Please take advantage of the Trekking First Aid Zone, concentrating on problems that may occur while trekking .
Health issues when trekking
There are a number of possible health issues you should look out for while trekking and treat as quickly as possible. Below is a list in no particular order of severity or importance.
The best way to prevent blisters is to have feet that are conditioned to walking for long distances. There is no substitute for miles, failing this, wear two pairs of socks. A thin, wicking inner sock and an outer cotton sock will help to reduce friction on the feet.
Early prevention of blisters
If you feel like you are getting a hotspot on your feet, stop, cover with really sticky plasters and then continue. Don’t continue walking until the pain is too unbearable or worse of all, the skin is broken. Preventing blisters from expanding, or peeling off your skin is key to keeping you feet healthy on a long trek.
Keep your feet as dry as possible. Many parts of eastern Tibet are wet and can experience a lot of rain, so often it’s almost impossible to keep your feet 100% dry. However making a big effort to dry out your feet whenever possible will make them less prone to blisters. If you get a blister, I would recommend popping it as soon as possible, in as clean as conditions as you can achieve, drain it, then cover it tightly with plasters to prevent more friction. Don't let blisters grow out of control. Keeping the skin on your feet is highly recommended.
The principle cause of cramps is the over use of muscles. Therefore the best way to prevent cramps is to make sure the muscles are conditioned and up to the stress you will put on them, or in other words, train more. Trekking in eastern Tibet can be incredibly punishing on even the most conditioned of muscles.
Another cause of cramps is electrolyte depletion. Electrolytes help the muscles function, think of them as the engine-oil of the body. Without them, the moving parts begin to seize up. When you sweat, electrolytes are lost. These precious minerals need to be replaced to avoid cramping. You should consider carrying powdered electrolyte mix such as Pocari or Gatorade or carry sport gels like Power Gel or Gu, which all contain electrolytes. If you don’t have access to these then make sure you eat lots of salty foods as often as possible.
If your feet crack then the pain is worse than any blister. This kind of vertical cracking down your feet can occur after hours and hours of having damp feet, either from the rain or sweat. You really don’t want this to happen to you halfway along a trek, it will completely debilitate you. To prevent it, make every attempt to keep you feet as dry as possible. When you stop to rest, air your feet and dry out your feet/socks in the sun, if possible. Dry out used socks on the back of your pack and remember to put them in your pack if it starts to rain. Make sure you have always got some dry socks to change into.
Gortex shoes are great at stopping water coming in from the ground, but not so good at preventing water coming from the sky, unless you wear gators. Once wet they can be much harder to dry out, leaving you with wet feet all day, even if the shower was just for an hour.
Bites can be very debilitating. Especially if you're subject to a sustained attack or your clothes or gear gets infested. Carry bite cream and antihistamines to soothe the itchiness.
At altitude the sun is much stronger, so take extra care to prevent sunburn. Many treks cross exposed, hot, dry areas that have little shelter from the sun, so you should apply sun cream early and whenever possible. The key is that the environment is aggressive enough without also adding preventable ailments like sunburn.
Food poisoning is always a potential problem when eating in remote areas. The best way to prevent food poisoning is to eat sensibly. However this also has to be put into context with the fact that you NEED to maintain your calorie in take. So, if you are really precious with your eating habits then maybe trekking in remote areas is not for you. A few simple hygiene practices can go a long way in keeping yourself healthy, such as;
· Wash your hands whenever you get the chance
· Clean any dishes or utensils with boiling hot water
· Don’t eat wild mushrooms.
· Eat only hot, freshly cooked food.
· Boil water or purify before drinking
· Don't eat raw vegetables or peeled fruit
· Eat meat which has been well cooked at a high temperatures
If you find yourself with food poisoning a few simple things can keep you fit enough to keep walking, such;
· Drink plenty of fluids (to prevent dehydration)
· Drink tea, barley or rice water (to soothe inflamed stomach or intestine)
It is very easy to get many minor cuts or abrasions on your hands and legs. Treat these at night with antiseptic cream to prevent them becoming infected. If you find that you have lots of tiny nicks on your hands. Rub the antiseptic cream into your hands like you would a hand cream. This will make sure that every tiny cut gets treated
Acute Mountain Sickness (AMS) is a constellation of symptoms that represents your body not being acclimatized to it's current altitude. As you ascend, your body acclimatizes to the decreasing oxygen (hypoxia). At any moment, there is an "ideal" altitude where your body is in balance; most likely this is the last elevation at which you slept. Extending above this is an indefinite gray zone where your body can tolerate the lower oxygen levels, but to which you are not quite acclimatized. If you get above the upper limit of this zone, there is not enough oxygen for your body to function properly, and symptoms of hypoxic distress occur - this is AMS.
