Mountain Medicine
by Colin Fuller, MD
(updated 3/25/04)

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The following article by Colin Fuller, MD, focuses on the prevention, diagnosis and treatment of snow blindness, sunburn, hypothermia, mountain sickness, dehydration, gastrointestinal (GI) illnesses, soft tissue injuries, and frostbite. In addition to the article on Mountain Medicine, the contents of a Medical First Aid Kit are listed below.

Dr. Fuller, a respected cardiologist, recently completed innovative research on more than 5,000 high school athletes to determine the effectiveness of screening methods during pre-sports physicals. He lives with his wife, Robin, and daughters, Erin and Meaghan, along with son, Matt, in Reno, Nevada.

Dr. Fuller has more than 35 years of ski mountaineering and high altitude mountain climbing experience. He has climbed extensively in New England, the Cascade Range in Washington, Oregon and California, the Sierra Nevada and internationally. Dr. Fuller has climbed the highest peaks on six of the seven continents and has summited Mount Vinson (Antarctica), Mount McKinley (North America), Cerro Aconcagua (South America), Mount Elbrus (Europe), Kilimanjaro (Africa), Carstens Pyramid (Australasia) and nearly reached the summit of Mount Everest (Asia) attaining an elevation of 28,500 feet. He has made a successful ski descent of 25,000 foot Muztagata in Western China.

Contents: Medical First Aid Kit, followed by and article on Mountain Medicine that includes a discussion of mountain sickness, hypothermia, sunburn and snow blindness, dehydration, water purification and gastrointestinal illness (GI), soft tissue injuries, frostbite, minor aches and pains and lightning.

For further reading, see Backcountry Medical Guide by Peter Steele, MD.

 

Medical First Aid Kit

Mountaineering first aid begins with the understanding that it is the responsibility of every backcountry skier, snowboarder, hiker and climber to have complete knowledge of basic first aid practices and the ability to properly care for an injured partner in the wilderness. All backcountry travelers should take basic first aid training offered by the Red Cross and mountaineering first aid offered by many mountain guides. A first aid kit should be carried by each person. The kit should be small, compact sturdy and waterproof. A small plastic box with a tight, waterproof lid makes a good container to protect the kit and keep it dry. All medications should be clearly marked including dosage and expiration dates.

The following First Aid Kit has been developed for use on backcountry wilderness trips of three to ten days. The number of items included in your First Aid Kit can be pared back for shorter trips. The kit below is not as comprehensive as one that might be used on a major expedition, but is a compromise considering that a complete first aid kit would entail considerable weight.

First Aid Item

Application

Ibuprofen--Motrin/Advil, 200 mg

for aches, minor pain, joint and muscle stiffness, headache and fever

Personal medications

for asthma, diabetes, allergies, etc

Codeine

for severe pain

Antibiotics--Septra DS

for bronchitis and UTI (for women)

Sulfacetamide 10% solution

for an inflamed, purulent eye

Diamox 125 mg

for altitude sickness

Antacid tablets--tums, rollaids

for nausea and upset stomach

Antidarrheal agents--Imodium A-D

for diarrhea or loose bowels

Metronidazole (Flagyl), 250 mg

for severe, prolonged diarrhea when Giardia is suspected

Decongestant--Sudafed

for congestion and hay fever

Moleskin

for blisters

Band-Aids and 2 x 4.5" adhesive bandages

to protect cuts and lacerations

Butterfly Band-Aids

to close lacerations

Sterile 4" gauze pads

to cover and protect wounds

Two-inch roll of stretch gauze

for hard to bandage areas

Two-inch roll of adhesive cloth tape

to wrap sprains, secure dressings

Three-inch self-adhesive elastic bandage

for sprains, joint dislocations

Aloe Vera gel

for sun and wind burn, dry skin

Mild antiseptic soap or hydrogen peroxide

for cleaning abrasions and wounds

Topical antibiotic ointment--Neosporin

for minor abrasions, wounds

1% Hydrocortisone ointment

for rashes, severe sunburn and burns

Scissors (part of Swiss Army knife)

