Here are some tips on avoiding and dealing with some common outdoors hazards. I recommend taking a good first-aid book or medical guide in your first-aid kit. Many are available, but I like the books by Dr. William Forgey, president of the Wilderness Medical Society, who devotes much of his time to perfecting outdoor medicine. His Wilderness Medicine, Beyond First Aid, 5th Edition (Globe Pequot, $15) is an extraordinary book, designed for people far from medical help, that goes deeply into diagnosis and treatment for a huge range of problems in clear, nontechnical language.
Traffic
Your children are a lot more likely to be hit by a car than eaten by a bear on a national park trip. Many drivers are in unfamiliar vehicles, such as rented RVs. Pedestrians have even been hit by big rear-view mirrors. Don't let your guard down in parking lots and on roadsides.
Crime
The parks are busy, open places, and serious crimes sometimes happen there. A survey by the Wall Street Journal in 2000 showed that many parks had more serious crimes in a year than search-and-rescue operations. The pattern wasn't what you would expect: Cape Cod National Seashore had 155 search-and-rescue incidents and only 13 serious crimes, whereas Yellowstone had 35 searches and 119 crimes. Do the same things to protect yourselves as you would do at home: Keep your children with you, lock the car, and so on. You can't avoid all exposure to theft while camping, but you can make it more difficult, so that criminals will go after someone else. For example, when you have to leave stuff in camp, don't leave it in plain sight.
Seasickness & Motion Sickness
Being seasick or carsick is one of the worst feelings in the world. We've found Dramamine to be effective. The product as currently marketed is labeled for children as young as 2, but you have to break the tablets into ever-smaller pieces to get the right dosage. For convenience, buy the orange-flavored chewable variety -- original Dramamine tastes terrible and so requires lots of water to get down. You have to take the medicine an hour before you get on the boat or start the drive for it to be effective. It does make you sleepy-potentially a good thing for kids. On a boat, take a child who feels seasick up on deck, where there's fresh air and you can see the horizon. Keeping your eyes on the horizon helps.
Altitude Sickness
Altitude sickness is common at elevations above 10,000 feet, where the body needs time to adjust to getting less oxygen in each breath. Spending a few days in the mountains before high-elevation hikes helps, as does drinking lots of water. Symptoms include headache, nausea, fuzzy thinking, and fatigue. Watch children, especially those being carried in backpacks, for lethargy, which could indicate a problem. Dizziness and poor judgment, leading to accidents, may be the main dangers at elevations family hikers are likely to attain. The cure is to return below 8,000 feet.
A life-threatening buildup of liquid in the lungs or brain caused by high elevation normally occurs only above 14,000 feet, but can happen at lower elevations in people who are especially susceptible. Symptoms include coughing, breathing trouble, and poor coordination. Serious altitude sickness can kill fast, so you should get down as soon as possible.
Dehydration & Heat Exhaustion
The body normally uses 2 or 3 quarts of water a day, and in the desert you need four times as much. If you lose just 2% of the water in your body, you can suffer weakness, headaches, and nausea, and you may stop thinking clearly or become irritable. This can happen in any climate, and it's dangerous. If your urine isn't light-colored, you're probably not drinking enough water. The cure is to drink, even if you aren't thirsty. Also make your kids drink, especially when you are hiking. Beverages with caffeine or alcohol are counterproductive. Juice is okay, but when children drink enough for good hydration they also get a lot of sugar, which can spoil their appetite for nutritious food.
In sunny conditions, especially in the desert, eating and sun protection are very important. Caps with cloth flaps that hang down work well for kids, as do broad-brimmed caps. Wear light, loose clothing. If you drink a lot of water but don't eat, your body leaches out nutrients, contributing to dangerous conditions, including heat exhaustion and heat stroke. Both conditions happen when your body loses its ability to get rid of heat because of dehydration, not enough nutrition, or overexertion in the sun.
Symptoms of heat exhaustion include weakness, cramps, dizziness, or nausea; the skin becomes pale and damp. Give the victim food, water, and rest, and apply a wet cloth until the feeling passes. Heat stroke is the same condition, but much worse. Now the victim has similar symptoms, plus an elevated temperature; fast pulse and breathing; hot, dry skin; and mental symptoms such as confusion and passing out. The person's life is at risk, and he or she needs shade, cooling damp cloths applied directly on the skin, water, food, and quick medical attention.
Hypothermia
Dangerous loss of body heat, also called exposure, is a common killer in the outdoors. It happens when your body gets too cold to warm itself. You must be especially vigilant with children because their smaller bodies cool faster, and they may not notice how cold they're getting. Hypothermia can occur on a 50?F (10?C) summer day if you get damp and it's windy, especially if you are physically exhausted. Avoid hypothermia by eating well, being aware of how everyone is feeling, avoiding getting wet or sweaty, and wearing wool or synthetics that stay warm when wet.
