Throughout this book I tell you to seek expert advice if you are in any doubt about anything. Due to varying states of health, allergies, complications and circumstances, it is almost impossible to give general medical advice. In health matters, you should always seek expert medical assistance immediately. If you are caught in the jungle or on a mountain slope, miles from assistance, I offer some advice that could help to keep you alive. Before travelling, check with: your doctor to make sure that the general advice given here is relevant to you and your medical condition and history.

Water and Food – countermeasures

• If travelling with young or frail people, consult your doctor before you go. Decide if the risks are acceptable and consider leaving young and the old and frail at home. If you take them, ask your doctor about taking re-hydration formula or anything else to help them recover if they fall ill.
• If any member of your group suffers from an infection, seek medical assistance immediately. These infections can easily become life-threatening.
• Strictly observe basic hygiene rules. Wash your hands when you have been to the toilet and before you eat or handle food. Make sure you use good-quality soap. Make sure that you dry your hands thoroughly afterwards using a clean towel.
• When you brush your teeth while abroad, don’t trust the local water. Make sure that you use bottled or (cold) boiled water with your toothbrush.
• If self-catering, thoroughly wash all toilets, basins, kitchen work surfaces, plates, saucepans and utensils, using hot water and a bacteriological washing liquid or cleaner before you do anything else Then thoroughly wash your hands again.
• Don’t use a grimy wash cloth or tea towel. They are an efficient way of breeding and spreading germs.
• Any raw food is potentially contaminated. Don’t buy raw food that is exposed to the touch in shops and markets. It is also exposed to flies and air-borne contaminants. Don’t buy it. use it or eat it
• Some raw foods such as oysters are especially prone to infection.
• Never eat salad ingredients that are unwashed or may have been washed in local water. If the water is contaminated, the food is contaminated too.
• If you want to risk eating salad, thoroughly wash it yourself, using clean boiled and cooled water or bottled water.
• Try to eat hot cooked meals where possible! Cooking makes the food hot, which kills most infections. Hot food means safe food – as long as it is fresh, hot and recently cooked.
• Don’t forget that hot food served on dirty plates and with dirty cutlery, or drinks made with local water, can all infect you.
• How clean were the waiter’s hands when he handed you that bread roll?
• Undercooked food is as dangerous and sometimes more dangerous than raw food.
• Avoid re-heated or warmed food. Re-heating food creates the perfect breeding ground for infections. Some hotels prepare food then leave it sitting around for hours, if not days, and then re-heat it. Others cook food and leave it on display in a restaurant or buffet in barely warm food containers – all of which introduces infection and increases the risk of diners becoming ill. Try to avoid standing food. Aim to eat freshly cooked hot food.
• If the conditions in the restaurant or dining room look less than clean, eat elsewhere.
• Some tropical fish contain high quantities of ciguatoxin, a harmful bio-toxin. Barracuda is apparently the worst, but it is also present in red snapper, grouper and amberjack. Unless they are tested, nobody knows how much ciguatoxin they contain, so be wary of exotic fish!
• If you are self-catering, be careful where you buy your food. They may claim it is pork, but it could be lizard or donkey! Worse, you don’t know where that ‘apparent’ pork chop has been and how long it has been sitting there acting as an airfield for the local flies while it waits for you to buy it.
• If you buy fresh, try to buy things that you know are safe. Something that is wrapped by nature or a factory should be safe. A sack of local beans could be suspect. Baked beans in a can should be safe from contamination (assuming the can isn’t dented, past its sell-by date, rusty or pierced). An undamaged banana, orange or other fruit that has to be peeled should be safe because it was wrapped by nature.
• Avoid washing anything that you eat whole, such as grapes! Try to avoid eating fruit that you can’t peel, or wash using safe bottled water.
• Vegetables that need to be peeled and then cooked should be safe, because when the skin comes off most of the contaminants and potential infections are removed, and cooking kills almost anything else if you reach a high enough temperature.
• At a restaurant, don’t be scared to ask to see the kitchens, especially if you will be eating there for the duration of your holiday. I have seen kitchens where I wanted to wipe my feet on the way OUT because they were so bad. Dirty walls and floors, windows open to flies, rodent droppings clearly visible, cockroaches wandering around. Pans, cookers and vents clogged with fat and grime, and cooked and raw food sharing the same cutting board. In one kitchen I saw a rat sitting behind a bin chewing on something! If it looks bad, avoid eating there and consider quietly warning others in your hotel about your concerns. Don’t make a fuss. Some owners have been known to take a kitchen knife to a tourist who speaks out about a dirty kitchen. Report any concerns to your holiday company and get their response in writing.
• Even if you can’t see into the kitchen, if the rest of the place is overrun with flies, the kitchen probably will be too. Find somewhere else to eat.
• Beware of rich foods, and exotic sauces and spices. They alone can be rich enough to upset a British stomach raised on burger and chips and an occasional roast potato or pork chop.
• Unscrupulous cooks can use spices to disguise the taste of slightly rancid food. Avoid spicy food unless you like it. If so, make doubly sure that the kitchens are clean.
• Some countries see the quality of their water as a status symbol, so they won’t declare that it is unsafe to drink. It may be safe for the locals who have built up a working immunity to it, but it may not be safe for a tourist with no immunity.
• Drink bottled water, but make sure that the bottled water is safe. Criminals abroad know that we demand bottled water, so they are not slow in putting local tap or river water in bottles and selling it to us at a vast profit.
• Check bottled water is safe. Buy brands that you know and recognise. Check that the bottle lid is sealed and intact, then you are pretty sure that it has not been refilled with local water. Hold the bottle upside down and squeeze it gently, if it leaks it might have been tampered with. In any case, if water can get out through the cap, contaminants can get in. so don’t buy it
• Remember that water comes in other forms. Don’t order a glass of water with your meal – ask for a sealed bottle so you know it is safe. If you want a whisky with a little water or a glass of orange squash, make sure it isn’t local tap water they are using.
• Ice is water too, so avoid ice cubes or an ice lolly for you or the kids. They could be made with contaminated water.
• Similarly, avoid ice cream, yoghurts, etc. They could be swimming with harmful bacteria.
• Because they are made with boiling water, coffee and tea are usually safe, but consider avoiding local milk.
• Swimming pools are full of water. One survey showed over 25% of holiday pools used by British tourists abroad contained an unacceptably high level of bacterial infections. You only know it’s infected when the whole family suffers from something nasty a few days after taking a swim Avoid pools if you can. Make sure that the hotel or resort claims that their pool is clean and regularly tested and treated.
• On arrival, ask some of the guests who have been there for a while if they use the pool. If they say yes and they are OK, the water in the pool should be safe – for now anyway.
• Coastal seawater can also be heavily infected and/or contaminated. In rougher seas you are more likely to swallow some of the water with any infection and contamination it holds. (Also see warnings about strong currents, tides, sharks, jelly fish, etc. below.)