Zone of Tolerance
Go too high above what you are prepared for, and you get sick.
This "zone of tolerance" moves up with you as you acclimatize. Each day, as you ascend, you are acclimatizing to a higher elevation, and thus your zone of tolerance extends that much higher up the mountain. The trick is to limit your daily upward travel to stay within that tolerance zone.
The exact mechanisms of AMS are not completely understood, but the symptoms are thought to be due to mild swelling of brain tissue in response to the hypoxic stress. If this swelling progresses far enough, significant brain dysfunction occurs (See next section, on HACE). This brain tissue distress causes a number of symptoms; universally present is a headache, along with a variety of other symptoms.
Signs
The diagnosis of AMS is made when a headache, with any one or more of the following symptoms is present after a recent ascent above 2500 meters (8000 fee
- Loss of appetite, nausea, or vomiting
- Fatigue or weakness
- Dizziness or light-headedness
- Difficulty sleeping
All of these symptoms may vary from mild to severe. A scoring system has been developed based on the Lake Louise criteria; look at the AMS questionnaire for a simple method to evaluate an individual's AMS severity.
AMS has been likened to a bad hangover, or worse. However, because the symptoms of mild AMS can be somewhat vague, a useful rule-of-thumb is: if you feel unwell at altitude, it is altitude sickness unless there is another obvious explanation (such as diarrhea).
Anyone who goes to altitude can get AMS. It is primarily related to individual physiology (genetics) and the rate of ascent; there is no significant effect of age, gender, physical fitness, or previous altitude experience. Some people acclimatize quickly, and can ascend rapidly; others acclimatize slowly and have trouble staying well even on a slow ascent. There are factors that we don't understand; the same person may get AMS on one trip and not another despite an identical ascent itinerary. Unfortunately, no way has been found to predict who is likely to get sick at altitude.
It is remarkable how many people mistakenly believe that a headache at altitude is "normal"; it is not. Denial is also common - be willing to admit that you have altitude illness, that's the first step to staying out of trouble.
It is OK to get altitude illness, it can happen to anyone. It is not OK to die from it. With the information in this tutorial, you should be able to avoid the severe, life-threatening forms of altitude illness. Source www.basecampmd.com
Although there are a variety of altitude hazards to your health and many ways to prevent and cure - especially by knowledge and good commonsense - there is one single important health tip that can help you avoid all sorts of health problems…..it can completely alter your performance in trekking/climbing as well as your ability to acclimatize and deal with altitude. It is very simple yet crucial – it is the drinking of water.
Simple as that. Drink. Drink, Drink! Staying hydrated equips you to acclimatize, exercise better, fight off hypothermia and frostbite, constipation, diarrhea….so plan to drink a minimum of 3 liters per day at rest, add more as needed for exertion and other losses (eg if you are working hard and sweating you may need up to 8 liters, or if you are ill with vomiting or diarrhea and losing lots of fluids, you will need to replace those losses too.) One or two hours before trekking/climbing, try to drink 1-2 liters to “fill your tank” -- some find that they continue to drink more while active if they use an easily accessible hydration hose system (an example of a commercial system – Camelback – these prevent the hassle of reaching for a bottle – the hose is right next to your mouth!)
The best way to check that you are well hydrated is to check your urine. You need to drink until
it’s clear and straw colored. Deep yellow/amber urine color usually means you are concentrating and need more water. If you aren’t waking up at least once at night to urinate at altitude, you probably aren’t drinking enough.
Finally - remember that coffee, tea and chocolate contain caffeine, which is a diuretic and won’t do the work well. Count in only 50% liquid value with these. Source www.basecampmd.com
Frostbite
Prevention is the key to avoiding frostbite. Here are some important reminders:
- Stay well hydrated and well fed to enable your body to generate heat!
- Avoid alcohol, which can impair your sensation (and judgment!)
