What to do if a team member falls sick?

Question

Recently I fell ill whilst car camping and it made me consider the situations when not around amenities. In addition to this I recently was part of a four man, one dog team climbing Snowdon and one of us fell ill with a severe migraine, and we carried on despite the migraine as the team member wished to do so, which also got me thinking.

Obviously there is only so far the common sense and opinion of someone who is unwell can be taken before someone has to step in for the sake of their safety, and I understand obviously some sicknesses are more serious than others but I would assume it is better to stop in the location you are in, or slow your trek down with plenty of rests. If you are in a large group, meals and toilet areas would I assume also become a problem if you are in an area for a while.

If a member of your team falls sick mid-trek, and you are rather far from the closest amenity, what is the best cause of action to ensure the safety of the individual as well as the team?

Are there any essential practises that the team leader / first aider should consider?

Answer 1

Decide depending upon the impact that person has on the group and the event. If he/she is a crucial member to keep going, may be the group should agree to call it off, and decide to turn back or set up a camp, depending upon the supplies and the location. You'd never want to make someone walk back home is he/she is really in not a shape to sustain the exertion.

1. Check what dependencies the group have over him/her and make a group decision if He/She can rest and be accompanied by one of the members (preferably the most experienced member), while other go on and come back in a few hours. For a multi-day hike, I'd recommend sticking together, no-one goes ahead, either rest or turn back.
2. If its something like Diarrhea and/or Vomit, Inquire if He/She has drunk and/or ate from unhygienic sources. Food poisoning can get worst by every passing hour. Sometimes sun stroke can also cause similar symptoms. Whatever the reason, everybody turning back and getting to the nearest medical center should be a wise, sensible and obvious decision to make.
3. If its something like Migraine or bad headache, inquire if He/She has been struggling with Acrophobia or similar issues while exerting at higher grounds. If its a casual Headache/Migraine, then may be He/She can be accompanied by someone wiser and rest in the tent (if the group has brought along), a mountain hut or some safe place, preferably sheltered (considering if its rains).
4. If He/She is still able walk neatly, group should consider asking him/her to walk down to the car with someone wiser accompanying him/her. That shall be the safest place to rest.
5. Inquire if He/She has some sort of a reaction from general medicines like Metronidazole, Domperidone, Aspirin, Amoxicillin, etc. Out of these, Amoxicillin is an irregular member in the bunch of medicines known generally. Its used to treat a wide variety of bacterial infections. I always keep it with me, just in case. One should also consider a fact that overdose of Amoxicillin can cause Diarrhea. If that is not an issue, you can consider giving him/her the required and suitable pill. (I assume, if you have them in the Medical Kit at first place, you are expected to have general information about dosage). Its usually advised to sit back and rest after you take some medicine.
6. In case of Fever, its not out-of-the-blue, the symptoms can be observed before the mercury rises. In such a case, its a wise call to turn back.
7. If its a multi-day hike, and if someone starts suffering from Diarrhea or Vomit, you should ensure that the person is kept Hydrated and if possible consider starting towards nearest medical facility. Just a side tip: I have observed that eating apples helps to at least control Diarrhea.
8. If someone gets bad migraine on a multi-day hike, you can consider camping immediately rather than making him/her walk further.

On a multi-day hike its very much possible that you have to stay, and you can't just turn back and go home. Spending a night in such a case is really difficult for the person as well the ones who care for him/her.

1. If its Diarrhea: Diarrhea is one of the common things that can screw your trek. Keep the poor fellow hydrated with water and Pedialyte, Rehydralyte or similar products which are available without prescription. Give him/her fruit juice (asynthetic, without pulp), broth, soda. Do not give him/her milk and milk-made products. Roasted/Boiled Potatoes are good to eat. Just keep in mind that too much of salt or sugar can aggravate Diarrhoea. If you have Oranges with you, then that is a good food to eat since they are loaded with vitamin C and believed to aid in digestion. Keeping something warm on the belly may also help relieve abdominal cramps. May be a collapsible hydration pack filled with lukewarm water?
Diarrhea is mostly non-contagious, so its totally okay that the carer shares the tent with the one who is suffering.

2. If its Fever: Elevated temperature, pulse, and breathing rate; chills or hot flashes, sometimes flushed skin, headache are symptoms of Fever. Make him/her wear light clothing and keep the bedding light. Medicines like Paracetamol, Ibuprofen relieve pain and reduce fever. I'd personally not consider taking both of them at the same time. Measure his/her body temperature regularly, if its getting higher, sponge him/her with cold water. Keep him/her hydrated. Abrupt fevers are mostly due to climatic changes. So being a caring person I wouldn't hesitate sitting by him/her in the same tent and keep the person calm, but that is absolutely personal opinion. Just in case if you are not ready to gamble about contiguous fevers, then you might consider setting up an alarm to check his/her temperature, make it quick, wear a mask or at least cover mouth and nose, wear gloves, use sanitizers. But that is not me, I wouldn't do that to the person, especially up there on a mountain, but again, thats a personal opinion.

