B - Be Prepared
E - Evaluate Risks
A - Activate Help
F - First Aid
E - Evacuate
R - Rescue
The BE SAFER acronym was made to provide a loose framework for handling a wilderness emergency for those who are not professionally trained in medicine or rescue. This BE SAFER acronym may not apply to every situation because every situation is unique. However, it is flexible enough for it to be used for any outdoor sport. And while safety should always be first, other aspects of BE SAFER may occur out of order. For instance, you may need to perform first aid before activating help. Or you may have to rescue a victim before first aid.
B - Be Prepared
There are many things you can do to completely prevent or better prepare for a wilderness emergency. Much of it should be done before your adventure begins. Take a wilderness first aid course or an outdoor skills and safety course. Get the hands on training. Learn more about your equipment, route, your partner, etc. Practice survival skills or rescue techniques. Learn, practice, repeat. Consider of Outdoor Safety Online course.
There are a few items that you should always carry if you are adventuring in the outdoors. These items are commonly known as the 10 essentials and include: Head lamp (or other light source), first aid kit, water, food, warm clothes, map or GPS, fire starting tools, sun protection, repair kit, and emergency shelter.
Base Medical likes to add one more item to the list, a communication device . This may be a cell phone, radio, or personal locator beacon. In the most minimal form, it could be a whistle. If you experience an emergency, the chances are that you will need outside help because it will be beyond your capability. Having a means of communication can mean the difference between life and death, but it should also not be heavily relied upon, creating a false sense of security. And while we are on the topic of communication...always tell someone where you are going and when you expect to return, even if it’s just a short day trip.
E - Evaluate Risks
Before each outing, even a short one, evaluate the risk that may be present from the environment, the terrain, and the activity. Plan for these appropriately.
- Environmental Risks - This may be foul weather like a snow storm or temperature extremes.
- Terrain Risks -This could include falling ice or rock, avalanches, steep slopes, or dangerous river crossings.
- Activity Risks - The risk from each given outdoor activity can be very different. Rock climbing has a higher risk of falls. Mountaineering would include HACE and HAPE. Kayaking can see higher shoulder dislocations and the threat of drowning.
After evaluating the environmental, terrain, and activity risks, prepare for them as much as possible. Consider what knowledge and resources you will need to handle such risks. This may mean adding an extra insulating layer, a helmet, or crampons to your pack, or bringing a personal locator beacon if you know you may not have service. We also suggest tailoring your first aid kit for each adventure. You can learn more about that here: How to Customize Your Wilderness First Aid Kit
S - Safety
First and always first is safety. This includes your safety, the victims safety, and the safety of anyone else present. We do not want to create more victims. Evaluate the environment for safety hazards like falling or loose rock, hanging ice, lightning, angry mountain goats and so forth. Consider relocating to a safer location if it’s possible.
A - Activate Help
This is where that 11th essential item comes into play. Early communication and activation of a rescue response team can really make a difference for a person that has suffered a serious injury or illness.
This step may not be required if you think you are capable of handling the situation on your own. Self evacuation and self rescue is the best option if it can be done so safely and without causing further harm. This does not mean that you should never call for rescue or you should try to handle situations that are beyond your capability. However, there are many situations that you can handle, you just need to be ready and knowledgeable.
Next is to perform immediate first aid treatments on the victim if they are with you. You need to rapidly find and fix serious life threats if any. The airway, breathing, and circulation (commonly referred to as the ABC’s) are essential for sustaining life. Any problem directly affecting the ABC’s is considered an immediate threat to life and must be corrected. Try not to move the victim too much if you think there is a chance of a neck injury.
Ideally, you should already know how to do this. This is where the skills and knowledge from a wilderness first aid class are invaluable. It really can save a life. Again, consider a hands on training class or at the very least, our Outdoor Safety course.
After the ABC’s are treated, keeping the patient warm and protected from the environment should be considered. In severe trauma emergencies, a drop in body temperature can accelerate a dangerous and deadly condition known as shock. If possible place some sort of insulation between the victim and the ground, and over the victim. Learn more about keeping a victim warm here: 4 Ways the Body Loses Heat in the Wilderness
Other not as threatening problems, like a wrist fracture, can be addressed later.
E - Evacuate
After treating all life threats to the best of your ability, perform the needed rescue techniques, start to self evacuate, or wait for outside rescue (the R in SAFER).
Again, self evacuation and self rescue is the best option only if it can be done so safely and without causing further harm. If this is the case, then begin to self evacuate. Be aware that the situation can change, and may require outside help.
If you were not able to activate help, or if the situation is too dangerous, you might need to make the difficult decision to leave the victim to go get help. This may be especially true if you are with one other person, and it is that person who is hurt. Before leaving, make sure the patient is in a safe location with food and water. Attempt to keep them warm and isolated from the environment.
If they are semi conscious or unconscious, put them in recovery position before you leave, even if there is a potential spine or neck injury. Try to be gentle on the neck! The recovery position helps maintain a good passageway for air to move in and out of the lungs. This is very important.
To place a patient in recovery position, lay the patient onto their side with the ground arm extended. The other arm should be positioned so that the patient’s cheek rests on the back of the hand. This is to keep the head in position. The head should be positioned so that it's tilted slightly back to ensure an open airway. Finally, the right leg should be bent to prevent the patient from rolling forward onto their face. The recovery position is meant to maintain an open airway and prevent aspiration of stomach contents.
R - Rescue
Sometimes, you may have to wait many hours or days for outside help to arrive. While you are waiting for rescue, there things you can do to be proactive. Think of what you will need to stay warm and protected while you wait. It’s important to know that trauma injuries and the cold do not play well together. These two factors can lead to or worsen shock. So do your best to keep the victim (and yourself) warm and insulated from the ground and the outside environment. Just a simple space blanket laid over the victim will not cut it. You may need to improvise insulation out of rope, a tarp, extra jackets, etc.
A shelter should also be considered, especially if the environment is very cold and wet. This could be a tent or you may have to build one out of a tarp, branches, etc. Or dig a snow cave. But of course, you may also find yourself in a situation where there is little you can do to shelter yourself, like if you are on a belay ledge half way up a climbing route.
This is also a great time to do the other not so urgent medical treatments, like splinting a broken wrist. Learn how to splint broken bones in this free online mini-course: Wilderness Splints.
As you may have noticed by now, BE SAFER is not as straight forward and easy to understand. Emergencies are complex and unpredictable. A generic check list can not be applied to an emergency with a one size fits all mentality, especially in the wilderness. However, BE SAFER should be used as a guide to navigate wilderness emergencies if you have no medical or rescue training. Each of it's components must be considered.