In Sarek help will not arrive fifteen minutes after a phone call, because on most routes you simply cannot make a phone call as there is no coverage, the nearest hospital in Gällivare is a good hundred, maybe two hundred kilometres away from here, and the helicopter from Kiruna takes off when the weather allows it, not when you need it. From my experience as a guide I know that after calling an SOS you realistically wait from several hours up to even a full day. This is not a reason to panic, just a reason to know calmly what to do in that first hour, before any rescue operation has even started.

This article will not replace either a proper first aid course or wilderness first aid training — that is not its purpose. I rather want to show how I think about injuries in the field myself, and what is worth learning before going into Sarek for several days.

The most common injuries in Sarek — and how to recognise them

Over the years I have noticed that, contrary to the fears with which tourists arrive, dramas really happen quite rarely. From the perspective of a group the statistics look more or less like this.

Number one is the sprained ankle. Sarek is stones, tussocks of grass which in Swedish are called tuvor, and bogs — all the things on which it is easy to put your foot in the wrong place. Most often this happens at the end of the day, when the legs are already tired, and the nearest road is comfortably a dozen, perhaps twenty kilometres away.

Right behind ankles come blisters and chafing. Sounds trivial, but they can hold up the whole group. After two days, badly fitted boots take a person out more effectively than the flu.

The third thing I expect is mild hypothermia. All it takes is long rain, wind and a few degrees above zero. „Mild” means the person shivers and starts to move more slowly. If the shivering stops, and on top of that a strange drowsiness or confusion sets in — that is already moderate hypothermia and a situation in which I call for help without hesitation.

To this you have to add all the everyday small stuff: cuts, abrasions from the backpack belt, burns from the stove. All of this looks harmless, but left without a dressing it can fester within a few days.

The first hour — how to think when something has happened

I have a simple scheme which I teach to groups. First, assessment: is the casualty conscious, are they breathing, is there a bleeding wound somewhere under the jacket that you cannot see from a distance. Only then do I go down to the details, because order matters — an ankle can wait ten minutes, a bleed from a thigh will not wait.

The next step is stabilisation. Warmth is the absolute priority in an arctic climate, even in the middle of summer — emergency foil, an extra layer, insulation from the ground, because cooling through the ground catches people out more often than frost in the air. To this add water, a dressing, a moment for the casualty to come back to themselves. Only from this point do I take the decision on what to do next: we walk out on our own, we stay and wait, or we call for help. Each of these paths has its place.

I call for help when the casualty is not able to walk on their own, when I suspect a fracture, a head injury, moderate hypothermia or anything that exceeds my competence. I do this with the Garmin inReach — I press SOS and write briefly what has happened — or with a satellite phone, calling 112. In Sweden this number calls out Fjällräddningen, the mountain rescue.

What I can really do in the field

I want to show honestly what my realistic range as a guide looks like — nothing beyond that, because playing at being a doctor in the wilderness usually ends worse than the injury itself.

With a sprained ankle I only take off the boot if I can see it is swelling rapidly. I stabilise with an elastic bandage and give ibuprofen. If we have a stream nearby, you can cool the leg briefly, a few minutes with breaks — but a long compress of ice-cold water in an arctic climate I do not risk, because that is a direct route to circulation problems. A trekking pole goes as a support. If the person cannot stand on the leg — we stay and call for help.

With blisters the rule is simple: it is better not to let them happen than to treat them. At the first discomfort I put on a hydrocolloid plaster or an ordinary silk tape plaster. If a blister has already formed, I do not pierce it in the field — a hydrocolloid dressing and a change of socks are usually enough to get through to the end of the day.

For mild hypothermia I act according to a scheme that is not complicated: dry clothing, even if you have to borrow it from the rest of the group, a warm sweet drink, a sleeping bag, a tent, insulation from the ground. No alcohol — contrary to what you sometimes hear, alcohol dilates the blood vessels and only makes things worse.

A cut I rinse with clean water, preferably boiled or filtered, I apply a sterile dressing and fix it with tape. Deep wounds, especially on the thigh or calf, where there are a lot of vessels close by, that bleed profusely, I dress with a pressure dressing and call for help. In the field I do not stitch, there are no conditions for that.

The first aid kit I carry to Sarek myself

You will not find anything exotic in it, but every item has its justification.

And one more thing — it weighs nothing and can save your skin: leave a trip plan with a trusted person. The route, the planned camp sites, the date of return. If you do not get in touch at the agreed hour, somebody will know where to start looking. In Sarek this can be more important than the contents of the first aid kit itself.

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