to cut bandages, mole skin, tape

First aid field manual

for reference and guidance

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Mountain Medicine
The Sierra Nevada is generally a benevolent mountain range, hence, its year-round popularity for hiking, climbing, backpacking, fishing, and backcountry skiing . The summer and fall hiking, climbing and backpacking season generally runs from June through October. The ski mountaineering season, typically from December to June, coinciding with the period of greatest precipitation, predominantly snow. As a consequence of snow, rain, lower atmospheric pressure, high winds, cold temperatures and bright sun, specific medical problems may develop for backcountry skiers and snowboarders. Below is a discussion of common medical problems that may be encountered in the backcountry during the summer/fall season as well as the winter/spring ski season. The discussion centers on the prevention, diagnosis and treatment of hypothermia, sunburn, snow blindness, acute mountain sickness, High Altitude Pulmonary Edema (HAPE), dehydration, gastrointestinal (GI) illnesses, soft tissue injuries and frostbite.
Mountain Sickness
Mountain sickness, or altitude sickness as it is sometimes called, is due to hypoxia (an abnormal condition resulting from a decrease in the oxygen supplied to body tissue). Typically symptoms are not noted until 8,000 to 10,000 feet has been attained with about 10-40 percent of hikers experiencing various symptoms. At 14,000 feet a hiker is capable of performing only about 60% of their normal sea level capacity. Because the air is thinner at elevation each breath contains a significantly reduced quantity of oxygen. Consequently there is less oxygen to be circulated to the brain, internal organs, tissues and muscles. The mechanism by which the reduced oxygen produces the various symptoms of mountain sickness is uncertain but the evidence suggests some alteration within the cells lining the small blood vessels that in turn allows water to leave the blood vessels and accumulate in the tissues in an abnormal manner.

Mountain sickness is not a specific disease but is a general term for a group of widely varying symptoms caused by a rapid rise in elevation including 1) acute mountain sickness (AMS); 2) generalized edema; 3) disordered sleep; 4) high altitude pulmonary edema (HAPE); and 5) high altitude cerebral edema (HACE). These disorders represent a spectrum of altitude related problems from the less serious AMS to the often fatal HAPE/HACE.

Acute Mountain Sickness (AMS)
Symptoms of acute mountain sickness include lack of energy, loss of appetite, mild headache, nausea, dizziness, shortness of breath, lassitude and disturbed sleep. These symptoms generally resolve over 24 - 48 hours at a given altitude, and more quickly if one descends. Diamox (a mild diuretic which acidifies the blood) 125 mg. taken twice a day may be used by those individuals who suffer repeatedly with unpleasant symptoms despite a slow ascent. This prescription medication should only be taken until maximum altitude is attained or for 3-5 days, whichever is less. Diamox can be started a day before your trip. I suggest half a tablet (60 mg) taken twice a day may prove just as effective as the full dosage of 125 mg. Victims experiencing moderate mountain sickness involving severe headache, nausea and vomiting need to descend immediately.

Children are more prone to acute mountain sickness than are adults. This should be considered and adjustments made when taking children to elevation. It is best to take them on hikes to the top of several lower peaks in the 11,000 or 13,000 foot range to see how they perform at these elevations. A slower rate of ascent will decrease the incidents of acute mountain sickness in children, and adults alike, and will improve your party's changes for success.

General Edema
General edema is a harmless disorder occurring during the first couple of days to a week once high altitude is attained. Edema is an abnormal collection of fluid in the extra cellular, extra vascular compartment, typically in dependent parts of the extremities. Edema is probably caused by the increased permeability of small blood vessels and reduced kidney function resulting from reduced concentrations of oxygen in the blood. This fluid retention can cause a noticeable weight gain of four or more pounds. The excess fluid retention can cause a swelling of the face, eyelids, ankles, feet, fingers and hands. Urine output may be scanty in spite of adequate fluid intake. In the absence of AMS, it can be effectively treated with a diuretic.

