Health & Safety
Travelling in mountains excites a sense of adventure. The rugged countenance of these landscapes, with their looming peaks and sinuous ridges stirs in us thrilling visions of exploration and escape. However, in that roughhewn beauty remains one constant element: potential danger. Mountains are hard places, and although their slopes may be inviting they are also to be respected. Mountains are temperamental, they can change their attitudes on a whim, and like all adventures, highland journeys contain inherent risk and uncertainty. Being unprepared for these risks will invite danger. Therefore, it is extremely important to be knowledgeable about the risks and how to deal with them. Mountains can affect us in many ways, from the natural elements, to sickness, to slips and falls and it’s vital that you know what to do if you face such situations. A heightened level of preparedness may not only limit dangers, it may increase your enjoyment of the mountains. Remember, safety comes first.
Potential Diseases
This is a brief list of diseases in South Korea that may affect travellers, particularly while trekking through the montane, afforested, and rural regions of the country.
- Diarrhea, specifically “traveller’s diarrhea,” is a bacterial ailment common to those who first arrive in South Korea. Often no more than an annoyance, traveller’s diarrhea can inhibit progress on the trek, but can be treated easily.
- Filariasis (aka Philariasis) is a parasitic disease commonly found in rural areas, especially in rice-growing regions. It is spread by mosquito bites.
- Hepatitis A is an infectious disease that targets the liver. It is a food-water borne virus that commonly enters the body via the fecal-oral route (fecal particles of one host entering the body of another via the mouth through food or water).
- Japanese encephalitis is a mosquito-borne virus that is commonly found in birds and domestic pigs and in rural regions. Affecting the central nervous system, the disease can be severe. There have been recent epidemics of the disease in Korea, but it is currently controlled via vaccination.
- Leptospirosis is a bacterial disease, and one of the most common zoonoses. It is usually transmitted through the urine of an infected host and is most commonly found along moist, muddy areas where wild and domestic animals frequent. Humans become infected via contact with food, water, or soil containing traces of infected urine.
- Lyme disease (aka borreliosis) is caused by species of the bacteria Borrelia, the vectors of which are ticks. Borreliosis is currently listed as an emerging infectious disease, meaning that incidences of it in the past two decades have increased and are threatening to grow. Be cautious of ticks when trekking through afforested areas.
- Malaria is no longer very common in South Korea, but cases still occur from time to time. Cases of malaria are generally limited to the northern provinces of Gangwon and Gyeonggi, as well as around the demilitarized zone.
- Rabies is a neuroinvasive disease that causes potentially fatal swelling of the brain. The risks are perhaps low, but there are many mammals among the mountains, particularly dogs and cattle in the villages. See a doctor immediately if you are bitten by any animal.
- Typhoid is a bacterial infection transmitted by the ingestion of fecal particles of an infected host in the food or water of another potential host. Typhoid causes inflammation and ulceration of the intestine. It is most common in summer.
Potential Physical Conditions
The following is a brief list of the most common potential conditions one may expect to face on the Baekdu Daegan trek and what can be done to combat them. This is not to be considered a complete list, or an adequate substitute for direct medical advice or treatment from a physician. Note that there’s no danger of acute mountain sickness while trekking Korean mountains. The highest point one can reach on the mainland is Cheonwangbong, the summit of Jirisan, at 1,915 metres above sea level. Changes in human physiology due to hypoxia (inadequate levels of oxygen in the blood) begin to occur at 1,500 metres above sea level; however, as arterial oxygen saturation at 1,500 metres is maintained above 90%, acclimatization is very rapid and the chance of altitude sickness is extremely low.
It would be beneficial to have first aid training to increase safety while in mountains. Contact your local Red Cross or other medical service that offers first aid courses and consider taking classes. First aid courses in Korea are available through the Korean branch of the Red Cross (www.redcross.or.kr/www/eng/index.jsp). They offer first aid courses in English.
Blisters
Foot blisters are a common ailment for trekkers. Caused primarily by the friction induced by walking vast distances over long periods of time, foot blisters can range from being no more than minor nuisances to very painful hindrances.
