Mountain First Aid Essentials

There's a moment that comes on almost every hillwalker's journey — the moment you realise that the cheerful St John Ambulance course you did at work doesn't quite cover what to do when someone turns an ankle on the boulder field below Buachaille Etive Mor, three hours from the nearest road, with the cloud dropping and the temperature falling. Mountain first aid is a different discipline. The principles are the same, but the context changes everything: you're remote, exposed, possibly alone, and the casualty might be you.

This guide won't replace a proper mountain first aid course — and I'll strongly recommend you take one — but it will give you the knowledge and kit to deal with the situations most likely to arise on a day in the Scottish hills. Carry this knowledge alongside your waterproofs and your compass. You may never need it. But if you do, you'll be profoundly glad you have it.

Why Mountain First Aid Is Different

In a town, if someone is injured, you call an ambulance and it arrives in minutes. On the summit of Ben Alder, the nearest road might be a four-hour walk away, there may be no phone signal, and even after you raise the alarm, helicopter rescue could be delayed by weather for hours. This changes your priorities fundamentally.

In a mountain environment, your job is not to provide definitive medical treatment. Your job is to:

Prevent the situation from getting worse — especially by managing heat loss
Keep the casualty as comfortable and warm as possible while awaiting help
Make good decisions about whether to self-evacuate or call for rescue
Provide clear information to mountain rescue when you contact them

The cold is your biggest enemy. In lowland first aid, hypothermia is a footnote. In the mountains, it's the thing most likely to turn a manageable injury into a life-threatening emergency. A walker with a sprained ankle who can be kept warm and sheltered while rescue arrives will be fine. The same walker left lying on wet ground in the wind for two hours without insulation may not be.

The Essential Mountain First Aid Kit

Your first aid kit needs to be lightweight enough that you'll actually carry it, and practical enough to be useful in a wet, windy, cold environment. Forget the bulky workplace kits with their burn gel and eye wash — you need mountain-specific items.

The Core Kit

Blister plasters (Compeed or similar): Probably the item you'll use most often. These are genuinely excellent — a hydrocolloidal pad that cushions and protects hot spots before they become full blisters. Carry at least four.
Zinc oxide tape (2.5cm roll): Incredibly versatile. Use it for strapping minor sprains, securing dressings, taping hot spots, even emergency boot repair. One roll lasts ages.
Crepe bandage: For supporting sprains and strains. A 7.5cm bandage is the most useful width.
Triangular bandage: Doubles as a sling, a bandage, padding, or a head covering. Weighs almost nothing.
Non-adherent dressings (2-3): For covering wounds without sticking to them. Melolin or similar.
Adhesive dressings (assorted): Standard plasters for minor cuts and grazes.
Antiseptic wipes: For cleaning wounds when there's no clean water available.
Nitrile gloves (2 pairs): Always treat someone else's blood as a potential infection risk.
Emergency shelter (group shelter/bothy bag): This is arguably the single most important piece of first aid equipment you can carry. A lightweight group shelter that fits over two to four people creates an immediate windproof, largely waterproof environment that can raise the temperature inside by 10-15°C within minutes. Weighs around 300-500g and could save a life.
Foil emergency blanket: Lighter backup to the group shelter. Reflects body heat and blocks wind. Noisy and fiddly in wind, but far better than nothing.
Painkillers: Ibuprofen and paracetamol. Both, because they work differently and can be taken together. Ibuprofen reduces inflammation (useful for sprains); paracetamol handles general pain.
SAM splint (optional but recommended): A mouldable aluminium and foam splint that weighs about 100g and can stabilise almost any limb injury. Worth the weight on longer days in remote terrain.
Whistle: Already on your rucksack, hopefully. The international distress signal is six blasts in a minute, repeated after a minute's pause.

What Not to Bother With

Leave behind the scissors (use a penknife), the tweezers (for what?), the eye bath (when would you use this on a ridge?), and those strange triangular bandage pins that nobody can work with cold fingers. Keep it simple, keep it light, keep it useful.

Basic Casualty Assessment: ABCDE

If someone is seriously injured or unwell on the hill, you need a structured approach. The ABCDE framework gives you one, and it works whether you're on the summit of Ben Nevis or in a supermarket car park.