Disordered Sleep
Disordered sleep is as troublesome to the one experiencing the symptoms as it is to the tent mate. The symptoms include fitful sleep, Cheynne Stokes respirations (periods of not breathing for up to 60 seconds followed by rapid breathing while asleep), and a sense of general tiredness the next morning. In some hikers, it is the only symptom of high altitude, and may persist the entire time while at elevation. Presumably, the mechanism causing disordered sleep is cerebral hypoxia. Acetylzolamide (Diamox), 60 mg or 125mg. taken before going to sleep may help to reduce the symptoms.

High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE)
Both HAPE and HACE are rare in California, occurring in about 0.5 percent and 0.1 percent of hikers venturing above 8,000 feet. But both are true emergencies necessitating immediate descent and prompt medical attention. Descent usually cures these mountain emergencies miraculously. Do not delay descent because of night, inconvenience, experimenting with medications, or in the expectation of a rescue. In the descent of 1,000-3,000 feet, the victim must always be accompanied by one or more individuals and, in severe cases, carried. Even a modest descent can improve the conditions of the victim markedly and save their life. On several occasions hiking companions on Mount Whitney experienced severe signs of mountain sickness at 12,000 feet but when urged to descend 1,500 feet, the symptoms disappeared rapidly.

In the case of HAPE, the lung's air sacs fill with fluid that has oozed through the walls of the pulmonary capillaries. As more air sacs are filled with fluid, the oxygen transfer to the pulmonary capillaries is blocked, resulting in cyanosis (decreased oxygen saturation of hemoglobin, with a bluish cast to the lips and nail beds). The symptoms are inordinate shortness of breath and a dry, nonproductive cough or a cough producing a small amount of pink-tinged sputum (caused by blood from the lungs). Without immediate treatment, HAPE may eventually lead to severe hypoxia, coma, and death. As noted above, treatment is immediate descent. If descent is not possible, give the victim a 10 mg. capsule of nifedipine every 6 hours or a 30 mg. slow release capsule of nifedipine every 12 hours. A rescue party with supplemental oxygen should administer it at a rate of 4-6 liters per minute along with nifedipine.

With HACE, fluid is retained in the brain cavity, causing swelling inside the skull. It is characterized by severe headache, nausea, vomiting, mental confusion, poor judgment, ataxia (clumsy or uncoordinated gait), and eventually coma and death. Without immediate treatment, HACE may quickly lead to coma and death. Immediately lowering the victim often can make a significant difference. If descent is not possible, treat with dexamethazone, a powerful steroid used in neurosurgery to shrink the brain. Give the victim 2 pills of dexamethazone (4 mg. each) followed by a single dose of 4 mg. every 4 hours. As with HAPE, a rescue party with supplemental oxygen should administer it at a rate of 4-6 liters per minute along with dexamethazone.

Prevention and Recovery
There are several things you can do to prevent or reduce the severity of the various forms of mountain sickness discussed above. Camping at the end of the road or as high as possible for a night or two before beginning your hike is extremely helpful in adjusting to the altitude. When going above 10,000 feet take your time on the ascent and camp for the day sooner rather than later to allow your body to acclimatize.

Drink plenty of water or your favorite sport drink several days before the hike and during the outing. Research suggests that there is a direct correlation between fluid intake and susceptibility to mountain sickness. Ample fluid intake is essential to preventing dehydration and altitude sickness.

Acetazolamide (Diamox), a mild diuretic that acidifies the blood, may be taken (60 mg or 125 mg. twice daily) both prophylactically to help prevent symptoms from occurring and therapeutically to lessen the symptoms after they occur in a victim. This prescription medication can be started the day before the trek and continued until the maximum altitude is attained but not longer than 3-5 days. Side effects include a tingling of the face and fingers and frequent urination. Victims experiencing moderate mountain sickness involving severe headache, nausea, and vomiting must descend immediately.

