BY CORY JONES
DIRECTOR OF
HIGHLAND EXPERIENCES
HTTPS://HIGHLANDEXPERIENCES.COM
Cory Jones
Bio
Cory is an experienced outdoor educator, expedition leader, and Director of both the First Aid Training Co-operative and Highland Experiences Ltd. With over 25 years of working across the UK and internationally, he specialises in first aid training for remote environments and is also a mental health first aid trainer. A seasoned paddler, Cory is a Paddle UK Endorsed guide. He has guided sea kayaking and canoe trips in Scotland, Canada, Baja and East Africa.
Cory is also a regular contributor to Wee Wild Adventures, where he blogs about paddling journeys, remote travel, and practical field skills for outdoor enthusiasts.
To download a free copy of our Outdoor First Aid manual, follow this link: https://firstaidtrainingcooperative.co.uk/download-your-free-digital-first-aid-manual/
First Aid for Paddlesports (part three): Casualty management
Not all paddling injuries happen in a moment. Some build gradually. In the final part of this series, we include issues that may develop slowly and look at their management, as well as how to handle the worst-case scenario – multiple casualties.
Scenario 1
A kayaker has taken a nasty swim in a river. They appear fine, but the next day they call you and complain of shortness of breath. Secondary drowning.
In secondary drowning, watch for delayed symptoms. In rare cases, a casualty who has inhaled water during a near-drowning incident may appear to recover initially, only to deteriorate hours later.
This is called secondary drowning. Inhaled water can irritate the lungs, causing inflammation and fluid build-up – a condition known medically as delayed pulmonary oedema. Signs to watch for include persistent coughing, difficulty breathing, discomfort when the casualty tries to lie down, unusual fatigue, chest pain, or changes in the voice. If any of these symptoms develop in the hours after immersion, especially if the person was struggling in the water, seek medical help immediately. Constantly monitor casualties for at least 24 hours after a significant water rescue, even if they seem well at first.
Scenario 2
Your fellow paddler has been on the go for a couple of hours; they complain of feeling dizzy and dry-mouthed. Dehydration.
Surrounded by water, it’s easy to forget your body might be running dry. But dehydration is common in paddle sports. Physical exertion, heat, dry wind, thick clothing and poor hydration planning all contribute. Symptoms to watch for include dehydration, which can develop subtly and escalate quickly, with common signs including headache, fatigue and lethargy, dizziness, poor concentration or irritability, and dark, reduced urine output.
Preventative steps and first aid include drinking small amounts regularly throughout the day. Use a hydration bladder or water bottle that’s easily accessible. Use electrolyte tablets or rehydration salts on long or intense paddles. Take frequent rest breaks, particularly in hot or windy conditions. Mild dehydration can be reversed with oral fluids and rest. If the casualty is confused or fainting, evacuate and seek medical advice.
Scenario 3
Carrying boats across rocky ground, someone slips and turns an ankle. Joint sprains and strains.
Not every injury is dramatic. Long paddling days can strain wrists, elbows and knees. Slips when portaging or getting in and out of boats often cause ankle sprains. Signs include pain, swelling, limited movement and bruising. Support the joint with a cohesive bandage (like Vet Wrap), which provides compression even when wet. If pain is manageable and the person can move the joint, you may be able to continue cautiously. Cohesive bandages can be used for support at the end of a long day’s paddling or boarding when wrists or knees begin to ache.
If, after a fall, a joint is unstable, numb or visibly deformed, treat it as a fracture. Splint or immobilise and plan an evacuation. The main aim is to prevent further damage.
Scenario 4
A paddler slips whilst carrying their boat and falls with an outstretched arm to protect themselves. They now complain they cannot lift their arm. Shoulder dislocation.
Dislocations were once more frequent in moving water, but modern techniques have reduced the number of shoulder injuries. However, they can still happen. If, after an incident, someone clutches their shoulder, has disproportionate pain, cannot lift their arm, or you see a visible lump or droop where the joint used to be, it’s likely dislocated.
Do not attempt to reduce (pop) the shoulder back into place. Instead, immobilise the arm in the most comfortable position. A sling improvised from a paddle leash, drybag strap or spare clothing can provide support. Arrange evacuation.
Scenario 5
After landing on a wave-cut platform, a kayaker has minor finger injuries: small cuts and abrasions, with a risk of infection.
Sharp rocks and barnacles on landing zones can slice exposed hands and feet. These wounds are often dirty and prone to infection, especially from marine bacteria. Flush the wound thoroughly with clean, fresh water. Avoid seawater, as it may contain further contaminants. Remove visible grit or shell fragments, apply a sterile dressing, and apply pressure if bleeding. Watch for swelling, redness, or increasing pain. A medical professional should always review deep wounds.
Waterproof dressings (Easiplaster) or tape are invaluable additions to your paddling first-aid kit.
Scenario 6
A paddle complained of rubbing and pain in their thumb 20 minutes ago. Now they have a painful red patch of broken skin. Blisters.