Rabies – countermeasures

• Avoid animals when you go abroad – any of them could be infected.
• Use common sense and don’t go anywhere near an animal that the locals are avoiding.
• Avoid any animal that seems to be aggressive or behaving oddly.
• Don’t get bitten or scratched by any animal.
• Treat and cover all scratches and cuts, to prevent infection from entering an open wound.
• If bitten or scratched by an animal, seek medical help immediately.

Lyme disease – countermeasures

• Walkers should avoid walking in areas where ticks are known to be common – take local advice.
• Wearing long trousers that are tucked into socks, long-sleeved shirts, etc., offers some protection if you have to work or walk in an area where the ticks are present.
• Don’t leave bare skin exposed or places where the ticks can get into your clothing. A shirt may be buttoned, but ticks can still get inside the shirt.
• Tick repellent used according to instructions on your skin and clothes should deter the ticks.
• Anyone walking in brush, bracken, etc., should regularly stop to check for and remove ticks. It is unlikely that infection will occur in the first 36 hours of tick attachment. Regularly removing them will drastically reduce the risk of infection.
• I am told that the way to remove ticks is to touch them with a burning cigarette – if you do, they let go. If you are a non-smoker, avoid trying to hold the tick to pull it off. Pinching the tick tends to squeeze it, injecting the contents of the tick through its own bite into your body. Instead, use the same method that is used to remove a bee sting. Put the thumbnail against the body above the tick Scrape downwards through the tick so that your thumbnail acts as a blade pulling, scraping and removing the tick.
• If you discover that you have been providing lunch for any ticks, scrape them off, then take them with you in a sealed container to seek medical advice, or leave them on and get the doctor to remove them – assuming you can get an appointment quite quickly.

General mosquito, tick etc. – countermeasures

Though the medication is effective, you will still have to take precautions to avoid being bitten.

• Take any medication prescribed and always finish the course of medication. Don’t assume that you can stop taking it because you are feeling OK or are back in the UK.
• Take and use effective insect-repellent creams.
• If you suffer from any fever and feel ill while abroad, or for up to three months after you come back from an infected area, see your doctor. Describe your symptoms and tell him you recently returned from an area infected with malaria.

Avoiding mosquitoes – countermeasures

There are three basic strategies.

Avoidance

• Don’t give mosquitoes an opportunity to bite you by avoiding them in the first place.
  • Places. The mosquito needs standing water to breed. A warm, humid, swampy area with plenty of pools or ditches full of stagnant water will provide an ideal breeding ground. When arranging your journey, avoid any area where conditions make it likely that the mosquito population will be high.
  • Location. Most mosquito, tick and other insect-borne infections can be identified as being common in a given place. By avoiding travel to those places, a traveller can avoid exposure to the infection. Research and local advice should tell you the places to avoid. Generally, rural locations offer the greatest hazard.
  • Time. The mosquito is particularly active during twilight at dawn and dusk and fairly active all night. If possible, plan your activities to avoid the times when the mosquito is most active.
  • Season. To some extent some mosquito and other insect-borne infections are seasonal. By researching the destination and diseases, a traveller can avoid the times of year and seasons when infections are being carried by these insects.
  • Smell. As mentioned above, whatever your combination of smells, if you are plagued by mosquitoes. you might try changing your smell. Use un-perfumed soap, or use a different brand of deodorant, your fabric softener, shampoo, hairspray, hair gel, skin cream, perfume or anything else you can think of that may change your smell. But remember your aim is to put the mosquito off, not the other people in the hotel or on the beach around you!
  • Speed. Wind speed or your speed will defeat the mosquito. For example, when you are standing (safely and well back) on a cliff top enjoying a bracing wind, you will not suffer mosquito bites, because they couldn’t cope with the wind strength. Similarly, if you have a convertible car with the hood down and are driving to a party through the smelliest swamp, you are safe from a mosquito, because they can’t catch up with a car doing 50 miles per hour. (Is it safe to be doing 50 miles per hour through a swamp?)

Barriers

• Putting barriers between you and a mosquito will protect you.
• Before you go to bed:
  • If fitted, close mosquito screens at all doors and windows before dusk. If no screens are present, close the doors and windows to stop more mosquitoes coming into the room.
  • Spray the room with a mosquito killer, to kill any that got into the room when the doors and windows were open.
  • Turn up the air conditioning if you have it. Apart from making you more comfortable, the cooler temperature seems to make mosquitoes less active and so less likely to bite.
  • Make sure that beds are fitted with mosquito nets.
  • Give a final spray of mosquito killer inside the net half an hour before you get into bed (giving the spray time to dissipate before you get in).
  • When you get into bed, make sure that there are no live mosquitoes inside the net, and that the net is properly fitted and tucked in.
• Wear clothes that will cover as much bare skin as possible.
• Wear long sleeves and trousers to expose the minimal amount of skin to mosquitoes, especially in calm weather and at dawn and dusk when they are most active.
  • Consider increasing your protection by tucking trousers into socks to prevent mosquitoes crawling inside your clothes.
  • Think about wearing gloves and a hat too.
  • A mosquito hat has mosquito netting attached. It is a wide-brimmed hat with a veil of mosquito-proof netting which keeps the mosquitoes off your face, ears and neck. It also prevents that annoying tickling and the whining noise when they cluster around your face.
  • When wearing a mosquito hat consider tucking the netting into your shirt to prevent mosquitoes from getting underneath where they can bite.
  • You can sit in a screened area, a sort of patio with walls and a roof of mosquito mesh screens all around you. Just like getting ready for bed, you will have to spray and kill any mosquitoes that are already inside. When the screened area is clear and the screens are shut, you have the advantages of sitting ‘outside’ while being protected from mosquitoes and other insects.
  • Mosquitoes seem to be attracted to bright colours, just like a bee or wasp will fly around somebody in a bright yellow top. Avoid clothes made of bright-coloured material and some flower and leaf prints. Plain colours such as khaki, beige and olive seem to be safe to wear.