Prevention
The easiest way to protect your feet from blisters is to wear well-fitting, comfortable boots and dry socks. Blisters form more readily on moist skin, and so hiking socks are often worth their expense, as they are designed to absorb moisture. If you’re on a multiday trek change your socks daily and wash used socks regularly to have them dry and ready to be worn when needed. Take off your socks regularly to allow your feet to air.
Treatment
It is important not to break the blister as this may invite infection. Keep the blister clean by washing it with fresh water; keep it disinfected with rubbing alcohol or iodine. Walking with a blister can be painful, especially if it occurs on the bottom of the foot. The best method of treatment is to use adhesive moleskin. Measure the size of the blister and cut out a square of moleskin larger than the blistered area. Fold the moleskin and cut out the center using scissors. Make sure the hole you’ve cut is slightly larger than the blister; make sure the edges of the moleskin-square remain in tact. Apply the moleskin to the blistered area, making sure the hole fits around the blister (don’t stick the adhesive back of the moleskin onto the blister itself). The moleskin will protect the blister from friction as you continue trekking. Rest the blister for as long as possible. Before starting trekking again, put on clean, dry socks. If your boots are wet, it is best to wait until they dry before you continue trekking with the treated blister. If a blister bursts on its own, do not remove the remaining pocket of skin. Gently push the remaining fluid out of the blister, cleanse the area with an antiseptic, and apply a soft dressing, like gauze. Most blisters will not require professional medical care. If the blister, however, appears to have become infected (pus may be present, with increased pain), see a physician as soon as possible.
Fractures
Bone fractures can be very painful and inhibiting. There are several types of fractures that pose a risk for adult trekkers. A comminuted fracture is the result of the bone being shattered into small pieces. Simple fractures are the breaking of bones without the laceration of the skin. Compound fractures are the opposite, broken bones with the presence of skin laceration. An avulsion fracture occurs when tendons are torn off of bone by overly strong muscular contractions, causing pieces of bone to break free with the tendons (in trekkers, the knee is at particular risk of avulsion fractures).
Prevention
Reckless behaviour is the most common catalyst of fractures. Mountains are rugged and it is important to remember that intelligence and common sense rule the day. Do not take excessive risks. Don’t run on the trail (this also puts other trekkers and hikers in danger). Taking your time increases safety and allows you to enjoy the exquisite beauty of the fauna, flora, and scenery of the mountains. If you choose to climb, boulder, or scramble be sure you’re prepared and to stay within your physical limits.
Treatment
Fractures can be simply treated on the trail by splinting. Note that it may be necessary to straighten a fractured limb before splinting if the limb appears misshapen or deformed. If possible, have another person hold the limb above the point of fracture. Very gently pull on the fractured limb. The traction should straighten the fracture. If you or the injured are uncomfortable doing this, do not attempt it. Improvise splints from trekking poles, rolled up sleeping mats, tree branches, or anything suitable. If the injured is wearing shorts or short sleeves, be sure to place fabric on the limb to avoid the splint making direct contact with the skin. Be sure the splint isn’t restricting blood circulation. Upper arm fractures can be secured in a sling rather than a splint. If the femur (thigh bone) is fractured, a standard splint will not be adequate. Very gently straighten the leg with the fractured femur. Apply a splint to the back of the leg, extending from the lower buttocks to the back of the knee. Secure the fractured leg to the good leg with rope, strips of fabric, or whatever is available. The injured will require much assistance in evacuation, and helicopter rescue may be necessary. For compound fractures, apply clean dressing (preferably disinfected) to the laceration, and then apply an appropriate splint. Once a splint has been applied to a fracture, evacuation from the trail in search of professional medical help is imperative, particularly with compound fractures.
Frostbite
During the autumn and winter months, Korean mountains can be very cold, presenting the risk of frostbite. Frostbite is literally the freezing of skin tissue. It occurs below 0 degrees Celsius and most commonly affects parts of the body farthest away from the heart, such as fingers, toes, and other extremities, where blood flow is less intense, particularly in cold climates when the body directs blood flow away from extremities to reduce heat loss.
There are basically three types of frostbite. The first is frost nip, characterized by white skin and a loss of sensation. Once the affected area re-warms, it will turn red due to increased blood flow and may tingle. A frost nipped area will recover completely.
