Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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"Avoiding Disaster In Adventure Travel" by Jay Lemery

I had the good fortune this past year to travel to Everest Base Camp with Dr. Jay Lemery, the director of Wilderness and Environmental Medicine at Weill Cornell Medical College and an assistant attending in emergency medicine at New York-Presbyterian Hospital/Weill Cornell Medical Center. Jay is a rising star in the field of wilderness medicine, and his fondness for the wilderness is matched only by his unrelenting sense of humor.

What follows is a piece that Jay wrote for Science Briefs, an electronic newsletter published by the Office of Public Affairs that focuses on innovative medical research and patient care at Weill Cornell Medical College. I couldn't have done better myself, so I thought I would pass it along:

"Each year, flocks of adventurer-travelers head for the mountains and deserts only to find themselves lost, injured, sick or cold; in a remote place far from help; and with the sun going down. These situations can sometimes turn from anxious to dangerous, and what makes them more unfortunate is often the back story. Many of these misfortunes could have been avoided or minimized if only the travelers had packed certain items into their packs or knowledge into their heads before venturing into the great outdoors.

'People need to remember,' says Jay, 'In the wilderness, help isn't always nearby, and salvation often needs to come from within.'

Obviously, some trips require more preparation than others, but every trip requires some. Below are several tips from Jay that might help you:


Inform people where you are going, and share your route and expected return date with them. If you're going to a place with rangers, inquire if you should register as a visitor. Have a method to communicate with people in your party as well as civilization. This may require more than mobile telephones, which sometimes have sketchy or no reception in remote areas. A radio may be necessary, and, if it is, know how it actually works and how to properly summon help with it.


This section should be divided into two parts: not getting lost and guiding help toward you. Having maps of the area and a compass, and knowing how to read them, will assist with both parts. A GPS (global positioning system) device might also be helpful, but have a map and compass in case the device fails or the satellite is temporarily out of order. 'Carry a source of light and carry a back-up source as well,' says Jay. 'This will help you navigate in darkness and prevent accidents such as falling into a crevasse.' Lights can also signal help if needed. Tiny LED (light-emitting diode) headlamps provide a fair amount of light, and some can work for around a hundred hours on a single set of batteries. Lastly, carry a whistle, which can attract attention or, if lost, guide ground rescuers to you.

Surviving Weather

Especially in mountainous and desert regions, weather and temperatures can change quickly. It is not unusual for the temperature to dip 30 to 40 degrees (Fahrenheit) when nightfall arrives. Cold or warm fronts, with rain, snow or storms can also move in quickly.

To handle these conditions bring clothing that is versatile and dries quickly, such as synthetics, which dry much faster than cotton. Create a base layer that wicks perspiration away from your skin. Create a mid layer that will retain body heat; typically, fleece is used. And, bring an outer layer - a wind and waterproof jacket and pants - to repel the elements. A lightweight foil blanket can also be handy to retain body heat in an emergency. It can function as a wind and waterproof shelter as well.

Injuries and Illness

'Fortunately, most injuries that occur in the wilderness are what physicians call minor trauma - sprains, blisters, or rashes - and the most prevalent medical illness is gastrointestinal upset,' says Dr. Lemery. (Amen. Jay had to help pick me up after I was struck down with a nasty case of diarrhea in Nepal.) Pack a first-aid kit with tape, bandages, gauze and antiseptic solution, and most minor traumas can be kept from becoming major ones. A key point is to administer treatment quickly in order to avoid infection. For example, when you feel a hot spot on your foot (a blister forming), stop and wrap it before it becomes infected.

Be careful of sunburn, too - another common minor trauma. Bring a wide-brimmed hat, sunglasses, and sunscreen for protection. Ideally, bring clothing that offers complete coverage in case you're lost or stranded and run out of sunscreen. Remember the same clothing that keeps you dry or warm can also shield you from the sun.

For gastrointestinal upset, over-the-counter antacids and anti-diuretics are usually sufficient. However, if the illness persists for more than several days or worsens, you probably should break your route and seek medical attention. Most people get gastrointestinal upset from drinking contaminated water or eating contaminated food. Having a method to (disinfect and) purify water (such as iodine tablets or filters) and an adequate non-perishable food supply can reduce the risk of getting GI distress in the first place.


If going to a subtropical area where malaria is present, take prophylactic medications (typically, Chloroquine or mefloquine) to protect against malaria. In all areas, insect repellent, long-sleeved clothing and netting can help prevent insect bites and ward off the annoying 'buzz' that prevents a good night's sleep. Consider an EpiPen (or Twinject) if someone in your group has known allergies to insects.

Rescue and Evacuation

And finally, what if something really goes wrong? 'Ask for help,' says Dr. Lemery. 'Don't hold strong and fall into even greater danger.' Keep in mind, however, that help is not always free. Rescue squads usually charge for their services as will medical providers once the helicopter gets back to civilization. Sometimes your regular medical insurance policy will cover medical expenses (check your individual policy) but, if not, a traveler's medical insurance and 'rescue insurance' policy can save considerable expense. These work like most kinds of insurance. Holders pay a premium and are entitled to services if needed.

Travelers in certain areas might also want to consider contracting with an evacuation company. These companies usually know how to navigate local politics and can evacuate clients from a region or country - often very quickly. In areas with poor medical facilities, an unstable political situation, or the propensity for natural disasters, contracting with an evacuation company can be helpful. These companies frequently function like insurers. You buy a policy and summon help if needed."

Thanks, Jay. Let's go on another adventure...

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photo of Dr. Jay Lemery by Paul Auerbach

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.