Watch out for shivering, sluggishness, lack of communication, and irrational actions. If a person shows symptoms of hypothermia, get him or her indoors, out of damp clothes, and warm as soon as possible. Shivering is a key symptom. If the victim can still shiver, the body should be able to warm itself with warm, dry clothes and shelter. If the victim is too cold or physically exhausted to shiver, that is a sign that you must add heat from outside the body. Putting on more clothing won't help at this point. In the field, get the victim undressed and into a sleeping bag, skin-on-skin, with one or two warm people. Unless the victim is showing signs of shock, give plenty of warm liquids.
Giardia in Water
In the past 20 years, streams all over the North American wilderness have become polluted with a protozoan cyst from feces called Giardia lamblia, which causes chronic diarrhea. You can also pick up various nasty bacteria and, less frequently, viruses in some areas. Drinking untreated water from any water body is a risk not worth taking. Giardia is difficult to diagnose and can last for years if untreated. Symptoms usually show up a week to 10 days after exposure and last 1 to 3 weeks, but can return for repeated bouts. If you come down with diarrhea within a month or so of an outdoors trip, ask your doctor for a giardiasis stool test.Burns
In a campsite, sources of burns aren't as well isolated from children as they are at home. Kids can fall into the campfire, tip the camp stove, or spill hot drinks on themselves. Be conscious of this risk and set up camp to be as safe as possible, establishing clear rules about how to behave around the fire. In case of a burn, cool the skin as quickly as possible with cold water, then check your first-aid reference for treatment, which depends on the severity of the burn.
Sunburn
Most skin cancer in adults is caused by overexposure to the sun decades before, as a child, whether tanning or burning. Severe sunburns can also ruin your trip. Wear sun hats with flaps or wide brims. Always apply sunblock with an SPF of at least 15, even on an overcast day. This is especially important at high elevations or on the water. An SPF higher than 15 doesn't offer much additional protection -- just a few percentage points. Applying it heavily and often is much more important.
There's not much to do about a burn. Get out of the sun immediately. Aspirin, cool compresses, ointment, and cool baths with a half cup of baking soda added to the water are about all you can do for relief. Avoid lotions and creams, which can contain irritating alcohol or preservatives; oil-based ointments such as Vaseline are okay.
Drowning
These tragedies happen incredibly fast, so you need to keep a sharp eye on your kids whenever you're near water. You should hold on to toddlers or have them on a leash. Swim in pairs, and make sure someone onshore in your party is keeping track of you. River swimming and inner-tubing are highlights of visits to some parks, but do ask a ranger first if water conditions are right, and have a grown-up go in before the kids to get a feel for the current. It doesn't take much to carry away a little person.
Falls
Many people are killed or injured in the parks when they fall into canyons or off mountains. They're often young adults attempting dangerous sports without proper training or safety gear, but people have also simply gotten dizzy at the edge of the Grand Canyon and fallen in. Keep a hand on your children, and don't hike where a fall could lead to disaster. Enroll teenagers who want to climb in programs where they can learn to do it safely. With luck, such a class will teach respect for the dangers of climbing, and contempt for those who take risks without knowing what they're doing.
Lightning
About 100 people a year die from lightning strikes in the United States, and many more are injured, making lightning a leading outdoor danger. In mountain areas where afternoon thunderstorms are common, especially the Rockies, plan hikes or boating for the morning so that you can get below the tree line and off the water by afternoon, when storms usually hit. Storms move faster than you do, so you can't count on getting to shelter once a storm appears. If you can, get inside a building; if you're already inside, stay there until the storm passes.
Lightning doesn't have to hit you directly to kill; an area around a strike becomes electrified. The most dangerous place to be is near a lone tree or another upright object. Standing on top or on the side of a mountain of alpine tundra is also dangerous. A thick forest is a good place to be, but not near the tallest tree.
If you're stuck above the tree line in a storm, squat with your hands on your knees and your feet on the ground in a depression in the ground, and keep your head down. Don't lie down. Stay away from tall rocks, cliff edges, cracks, rock debris, water, or anything that could conduct a strike to you through the ground.
Here are the six most deadly common activities in lightning storms, in order: working or playing in open fields; boating, fishing, and swimming; working on heavy farm or road equipment; playing golf; talking on the telephone; and repairing or using electrical appliances.
Dangerous Wildlife
All wild animals are potentially dangerous, even little squirrels. Don't ever approach or try to touch a wild animal of any kind. They can carry anything from rabies to bubonic plague, and even a minor bite is serious business.
