cold for longer than necessary. Think about asthma or thoracic contusion and limit physical effort.
In C, look for external bleeding and stop it with direct pressure and a compression bandage. If it does not stop, apply a commercial or improvised wide tourniquet, as proximal as possible, and note the time. Assess pulse, skin colour and temperature, and watch for signs of shock: cold and pale skin, confusion, RR > 24 and rapid pulse.
In D, assess AVPU or Glasgow if you know it, check the pupils and capillary blood glucose if you have a meter. In diabetics, suspect hypoglycaemia and offer sugar if they are conscious.
In E, examine from head to toe looking for hidden injuries and remove clothing with scissors if necessary. Protect from the cold with a thermal blanket and ground insulation: warming up is treating.
Note what you see and what you do: mechanisms of injury (5 m fall, rock to the helmet), estimated vital signs and the time of each intervention. When communicating, use the MIST template: Mechanism, Injuries, Signs and Treatment.
If breathing or circulation are unstable, limit movement, create shelter and prepare the site for an assisted rescue. If the condition is stable and evacuation on foot is possible without worsening the injuries, consider moving towards a point with coverage or a track.
What to do step by step in the most frequent incidents
Acting in order and with calm avoids errors and saves energy.
Haemorrhages
Apply direct pressure with gauze or clean fabric for 10 minutes, without lifting the gauze to look at the wound. If the dressing becomes soaked, add more material on top without removing the previous one and apply a compression bandage.
The tourniquet is only for massive haemorrhages that do not stop: wide, high and tightly applied, with the time noted visibly. Once the haemorrhage is controlled, elevate the limb if possible and watch for signs of shock. Do not remove impaled objects: stabilise them.
Fractures and sprains
Assess circulation, sensation, and distal movement before and after immobilising. Gently realign only if there is no distal pulse or the pain is unbearable; if you feel resistance, do not force it.
To immobilise, improvise splints using a mat, walking poles, and bandages or scarves, and cover the joints above and below. Afterwards, elevate the area and cool it for 10-15 minutes with fresh water or wrapped snow, avoiding frostbite.
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Loss of consciousness and seizures
If the person is unresponsive and not breathing, start CPR 30
and ask for an AED if one is available in the mountain hut. If they are breathing, place them in the recovery position and protect the airway.In the event of a seizure, do not restrain the person: clear the surroundings, protect the head, and monitor the duration of the episode.
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Burns and stings
For thermal burns, cool with clean, lukewarm water for 15-20 minutes; do not apply ice or break blisters. Remove rings or watches before swelling occurs. For severe sunburn, seek shade, hydrate orally, and cover the area with a light layer.
If you are stung by a bee or a wasp, remove the stinger by scraping, clean the area, and apply local cold. Watch for signs of anaphylaxis, such as extensive hives or difficulty breathing, and administer an antihistamine if you have it and the person can tolerate it.
Cold and pain
In initial hypothermia, insulate from the ground with a mat, wrap with dry layers and a thermal blanket, and prioritise the head, neck, and torso. Combine passive heat (clothing) and gentle active heat (lukewarm liquids if conscious); avoid rubbing. In moderate-to-severe hypothermia, minimise sudden movements due to the risk of arrhythmias.
For pain, paracetamol or ibuprofen can help if there are no allergies or contraindications; avoid aspirin in cases of trauma due to its anticoagulant effect. Hydrating, feeding, and protecting from the cold usually reduces pain without drugs.
When to evacuate
Prioritise evacuation when the terrain or weather worsens or when maintaining stability consumes more resources than are available. If the injury is stable and the group can walk without making it worse, consider a progressive exit towards a track or mountain hut; if not, protect, signal, and wait for rescue.
Requesting rescue without hesitation: criteria, notification, and coordination
Knowing when and how to ask for help is part of the trip plan, it is not a failure. You decide this before setting off, with your phone charged and the emergency number at hand.
1. Criteria for requesting mountain rescue: When to call?
There is one rule that resolves almost all doubts: if the injured person cannot leave the mountain on their own feet and safely, call emergency services. The activation time works in your favour and you can always update or cancel the call if the situation improves.
Call also when vital signs are unstable: difficulty breathing, very fast or very slow pulse, confusion. The same applies to a haemorrhage that does not stop despite compression or a tourniquet, or an open fracture or a deformity that leaves the distal area without a pulse or sensation.