- Avoid smoking, which will constrict your blood flow
- Don’t climb/trek under extreme weather conditions (wind, very cold)
- Avoid tight fitted clothing, no wrinkles in the socks
- If your clothing/socks/gloves get wet from snow/rain or perspiration, DRY them quickly – including boot insoles
- Wear mittens rather than gloves in extreme cold and a liner glove underneath if you need quick temporary access to fingers (e.g. photography)
- Never ignore numbness – as an old professor once told me – “if you feel your fingers and toes getting numb and you ignore it, that numbness might be the last thing you ever feel!” Numbness is a sign that you may be getting into trouble. If it doesn’t resolve by increasing activity, you need to get somewhere to take off your gloves/boots and rewarm yourself.
- Avoid rubbing frostbitten areas – beating on them only increases the chance of injury and doesn’t help them rewarm faster.
- IF you or your buddy has frostbite, get somewhere warm, but only rewarm the injured area if there is no chance it will refreeze
– keep the area padded and protected against further heat loss. The quickest way to rewarm is to submerge in warm water (~104F, or the warmth of a hot tub, test the water first with a thermometer or an uninjured body part – a frozen hand can’t determine if the water is too hot!) Source www.basecampmd.com Hypothermia
Hypothermia can kill in mere minutes. Cold temperature, but also strong wind causes the body to rapidly lose heat. You start to shiver in order to maintain body heat from the rapid muscular shaking. If your body temperature drops to 35C/95F, you may get dizzy and disoriented, then the shivering stops. The body now maintains temperature only around the important organs; heart, brain and lungs and shuts down blood circulation to the arms and legs. Your pulse becomes weak and slow. Your blood vessels widen. Now, you feelhot and want to remove your clothes, finally slipping into unconsciousness. Eventually, your heartbeat stops.
Full blown Hypothermia will not be improved by additional clothing since clothing doesn’t generate heat. In difficult climbing situations, you need to put hot water bottles in your armpits, to your crotch and/or stomach – or you can strip and get into a sleeping bag - together with another undressed person, to warm up by the others body heat (yeah, yeah - keep your dirty imagination to yourself!).
Otherwise - keep moving until at safety. In 1998, a climber died of hypothermia on the North Side. All that was found left of him was his clothing neatly folded below the summit. This is quite typical of the condition. Confused, the brain tries to bring some order in the situation, thus folding the clothes.
Again, prevention is key! Here are some tips:
- Stay well nourished to help your body produce heat and shiver effectively when needed.
- Stay well hydrated and well rested.
- Change wet inner garments promptly
- INSULATE! (head and neck are key!) Source: www.basecampmd.com
Fractures
A fracture is any type of break in a bone. Most broken bones are simple butt it's useful to define the common, as well as some uncommon types of fractures (be aware that more than one type of fracture may be present in one victim):
A complete fracture occurs when a bone is broken completely through. This results in a bone in two or more pieces.
A partial fracture is a break that does not go all the way through the bone.
A simple or closed fracture doesn’t break through the skin.
A compound or open fracture is one where the broken bone breaks through the skin.
A greenstick fracture occurs only in children. The bone breaks on one side, but only bends on the other side. The reason the type of fracture occurs only in children in because the bones of children are much more flexible than the bones of adults.
A stress fracture is a very small crack, or series of cracks, in a bone occurring after repetitive activity that puts stress on a bone. Runners and basketball players are especially prone to stress fractures. About 25% of all stress fractures occur to the tibia (shinbone).
In an impacted fracture, the broken ends of the bone are driven together.
A spiral fracture occurs when a bone is twisted until it breaks. Imagine a wet rag being wrung out until it rips in two. Ouch!
Signs and symptoms of a fractured bone
The victim heard or felt a snap at the time of the injury.
The victim feels like bones in the injured area are grating together.
The victim is unable to use the affected body part in a normal fashion.
The injured body part looks deformed.
The injured area may be swollen and bruised.
The injured area may feel cold and numb.
Of course, bones protruding through the skin is a pretty good indication of a fracture!
First Aid for Fractures
CALL Emergency services, if available.
It takes a great amount of force to break a healthy adult bone. The incident causing the fracture may have caused other injuries. Care for any life threatening conditions first.
Control any bleeding present.
Apply an ice pack, or ice cubes wrapped in a towel, to the injured area. This will help to reduce swelling and reduce pain.
Help the victim remain calm and as comfortable as possible.