Superficial frostbite is characterized by pale, cold skin, and affects the tissues underneath. After a couple days, blisters will appear on the affected area, eventually forming dark, scab-like carapaces. These carapaces generally fall away from the healthy surrounding tissue after a few weeks.
Deep frostbite occurs when deeper tissues, muscles, tendons, and sometimes bone are affected. Affected areas are insensitive, firm, and black. Gangrene eventually sets in.
Prevention
Your best defense against frostbite is your clothing. It is essential that you are prepared for the cold if you decide to trek in late autumn or winter. As frostbite is more likely to occur in windy and wet conditions mixed with below zero temperatures, waterproof and windproof outer shells are essential to your trekking wardrobe. Warm inner shells, such as polar fleece are invaluable. In cold conditions, keep your ears, fingers, and toes properly covered. Be sure that your clothing isn’t too tight as this can restrict blood circulation which may promote the onset of frostbite. Note that mittens are warmer than gloves as your fingers are not separated; in very cold temperatures, gloves shouldn’t even be considered. Proper sleeping gear, like a goose-down sleeping bag, is a must if you choose to sleep outdoors. Dehydration, long term contact with metals in cold conditions, and tobacco use may all contribute to the onset of frostbite.
Treatment
Re-warming of a frostbitten area must be initiated immediately. If possible, the frostbitten individual should be evacuated from the trail before re-warming commences because re-warming while outside increases the risk of refreezing. Note that it is possible to walk with frostbitten feet, but thorough assistance should be given and with the utmost care so as to avoid further damage. Once thawing has taken place in frostbitten feet, it is unlikely that a person will be able to walk on their own. If evacuation is not immediately possible, seek efficient shelter away from cold, windy, and wet conditions. Remove wet clothing only if dry covers are available. Loosen or remove any clothing that may be too tight. Get the affected person under blankets or into sleeping bags. Do not rub or massage the frostbitten area. Keep the person away from close contact with fire as this may overheat the affected area. Note that once thawing has taken place and the blood begins flowing again in the frostbitten area, the affected person will be in extreme pain. At some point, preferably sooner than later, the affected person needs to get to a hospital.
Heat Stroke
South Korea is hot and very humid in the summer. Even the high alpine meadows offer little refuge during these sticky, steamy months. Exerting oneself while outdoors during these times of year increases the risk of heat exhaustion. Heat exhaustion occurs when the body is exerted in hot weather and has become dehydrated due to inadequate intake of water. Headache, dizziness, fatigue, and sweating are common symptoms. If heat exhaustion remains untreated, the core body temperature will continue to rise. As it rises between 38 and 40 degrees Celsius, the body will experience the onset of hyperthermia, an abnormally high fever initiated without the control of the body’s thermoregulatory system. A continually rising core body temperature poses the risk of a medical emergency, namely heat stroke. If body temperature rises above 41 degrees Celsius, the body’s ability to self-regulate temperature becomes compromised. The skin will be hot to the touch, headache is severe, gastrointestinal pain is present, and sweating, in fact, ceases. If left untreated, the heat stroke will grow in severity and can lead to coma and potentially death.
Prevention
Luckily, preventing these conditions is relatively easy. Keep hydrated with clean water. Water as our natural hydrator is more adequate than carbonated drinks, juices, and the like. Wear a hat with a brim, such as a cap or fedora. Consider wearing lighter colours as they attract less heat than darker tones. Take regular breaks in the shade, especially if you experience fatigue.
Treatment
Remove the inflicted individual from the sun and begin oral rehydration immediately. Apply cool water to the skin by wetting a sponge, towel, or article of clothing, dabbing it against the head and neck. Fanning is also effective. If it seems the person has heat stroke, begin the above steps and then evacuate the inflicted from the trail and seek professional medical assistance.
Hypothermia
By definition, hypothermia refers to a subnormal body temperature. The adult human body maintains a core temperature of 37 degrees Celsius, and hypothermia is initiated when this core temperature drops below 35 degrees. This may occur in any season given the proper conditions. Many people make the mistake of believing that hypothermia is strictly a winter-limited infliction. While hypothermia is more common in winter, it can occur in any season.