The following measures will help alleviate the discomfort associated with mountain sickness and may promote recovery.

1. Avoid heavy exertion but maintain light activity (such as walking) to increase circulation. The natural tendency is to lie down and rest but this reduces circulation.

2. Drink plenty of water, more than you think is necessary. A sport drink also is beneficial.

3. Eat light meals, avoiding too much fat. Warm soups are excellent.

4. Take an aspirin, acetaminophen, or ibuprofen for symptom relief.

5. Take acetazolamide (Diamox 125 mg.) twice daily.

6. Monitor closely for HAPE or HACE. If early signs are apparent the victim must be taken 1,000-3,000 feet lower. If an immediate improvement is not observed, remove the victim from the mountain.

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Hypothermia
A primary concern during the summer months is wet and windy weather generated by afternoon thunderstorms. Wet and windy conditions (snow, sleet, hail and thunderstorms) without the proper clothing for protection from the elements can quickly lead to hypothermia. Hypothermia can become a potentially serious medical problem in the mountains especially for those above tree line. If a hiker becomes wet, the wind can quickly strip the body of its core heat at alarming rates. A relative low wind speed of 10 to 20 miles per hour can have a dramatic and potentially fatal effect on a wet hiker. And what may be even more surprising is that it is not necessary for the ambient air temperatures to be below freezing for hypothermia to take place as hypothermia often occurs at temperatures above freezing. The best prevention is to not get wet in the first place by taking wind proof and water repellent outer clothing such as a poncho, gore-tex parka, or other water-protective garments.

The symptoms of hypothermia are decreased mental acuity, reduced physical ability, slowness, tiredness, confusion, and, eventually, after shivering has ceased, coma and death. A hiker, climber or ski mountaineer is at risk for hypothermia when wet and tired. Moisture on one's skin or clothing is the enemy. Wet falling snow, sleet, hail, or rain from a summer thunderstorm can quickly soak a hiker. If not adequately protected against these elements, a cold, wet and tired hiker may quickly become a candidate for hypothermia.

Hypothermia is a condition where the core body temperature decreases to a level where normal muscular and cerebral functions are impaired. Normal body temperature is within one degree of 98.6 degrees Fahrenheit. As the core body temperature drops various symptoms of hypothermia appear. At core body temperatures between 94 and 97 degrees muscular incoordination, weakness, a slow stumbling pace, mild confusion and apathy appears. As the core body temperature drops to 90 to 93 degrees there is gross muscle incoordination, frequent stumbling, mental sluggishness with slow thought and speech. Hallucinations may develop. Shivering is often uncontrollable. At lower body temperatures cerebral function deteriorates and death, due to cessation of effective heart function, occurs between 78 and 82 degrees.

Effective water and wind resistant clothing for your head, hands, body and feet is critical. Compounding the environmental factors is moisture from perspiration. Whether your clothing gets wet from precipitation or perspiration, the end result is the same: risk of hypothermia. Keep yourself and your clothing dry at all times. Use the layering method of dressing: a wicking layer next to the skin such as capilene or polypropylene, a layer such as pile or fleece for insulation, and a breathable water proof layer on the exterior. Remove or add layers as conditions dictate. Keeping well nourished and hydrated will help maintain normal body temperature.

Hiking should not be done alone. A serious danger of hypothermia is that the victim quickly loses the ability to think rationally and will not take the necessary actions to save their own life. A partner is invaluable in recognizing the early danger signs of hypothermia, taking the critical action that is required to save a friend's life, and in helping them recover from hypothermia.