A — Airway: Is the airway open and clear? If the casualty is talking, the airway is fine. If they're unconscious, tilt the head back and lift the chin to open the airway. Check for obstructions.
B — Breathing: Are they breathing normally? Look at the chest rising, listen for breath sounds, feel for air on your cheek. If they're not breathing, start CPR (30 compressions to 2 breaths). On a remote mountain, this is a desperate situation — get help called immediately.
C — Circulation: Is there serious bleeding? Apply direct pressure with whatever you have — a dressing, spare clothing, your hand. Elevate the limb if possible. Don't remove blood-soaked dressings; add more on top.
D — Disability: What's their level of consciousness? Are they alert, responding to voice, responding to pain, or unresponsive? This is vital information for mountain rescue.
E — Exposure: Protect them from the elements. This is where mountain first aid diverges most sharply from standard training. Get the group shelter up, insulate them from the ground, add layers, get hot drinks into them if they're conscious. Environmental exposure will worsen any injury.

Run through ABCDE in order, deal with each problem as you find it, and you'll handle the vast majority of mountain emergencies competently.

Dealing With Common Mountain Injuries

Blisters

Prevention is everything. The moment you feel a hot spot — that warm, slightly tender patch on your heel or toe — stop and deal with it. Don't convince yourself it'll settle down. It won't. It'll get worse with every step until you're limping off Schiehallion in genuine misery.

Hot spots: Apply a Compeed plaster or zinc oxide tape directly over the area. Make sure the surface is dry first — the tape won't stick to sweaty skin.
Intact blisters: Don't pop them. Cover with a Compeed and keep walking. The fluid inside is sterile and acts as a natural cushion.
Burst blisters: Clean gently with an antiseptic wipe, apply a non-adherent dressing, and tape securely in place. Change the dressing when you get home.

Long-term, address the cause: boots that don't fit properly, socks that bunch, or laces tied too loosely. Two pairs of socks — a thin liner and a thicker walking sock — can make a remarkable difference.

Sprains and Strains

Ankle sprains are the bread and butter of mountain first aid. Uneven ground, tired legs, and a moment's inattention — it happens to everyone eventually. The classic RICE protocol applies:

Rest: Stop immediately. Don't try to "walk it off."
Ice: You won't have ice on the hill, but a cold stream or a water bottle filled from a burn works well. Apply for 15-20 minutes if practical.
Compression: Wrap with a crepe bandage. Firm but not tight — you shouldn't lose feeling in the toes.
Elevation: Sit down and prop the foot up on a rucksack.

The key decision with a sprain is whether the person can walk out. If they can bear weight — even with a limp and a walking pole for support — a slow, careful descent is usually better than a long wait for rescue. Give them painkillers, strap the ankle firmly over the boot, and take it steady. If they can't bear weight at all, that's a rescue situation.

Cuts and Wounds

Most cuts on the hill are minor — a scrape from a rock, a scratch from heather. Clean them, cover them, carry on. For anything deeper:

Control bleeding with direct pressure
Clean the wound if you can (clean water or antiseptic wipes)
Cover with a non-adherent dressing and secure with tape
If the bleeding won't stop with sustained pressure, or the wound is deep enough to see fat or muscle, that needs professional attention

Hypothermia

This is the big one. Hypothermia kills more hillwalkers than falls do, and it can set in with frightening speed on an exposed Scottish ridge. The combination of wet clothing, wind, fatigue, and inadequate food is a perfect recipe. It doesn't need to be winter — summer hypothermia on the Liathach ridge in a July rainstorm is entirely possible.

The signs progress through stages:

Mild (35-32°C): Shivering, cold hands and feet, fumbling with zips and buckles, quieter than usual, slightly confused
Moderate (32-28°C): Violent shivering that then stops (a bad sign), confusion, slurred speech, stumbling, irrational behaviour (removing clothing, denying they're cold)
Severe (below 28°C): Unconsciousness, barely detectable pulse, rigid muscles. This is a medical emergency requiring urgent evacuation.

What to do:

Stop. The casualty cannot generate enough heat while walking into the wind.
Shelter. Get the group shelter up immediately. Get the casualty inside it, out of the wind and rain.
Insulate. Put them on something — a rucksack, a rope bag, spare clothing — anything between them and the cold ground. Ground contact sucks heat away faster than air.
Warm. Add dry layers. A hat makes a significant difference. Warm drinks and sugary food if they're conscious and able to swallow. Another person's body heat inside the shelter is effective.
Do not rub their limbs, give them alcohol, or put them in a hot bath (not that you'll have one on An Teallach). Rapid rewarming of the extremities can cause cold blood to rush to the core, potentially causing cardiac arrest.