Request rescue if you suspect a spinal injury or a head injury with vomiting or loss of consciousness. Add moderate-to-severe hypothermia, heatstroke, a severe allergy, and decompensated asthma to the list.
With several injured people, in a very remote area without coverage and without a safe path, or if you have become disoriented and cannot find your way back with a map, compass, or GPS, the call is the priority. When in doubt, call early.
2. Essential information for communicating with emergency services
When you call emergency services from the mountain, the order of the message decides how long they take to arrive. First, say where you are and how many of you there are; then, what has happened and how the injured person is.
Location comes before anything else: coordinates 43.1234°N, -5.9876°W or UTM, the name of the trail GR-11 and a visible landmark that you can describe. Add the number of people affected, for example "two people, one with an ankle fracture, conscious; another uninjured".
Then explain the mechanism, such as "slip on a snowfield, 20 m fall down a grassy slope". Continue with the signs ("bleeding controlled, pulse present, skin cold"), the treatment applied ("compressive bandage, improvised splint, warm clothing and oral glucose") and the conditions of the place ("soft snow, fog, no stable coverage, access via 4x4 track in 2 km").
The MIST template helps you not to forget anything: Mechanism, Injuries, Signs, and Treatment. Repeat the message to the operator and ask for confirmation that they have understood it.
If your community uses the My112 app, send the automatic position and photos if they ask you to. Keep your phone in power-saving mode and protected from the cold to prevent it from turning off.
3. Preparing the injured person and the site for the arrival of the rescue
Once you have already requested help, your job is to ensure the rescue team arrives, assesses, and evacuates quickly, without adding new risks. That preparation starts as soon as you hang up the phone and is done with what you have on you.
Make yourself seen. Use the whistle with three repeated blasts, wear bright clothing and set the headlamp to strobe mode. Clear a safe area, remove backpacks and poles, and mark the zone with colours that contrast with the terrain.
Protect the injured person from the weather with extra warm clothing, a thermal blanket, and a windbreaker, and insulate them from the ground. If there is a slope, place them in a stable position and secure them, without forcing their neck.
Have the documentation, the list of medication and allergies, the times of what occurred, and the material you have used at hand. When the team arrives, answer their questions and follow their instructions, keeping the group compact and visible.
If you hear the helicopter, put away hats and loose objects, secure the blanket, and do not approach the landing zone until they tell you to.
Practical lists for your backpack: first aid kit, equipment and preparation
A day in the mountains with wind, cold and fine rain tests everything you are carrying. That is why backpack equipment is designed for that scenario, not for the sunny day in the photo.
The rule is simple: fewer pieces, but each one fulfilling several functions. And, above all, that you know how to use it before you need it. In the lists below, you have the first aid kit, the material and the prior preparation organised so you can review them at home, calmly, before setting off.
1. Essential mountain first aid kit: what to carry in the mountains
A mountain first aid kit weighs very little and resolves urgent issues until help arrives. Always carry it in your backpack, even on short outings, and adapt it to the duration and distance of the route.
To stop a haemorrhage, you need an elastic bandage and sterile gauze: they are lightweight, versatile and serve to apply pressure and cover the wound. Add a lightweight commercial tourniquet or a wide, strong tape for massive haemorrhages in limbs. A haemostatic dressing accelerates coagulation in difficult bleeding, but only if you know how to use it.
- Plasters, gauze, hydrocolloid dressings and cloth adhesive tape cover wounds and blisters for small dressings.
- Antiseptic wipes or povidone in single doses disinfect quickly and with a controlled dose.
- Nitrile gloves and hydroalcoholic gel act as a barrier and prevent infections.
- A triangular bandage or a large handkerchief can serve as a sling and for fixations.
- A mini folding mat or a lightweight mouldable splint immobilises ankles and wrists.
- Paracetamol and ibuprofen in blister packs, oral rehydration salts and an antihistamine cover the basics.
- Glucose gel or sweets help with mild hypoglycaemia in conscious people.
- Small trauma scissors or blunt-tipped scissors and a pair of tweezers complete the tools.
- An indelible marker allows you to note times on the skin or on a tape.