Splinting of a fracture and preparing for transportation
If you must move the victim of a fracture, or other injury (such as a bad sprain) that inhibits walking, first you must splint the injury:
A RIGID splint can be created from anything that is made out of an inflexible material, such as wood, branches, walking poles or tent poles etc . Secure the splint with straps, para-cord, rags or torn clothes tied around the injured part and the splint.
You can use towels and clothes, or any other material to create a SOFT padding.
An ANATOMIC is when you use another body part to splint the injured area. For instance, a broken leg may be splinted to the other (uninjured) leg, or a broken arm can be secured to the torso to prevent movement.
When splinting an injury, remember these important tips
Splint an injury only if you MUST move the victim.
Apply the splint to the injured area in the position you found it. Do not try to straighten out the injured area. This may cause further injury.
As well as the injured area, splint the joints directly above and below the injured area to make sure the affected area remains immobilized. ALWAYS check the circulation around the injured area before and after splinting. If your splint is too tight, you may cut off circulation to the injured area, and possibly other areas, as well.
When transporting an injured person, make sure the victim is well splinted and well supported on both sides. If the victim is absolutely unable to walk (for example, two broken legs or unconsciousness), fashion a sled out of anything you can find—logs or branches secured together, or even a large cloth, and pull the victim, making sure your path is clear. If possible, have someone walk ahead of you to clear any debris out of your path.
Your ligaments are tough, elastic-like bands that connect bone to bone and hold your joints in place. A sprain is an injury to a ligament caused by excessive stretching. The ligament can have a partial tear, or it can be completely torn apart.
Of all sprains, ankle and knee sprains occur most often. Sprained ligaments swell rapidly and are painful. Generally, the greater the pain, the more severe the injury is. For most minor sprains, you probably can treat the injury yourself.
Follow the instructions for P.R.I.C.E.
PROTECT - REST - ICE - COMPRESS - ELEVATE
PROTECT - Protect the injured limb from further injury by not using the joint. You can do this using anything from splints to homemade crutches.
REST - Rest the injured limb. But don't avoid all activity. Even with an ankle sprain, you can usually still exercise other muscles
ICE - Ice the area. Use a cold pack, or a plastic bag filled with cold water to help limit swelling after an injury. Try to ice the area as soon as possible after the injury and continue to ice it for 10 to 15 minutes four times a day for 48 hours. If you use ice, be careful not to use it too long, as this could cause tissue damage.
COMPRESS - Compress the area with an elastic wrap or bandage. Compressive wraps or sleeves made from elastic or neoprene are best.
ELEVATE - Elevate the injured limb above your heart whenever possible to help prevent or limit swelling.
After two days, gently begin using the injured area. You should feel a gradual, progressive improvement. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others), may be helpful to manage pain during the healing process.
The sprain could be very serious if, you're unable to bear weight on the injured leg, the joint feels unstable or you can't use the joint. This may mean the ligament was completely torn. You have a fever higher than 100 F (37.8 C), and the area is red and hot. You may have an infection.
Inadequate or delayed treatment may cause long-term joint instability or chronic pain.
Heat Stoves, hot water, and even the sun can cause heat burns.
Chemicals Caustic chemicals such as Drano (used to clear material out of clogged drains) can cause chemical burns to the skin.
ElectricityLightning, electrical outlets, and live electrical wires can cause electrical burns.
While travelling in Tibet the most common burns you will come across are either from fire or the sun, but other burns can occur, ofr example car/bike exhaust burns or the improper storage of chemicals
Types of burns
There are three different types of burns.
First degree burns
A first degree burn involves only the outer layer of skin, and no lasting or permanent damage occurs. First degree burns usually heal within 2-3 days. Most sunburns are first degree burns. Symptoms of a first degree burn are generally limited to mild stinging pain and redness at the site of the burn. First aid for a first degree burn, if any is needed, is usually limited to immediately flushing the burned area with cool (NOT COLD) water. Aloe Vera gel, or a topical anesthetic spray (such as Solarcaine or Dermoplast) can be used to lessen the pain of the burn.