Treatments

• You can use chemical treatments to prevent bites.
  • You could spray the surrounding area, killing any mosquitoes present.
  • At the same time, drain or fill in any pools of stagnant water in the area to deny breeding grounds for new generations of mosquitoes.
  • You could spray your house, mosquito net, patio, even clothing (depending on the spray being used – check the instructions) to deter them.
  • You could apply special creams and sprays to yourself, concentrating on any exposed skin
• When using chemicals, be warned that they are quite strong. Abroad, you may be using a product from a questionable source where quality control and safety may not be the highest consideration.
  • Take local advice about which products work – but ask hotel staff, not the shopkeeper who wants to sell you the most expensive thing he has got.
  • Always read the can, bottle or packet before buying and before use.
  • Always read and strictly follow any instructions given.
  • If there are no instructions, don’t buy the product.
  • Do not eat, drink or breathe mosquito poison or repellents and do not get them in your eyes or in open wounds.
  • When using a new product, test it on a small area of fairly sensitive skin, such as the inside of your forearm, following the instructions on the packet. Wait to see if there is any reaction. If there is – don’t use it. If not. try using it on all exposed skin.
  • Only apply repellent on bare skin. Do not apply it to skin that will be covered with clothes. (Sometimes clothes rub and make the skin sore. If you have repellent on the skin and on your clothes, the rubbing action will grind the repellent chemicals into your sore skin.
  • Be wary of applying repellent to your forehead. You don’t want perspiration to carry it into your eyes.
  • When you have applied the repellent, wash your hands thoroughly.
  • Never touch your eyes or food until you have washed your hands thoroughly using soap and water and then fully dried them using a clean towel
• Though some reports suggest that taking vitamin B1 will stop a mosquito from biting you, other reports claim vitamin B1 makes no difference. Your choice!
• Some people claim that smoking will deter mosquitoes. That may work on the smell principle, but I have seen no research to prove the theory.
• Finally. I am told that mosquitoes don’t like Marmite. Apparently people who eat Marmite (the yeast-based savoury spread) seem to become ‘unattractive’ to mosquitoes!

injury and illness – countermeasures

• Before you leave the UK make sure that you have had all of the vaccinations that are recommended for your holiday destination.
• When you pack, include a basic medical kit, so that you can clean and dress minor wounds to keep infection and infestation at bay.
• Before travelling to remote places, seek expert advice on the medical supplies to take.
• Take advice about local threats to your health, such as dangers from swimming in rivers and lakes, snakes, scorpions, wild animals, blood-sucking insects, etc.
• If you are injured, treat the wound immediately. A small cut in a hot climate can become infected.
• The same cut in a cold climate can be just as dangerous. You might not be able to feel the pain that tells you that you have been injured. A small cut in sub-zero temperatures can lead to the loss of a finger or a hand.
• If you are bitten, scratched, stung or even sunburned, seek medical advice and treatment. Be safe, not sorry.

Geological movements – countermeasures

• Research will tell you which areas are subject to these risks.
• When you book, ask your travel agent to inform you of any impending eruption or other disaster.
• Some areas in the world are known to be on continental fault lines, and so are more likely to suffer problems. It is up to you to decide if the risk is too great to take.

Thunderstorm – countermeasures

• If you can hear thunder, you are probably close enough to the storm to be struck by lightning. If not you soon will be. so take shelter.
• As ‘positive lightning’ can strike from the top of a thundercloud and hit a target under blue sky up to 10 miles away, seek shelter whenever a storm is in the area.
• About 10% of lightning strikes occur in an area where there appear to be no clouds in the sky – that means to one side of the storm
• Check for thunderstorms and aim to be inside a building or vehicle during any storm, particularly violent tropical thunderstorms. Never stand in the open during a thunderstorm.
• If you see billowing clouds with dark bases and the wind strength is increasing, you don’t need a weather forecast to tell you that a thunderstorm could be forming, so get to safety.
• If lightning is forecast, seriously consider changing your plans, or have an alternative activity planned where you can take cover quickly. Then seek a building that will have walls all around you. not something like a carport which may not protect you. A cave would do in a rural area, or get into a vehicle (not a convertible) and wait until you can no longer hear or see the storm.
• A high proportion of lightning strike victims and witnesses report that there was no rain falling at the time. If you wait for the rain you are already too late.
• If you cannot get to cover, aim to be the lowest point in the area. You don’t want those leaders (upward-reaching fingers of charge) attracting a strike to the top of your head. Move to lower ground if you can, and if necessary lay flat in a depression even though it is wet and muddy and cold. Remember that if your hair stands on end this indicates that a leader is running up through you and a lightning strike is not far away. Under these circumstances laying in the mud becomes quite an acceptable option!
• A lightning strike to a nearby object can send electricity through the ground and to you nearby. We all know not to shelter under a tree in a thunderstorm. If caught in the open, as a rough guide you should estimate the height of the tree, and stay three times that distance away from the base of the tree (or other tall object) to be safe from the radiating effects of a strike on it.
• Discard any metal objects, such as golf clubs, walking sticks or a metal-framed rucksack, fishing rods, tennis rackets and tools. Get off a bike or motorcycle. Don’t lean on cars or metal fences and gates. Consider removing metal jewellery.
• Stay out of and away from water, because water is a very efficient conductor of electricity. Stay clear of beaches and get out of small boats and canoes. Don’t get caught a long way from the shore in a small boat in a thunderstorm. If you are, lower any sails for safety because of gusting winds, move to the middle of the boat and lay flat. Stay as far away from any metal fixtures and fittings as you can. Be wary of metal fittings on any safety lines, life belts, etc. you may be wearing.
• Even people in the water, swimming and scuba-diving aren’t safe. Swimmers can suffer injury through lightning strike.
• Give first aid after a strike and call for medical assistance as soon as you can. If the victim has stopped breathing, begin mouth to mouth. If the heart has stopped beating, a trained person should give cardiopulmonary resuscitation (CPR). If the struck person has a pulse and is breathing, address any other injuries.
• Beware of additional lightning strikes – lightning does strike twice in the same place!
• NOTE: After a strike, the human body drains the electricity, so you cannot get a shock by touching a victim and it is therefore safe to offer assistance (assuming there are no other risks around).
• The victim will have burns in two places. There is usually an entry wound/burn and an exit wound/burn. For example, a victim may have been holding a metal umbrella, and the lightning entered through their right hand, travelled down through their body and exited through their left foot into the earth. There will be a burn wound at the entry and exit points. Being struck by lightning can also cause nervous system damage, broken bones, and loss of hearing or eyesight.

Excess heat – countermeasures

• Take your time getting used to the climate.
• Pace yourself until you have acclimatised.
• Drink plenty of water (not alcohol).
• Don’t forget that when perspiring you need to replenish your body salts, so don’t forget to eat some salty foods to balance the loss or drink something specially formulated to rebalance the body chemistry.

Sunburn – countermeasures

General precautions

YOU must consider your personal skin colour, tolerance of sunshine, the location and climate you are in, the season, time of day and all of the other factors that determine whether you will burn or not. YOU have to make the decisions to protect yourself from sunburn.

