It is World First Aid day, so it seems an appropriate time for the superb Dirty First Aid series.

We all love to kayak, sure. It has some things we love and some we hate. First Aid often becomes the elephant in the room.

When was the last time you or your peers did a course or a workshop? Do you keep ‘up to speed’ on developments?

In this series I am pleased to offer a ‘dirty’ First Aid approach. This is suited to kayakers and river users. Using a ‘find it fix it’ approach to incident care and management.

Dirty First Aid - The Series
World First Aid Day

This first article will lay the foundations of rapid emergency aid. It’s a simple approach that a basic personal First Aid kit and things carried on you can deal with. Now is not the time to discuss what you should or should not carry in your kit. Read the series and make your own mind up.

First off lets look at a conscious casualty. It will form the building blocks for later articles. Remember whilst we all have river banter, perhaps now is not the time to joke. Our casualty may be scared, upset, acting irrational. Check your bedside manner and make sure you can get consent, people for some reason or other may refuse – don’t force it. If the casualty is with a boat/paddle etc keep an eye on these, especially is they go to hospital. Make sure they get them back. If equipment is likely to get removed via the rescue services make sure it’s labelled.

Primary Assessment

Obviously not all casualties will need a full head to toe assessment. If your casualty cuts a hand on a rock its pretty obvious. If the cut occurred when seal launching from a rock ledge could you rule out other injuries such as a spinal? – This latter case should prove that a full head to toe check is essential.

Making a full assessment and indeed offering aid to a kayaker is often tricky, PFD, dry suit etc, get in the way. The cold and wet environment, a slippery bank or tight gorge dealing with first aid is a challenge.

Our assessment needs to account for the safety of the first aider, people assisting, bystanders and emergency services as well.

Is a rock fall likely if you are in a gorge? Will the river flash? Remember survey the scene. Check for Danger.

Initial Assessment

Next up is our Initial Assessment, here we need to check what has happened. Did we witness the incident, if not can we find out? Don’t be afraid to ask questions? – ask the casualty for their name, medical conditions, what happened. Hey introduce yourself!

Dirty First Aid
World First Aid Day

If like me you have a bad memory use a marker pen to write this info down. As a starting off point lets assume they are conscious. What did they respond to?

Are they Alert?
Or do they respond to your Voice?
Perhaps they only respond to slight Pain such as a squeeze on the hand?
Or perhaps they are Unresponsive throughout.

Anything below Alert – time to treat as unconscious. Pick up and dial, or send for help if you can.

Throughout this Initial Assessment you will fill your ABC’s. If they respond hey presto you have your Airway – bingo. So how is the Breathing? Is it normal, labored, choking or a sign of anaphylactic shock, perhaps a sign of a chest injury or spine injury. Don’t worry about this yet, we will cover it in later articles. Now the C of our ABC, how is the Circulation, do you see a problem? What about catastrophic bleeds?

When a casualty is conscious this survey can be done pretty quick. Remember any problems found in your ABC check are serious THIS IS AN EMERGENCY.

Dirty First Aid
World First Aid Day

Top tips for primary survey

Check your bedside manner, get consent.

Use a marker pen to make sure you record details.

Write on a survival bag, skin or foil blanket. Helps in remembering the time line of events.

DR ABC – Danger, Response, Alert, Breathing, Circulation.

AVPU – Alert, Voice, Pain, Unresponsive.

If you don’t know your location, use a tracker device.



Old man river Darren Clarkson-King (DAZ) will be supplying a series of ‘Dirty First Aid’ articles for river runners.

Darren offers in-house training in the Himalaya and is a consultant for Nepal Association of Rafting Agents (NARA) making a blue print for an Industry standard.

He also paddles a bit.