Depending on the situation, one may experience either acute or subacute hypothermia. Acute hypothermia occurs when the core body temperature drops suddenly, such as would occur when the body is suddenly immersed in cold water. This can happen over a period of a couple minutes to a few hours. Subacute hypothermia occurs over a more gradual period of a few hours to a few days, commonly from over-exposure to cold due to inefficient clothing.
Hypothermia can further be categorized as either mild or severe. In mild hypothermia, the inflicted individual lacks proper coordination and judgment, and may lack balance. The first symptom is shivering. Shivering is the body’s natural response to being cold. As the body temperature drops, the body shakes in an attempt to keep the vital organs warm. It may be important to note that infants do not have a shivering mechanism. If you are in cold mountain conditions with an infant, make sure the infant is properly clothed. You will not be able to tell through physical means if the infant is hypothermic.
Severe hypothermia manifests when the core body temperature drops below 32 degrees Celsius. The condition is characterized by slurring, lethargy, and lack of clear judgment. As the body temperature of an inflicted individual drops below 30 degrees Celsius, shivering will stop. At this point, respiration will be slow and the pupils may be dilated. The body will be cold to the touch and the muscles stiff. The inflicted will likely be pale and have swollen skin. As the inflicted individual’s body temperature continues to drop, the chance of heart failure increases. If the core body temperature drops below 28 degrees Celsius, the inflicted individual is at serious risk of death.
Prevention
Maintaining the core body temperature is paramount in preventing hypothermia. Adequate clothing for the season and weather you’ll be trekking in is most important, as is appropriate sleep-wear and equipment (especially if you choose to sleep outside). A season-appropriate hat is essential. Stay dry as best you can. Proper rain shells are invaluable. If you do become wet, change into dry clothing as soon as possible. Be sure to carry a rain cover for your rucksack to keep your extra clothing dry in case of rain or snow. If it suits you, utilize the layer system; that is, wear several layers to keep warm. The layer system traps heat more efficiently than one thick article of clothing. Make sure your clothing, particularly your socks and boots, are not too tight. Tight clothing can restrict blood circulation, which can help advance hypothermia. Keep yourself well fed and properly hydrated. Note that over-indulgence in cigarettes and alcohol increases the risks of hypothermia.
Treatment
If hypothermia has manifested, it is imperative to remove the inflicted individual from cold, wet, and windy environments. Reduce further heat loss by insulating the inflicted from the ground, and replacing wet clothing with warm, dry layers. Warm the head, hands, and feet with efficient clothing. Cuddling with non-hypothermic individuals in sleeping bags (preferably two bags zipped together) or under blankets is an effective way to bring necessary heat to the hypothermic person. Hot water bottles wrapped in towels or sweaters are helpful if placed on the neck, chest, and groin, but do not apply them directly to the skin. Hypoglycaemia (low blood sugar) is often present with hypothermia, so administering warm, sweet liquids (such as warm juice) can help correct this problem, as well as aid with re-warming. Do not administer alcohol. Be sure that re-cooling doesn’t occur once the inflicted has been re-warmed.
A severely hypothermic person is at high risk of suffering from ventricular fibrillation (incomplete contractions of the ventricles resulting in a decrease of pulse and loss of blood pressure) and so must be handled very delicately. Simply moving the inflicted to apply warming layers can initiate ventricular fibrillation. It is important to immediately attempt to retain heat in the severely hypothermic individual, but evacuation from the trail is paramount. Once thermal layers have been applied to the inflicted person’s body, evacuation measures must be undertaken. If immediate evacuation of the person is impossible, furthered attempts at heat retention and re-warming must be administered until professional medical help is available. Note that a severely hypothermic individual may not be responsive and may have very shallow breathing. With dilated pupils, extremely slow heart rate, and cold, pale skin a severely hypothermic person may appear dead. At no time, however, should you assume this. Sufferers of severe hypothermia may be registering only twenty heart beats per minute. CPR (cardiopulmonary resuscitation) could save the inflicted individual’s life, but should only be administered if it appears absolutely necessary.
Lacerations
Cuts have a wide range of seriousness. Small cuts clot rather quickly and pose very little risk of serious bleeding. Large lacerations, however, particularly those in the scalp may bleed for quite some time.