Management of hypothermia is immediate shelter to stop further heat loss. Place the victim inside a tent or hut so that they are protected from the wind, cold, and the elements. Replace the victim's wet clothing with dry clothing and place them in a sleeping bag. Provide warm fluids (Jell-O, Tang, fruit juice, sports drink, apple cider) immediately. Avoid Caffeinated drinks as they act as a diuretic and contribute to volume depletion (loss of body fluids through urination). Previously the advise of the experts was to share body heat through body to body contact in a sleeping bag. However, the current thinking is to avoid surface re-warming (body to body contact, hot water bottles to the skin, etc.) as this suppresses shivering which is believed to be the safest method of re-warming the body core. If the hypothermia appears severe by symptoms, rapidly plan a rescue.

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Sunburn and Snow Blindness
Snow blindness is a potential problem whenever considerable amounts of snow remain on the ground. In the simplest of terms, snow blindness is sunburn of the epithelial layer (cornea) of the eye. Ultraviolet rays are present and threatening in any weather condition during the day. To protect against the damaging affects of the ultraviolet rays, it is essential to wear sunglasses at all times when traveling on snow. Even when cloudy and snowing, snow blindness can occur after only a few hours of unprotected exposure. Additionally, it is a good practice to wear sunglasses when hiking at higher elevations as there is significantly less atmosphere to filter the affects of dangerous ultraviolet rays. Snow blindness is extremely painful due to the eyelid moving over the inflamed cornea. Treatment is an eye patch over the affected eye(s) for a period of 24 - 48 hours. In most cases, the eyes heal quickly.

Sunburn is more easily prevented than treated. Apply sunblock lotion frequently and generously during the day. Use a sunblock that provides the greatest amount of protection (SPF 40 or greater) and one that protects against both Ultraviolet A and Ultraviolet B rays. Sunblock in conjunction with hats having wide brims and fabric that hangs around the neck and face is most beneficial in preventing sunburn to the face and neck. Apply aloe vera gel to sunburn and wind chapped skin as it promotes healing.

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Dehydration and Water Purification
Losses of two to four liters of liquid per day from perspiration, breathing, and urination are common for backcountry hikers and climbers. Dehydration is further compounded by the symptoms of mountain sickness-nausea and vomiting, and a dulling of the thirst sensation that accompanies a loss of appetite. Studies suggest that dehydration contribute to depression, impaired judgment and other psychological changes that occur at high altitudes.

Inadequate replacement of fluids results in reduced circulating blood volume, the symptoms of which are decreased work capacity, feelings of exhaustion and ultimately dizziness. The water you are carrying should be conveniently available. Water that is easily accessible will be more readily used. Drink small amounts of water often. Supplementing the water with Gatorade or a similar electrolyte sport drink helps to replace the daily fluid losses. Soup with breakfast and dinner also aid with water and mineral repletion. Thirst is oftentimes not an accurate indication of you liquid needs. Therefore, drink more fluids than you think are necessary throughout the day to prevent dehydration.

The question whether the water from mountain streams and alpine lakes is safe to drink has been a major concern for many years. Most backpackers have heard about Giardia lamblia or giardiasis but many are misinformed about the organism's prevalence in wilderness water and the seriousness of the disease. The U.S. Forest Service and National Park Service have issued many warnings advising campers and hikers to filter, treat with iodine, or boil all surface water before drinking. However, this advice does not appear to be based on scientific research or their own investigations but a public warning erring on the side of caution.

Over the years, the National Park Service and the U.S. Forest Service, have filtered hundreds of gallons of water from wilderness streams and have found few organisms. According to research, at least 10 to 100 giardiasis must be ingested to infect a person. When one realizes that Sierra Nevada water contains fewer Giardia cysts than the municipal water supply of the city of San Francisco and Los Angeles, it becomes apparent that Giardia is not a serious threat to those that drink from a Sierra Nevada stream or lake. Below are some typical giardia cyst concentrations (cysts per liter) measured throughout California. Click here for a complete discussion of giardia in the Sierra Nevada.