Answer 2

Your first objective will be to address any immediate threats to life, gain patient consent, and conduct a thorough patient assessment. Each injury or sickness will have its own criteria for action, but they can generally be classified into three responses: Stay and play, take a rest day, or evacuate. If you are taking the role of first aider for the group, you should already be familiar with which problems rate a particular response.

As a rest day has potential to turn into an evacuation, and as an evacuation can require as many people available as possible, one should be very cautious about splitting up the group unless sending a party to seek additional assistance. (For minor ailments on casual excursions, having a few people walk the casualty out may make sense. I say "a few" to avoid having the assistant being alone if they will be rejoining the group.)

So, once you have stabilized the patient and determined which category they are in, the next step is planning. For a rest day or a delayed evacuation you'll want to consider shelter and supplies: unless on a multi-day trip you may find yourself short of both. If you'll be sending people for help or re-supply, make sure you don't have any tasks that need their help before you send them away. Prepare two copies of a SOAP note and send one copy with the team that's going for help, along with information on who else is present, what supplies you have, and where you are. This is also a good time to make sure everyone else in the party is also equipped and ready for the expected stay.

In terms of drugs there are very few occasions which require immediate medication. Epinephrine, for those with severe allergies, is one of the few medications that become necessary in a very short time frame, after which an immediate evacuation is necessary. Aspirin (for heart attacks) and diphenhydramine can also fall into this category. However, altitude sickness is best treated by immediate descent and most other ailments will burn themselves out given time and rest. Painkillers are common comfort items but rarely truly necessary. I hesitate to list antibiotics both for legal reasons and practical ones: at least in the US administering them isn't legal, outside of a severe infection they aren't really needed, and short-term or improper use is likely to contribute to the growing problem of resistant bacteria.

Answer 3

Great question. Just to add to the already excellent answers; there is an SAS abbreviation which has always served me very well, and it applies here. PLAN your course of action;

• Protection: The safety of the group, and the individuals within the group, is of greatest importance. Ensuring you protect the group and it's members is the first priority. It depends on the location, and the weather for you to decide the best course(s) of action to ensure that.
• Location: Exposure is a merciless enemy. High winds, temperature extremes and terrain must all be considered. If you are in a particularly hostile environment, it may be best to set up camp, as above, to ensure protection of the ill party and the group. Alternatively, given fair weather and relatively accessible terrain, pressing on to the nearest safe point may be best.
• Acquisition: Getting the stuff you need; food, water, (in this case, medicine) is next. Once the P and L have been decided upon, it's time to acquire the necessaries for treatment, even if that is paracetamol or ibuprofen. A warm tent, plenty of fluids, in-depth assessment of the ill party all fall under this category. Don't forget you may have one ill person in your immediate concerns, but the group will soon grow hungry, thirsty, and potentially tired while waiting for treatment of the individual.
• Navigation: By this point, you (or a senior) has taken definite action to protect all those involved, you have decided on your location (stay, go on, pitch camp, etc) and you have acquired the necessary materials, or at least decided how to do so. Now you must decide on navigation. If you are pressing on, where are you going? If you're staying put, or pitching camp, when will you move on, who will it be? The whole party or an individual? Do you know where you are going - very important to establish this at the outset and make it clear to all involved. If you don't know, be honest.

PLAN applies to group-size decisions, or even your own actions within the group. It's an excellent concept to remember because it forces you to stop and think about a course of action, and then act on, and ideally stick to the plan.

Whatever you decide upon, make it clear to all parties involved. A deteriorating patient being dragged down a mountain will inevitably cause distress (and potentially, anger) amongst the group; very dangerous in a hostile environment.

Further Notes

In my observation, men will usually want to press on in the event of illness, or injury, if they are able to. Contrasted with women, who are more likely to opt for a rest or to camp up. You or a senior member might have to take the decision on behalf of an ill/injured male companion, for his, and the group's safety.

Pressing on in the event of a persistent high fever is almost always a bad idea. The heart works harder when the body temperature increases, and continuing, even at a reduced pace, increases the work it has to do even more. That has knock-on effects, and may even cause damage to the patient's heart. Knock-on effects include nausea, exhaustion, vomiting, dehydration, etc, etc.

In almost all cases, hydration is key - provided the water is clean. Do not introduce fluids from an non-trustworthy source.

And lastly, throw in a pinch of kindness. The dude is ill, how would you feel if you were pressed, or expected to continue under similar conditions. Comfort, and make them comfortable, if you can. Reassurance and a good chat will also do wonders in most cases. Also don't underestimate the heartening effect of a good brew for all parties involved. By "brew", I mean tea or similar, NOT alcohol!

Hope for the best, PLAN for the worst. :)