Prevention
Be careful when using sharp objects, like knives or axes. A trip on rocks may result in an open wound with a contusion (bruise), so take your time on rugged or slick terrain.
Treatment
A small cut can be treated by simply cleaning it with water and applying an adhesive bandage. More serious lacerations require pressure be applied with a dressing or other clean fabric over the wound. Pressure should be applied for five full minutes before it is checked to see if bleeding has stopped. Remove the material used to apply pressure and dress the wound with clean dressings. To avoid irritating a clotting wound, check the dressings only as needed. Larger lacerations, in addition to cleaning and dressing, may require suturing (the joining of the edges of the wound). The most practical method of this on the trail is by using Steri strips. Once the laceration has been probably dressed, the injured should be evacuated from the trail to receive professional medical care.
Snake Bites
There are various species of snake found in South Korea. Not all of them are venomous, but all can bite. Unless you an ophiologist, it is best to treat all snakes as potentially dangerous. Snakes are remarkable reptiles and they must be treated with utmost respect and care. The following lists the most common species of terrestrial snake found in South Korea, with their common Korean names:
- Amur ratsnake (Elaphe schrenckii); Gurung-I (구렁이)
- Asian keelback (Amphiesma vibakari); Daeryuk-yoohyul-moki (대륙유혈목이)
- Black-headed snake (Sibynophis collaris); Bibari-bem (비바리뱀)
- Cat snake (Elaphe dione); Nooruk-bem (누룩뱀)
- Red-banded odd-tooth snake (Dinodon rufozonatus); Neung-gu rung-i (능구렁이)
- Red-tongue viper (Gloydius ussuriensis); Seo Salmo-sa (쇠살모사)
- Short-tailed mamushi (Gloydius blomhoffii brevicaudus); Salmo-sa (살모사)
- Short-tailed viper (Gloydius saxatilis); Kachi Salmo-sa (까치살모사)
- Slender racer (Coluber spinalis Shil-bem (실뱀)
- Tape snake (Zamenis spinalis); Bisa (비사)
- Tiger keelback (Rhabdophis tigrinus); Yoo-hyul Mok-I (유혈목이)
Prevention
Snakes will not actively attack humans and usually only attack when provoked. A snake will prefer to flee than fight something bigger than itself, like a burly trekker. Snakes can accidently be stepped on though, especially in tall grasses, so watch your step. Be aware when you are moving up rocks or a steep part of the trail where you cannot see what’s just beyond the rise. If you are lucky enough to come across a snake, keep your distance and do not disturb it. Let the snake go along its way. If you are sleeping outdoors, a thorough check of your sleeping bag before you sleep may be a good idea.
Treatment
Since you will not likely know if the snake that has inflicted a bite is venomous or not, it is important to follow the necessary first aid procedures against venomous bites for all snakes. Act quickly. Have the bitten individual lie down and get as comfortable as possible. Some first aid procedures suggest not washing the bite wound, because physicians may require samples of the venom left on the skin to determine what kind of snake inflicted the bite. Other institutions do suggest washing the wound with soap and water. Do not irritate the wound by rubbing or touching it. Do not incise the wound and do not try to suck out the venom. Bandage the wound with clean dressings. Immobilize the wounded area; use a splint if possible. Begin evacuation procedures and get to the nearest medical centre as soon as possible. Do not try to find, catch, or kill the snake; this will not help the bitten individual and nothing will be gained by killing the animal (which may be an endangered or protected species. Remember, snakes are a vital part of healthy ecosystems).
Snow blindness
Snow blindness (photokeratitis) is the burning of the cornea due to prolonged exposure to ultraviolet light as it reflects off of snow and ice (and less often, off of water). It results in temporary, but intensely painful blindness. As altitude is gained above sea level by intervals of 300 metres, UV radiation intensifies by 4%, increasing the chances of damage to the eyes (ie, at 600 metres, there is 8% more UV radiation than there is at sea level).
Prevention
Preventing snow blindness is relatively simple: wear sunglasses. Appropriate sunglasses or goggles with UV filters can block more than 99% of UVA and UVB radiation from the eyes. Sunglasses or goggles that wrap around the head are most effective. A hat with a large brim may also help.