• Stay out of the sun during the hottest part of the day, usually between 10am when it starts getting hotter, reaching a peak at about noon, and falling off after 2pm. If you have fair hair or red hair and light skin or have just arrived at a tropical destination, you may want to expand that danger period to 9am-3pm.
• Remember that you are still receiving UV radiation when sitting in the shade. Light and radiation reflect and bounce off the sea, the beach and buildings, which means you are still burning while sitting under an umbrella or in a beachside bar.
• UV radiation is reflected by different surfaces, which may even amplify the effects of UV exposure. As an example, snow reflects about 90% of UV radiation (which causes snow blindness). Beach sand reflects only about 20% of UV radiation. Remember that some things absorb UV radiation. Glass absorbs almost all UV radiation so sitting behind glass is quite safe.
• When it is daylight the sun is up there somewhere, even if it is overcast or cloudy. It may seem dull but the sun is still shining and UV radiation is still burning through those clouds and reaching you.
• Plan your activities to avoid the strongest sunshine, taking into account location, season, the time of day, weather conditions and the task to be done.
• Buy and wear a broad-brimmed hat to protect your head and the back of your neck from the sun.
• Cover your skin with loose and lightweight clothing, long-sleeved shirts and trousers. Any covering will offer some protection from the sun. Loose lightweight clothes will protect you without making you too hot.
• Be aware that some clothes are designed to allow UVB to pass through so that the wearer can still ‘get a tan’.
• Open-mesh fabrics and any clothing with a loose weave will tend to allow some radiation to pass through, so you will still burn. Try any new clothing before you rely on it to protect you for longer periods.
• Buy a good-quality sun cream, with a high protection factor. About half an hour before exposure to the sun, apply it to all exposed skin, not forgetting ears, nose, back of the neck and elbows. Any exposed skin is likely to burn.
• Anyone participating in outdoor activities (surfing, swimming or other sports) should be aware that sunscreen is likely to be washed off, worn off or be affected by perspiration. Be particularly careful about re-applying the sunscreen to maintain good protection.
• After swimming, jet-skiing, surfing, etc., you should get out of the sun or dry off with a towel. Full sun on wet skin will burn the skin in a very short while.
• Mountaineers and glider pilots or others who reach higher altitudes must realise that the level of solar radiation present increases with altitude. The higher you climb the stronger the radiation and the quicker you will burn. Protect particularly the back of the neck and the nose.
• If you begin to feel any effects of the sun, your skin is telling you to go into the shade and away from any UV radiation. By the time you start to feel uncomfortable, your skin has already been ‘damaged’.
• Adults should make sure that children wear suitable clothing and that they keep this on while playing. An unsupervised child in a park or on a beach can quickly shed a hat and other clothes as they play.
• Children have particularly sensitive skin. Remember the effects of solar radiation are cumulative You should frequently apply high protection factor sunscreen to them, and plan to take them to indoor activities on high sun strength days.
• Babies under a year old should be kept out of and protected from direct and reflected sunlight and radiation.
• People who are on certain medication such as diuretics, and people with some skin conditions such as eczema and psoriasis (which in non-medical terms means you have a weak skin), need to take extra care to avoid the effects of UV radiation.
• As a final thought, remember that a ‘tan’ is just a visible symptom of damaged skin. Healthy skin is the colour of your skin ‘where the sun doesn’t shine’. The bigger the difference between your ‘pink bits’ and your tanned skin, the greater the damage your skin has already sustained.

Sunburn treatment – countermeasures

• First, remove the patient from the sun and take them to a clean cool place.
• For mild sunburn, take the heat out of the skin. Take a cold or cool shower. If a cold bath or shower is not possible, put a clean, cold, wet cloth over the affected areas, and allow a fan to blow air over the cloth to evaporate the water and cool the patient.
• If necessary, the patient can be given Ibuprofen or other over-the-counter painkillers, as long as they are not allergic to them or taking any other medication at the same time. If in doubt, seek medical advice.
• Commercial products are widely available to treat sunburned skin. Look for calamine lotion and aloe vera. Whatever treatment you use, never use anything that feels greasy, because grease traps heat, reflecting heat back into your skin and making the burn worse.
• If blistering develops, the skin will probably break, leaving a wound through which infection could enter the body.
  • Keep sunburned skin clean.
  • Avoid any hot baths and showers – the heat will add to the damage and discomfort.
  • Avoid infection by making sure that anyone treating the sunburn patient thoroughly washes their hands.
  • If blisters do form, never burst them deliberately.
  • Following the instructions on the packet or advice given, you may apply antibacterial cream to the area.
• Severe sunburn can be accompanied by dehydration. If there are any complications or you have any cause to be concerned, seek medical advice immediately.
• After being burned, learn your lesson. Remember that the effects of solar radiation are cumulative so take sensible precautions in future.
• Think about other members of your family or group. If you have been burned, elderly, young or light-skinned members of the group may be hiding sunburn because they are embarrassed to admit it.

Sunstroke and heat stroke – countermeasures

• Stay out of the sun.
• If you are not used to the heat and humidity, avoid any activity that requires you to work hard or 74 play active sports in the sun and heat.
• Be particularly careful with young or elderly people in a hot and sunny environment. Don’t underestimate the cumulative heat that can be experienced when walking in a canyon for example. The rock walls can reflect and retain the heat and turn a canyon into a natural oven.

Dehydration prevention – countermeasures

Adults should be sensible enough to recognise when conditions can cause dehydration. If you are not used to hot, humid, sunny conditions but have to work, walk or play hard, beware.

Adults should extend their care of children and the elderly when conditions are likely to promote dehydration.

• Try to stay out of the sun and heat.
• Reduce your activity to a sensible and sustainable level, or undertake activities earlier or later in the day when it is not so hot.
• Drink plenty of water. Make yourself drink it even though you don’t feel thirsty. Take regular small drinks to be sure that you are taking in more water than you are losing. Remember, by the time you feel thirsty you are already a little dehydrated. If you are very thirsty you are definitely dehydrated!
• You can drink some sports drinks, which are formulated to help your body maintain its electrolyte (chemical) balance, but they can be quite expensive and are not widely available.
• If you feel or see any of the symptoms listed above, assume that you are losing the battle against dehydration and take immediate steps to prevent further loss.

Dehydration treatment – countermeasures

• Watch for the warning signs of dehydration. The conditions that cause dehydration are plain to see. Don’t become dehydrated because of stupidity.
• Early dehydration can usually be treated at home after seeking advice from a doctor, but always consult a doctor when dehydration is suspected, especially with children.
• Early dehydration can be treated by drinking water. More severe cases will need formulated drinks that restore body salts as well. If available, sports drinks may be recommended because they are formulated to restore the balance of salts and electrolytes.
• In more severe cases a patient will have to be hospitalised. Remember dehydration can cause organ failure and damage. If in doubt, get in the cool and seek medical advice.

Dazzle – countermeasures

• Early morning sun and late afternoon sun coming from low on the horizon might dazzle you.
• Wear a good pair of sunglasses.
• The sun can dazzle you at any time of the day, by reflecting off cars and windows. When you drive up a steep hill you may find yourself looking directly into the sun.
• If dazzled while driving, slow down carefully. Remember that drivers behind might already be dazzled, so they won’t see your brake lights and won’t stop when you do.

Hypothermia – countermeasures

The advice is different if the victim is on land or in the water. If you believe that somebody is suffering from hypothermia, seek shelter and urgent medical advice and assistance.