Even experienced paddlers get blisters from time to time. Repeated strokes under pressure, especially with wet hands or poor grip technique, can wear away the skin on the thumbs, palms, and fingers. For intact blisters: clean the area and apply a blister dressing or hydrocolloid plaster. For burst blisters: rinse with clean water, apply antiseptic, cover with a sterile pad and tape in place. Then monitor for redness, swelling, or pus – signs of infection that require medical attention.
Blisters might seem trivial, but if they compromise your grip or cause infection, they can rapidly affect safety and mobility.
And finally, multiple casualty management
In a group paddling incident – such as a capsize in rough water or a collision – it’s possible to have more than one casualty. Start by calmly applying the ABC approach to each individual and identify who has life-threatening needs. Prioritise those who are not breathing, unconscious or severely bleeding. Delegate tasks to others in your group: one person calls for help, another provides basic first aid, and someone gathers up lost or loose kit if it’s safe to do so. Use group shelters, spare kit and buoyant platforms to support multiple people. Reassure constantly and reassess regularly – conditions and casualty status can change fast in cold or remote environments.
You may never face a serious first aid situation on the water. But when you do, you’ll be glad you practised. Take a tailored Outdoor First Aid course. First Aid Training Co-operative offers paddler-specific first aid training. Learn how to assess risk, treat common injuries and adapt techniques to your environment. Rehearse your scenarios in real gear, on real water.
To download a free copy of our Outdoor First Aid manual, follow this link: https://firstaidtrainingcooperative.co.uk/download-your-free-digital-first-aid-manual
Great and useful article.
Apologies for the long comment, but re Shoulder Dislocation in Scenario 4, as with all medical conditions and treatments, it’s worth being aware that there are a range of opinions, and it’s well worth considering – especially for remote trips or where evacuation might be long and maybe dangerous – preparing with some basic training in reducing shoulder dislocations.
There is – according to a top Australian orthopaedic shoulder surgeon who I heard speak at a kayakers’ workshop on managing shoulder dislocations – a ‘golden 2 minutes’ of opportunity immediately following a shoulder injury in which to reduce a dislocation – ie to get the head of the humerus back to where it should be – with little effort and relatively little pain, and while the musculature surrounding the joint is still relatively flexible and pliable.
The ‘golden 2 minutes’ makes it clear that quick action is imperative: it’s vital to act before shock and muscular contraction sets in as the joint ‘automagically’ begins to protect itself against further trauma and effectively seizes up, becoming increasingly tender and painful.
If the dislocation occurs in a remote area where evacuation might require many hours or even days and severe discomfort for the casualty, rapid reduction of a shoulder dislocation can help avoid:
– increasingly severe pain during what might be a potentially awkward and maybe even dangereous evacuation,
– the need for strong analgesics which could be out of date, and may not be effective, having been sitting unused in someone’s first aid kit for years, or in a potentially somewhat dodgy medical facility (especially UK haha) when/where the shoulder is eventually reduced; and
– potential complications in the form of (‘adhesive capsulitis’) resulting from prolonged immobilisation and inflammation. It’s worth being aware that early mobilisation of the joint (under controlled conditions) is the most effective means of minimising the risk of what can be a very long and painful, not to mention inconvenient, period of frozen shoulder lasting anything from about 1-3 years – and which will severely impact the casualty’s paddling (and drinking abilities)!
The paddler may not (or may) be able to continue paddling, but overall, evacuation following reduction of the dislocation is likely to be a whole lot easier and less painful for all concerned.
In one of the most common mechanisms of dislocation for a paddler, where their shoulder at full extension while executing a support stroke or brace in a hole, typically with the affected hand up and behind the head, the simplest and most effective approach to reducing a dislocation is to get the humerus to go back in the same way as it came outL ie get the casualty to sit down, explain what you (or rather they) are going to do – which is to gently guide the affected arm up and back in the action of preparing to throw a cricket ball.
Assuming the casualty is sitting down, and is likely to be supporting the affected arm, holding the wrisst with their opposite hand, guide (ideally the casualty will be able to do it themselves) or gently lift the affected hand to mimick preparing to throw an imaginary ball with an overarm action.
This involves very gently lifting the hand up and back until the hand is level with or just behind the ear, the forearm is at or just past the vertical and approximately at right angles to the upper arm. This action makes the head of the humerus gently rotate in the joint, and with luck and a following wind – it will pop back to where it is came from with a satisfying click.
IMPORTANT! It’s only the phase of preparing to throw an imaginary ball that is needed: do not let them try and chuck said ball!
I can attest to the effectiveness of this method which I’ve personally executed. It’s simple, feels very natural to the casualty and is surprisingly effective. BUT it is important that you (and ideally also your paddling mates):
– have had some training in dealing with such an injury (especially if any member of the party has suffered prior shoulder dislocations),
– know what to expect and what the options are if confronted with a dislocation,
– have assessed the risks of reduction vs immobilisation,
– are confident there are no potential complications to the injury such as fractures or nerve entrapments, and
– have the casualty’s consent to do so (ie they actually want you to do it).
Hopefully this knowledge might inspire some important basic medical training for those going on remote trips, and even better if it helps even one person avoid longer term frozen shoulder.