Treatment
The most severe aspect of snow blindness is the pain. The snow blind individual should be taken indoors, if possible, or put in a location away from the influence of the sun. The inflicted should be made comfortable, preferably lying down. If the person is wearing contact lenses, they must be removed. An over-the-counter anti-inflammatory (ie, ibuprofen) can help reduce pain. Thick eye pads made from gauze and lightly held in place with bandages will help protect the eyes. Cold-wet compresses are also helpful. Note that the effects of snow blindness may only begin to occur several hours after one is inflicted. Recovery may take several days.
Spinal Injuries
Slips and falls along rocky terrain pose the threat of spinal cord injuries. An injury to the spinal cord means to some degree a loss of function in the body. This can mean a serious change in life style as a severely injured person will have to adapt to paraplegia, or more drastically, quadriplegia.
Prevention
As with fractures, reckless behaviour increases the risk of spinal injuries. Be responsible and take your time on the trail. Those most prone to spinal cord injuries are young men. This group tends to be more reckless and careless of safety. There are, however, reckless people in all age-gender groups and such people are at the greatest risk of obtaining spinal injuries. Nonetheless, accidents can happen to anyone. Go slowly and be cautious.
Treatment
Treating a person who appears to have a spinal cord injury can be daunting. If the injured person is not paralyzed, moving him for evacuation can cause the bones of the spine to slip, suddenly paralyzing him. This is rare, however. If the person is unconscious, the ordeal becomes more challenging as the injured cannot inform you of numbness, paralysis, or the location of pain. In all situations, handle the injured person with care and caution. As the mountains in South Korea are not exceedingly remote or high, helicopter evacuation is readily available. If you don’t have a cellular phone, it may be faster and easier to get to a village or park ranger station on your own to find help than try to evacuate the injured. Make the injured as comfortable as possible. Be sure they are warm. Keep the person’s back and neck as straight as possible, and provide neck support with a collar improvised out of a folded newspaper, a sleeping roll (mat), or any other firm but soft, bendable material (avoid using heat conducive materials). Once the person is comfortably secured, make sharp note of the person’s location (to correctly direct rescue teams), and find help immediately. Parts of the trail are frequented by local hikers who have cell phones. Note that some people often have a tendency to move injured people without thinking of the potential dangers. Do not allow anyone to move the injured unless they are medical professionals.
Rescue Services
Emergency services in South Korea have been steadily evolving since the 1988 Olympic Games were held in Seoul. By dialing 119 (not 911 as is common in most western countries) the Emergency Medical Service is activated, and the caller automatically obtains access to the National 119 Rescue Service. The National 119 Rescue Service and its regional 119 Rescue Service sub-organizations are responsible for all emergency rescue services in South Korea, including mountain rescue. English service is available.
In an emergency situation, get access to a telephone as quickly as possible. Luckily, if you don’t have a cell phone most local hikers do, and villages, towns, and temples dot most of the mountains, therefore making it relatively easy to contact rescue services. If you must leave an injured individual on the trail to find help, be certain to make sharp note of the person’s location so the person can be administered to quickly.
First Aid Kit
A first aid kit is your primary tool in administering help to an injured individual. All mountaineers should have a well stocked kit. It is also a good idea to consider carrying more than one kit depending on the size of your trekking group. A first aid kit is useless unless you know how to use the items contained within it. Read the manual, and know exactly where all the items are located in the kit. Keep the kit in an easy to reach place in your rucksack; don’t store it in the bottom. The following is a list of suggested items for a well-stocked first aid kit. Of course, a kit must be adapted to suit personal needs of medications and preferences. Talk with your doctor or pharmacist for more tips on how to stock a first aid kit.
- first aid manual
- adhesive tape
- adhesive bandages (various sizes, plus several waterproof ones)
- alcohol wipes
- anti-inflammatory medication
- antiseptic (solution and wipes)
- burn cream
- calamine lotion
- cotton bandages
- diarrhea medication
- dressings (sterile)
- elastic bandages
- gauze (sterilized)
- gloves (rubber; sterilized)
- moleskin (with adhesive back)
- pain killers
- paper stitches (i.e. Steri strips, for suturing)
- safety pins
- scissors
- sewing kit (portable)
- sports tape
- thermometer
- tinidazole (for treatment of giardiasis)
- tweezers