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First aid for rock climbers

Many people have done a first aid course in the past. But afterwards it’s easy to let the knowledge slip. But just what are the basics of first aid that every climber should know?

Posted by Nick Arding

Many people have done a first aid course in the past. But afterwards it’s easy to let the knowledge slip. But just what are the basics of first aid that every climber should know?

From that distant course you might remember the ‘ABC’ priorities (Airway, Breathing and Circulation) and a few procedures, but applying them under extreme stress can become a very different matter. Let’s take a look at a few of the basic skills and how to apply them.

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You can’t save everyone

There are two extremes of casualty; those who will live despite you inflicting your worst first aid upon them, and those who will still die despite the efforts of a full A&E resuscitation team. But in the middle are the third group – those who will be saved by their mate opening their airway or successfully stopping catastrophic bleeding.

Simple as ‘ABC’

Most first aid courses follow this mnemonic so you can remember what to do under stress – like when you’ve watched your partner crater. ‘A’ stands for Airway, but it can also stand for Assess. Assessing the situation for danger is your first priority – there’s no point in getting killed before you can offer help. Then turn to the casualty. If they’re screaming their head off you can breathe a sigh of relief, they’re conscious and breathing – all you need to worry about is them bleeding to death.

Coming up for air

The silent casualty is a situation to dread, as you need to start diagnosing some pretty vital stuff without any help. First open their airway. This is really easy and involves carefully tilting the head back, opening the mouth and pulling the chin forward. Look inside the mouth to make sure there are no broken bits in the way and then listen for breathing. An unconscious casualty may not have the muscle tone to keep their tongue from blocking their airway and this simple manoeuvre has saved lives countless times. “But what if they have a broken neck?” is a common question. Well, one sure way to die from a broken neck is if you can’t breathe at the same time. If you can’t detect any breathing then it’s possible that either you’ve missed it or they’ve had a heart attack. The only thing that can revive a heart attack victim is a defibrillator and some pretty advanced drugs. CPR may help keep the person alive for a limited amount of time but must be started as soon as possible.

Stopping the flow

Conscious or not, the next priority is bleeding. Massive external bleeding is not only easy to see but can be relatively easy to stop. Apply direct pressure with a pad (a NATO First Field Dressing is the best thing) but check the wound first to make sure you don’t drive anything deeper into the wound. Arterial bleeding is difficult to stop – you have to press really hard in exactly the right spot. Internal bleeding from the chest, belly, pelvis or thigh is just as serious but more difficult to diagnose and impossible to stop without surgery. If the casualty is going into shock (rapid weak pulse, rapid breathing, cold and clammy) then suspect internal bleeding. Treat for shock (raise the legs and keep warm) and seek evacuation as soon as possible.

Head injuries

A common climbing injury that often looks worse than it is. A wound to the scalp bleeds profusely but may not be too serious. As with other bleeding, check the wound site and apply direct pressure. A fractured skull is far more serious and may also involve a compression injury to the brain. Either way there’s not much you can do apart from to monitor their vital signs (pulse rate, breathing rate and size of pupils) as a record of this will really help when they get to hospital. Protect the casualty from the environment and get a rescue team in as soon as possible.

Leaving the casualty

With the possibility of fractures to the spine and pelvis in any climbing fall, the casualty should only be moved if absolutely necessary. But if you’re leaving an unconscious casualty to fetch help you must leave them in a safe airway position. Some call this the recovery position but it doesn’t really matter what the position is, so long as any vomit or mucus produced by the casualty drains out of their mouth rather than going back down their throat. Get them in this position as carefully as you can without twisting or bending their spine (a cushion or rolled up fleece under the head helps) and make sure they won’t roll when you leave them.


Do a first aid course if you’ve not done one in the past, they can even be quite fun! And if it happens for real, remember that you can only do your best. And the best thing you may be able to do is to keep that airway open.

Nick Arding is an AMI member and a trainer and assessor with Adventure First Aid. Having spent much of the past 30 years in the mountains he has plenty of first hand experience at applying sticking plaster to other broken climbers.