The best treatment for hypothermia is prevention. Eat regularly, drink plenty, wear appropriate layers, and turn back before exhaustion sets in. Watch your companions — hypothermia makes people poor judges of their own condition.

Heat Exhaustion

Less common in Scotland, but it happens — particularly on hot summer days on long, exposed walks. The signs include heavy sweating, nausea, dizziness, headache, and pale clammy skin.

Move the casualty to shade (or create shade with a jacket)
Lie them down with legs raised
Give them water to drink — small, frequent sips
Cool them with wet clothing on the neck and forehead
If symptoms don't improve within 30 minutes, or they become confused or stop sweating, call for help — they may be progressing to heatstroke

When to Call Mountain Rescue

This is a judgement call, and it's one that many walkers agonise over — nobody wants to "waste" mountain rescue's time. But rescue teams are unanimous on this point: if in doubt, call. They would far rather respond to a call that turns out to be manageable than learn that someone suffered needlessly because they were too embarrassed to ask for help.

Call mountain rescue if:

The casualty cannot walk and cannot be safely assisted to walk out
You suspect a fracture, a head injury, or a spinal injury
The casualty has chest pain, difficulty breathing, or signs of a stroke
Hypothermia is moderate or severe and not responding to your efforts
You are lost in dangerous terrain with deteriorating conditions
The situation is deteriorating and you're not confident you can manage it

How to Call

Dial 999 (or 112)
Ask for Police, then ask for Mountain Rescue
Be ready to give: your location (grid reference if possible — the Munros app shows this), the nature of the injury or emergency, the number of people in the party, the casualty's condition, the weather conditions at your location, and your phone number
Stay on the line and follow their instructions
If you have no phone signal, try sending a text to 999 (you need to register for this service in advance by texting "register" to 999). In some areas, you can get a text through when a voice call won't connect.

While waiting for rescue, keep the casualty warm and sheltered, monitor their condition, and make yourself visible. If you have a whistle, six blasts repeated every minute is the international distress signal. Wear bright clothing if possible, and be ready to guide the team in.

Keeping a Casualty Warm and Sheltered

I've mentioned this several times already, and that's deliberate — it's the single most important thing you can do in almost any mountain emergency. Here's a step-by-step approach:

Get the group shelter up. This is your first action after ensuring the scene is safe. Even a bin bag is better than nothing, but a proper group shelter is transformative.
Insulate from below. Rucksacks, rope bags, spare clothing, sit mats — anything between the casualty and the ground. Heat loss through conduction to cold, wet ground is rapid and relentless.
Add layers on top. Spare jackets, waterproofs, emergency blanket. A hat is essential — significant heat is lost through the head.
Give warm food and drink if the casualty is conscious and able to swallow. Sweet tea, hot chocolate, soup — the warmth and the calories both help.
Share body heat. If hypothermia is a concern, another person getting into the shelter close to the casualty is one of the most effective warming techniques available.

Take a Course

Reading an article is a start, but there is no substitute for hands-on training. A mountain-specific first aid course will teach you to practise these skills in realistic conditions — outside, in the cold, with simulated casualties and real equipment.

Several organisations offer excellent mountain first aid courses in Scotland:

Mountaineering Scotland runs courses tailored to hillwalkers
Wilderness Medical Training offers 16-hour and two-day mountain first aid courses
Many outdoor centres and climbing clubs run their own courses throughout the year

A two-day course covers everything in this article and much more, with practical scenarios that build genuine confidence. It's one of the best investments you can make as a hillwalker — right up there with good boots and a decent waterproof jacket.

The Scottish hills are generally forgiving places. Most days out end with nothing worse than tired legs and a craving for cake. But the mountains don't owe us safe passage, and the gap between a good day and a bad one can narrow surprisingly fast. Carry the kit, learn the skills, and walk with the quiet confidence of knowing you can handle whatever the hill throws at you.

Mountain First Aid Essentials: What Every Hillwalker Needs to Know