On land

• Let somebody know where you are going and when you will be back.
• Arrange for them to check on your return and raise the alarm if you do not return when you should.
• Carry a whistle to signal rescuers or people around you.
• Carry a signal mirror or flares to signal aircraft in more remote areas.
• In the wilderness, try to make a signal that is visible from the air, for example by laying branches in a cross, or by making a smoky fire that can be seen from a distance.
• Find or make shelter as soon as you can. Dig a snow hole (a cave in a bank of snow – but don’t get buried or cause an avalanche). Build a shelter from any materials you can find. Get in and get out of the wind but keep an air hole open (don’t suffocate).

At Home

• Anyone who lives alone or in remote areas should agree to mutual checks with several other residents. Call each other every day and make sure that each of you is alert, responding, answering questions correctly and seems healthy.
• Wear multiple layers of loose clothing. The insulation effect of multiple layers increases your body heat retention.
• If you feel cold, wear a scarf and hat even indoors. A lot of heat is lost through the head, so cover it in extreme conditions.
• Put extra blankets on the bed at night. In really cold weather you can suffer from hypothermia while sleeping. Consider sharing a bed!
• Eat a sensible balanced diet. Your food is the fuel that keeps your body running.
• Make sure that you drink enough fluids. Warm drinks help to maintain your temperature and prevent hypothermia.
• Avoid alcohol! It is a stimulant, but though you might think of it as a ‘bracer’, the net effect is that alcohol will make you lose body heat and accelerate the onset of hypothermia. Fall down drunk. and you could be on your way to the undertaker!
• Make sure that you get enough rest and sleep. Lack of sleep makes you more susceptible to hypothermia.
• Stay dry. Wet clothes lose their insulating value. If you get wet from perspiration, rain or snow. change into dry clothes as soon as you can.

On the water

Take sensible precautions, such as:

• Knowing the limitations of your boat.
• Knowing your personal limitations in skill and ability as well as strength.
• Having the right equipment on board.
• Having a radio so that you can pick up weather reports and summon assistance.
• Taking shelter if a storm is approaching.

If you still get into trouble:

• Summon assistance immediately you start having problems. Don’t wait until you are desperate.
• Stay out of the water for as long as possible. Water conducts heat away from the body at least 25 times faster than air.
• Make sure you wear a lifejacket and that it is properly fitted and secured.
• When in the water don’t remove any clothing. Even wet clothes and shoes offer a little insulation when you are in cold water.
• Don’t try to swim to shore. In cold water even the strongest swimmer is unlikely to be able to swim more than half a mile. Swimming quickly drains your energy, increases your heat loss and accelerates the onset of hypothermia. Even if you get to shore you may be in no condition to walk several miles in soaked clothing to find help.
• If you often sail in cold waters, buy and use a ‘survival suit’ for everyone on the boat.
• Make sure that you have and use good-quality life jackets and rafts.
• When abandoning a boat, take food, water, radio, signal devices and a prepared survival kit with you.
• Don’t leave the boat until you have to. If you have to abandon your boat, stay near it. Rescuers will be able to spot a big sinking or burning boat easier than they will spot you alone. Any search for you will start with your boat.
• If you have to get into the water, reduce the surface area you are presenting. Make every effort to cover and protect those areas where heat loss will be greatest.
  • Cover the head and neck area. Some survival suits come with a full-face hood. If yours has one, use it.
  • Hold your arms into your sides to protect the armpits.
  • Hold your legs together and raise them to a sitting position to reduce heat loss from the groin.
• If you are in a group:
  • Keep the group together near the boat. A group will be easier to spot than individuals.
  • The group will be able to maintain good spirits. Survival experts say that a positive mental attitude is a major contributor to survival.
  • Consider tying yourselves together to stop people drifting away if they fall asleep or become unconscious.
  • Huddle together, sharing body heat, and reducing the surface area of skin that is exposed to the cold water.
  • Keep children in the centre of the group where they will be best protected.

General Advice

• Always let somebody know where you are going and when you will be back.
• Arrange for them to check to make sure you returned as planned. If you don’t, they should raise the alarm and tell the authorities where you were going and how.
• Try to make a signal that is visible from the air. For example, release dye into the water or spread a sail on the water.

NEVER

• Never try to give a hypothermia victim food or drink.
• Never try to artificially warm a hypothermia victim. For example, DO NOT wrap them in working electric blankets, DO NOT put them near to a blazing fire, DO NOT put them into a warm or hot bath or shower.
• Though it is a standard first-aid treatment, DO NOT raise the patient’s feet. That will force cold blood from the limbs to flow back into the body core, worsening the patient’s condition
• DO NOT move the patient unless you absolutely have to. In advanced hypothermia the patient’s heart will be weak and dragging them around might kill them.

Frostbite – countermeasures

• Carefully move the victim to shelter to protect them from the wind and cold.
• Summon medical assistance, describe the symptoms and effects and seek advice as to what you should do.
• Remove wet and tight clothing.
• Cover the victim in multiple layers of dry blankets.
• Attempt to warm affected areas by gentle skin-to-skin contact. For example, a conscious victim can hold their frostbitten fingers in their groin or armpit.
• Only on the advice of a doctor, should you consider immersing frozen areas in warm water. If you do, you should control the water temperature because the victim won’t be able to feel it and is in danger of burning the affected area. They won’t realise how hot the water is.
• When medical assistance arrives, take the victim to hospital as soon as possible.
• DO NOT try to thaw areas that are frozen.
• DO NOT make a victim walk on frozen feet.
• DO NOT warm frozen flesh on or near naked flames.
• DO NOT rub frostbitten skin with snow.

Eye Damage

Cold weather can also affect the eyes.

• Eyelashes freezing together. Cup your hand over your eye. The combined heat of your hand and eye will melt the ice so that you can open your eyes. This is a warning sign that you should be seeking shelter!
• Freezing of the cornea, which can happen when a patient is struggling through strong cold winds and forcing their eyes open so that they can see where they are going. If it happens, cup the hands over the eye until the natural warmth thaws the cornea. If a cornea has been frozen, if possible wear a patch over the affected eye and seek urgent medical attention.
• Snow blindness. A condition where the dazzle and UV radiation reflected by the snow can injure the eye.
  • It generally takes about 12 hours to develop.
  • The eye feels dry and irritated. Patients report that their eye feels as though it is full of grit or sand.
  • Moving the eye around causes extreme pain.
  • Eyelids may be red and swollen.
  • Tears often flow freely.
  • Exposure to sunlight hurts the eyes.
• Treatment for snow blindness:
  • Do not rub the eyes.
  • Apply cold compresses to the eyes.
  • Keep the patient In a dark environment.
  • Seek urgent medical advice.
• Prevention of snow blindness:
  • Wear good sunglasses or goggles
  • Though the lenses of sunglasses or goggles protect the eyes from the front, there may be gaps at the side. Make sure any sunglasses or goggles used have ‘side shields’ to fully protect the eyes.
  • Remember to wear sunglasses or goggles even if the sun is obscured behind clouds.