~1000 = Typical swimming pool contamination
~100 = Giardiasis is plausible
~10 = Minimum needed to contract giardiasis
~1 = Some wilderness water outside California
0.12 = San Francisco water
0.108 = Worst Sierra Nevada water measured
0.030 = Los Angeles water
0.013 = Trail Camp on the Mount Whitney Trail
0.003 = Whitney Portal

The medical literature does not support the widely held perception that giardiasis is a significant risk to hikers and campers in the Sierra Nevada or the United States. Specifically, in 1987, 1996, and 1997, Dr. Robert L. Rockwell conducted extensive research on giardia in the Sierra Nevada including scholarly, peer-reviewed research and concludes that you can indeed contract giardiasis on visits to the Sierra Nevada but it won't be from the water.

Proper personal hygiene is far more important in avoiding giardiasis than treating the water. Health experts estimate that one out of five persons are giardia carriers. Asymptomatic carriers can spread the disease without knowing it. Cooks and food handlers can easily spread giardia when good hygiene is not practiced. This is consistent with the finding that a majority of giardiasis cases are caused by fecal-oral or food borne transmission. In the backcountry it is wise to use antibacterial waterless soap after each nature call and before preparing and eating meals.

However, if you still have concerns and want to take extra precautionary measures, there are three acceptable methods for treating the water: iodine tablets, filtering, and boiling. All are effective against giardia. I follow the simple rule that if the area is heavily used by hikers, pack animals, or open range cattle grazing, I treat the water with iodine tablets as a preventive measure against bacteria and pathogens that could enter the water from human/animal waste. Those areas where the National Park Service and US Forest Service allow horses and pack animals to graze in sensitive alpine meadows, near mountain lakes, and along wilderness streams, are of particular concern. For further discussion of the impacts of horses and pack stock in the backcountry, see Tread Lightly, Protect the Fragile Ecosystems.

Medical research has established that iodine tablets are a highly effective agent for sterilizing drinking water. In extremely cold water, allow 10-30 minutes for the tablets to dissolve. To speed the process, break the tablet into small pieces as you add it to the water. If you do not like the flavor left by the iodine, you can buy a neutralizing tablet that eliminates the offending taste or drop in a small amount of Vitamin C. Vitamin C eliminates the iodine taste and provides a pleasant sweet taste to the water. A powdered sport drink also masks the iodine flavor effectively. Iodine also is effective at killing waterborne viruses. Iodine tablets are the least costly way to treat drinking water, and their weight is negligible.

Water filters are a reasonable method to purify water but they have several drawbacks: they do not remove waterborne viruses, are costly, heavy, and it is time consuming to pump the water through the filter. Viral contamination in the backcountry is not common but diseases such as hepatitis are serious. Filtering alone does not ensure safe drinking water, iodine or chlorine-based purification is needed.

Boiling water for 3 minutes kills almost all infectious microorganisms, including giardia cysts. Boiling the water is a highly effective way to ensure safe drinking water but it is inconvenient and time-consuming unless done with your meal.

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Soft Tissue Injuries
Soft tissue injuries (minor burns, sprains and bruises) are not an uncommon occurrence befalling the the hiker, climber, backcountry skier and snowboarder. Apply cold compresses (packed snow) or ice-cold water from a nearby stream applied intermittently during the first 48 hours but most importantly during the first twenty minutes after the injury occurs. The cold compresses cause vasoconstriction which prevent swelling, the greatest cause of subsequent pain. Ibuprofen helps reduce the pain and swelling as well.
Frostbite
Frostbite is an injury produced by cold in which the affected tissues are frozen. In response to the cold, blood flow to the periphery (hands, feet, nose, ears, etc.) and the skin is reduced while flow to the body core (muscles, abdominal organs, brain and heart) is preserved. Peripheral vasoconstriction may be so severe that peripheral circulation ceases. This can result in a freezing of the tissue leading to severe cold damage such as leakage from the capillaries, ice crystal formation within the tissue and eventually irreversible tissue damage. Typically this scenario happens in subfreezing conditions (or when the wind chill factor is below freezing) to an exhausted backcountry skier or snowboarder with inadequate clothing, reduced caloric consumption or inadequate fluid intake. Prevention includes meticulous attention to proper clothing, generous caloric and fluid intake and setting a reasonable pace that will not result in exhaustion.