Second degree burns
Second degree burns, also called partial-thickness burns, affect the top layers of the skin, and may occasionally affect part of the deeper layers of skin. With a second degree burn, the skin is able to heal itself, but scarring may occur. Second degree burns typically heal within 2-3 weeks. Symptoms of second degree burns include the redness and pain associated with first degree burns, although the pain may be more intense, as well as the formation of blisters at the site of the burn. Blisters form when the outer layers of the skin separate from the inner layers, and fluid accumulated within the space between the layers. First aid for second degree burns is the same as for first degree burns, with an added caution: if blisters form at the site of the burn, DO NOT pop them! They are there for a reason (to help heal the skin) and popping them before they’re ready doesn’t help, and may even hinder, healing. A popped blister is very painful, and you certainly don’t want to add more pain to an already painful situation. Usually, the body will absorb the fluid inside a blister, and the blister will go away on its own.
Third degree burns
Third degree burns are also called full-thickness burns, or critical burns. Third degree burns destroy all the layers of skin, and can even affect fat, muscle, and other tissue below the level of the skin. Third degree burns have even been known to destroy bones. Third degree burns can be life-threatening, and require immediate medical attention. Symptoms of a third degree burn vary greatly between those of first and second degree burns. A third degree burn is usually painless, due to the destruction of all nerve endings in the burned area. The burned area can range from an ashy-white color to charred brown or black, possible with white patches underneath. FIRST for third degree burns involves managing the victim’s situation until the person can be treated in a hospital. DO NOT remove any clothing or material from the burned area—peeling clothing off a serious burn may cause more damage. Cover the burn with a CLEAN cloth or sterile dressing. Do not apply pressure. Covering the burn helps prevent heat and fluid loss. The most serious threats to life from a third degree burn are the systemic (body-wide) effects the burn causes:
Loss of water and plasma.
Decreased blood circulation.
Decreased urine production leading to kidney failure.
A decrease in the body’s immune response.
A high risk of bacterial infection—the burn area provides an entry point for bacteria into the body.
GET HELP as quickly as possible for the following burn situations: Evacuate to the nearest big hospital.
ANY suspected third degree burn.
Any burn victim having trouble breathing.
Second degree burns covering more than one body part, or affecting the genitals, head, neck, hands, or feet.
Any burn (other than very minor) to a very young or very old person.
Any electrical or chemical burn, or a burn from an explosion. Victims in these situations may have internal burns you aren’t able to see.
Burn prevention
Always be alert when making or around open fires or large Tibetan stoves
Be careful of hot pans on the stove, keep handles turned inward
Don't mess around with electricity wires in remote areas
When you are working with an electrical device, make sure it’s unplugged, or the power is turned off
Don't mess around with any chemicals or unkonwn substances
Scrapes are the mildest and most common type of wound. A scrape occurs when the outer layer of skin is scraped off. Scrapes can be very painful since nerve ending just below the skin can be exposed.
Cuts
A cut occurs when a sharp or blunt object splits the skin. Cuts range from mild (like a paper cut, although some paper cuts can hurt terribly!) to severe, such as a cut from a large knife. Deep cuts can damage all layers of the skin, fat, muscle, soft tissue, blood vessels, nerves, and even bones.
Puntures
Puncture wounds occur when a sharp object pierces the skin. Again, punctures can be mild, such as a pinprick, to life-threatening, like a gunshot. A stab wound, depending on the use of the knife, can be considered a cut or a puncture. Severe puncture wounds can damage blood vessels and even vital organs, if the puncture is deep enough.
Avulsions
An avulsion is a cut serious enough to partially or completely remove a significant amount of skin or soft tissue from the body. Some avulsions can even cause accidental amputation of a body part, such as a finger or toe. Symptoms of wounds will depend on the wound itself, but mainly involve some degree of bleeding and pain. Very deep wounds can cause internal bleeding and injury, so be sure to pay attention to any complaints the victim may have, even those that don’t seem related to the wound itself.
First Aid for mild and moderate wounds
Wash the wound with soap and water, and dry thoroughly.
Apply a small amount of antibiotic ointment, if you have some.
Apply a bandage, if the wound is still bleeding. If not, leave exposed to the air.
First Aid for moderate and severe wounds
Control bleeding. Cover the wound with a clean cloth or sterile dressing and apply pressure. If the wound is bleeding freely, do not wash.
Elevate the wound above heart level if broken bones are not present or suspected.
Wrap and secure a bandage around the covering to keep it in place. Add more layers of covering if blood is soaking through. Do not remove any layers of covering already in place.
Suffering a severed limb may seem over-dramatic, but a good friend of mine had to deal with a guy’s arm which got completely severed off by an on coming truck on the way back from Mt. Kailash. So it happens!