Altitude sickness – countermeasures

Other than by previous experience, there is no way to predict how any individual will react to high altitudes. Generally, the best prevention is common sense, preparation, acclimatisation and more acclimatisation.

• Take exercise before you go to increase your general level of fitness and the ability of your lungs to cope with the strain of altitude.
• Stop smoking.
• Select a sensible route.
• Plan for a gradual ascent. Pace yourself, do not try to climb too high too fast.
• Take a few days to acclimatise at your starting point.
• Drink more fluids than usual when travelling and at altitude.
• Allow extra rest days at intermediate altitudes. As a general rule plan to stay one extra day and night after climbing 1000 metres (3,280 feet).
• When travelling avoid alcohol or other stimulants.
• Avoid using sleeping pills or any medication designed to relax you or help you to sleep.
• Never travel alone.
• Don’t try to carry too much.
• Keep an eye on each other. If anyone suffers any symptoms, go back down.

Acclimitisation – countermeasures

In the absence of any other guidance, the basic rules below will help a healthy adult to achieve the safest and most efficient acclimatisation.

• Make your way slowly to altitude, travelling from sea level by car if possible to 3,000 metres (10,000 feet), then slowly walk to higher altitudes, taking your time and stopping to acclimatise when you need to.
• Avoid flying or driving direct to altitudes of over 3,000 metres (10,000 feet). The body will require a longer time to recover from the transition from sea level, and will take longer to acclimatise.
• When travelling to altitudes above 3.000 metres (10,000 feet), don’t climb more than 300 metres (1,000 feet) per day.
• Aim to ascend by an average of 300 metres (1,000 feet) per day.
• Take at least one full rest day (and night) for every 900 meters (3,000 feet) you ascend.
• If you begin to show symptoms of altitude sickness, descend.
• If symptoms persist or increase, descend further and seek urgent medical assistance.
• In a group (you should never be travelling alone), remember that different people will acclimatise at different rates. Just because a group leader feels well enough to go on after half a day, it doesn’t mean that the rest of the group has acclimatised yet.
• American research shows that people travelling in a group are actually more likely to die of altitude sickness and complications than single travellers (probably because people who travel in a group don’t want to hold up the group or don’t want to appear weak, so they agree to carry on when they are not really ready). When travelling in a group, make sure that everybody is ready and agrees to move. Keep a close eye on all group members.
• Climbing to altitude and then waiting to acclimatise often leaves people dehydrated. Aim to drink at least five or six pints of water each day.
• Avoid alcohol.
• Do not take drugs (other than prescribed medication – having checked with your doctor that you would be safe to climb to altitude with your condition).
• Do not smoke. Before travelling you should have given up smoking to allow your lungs to be as efficient as they can be.
• Seek advice as to what foods to take and eat while ascending, staying at altitude and descending.
• Where possible, even if given medical permission to climb to altitude, it is recommended that pregnant women should stay at or below 3,658 metres (12,000 feet).
• Be warned that children are as susceptible to altitude sickness as adults, but they may not tell adults in the group that they are feeling unwell and have been known to hide symptoms. Watch them very closely for any signs of altitude sickness.

Motion Sickness – countermeasures

• Widely available medication can reduce or remove susceptibility to motion sickness. Seek advice and medication from your pharmacist or doctor.
• Get a good night’s sleep the day before you travel.
• Some people report that acupuncture has helped them. There are commercially available ‘acupressure’ wristbands that are reported to press on the correct acupuncture points to suppress motion sickness.
• Some people report that hypnotism has helped them.
• Select a seat at a point that will have the least movement. To explain that, imagine that your ship is a seesaw. If you sit at either end when the seesaw is in use, you will travel up and down several feet, but if you sit in the middle you will hardly feel any movement at all. Select a seat or position on any transport which is the equivalent of the centre of the seesaw.
  • At the exact centre of a ship (where the rolling and pitching will be least noticeable).
  • In the front seat of a car.
  • Seats between (not over) front and back wheels in buses and coaches.
  • Over the wings in an aircraft.
• Sit still. The more head movement you generate the more you intensify the mixed messages being sent to your brain.
• Try to sleep if you can. If you are asleep most of the senses shut down so mixed messages are reduced.
• Don’t try to read a book. You will usually feel better if you focus on a distant object. (The further the object is away, the smaller any movement appears to be.)
• In aircraft, avoid looking at the in-seat television screens.
• Eating can affect your response to motion.
  • Don’t eat rich food before your journey.
  • Avoid any foods that are high in fat.
  • Don’t eat dairy products before or during the journey.
  • Don’t drink alcohol before or during the journey.
  • Avoid coffee and tea before and during a journey.
  • Don’t smoke just before or during the journey.
• Try to eat something light before travelling. Fruit is best, particularly oranges (because if you are ill they taste the same on the way up as they did on the way down).
• Get as much fresh air as you can.
• Avoid strong smells such as diesel on a ship, or strong tobacco, strong perfume, aftershave, etc.
• On a ship move away from areas where there is heavy vibration from engines or propellers.
• In a car, if small children are strapped into child seats, raise them up enough so that they can see out of the windows and therefore focus on distant objects.