Diagnosis begins with a heightened awareness of the risk of frostbite in a cold environment. The first signs are pallor (whiteness) with pain and cold sensation in the affected area. As freezing progresses, pallor increases and all sensation is lost. Finally as deep frostbite occurs, the tissues (fingers, toes, nose, ears, etc.) become hard. Treatment in the field is difficult. Protection of the affected part is important. Do not rub or subject the area to any type of trauma. However, walking on frozen feet for eight to twelve hours to get definitive help is better than remaining in the cold environment for a longer period of time or re-warming the feet in the field and then walking on them. Definitive treatment is rapid re-warming of the affected area (such as with a 110 degree Fahrenheit water bath) once the victim is in a steady warm environment. If the victim remains cold while the affected area is re-warmed, vasoconstriction and reduced blood flow to the area will continue and further damage may occur.

Minor Aches and Pains
You can be assured of aches and pains, and many sore muscles and joints during and after your climb. Ibuprofen (Motrin/Advil) is the wonder drug for hikers and climbers. Taken with food, once or twice during the day, 200 mg. will help ease the many aches, pains and soreness associated with strenuous exertion of climbing and hiking. A 200 mg tablet at midday acts as a powerful second wind allowing the tired and sore hiker to continue for several more hours. Another tablet (200 mg.), taken before bed, will help reduce stiffness and greatly improve the quality of sleep. Five to ten minutes of stretching exercises at the end of the hike as part of the cooling down process, and then again before going to bed, is also extremely helpful in reducing stiffness and improves sleep.
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Lightning

Lightning hazards are three fold: 1) a direct strike, 2) ground currents, and 3) induced currents (in the immediate vicinity of a strike). Lightning is electricity and when the more than 100 billion, billion electrons in an average bolt strike a peak or tree they instantaneously spread in all directions causing considerable damage. The electrical discharge radiates outward and downward decreasing rapidly as the distance from the strike increases.

Two factors determine the extent of injury to hikers and climbers: the amount of current received by the victim and the part of the body affected. The most serious threat would be current running from one hand to the other passing through the heart and lungs or from head to foot passing through the vital organs. This would be serious even if the amount of current was relatively small. A hiker could survive a larger amount of current if it did not pass through vital organs such as from one foot to the other passing through the legs.

The number one rule is to avoid areas that might be hit by a lightning strike. Seek a location with nearby projections or masses that are significantly higher and closer than one's head to any clouds that might drift by. In a forest the best place is amongst the shorter trees. Along a ridge the preferable location is in the middle as the ends are more exposed and susceptible to strikes. Below are some useful tips of what to do if caught in a lightning storm:

  • If a lightning storm is approaching, quickly descend to a safe location away from the summit and off exposed ridges;
  • If caught unexpectedly by a lightning storm in an exposed position, seek a location with nearby projections or masses that are significantly higher than your head;
  • Avoid moist areas including crevices and gullies;
  • Sit, crouch or stand on insulated objects-a coiled rope, sleeping bag, ensolite sleeping pad;
  • Occupy as small an area as possible keeping your feet close together and hands off the ground;
  • Stay out of small depressions, choose instead a narrow slight rise to avoid ground currents. A small detached rock on a scree slope is excellent;
  • Stay away from overhangs and out of small caves; and
  • When on a ledge, crouch at the outer edge, hopefully at least four feet from the rock wall.
Backcountry_Resource_Center--Paul Richins, Jr.
www.jps.net/prichins/backcountry_resource_center.htm

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