Bears
Black bears are common in many parts of the U.S. Grizzly or brown bears (two names for the same species) live only in the Rockies, from Yellowstone north, and in Alaska. Either species can be dangerous, but advice about how dangerous black bears are varies in different parts of the country. They are smaller, reaching a few hundred pounds, and in natural conditions live primarily on plants. Unfortunately, many black bears in the national parks, especially in California, have come to rely on food and garbage from human beings. A black bear killed a hiker in Great Smoky National Park in 2000, the first such fatality in the history of the National Park Service.
The most important precaution is to store food securely. Never, ever take food, dirty clothing that smells like food, or even pungent soap or lotion into your tent. Follow National Park Service instructions at the campground. At some parks, storing food in the trunk of the car is sufficient, but black bears in California's Sierra Nevada know how to tear cars open to get to the food, and even which models are the easiest to open. Don't even leave loose papers in your car there, because a bear may mistake them for food wrappers. If there's a food storage locker at your campsite, keep all food you aren't eating at the moment in the locker, with the latch closed. Don't leave food unattended for any amount of time. In California, rangers advise that if a bear comes while you're eating, you should try to scare it off, but don't try to take food away from a bear. In the Rockies, where black bears are wilder, that doesn't happen as much, and you should steer clear of them at all times.
Before heading into the backcountry for a backpacking trip, you'll receive plenty of advice about bears from the Park Service. Follow it. In some areas hanging your food and pungent items from a long tree branch is sufficient, but anywhere in the Sierra and above the tree line in the Rockies, only bear-proof containers will do. California bears have learned to get food out of the trees, and they can destroy the tree in the attempt. You can inexpensively rent canisters at the parks where they are required (they cost around $80 each to buy), but be sure to plan your rations and toiletries so that everything fits. A typical canister is a cylinder a foot long and 8 inches in diameter that weighs about 3 pounds. Where food hanging is the recommended technique, such as at Yellowstone, be prepared with plenty of cord and a sack. At Great Smoky, many campsites have food-hanging cables. Whatever the storage method, always set up your tent away from your cooking and food storage area.
When hiking, make plenty of noise to avoid startling a bear, especially in brush or thick trees; wearing a bell, singing, or carrying on a lively conversation helps. Keep children nearby, because their small size makes them vulnerable. If you meet a bear in the woods, make a lot of noise, wave your arms, and keep your group together in a knot to look like a larger animal. The bear usually will walk away. Don't walk or run away, because that may make the bear interested in following, but do retreat slowly, keeping your face to the animal.
In Alaska, where we camp with our children in deep wilderness amid some of the world's thickest bear populations, we carry a shotgun loaded with slugs; in the parks, where guns are illegal, we carry bear deterrent spray made of capsaicin pepper. If a bear is aggressive, a fog of the burning spray is supposed to deter it (except in wind or rain). A can costs about $40, plus $10 for a holster. One good brand is Counter Assault (tel. 800/695-3394; www.counterassault.com). This dangerous stuff must be kept away from children.
We've met many bears here and all over the country, but we've never had to use the gun or the spray to defend ourselves. Bears are scary to think about, but don't let the fear deter you from enjoying the outdoors, because the actual hazard is slight compared to others you face every day.
Mountain Lions
These great cats live in small numbers in several western states. Sightings are rare and attacks even rarer; however, a child was killed on a hike at Rocky Mountain National Park a few years ago. Attacks happen near brush, where a lion can hide and pounce, and are unlikely if your group is together and noisy. The boy who was killed had run ahead of his family and was the size of a lion's normal game.
Bison, Moose & Deer
Large mammals are dangerous even if they aren't predators. These animals can move lightning fast and kick and trample a person who approaches too close and appears to be a threat. Each of these species has killed people. Always watch from a distance. Don't try to get closer for a picture. Even gentle-looking deer can be dangerous if you don't respect their space.
Snake Bites
Usually, people are bothering a snake when they get bitten. Be careful turning over rocks, reaching into dark places, and gathering firewood. If you are bitten, symptoms quickly follow, starting with a funny taste in your mouth. You may want to bring a snakebite kit, but in any event, get medical attention as soon as possible, keeping the bitten limb below the heart. Carry a person who has been bitten on the leg or foot.
Insects
Sting Allergies
Extreme allergic reactions to bee and wasp stings can be life-threatening. Watch children carefully, and head for emergency help at any sign of breathing trouble, fainting, stomach pain, or hives. If you suspect that one of you has a sting allergy, or if it runs in the family and the kids have never been stung, it's wise to prepare with a prescription epinephrine injector kit such as EpiPen Jr. Benadryl helps with swelling from mild bug bites.