Jetlag and air travel health – countermeasures

• Have a few good nights’ sleep before your flight. Being tired before you travel exaggerates the effects of jetlag in many people.
• If you suffer from motion sickness, consider taking commercially available medication and following the advice above.
• When I book a flight I try to arrive at my destination early afternoon. That means I can collect my baggage, transfer to the hotel, book in and unpack, explore a little, wind down a little and go to bed. I am usually tired from the journey so I sleep, then when I wake up, be it 5am or 10am, I start the new day with my biological clock synchronised with local time.
• The air quality in most aircraft is dry, stale and poorly filtered (so germs from other passengers are generously circulated around the aircraft). You are therefore likely to suffer from headaches, dry skin and a dry throat. On top of that, with the germs circulating it is the ideal environment to contract a cold, flu or other virus. Drink as much water as you can to counteract dehydration and resist the virus-loaded air.
• If you have special dietary requirements, most airlines claim to offer a service that will cater to your needs. If you contact them far enough in advance to explain your requirements you could try to request a special meal. In my experience, even on scheduled flights at least 50% of the time cabin staff just shrug and deny all knowledge of special meals.
• Don’t forget eye care. Dehydration, dry air and generally poor air quality are not conducive to the wearing of contact lenses. Consider wearing a pair of cheap spectacles for the flight and recovery period after the flight.
• Combat dehydration by drinking more water than you think you need.
• Most airlines are now 100% non-smoking. If you are a smoker, given the choice don’t smoke in-flight and avoid smoking before the flight as well.
• When taking off, suck a sweet or suck your teeth to balance the air pressure in your inner ears and sinus with the pressure in the aircraft. Some reports claim if you travel while suffering from a cold or flu, the pressure changes in a passenger airline can cause permanent ear and sinus damage. With severe or prolonged congestion, seek medical advice before flying.
• Depending on the length of the flight, and your ability to sleep in strange places with strangers moving around and the in-flight film playing, you may want to take a few things with you in your carry-on luggage.
  • My wife always takes a pack of moist wipes, the sort they use when changing babies. They are good for wiping your hands, or any other exposed skin. They refresh and moisturise. A cool moist wipe on the forehead is surprisingly refreshing.
  • Consider taking earplugs to cut out the aircraft noise so that you can get some sleep. (Travel shops sell earplugs.)
  • Consider taking an inflatable neck pillow and something to cover your eyes to shut out the light inside the aircraft, to make sleeping easier and more comfortable.
  • On a flight of more than three hours, I take a small toothbrush and toothpaste. When I can’t get a small tube of toothpaste, I take a tube that has just enough left for me to clean my teeth a few times. Rinsing my face and cleaning my teeth before descent and arrival always makes me feel 100% better.
  • Some people take and use moisturising hand creams and moisturising lipstick.
• Plan to wear something light and loose for the flight. You will almost certainly be stuck in economy-class seats for many hours. Don’t aggravate the situation by wearing tight and restrictive clothes to further strangle your internal organs.
• Similarly, wear loose slip-on shoes if you can. Your feet will swell during the flight so unless you want to constantly loosen the laces, wear slip-on shoes that will allow for the slight swelling.
• Stale air could also make you tired and irritable. Use any air vent over your seat to get as much as you can of what passes for fresh air on most airlines. If you think the air is still stale, ask the cabin staff if they can crank up the ventilation to freshen the air.
• Alcohol tends to dehydrate, causing problems with headaches. Drinking alcohol on a flight increases your chances of dehydrating and increases the effects of jetlag. Avoid alcohol before or during a flight.
• All stimulants tend to dehydrate the human body, and the cheap tea and coffee brewed by the gallon and served by airlines is no different. If possible, avoid tea and coffee before, during and immediately after a flight.
• While flying your digestive system is under stress, due to the air pressure changes and being squashed into narrow seats with little leg room. The effect is that, combined with dehydration, you are at a high risk of becoming constipated. Avoid rich, sweet, fatty and salty foods before, during and immediately after a flight.
• If flying in and out of third-world countries, remember the risks associated with contaminated shellfish, food prepared and washed in questionable conditions, etc. You avoided food poisoning while you were there, so don’t relax and come back with food poisoning from their sometimes suspect, cheap, mass-produced aircraft meals.
• Exercise will help to keep your body operating properly during the flight. Sitting squashed into economy-class seats, your body is in distress and not operating properly. If you take every opportunity to stretch your legs, or take gentle exercise in an area where it does not obstruct or interfere with crew or other passengers, you will help to keep your body functioning during the flight. Some researchers claim that exercising as soon as possible after arrival speeds up the acclimatisation process. (Also see section on deep vein thrombosis on p.138.)
• Now airlines insist that passengers check in hours before a flight, the problems are multiplied and extended. You check in and then have to sit and wait in the terminal for two or more hours, extending the time that your body is under stress. You are under stress, listening for announcements, keeping an eye on your carry-on luggage, trying not to lose the rest of your family or group, and often desperately looking for somewhere to sit down. Added to that is the problem of food and drink. Many airport outlets serve the same inedible concoctions that the airlines will serve up during the flight. I personally won’t eat anything I can’t peel or open from a sealed container at any airport.
  • When going to the airport, take a supply of safe food and drink. Why pay inflated airport prices for something that could make you feel ill? Take something of what you like to keep yourself going during the inevitable delays.
  • Don’t take fruit and other food onto the aircraft unless you plan to eat it during the flight. Most countries will not allow fruit and meat and other foodstuffs to be Imported’ so don’t make problems for yourself.
  • You will almost certainly have to wait for your flight, so be prepared. Find a comfortable spot where you can listen to announcements and see departure boards.
  • Get a comfortable seat out of the sun and away from a main access route, otherwise people will constantly be tripping over you and bumping into you.
  • Take something to read if you can, but at least every half an hour get up and stretch your legs.
  • If somebody else can keep an eye on the bags, take a walk around the terminal. You will be stuck in economy class soon enough, so you should take the opportunity to get some reasonable exercise when you can.
  • When your flight is called, walk to the departure gate, and walk to the baggage hall when you get to the other end in order to get your blood pumping. Don’t use lifts, escalators or moving walkways unless you have to.
• In the week running up to a flight, some people try to adjust their sleep patterns to suit their destination time zone. For example, they go to bed an hour earlier or later every couple of days so that the difference between their biological clock and their destination time zone is smaller and therefore easier to cope with.

Drowning – countermeasures

General advice

• Make absolutely sure that children are strictly supervised at all times when around water.
  • The person supervising children around water must be a strong swimmer.
  • The supervisor must be an adult, never allow older children to supervise younger children.
  • Supervisors will need to take a break. They cannot maintain concentration on more than two children for more than 2 hours. If you need a break, insist that the children come in for a break too, and make sure that they all come in and stay there. Lock the door if you have to!
  • The supervisor should have a phone at the pool, and should never go inside to answer the phone or the front door bell, make a drink, collect food or anything else.
• Teach your children to learn to swim or stay away from the water. At least if you know how to swim you stand a chance of reaching the shore.
• Make sure that all pools are protected by locked doors, fences at least 5 feet high, locked gates, and where possible alarms. Make sure that neighbour’s pools are fenced, locked and secured as well.
• Make sure that fences, gates and door locks are child-proof.
• Keep the area around water free of furniture, shrubs and sheds or other obstructions. You should have a clear view of the water so that you can see what is happening at all times, not just when you are supervising children. For example, a child visiting your neighbours may stray onto your property to see the water. It will therefore be safer if anyone in your house has a clear view of the water and anyone who may be around it.
• Consider making a monthly safety inspection of your pool.
  • Check any barrier or fence surrounding it for good repair, locks, gaps children can squeeze through, places they could climb over, etc.
  • Are gates locked? Is the key kept safely? Can children get to the key? Check that rescue equipment is available around the water, e.g. life belts, ropes, and long poles with hooks or loops on the end. Rescuers can use the long pole to reach anyone in difficulties without having to jump in themselves. (It is easier to see the victim while standing up on the pool edge or riverbank than it is when you are in the water too.)
  • If you have an outside hot tub, is it kept covered and locked when not actually in use?
  • If you have a pool at home, of if you have children, take a first-aid course so you know what to do if somebody is pulled from the water.
• Teach children that water can be very dangerous. Never let them treat areas near water as play areas. Keep toys off pool surrounds, riverbanks and the areas surrounding lakes and streams.
• Never swim alone and never leave a child alone near water, swimming pools or any container of water.
• When in a group near water, just as you would designate a driver who would not drink alcohol at a party, consider designating a lifeguard who will concentrate on keeping an eye on everyone around and in the water. You could take it in turns to be the lifeguard as long as you can swim and haven’t been drinking.
• Never leave a baby or very young child in water. A baby can drown in a baby bath while you answer the phone or the front door.
• Teach children to swim as soon as you can. Local authorities and education authorities can often advise on reasonably priced or subsidised lessons.
• Before diving into any water, everyone should check the depth and check for obstructions.
• Refuse to use a pool where the water is dirty or cloudy. Children have drowned in dirty pools because nobody could see that they were in difficulties.
• At home, treat the bathroom with as much care as you would treat a swimming pool, a child can drown just as easily in a bath.
• Remember that any container of water is dangerous. Empty and cover or turn over any tubs, pots, buckets, barrels, etc. that may hold water.
• If a child goes missing, it is vital that you should check any water sources first, whether it is a bath, pool, stream or bucket. Remember, with drowning you only have 4 minutes to make the rescue.