Prioritise single doses and flat formats to save weight, and check expiry dates before every outing. Customise your first aid kit according to your allergies and medical conditions. And remember that a first aid kit does not replace training: train yourself to use every piece.
2. Personal and collective equipment: key elements
That is why a mountain backpack carries equipment that serves to heal and to prevent things from getting worse.
A thermal blanket or a lightweight bivvy bag protects against cold and wind and helps to avoid hypothermia. To signal for help, carry your mobile phone with 100% battery, a power bank with its cable and SOS mode configured. If you are traversing areas without coverage, add a PLB or satellite beacon.
- Light: headlamp with new batteries and strobe mode, to signal and work with hands-free.
- Cutting and fixing: multi-tool knife and cloth adhesive tape, for repairs and bandages.
- Anchors: 5-6 mm cordage (10-15 m) and 2-3 lightweight carabiners, to secure backpacks and improvise soft anchors.
- Signalling: whistle, high-visibility vest or scarf and a signal mirror.
- Protection: thin gloves, hat or buff, sunglasses and sunscreen; prevention is treatment.
- Navigation: map, compass and mobile GPS with offline mapping.
Distribute the collective equipment among the group to provide redundancy for critical items.
3. Previous preparation and checks before setting off
Ten minutes of review at home avoids most scares in the mountains. Before setting off, leave the plan with the route, schedules and alternatives with a contact and with the ranger if you are sleeping in a mountain hut. Also define escape points and a non-negotiable "return time".
Check AEMET and review the risk of storms or avalanches, river flows and daylight hours. Adjust clothing, footwear and equipment to the reality of the day, not to the plan you made a week ago. Charge your devices, carry a power bank, check coverage on the maps and activate the mobile SOS. If you have a PLB, register the device and review its use.
Divide the basic functions of navigation, first aid kit and communication among the group. Practise CPR and ABCDE at home: 10 minutes of simulation saves panic.
Check the expiry dates in the first aid kit, replenish the single-use doses and adapt it to the activity (snow, heat, night). At home, have a "spare pack" ready to refill the first aid kit upon your return.
Before starting, do a quick check in the car: water, food, headlamp, extra warmth, gloves, first aid kit, paper and marker.
Mistakes that complicate an accident and how to avoid them
Haste, overconfidence and lack of knowledge are behind most failures during a mountain accident. Adrenaline clouds judgement, so the first thing to do is stop and assess the situation before moving.
Before deciding where to go or who to call, check where you are and what you see, without relying on the first sound that reaches you.
Common mistakes and what not to do
Running towards the injured person without looking at the terrain turns one accident into two. Before touching anyone, assess the situation and look for safe access.
Do not move the patient if it is not necessary: you could aggravate a cervical injury. Stabilise them where they are, wrap them up and wait for support if you have doubts. Do not immobilise the neck "just in case": do it only with reasonable suspicion of a spinal injury, such as a high-energy mechanism, cervical pain or neurological deficit.
A compression bandage is not removed to "see how it is going", because it breaks the clot. If it continues bleeding, add more on top and reinforce the pressure. Regarding medication, do not give anything without certainty and do not double doses: there is a risk of allergies or adverse effects. Keep basic paracetamol and ibuprofen if there are no contraindications.
Do not delay the call for fear of the cost or of bothering someone: that compromises evacuation and rescue. Activate 112 early and update the information if the person improves. And do not expose the patient too much to the cold to examine them, because hypothermia is avoided: uncover, examine and re-cover, quickly and by zones.
Replace impulse with method: safety, ABCDE, warmth, bleeding control, clear communication and simple decisions.
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Conclusion and next steps: training and recommended resources
Your safety comes first, the ABCDE puts chaos in order, and warm clothing saves more than it seems. With those three clear ideas, the next step is to practise.
Reinforce with practical training: CPR and mountain first aid courses, following the recommendations of the UIAA Medical Commission, the SEMES guides, and the ERC 2021 updates. Add periodic drills with your group.
Today you can assemble or update your first aid kit, practise improvised splints, and rehearse a 112 alert using the MIST template. Download offline maps and configure your mobile SOS or a beacon if you go out of coverage.
The community of mountain huts, clubs, and rescue teams sustains these landscapes. Your preparation is also a way of caring for the territory and for those who work in it.