Poisonous Spiders
Bites by poisonous spiders are rare but require an immediate trip to the doctor. Symptoms of a black widow spider bite include severe abdominal pain and hardness, and difficulty breathing.
Mosquitoes
West Nile virus has made mosquitoes a newly worrisome concern. While only 20% of people infected develop any illness, and only 1 in 150 develops a severe form of the disease, it's still worthwhile to avoid the small chance of such an illness. Tips to avoid bites: Use repellent that contains DEET (see "DEET," below, for advice on repellent), wear long sleeves and pants, use a screen tent at the picnic table, choose a windy campsite over one in the brush or near standing water, and burn mosquito repellent coils in camp.
The period from infection to the onset of disease symptoms is usually 3 to 14 days. Symptoms of the mild disease can be tough to tell from common fever and headache. Symptoms of a severe infection include headache, high fever, neck stiffness, stupor, disorientation, tremors, convulsion, and muscle weakness. See the CDC's West Nile virus website (www.cdc.gov/ncidod/dvbid/westnile) for more information. The site also contains a current map of where the virus is found. Teach children not to scratch bites. If you can resist for 30 minutes to an hour, they stop itching; if not, they get worse and can even cause skin infections.
DEET
Since the arrival of West Nile virus, pediatricians have changed their advice about the use of the most effective insect repellents, which contain the active ingredient DEET. Other products don't work as well and may not be as safe. Adverse reactions to using DEET are extremely rare and confined to situations where the product was not used in accordance with the label instructions. The risk of the virus or of Lyme disease from ticks is much greater than any risk from using DEET. On the other hand, there is no reason to use repellents with very high concentrations of DEET. More DEET doesn't keep mosquitoes away better; it just makes the protection last longer. We've gotten good results even among thick, Alaskan mosquitoes from DEET-based repellents made for children with a 7.5% concentration, reapplying every couple of hours.
However, the American Academy of Pediatrics now says even 30% concentrations are safe on kids when used correctly. But you must be careful: Have an adult apply the repellent, and keep it away from ears, eyes, mouth, or fingers the child might put in his or her mouth. Experts disagree on using it on very young children. Some say it is acceptable on babies over 2 months in low concentrations; others say 2 years. There is a good alternative, especially with babies: netting. In the very thick bugs we sometimes encounter in Alaska, which include black flies that don't pay much attention to DEET, we wear shirts with hoods of netting that can zip over the head. For more advice on DEET, see the Centers for Disease Control's West Nile Virus website, www.cdc.gov/ncidod/dvbid/westnile.
Ticks & Lyme Disease
Ticks can carry Lyme disease, especially in the Northeast and northern California (cases have turned up in 48 states). It starts with flulike symptoms and can affect the neurological system and heart if not treated with antibiotics. Ticks in the Rocky Mountains, the Southwest, and the Carolinas and neighboring states can also carry Rocky Mountain spotted fever, which causes fever, vomiting, and a measleslike rash, among other symptoms, and is fatal in 30% of cases.
Ticks attach to people by brushing off grass or undergrowth we walk through. Stay on the trail. Wear light-colored, long-sleeved shirts and pants tucked into your socks for hikes. Apply DEET-based insect repellent. After a hike, at bed or bath time, check everyone for ticks, especially on the scalp. Ticks are black and roughly the size of a pinhead. It takes about 48 hours for the tick to pass on the disease. Pull it out with pointed tweezers, taking a little of the skin at the insertion point, and apply alcohol and Neosporin antibiotic ointment to the wound. If a bull's-eye rash or flulike symptoms arise, see a physician. Rocky Mountain spotted fever shows up in about 6 days and progresses quickly. If you suspect something, see the doctor as soon as possible.
Poison Ivy & Poison Oak
Poison ivy grows on the East Coast, poison oak on the West. They are closely related, and the sap of both contains a highly allergenic substance that causes an itchy rash, or worse symptoms in sensitive people. It's best to avoid anything bearing a remote resemblance. I repeat the following chant to my children: "Stay on the trail."
If you think you have come into contact with either plant, wash the contact area with alcohol and soap strong enough to remove tree sap. The sap sticks to clothing and remains active for a long time, so wash anything that might have touched the plant. The rash takes 12 hours to 2 days to appear. Once it does, you have up to 2 weeks of misery ahead, longer if you scratch and it gets infected. Try hot baths and showers -- as hot as you can stand -- for up to 8 hours of relief from itching. Calamine lotion, aspirin, Aveeno oatmeal baths, and antihistamines such as Benadryl may help. Get medical treatment for extreme reactions.
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