Thanks to modern medicine, you may still be able to reattach the limb if you act correctly. You have to act fast, though, and keep your wits about you. Even if these instructions are followed to the letter, please keep in mind that there is still a high chance the limb will not be reattached. My friend carried a stranger’s arm all the way from the dusty roads of western Tibet to Hong Kong. Unfortunately the limb couldn’t be saved, but at least he tried.
1 ) Call an ambulance if available. If the incident happened where there is no phone service, or another such problem that interferes with you obtaining an ambulance for the victim, you or someone else will have to drive the victim and the limb to the hospital as quickly as possible.
2) Gently wash the severed limb with water. Rinse it, but do not scrub. This is not always possible, but it is good for sanitation reasons. If not possible for the limb to be washed, due to the distance between you and water, or other reasons, skip this. You don't want to waste time.
3 Wrap the limb in a moist, clean cloth.
4) Wrap limb again in a watertight material, such as a plastic bag.
5 ) Keep the limb cold. Do not freeze it. Direct contact with ice will destroy the tissue! Use bags of ice, snow or cold water, if at all possible. If this is not possible, remain calm, and find the coldest thing nearby. Remember, do this quickly.
6 ) Get to a hospital immediately. A limb saved in this manner can remain viable for reattachment for up to six hours, but due to the time it may take for the hospital to get everything they need together, you should never wait even a second.
Do these steps quickly, but try to follow them as closely as your time will allow. Decay starts the moment the limb leaves the body; you must try and slow it. The person who lost the limb should also be watched extremely closely at this time; never place more concern on the severed limb than on the person in question.
Only use a tourniquet as a last resort to stop the bleeding. You might cause further tissue damage.
Shock is a life threatening condition that usually results from severe physiological or emotional stress. Shock occurs when the body is not getting enough blood flow to the vital organs. Recognizing shock and treating it correctly may save a life.
Recognise the causes of shock.
Shock usually is associated with
Blood loss (hypovolemic shock)
Severe infections (septic shock)
Heart failure (cardiogenic shock)
Severe burns
Severe trauma
Dehydration
Severe allergic reaction (anaphylactic shock) - may be due to drugs, foods, insect stings or snakebites
Assess the situation
If the cause of the victim's injuries is a serious risk, i.e, road accident or a fall into a dangerous place, you may have to try to remove the victim to a safer place, or get help before attempting treatment. Call emergency services if available. Communicate with the victim if they are conscious. Look for injuries such as bleeding which you may be able to treat.
Look for shock symptoms.
Common shock symptoms include
Clammy skin (cool to the touch, and sweaty)
Pale skin
Nervousness, agitation
Disorientation/confusion
Thirst
Bleeding/blood loss
Rapid breathing
Blue-tinged skin (especially lips) or fingernails
Nausea or vomiting
Weak, rapid pulse
Dizziness / fainting
Begin treatment immediately if you see any of these symptoms. The sooner you begin treatment, the less likely a person is to go into shock. Make sure that the person is breathing and heart rate are steady.Lay the victim on his back, and elevate his legs about a foot. This is called the "shock position", and facilitates blood flow to the organs and brain. Make sure that the legs are higher than the heart.
Do this only if it does not cause further injury. You should not move someone to this position if he has suffered significant injuries to the legs, neck, head or spine. Do not put a very weak or unconscious victim on his back. Instead, lay him on his side in the recovery position. This will allow the mouth to drain in case of vomiting and prevent the tongue from blocking the airway. Try to maintain normal body temperature. You don't want the victim to get too hot or too cold. If it is cold, remove wet clothing and place an insulating barrier between the victim and the ground, if available, to decrease body heat loss (body heat is lost quickly through cold ground). A blanket, jacket, or sleeping bag will help. Wrap the victim in a rescue blanket or cover them with any available covering to keep them warm. If it is hot, move the victim to a shaded area and keep him out of the sun. Remove restrictive clothing. Watch for vomiting. If the victim vomits, tilt their head to the side and clear their airway. Do not move someone's head if they could have a head/spine injury. Instead log-roll their head and body as one (you'll need at least two people).
Treat the underlying injury. Do your best to stop bleeding, stabilize fractures etc or take other steps to prevent the victim from getting worse.
Keep the victim warm and comfortable until medical help arrives. Try to keep the victim calm; speak to him in comforting tones. Treat any injuries that you are able to competently treat, and observe anything which may be helpful to the emergency responders.