Adult safety

• Never swim
  • Alone.
  • After a heavy meal.
  • In unknown waters.
  • After using drugs or alcohol (alcohol and drugs are a contributory cause of nearly all recorded drowning accidents in Europe).
  • In deep or cold water.
  • When there is a fast current or tide.
  • You should also avoid using hot tubs after using drugs or alcohol. The water is warm and relaxing. If you fall asleep you may not wake up!
• If you can’t swim, and can’t avoid the water, wear a good-quality lifejacket that has been fitted correctly.
• Avoid fishing alone. There will be nobody to help you if you get into difficulties.
• Before jumping or diving into the water, always check for:
  • Other swimmers in the water.
  • Boats or other river users.
  • Depth. To dive safely water should be at least 9 feet deep.
  • Obstructions on and around the bank, in or under the water.
  • Currents and tides.
  • Broken glass, fishing line, old bikes and other hazards.
  • Don’t overload boats with cargo or passengers and remember that the safe load will vary depending on the water conditions.
  • If using boats, jet skis or other craft, make sure that you have been taught how to handle them safely and that you know the laws and rules for their use.
  • Do not use drugs or alcohol and then try to swim. Both will have an adverse effect on judgement and co-ordination.
  • Try to use supervised areas, particularly when swimming in the sea. Beaches where lifeguards are patrolling are usually clearly marked.
  • If warning flags are flying, don’t try to swim.
  • Stay away from ships, docks, piers and other structures when swimming. There may be spinning propellers, obstructions or rusty metal that can cut or trap you.
  • Don’t swim too far out to sea. If you want to swim a long distance, swim up and down along the shore, close enough to get to land if there is a problem.
  • If caught in a fast tide, never ever try to swim against the tide. Float with the tide and try to swim in to safety at an angle of 45 degrees to the shore, aiming for a point where waves are breaking on the beach. (Where you can see waves breaking on the beach is where waves are flowing in towards the beach.)
  • Only use jet skis, surfboards, wind-surfers, etc. if you are a strong swimmer, and always wear a lifejacket.
  • Only participate in surfing, scuba-diving, snorkelling, water-skiing and other ocean activities if you have had professional instruction and your equipment has been thoroughly checked and approved by a qualified person.
  • Don’t participate in any water-based activity alone. Always make sure that you are with somebody so that you can watch and help each other if there is a problem.
  • If diving or venturing to deeper water on surfboards, etc., consider wearing a wetsuit to protect you from the cold water.
  • If you are going to take a river or white-water trip on any craft, make sure that the operator is experienced and qualified. Make sure that you wear a lifejacket, safety helmet and any other safety equipment provided. If no safety equipment is provided, don’t go!
  • Beware of rogue waves that are bigger and stronger than the average wave. They could wash you off a sea wall or rocky outcrop, or capsize your boat.
  • Beware of high tidal ranges and very high spring tides. Know the tidal times and ranges at your resort. Don’t get cut off by the tide.

Drowning – first-aid

This is the advice I was given on my first-aid course a few years ago. If you live or play near water, attend first-aid training to learn the latest advice and techniques.

• Send somebody to call for help and medical assistance at the first sign of trouble, but make sure that you ask them to come back to report to you what they have done, so you know what is happening.
• Make a note of the time. You should report to paramedics or doctors how long the patient was under water and/or when the heart stopped, etc.
• Be ready to hand over the care of the victim to anyone with more skill or experience than you have.
• In cold water a pulse may be hard to find. Take your time to look for one. You shouldn’t start cardiopulmonary resuscitation (CPR) unless the heart has actually stopped.
• Clear the patient’s mouth to remove any seaweed or other obstructions.
• Start artificial respiration as soon as it is possible. On gently sloping beaches it may take you 2 or 3 minutes to carry a victim clear of the water because you have to wade in a long way. In those circumstances, stop in shallow water and give them a few breaths. Support the patient out of the water behind the head, bend the head back, gently pinch the nose and breathe into the patient’s mouth. Watch the chest rise with each breath as you blow. Help should soon be with you to take the patient to the beach.
• When clear of the water, turn the victim face down on the sand with their head to one side and arms stretched above the head. Infants or children could be held upside down for a short period. Raise the middle part of the body with your hands round the belly. This is to cause any water to drain out of the mouth and throat – this is an extension of clearing seaweed, etc. from the mouth. Drowning people suffocate, they very rarely breathe much water into their lungs.
• Give CPR until medical help arrives, or until you are relieved by somebody else who is qualified.
• If medical help has not arrived, in case they are having trouble finding you, send runners to the nearest road or access point to attract the attention of the ambulance crew or lifeguards. Tell them to stay there and guide the medical help back directly to the patient.
• When there is time, if the patient is cold, remove cold wet clothes and cover the patient with several layers of blankets, etc. to warm them, as long as this does not interfere with CPR.

Medication – countermeasures

• If you are already suffering from a condition that may require treatment or medication while abroad, get your doctor to write it down so that you can take a note with you listing:
  • The name of your condition.
  • The generic name (and the brand name) of the medication prescribed.
  • What strength and dosage of the medication has been prescribed.
  • Any other medication you may be taking, e.g. blood pressure pills.
  • Any other complication and/or conditions, allergies, etc. from which you suffer and which may be relevant in your treatment.
• Make sure that you have sufficient supply of medication for the duration of your holiday, and a week or so afterwards. (The extra week allows for travel delays, and time to get an appointment and repeat prescription when you get home.)
• Make absolutely sure that it will be legal for you to carry any medication through customs as you travel from country to country.
• Be very, very careful with self-prescribed medication that can be purchased without prescription in many countries. In some countries the ‘chemist’ is just a shopkeeper selling ‘potions’. He is not a trained pharmacist, so his advice is often sales talk, not a medical opinion or professional consultation.
• If you are prescribed or take medication while abroad, keep the packaging or bottle, instructions and label so that you can tell and show customs and your doctor what you were given and took.

First-aid – countermeasures

• Take a first-aid course. The Red Cross, St John’s Ambulance and other organisations offer first-aid courses.
• If nothing else, learn CPR – the kiss of life.