Essential First Aid Skills for Paddlers: Safety on the Water

This blog post will cover some of the most common injuries and dangers associated with paddling and will recommend basic first aid strategies for handling them.

Know the Common Dangers

While many paddlers can face a variety of emergencies (too many for one blog post to cover), there are some common first aid concerns that often recur:

  1. Drowning and near-drowning
  2. Hypothermia
  3. Cuts, scrapes, and puncture wounds
  4. Sprains, strains, and fractures
  5. Sunburn and heat-related illness

This blog post will focus on responding to these first aid situations.

Drowning and near-drowning

The most obvious life-threatening emergency would be drowning or nearly drowning. Even in calmer water, drowning is always a possibility, and though uncommon, all paddlers should prepare to resuscitate a drowning victim.

After the drowning victim has been removed from the water, you should call 911 immediately, assuming you have cell service.

Even if medical professionals are on the way, you still need to administer first aid immediately. In most drowning cases, you’ll need to begin hands-on CPR and rescue breathing.

While you can use this video to show you the basics of CPR, we strongly recommend contacting your local Red Cross to get certified in CPR. It’s an inexpensive, short course, and it may save someone’s life.


Hypothermia occurs when you are exposed to cold temperatures for prolonged periods and your body loses heat faster than it can produce it.

In short, you’re cold, and you keep getting colder.

Hypothermia occurs in stages, and if untreated, it can lead to death. The Center for Disease Control offers this simplified list of symptoms:

  • Shivering
  • Exhaustion
  • Confusion
  • Fumbling hands
  • Memory loss
  • Slurred speech
  • Drowsiness

If you spot any of these symptoms in a member of your paddling group, stop the trip immediately and get treatment.

If you forget specific treatment options, at least remember this: Get them warm and get them dry.

For more detailed options, the list below offers professional guidelines:

  • Get the person into a warm room or shelter.
  • Remove their wet clothing.
  • Warm the person’s core. Since you’re outdoors, use dry blankets, clothing, or even skin-to-skin contact.
  • You can give them warm (not hot) drinks, but do not give them alcohol.
  • After their body temperature has increased, keep the person dry and wrap them in a warm blanket.
  • Get the person proper medical attention as soon as possible.

For a more in-depth discussion of hypothermia, check out this video. Made in cooperation with the U.S. Coast Guard, “Cold, Wet, and Alive” appears dated but the information is current and useful.

Cuts, scrapes, and puncture wounds

This catch-all category of wounds can range in severity. Generally, you’ll want to stop the bleeding by applying pressure to the area. Once the bleeding has stopped, you’ll need to clean and bandage the wound.

Wounds that break the skin can pose a hidden danger: infection. Particularly when paddling, infection is a real danger as river water contains bacteria and chemicals that, if introduced into your bloodstream, can become life-threatening.

To prevent infection, change the bandages frequently to keep the wound clean and monitor the area for redness and swelling.

If you see signs of infection, you should seek medical help immediately, particularly if the redness/swelling is spreading.

Sprains, strains, and fractures

Injuries to bone, tendons, and other muscle tissue are too complex to cover in a blog post.

With these injuries, it’s often best to try to immobilize the injured area, often by making a splint or sling.

If you are paddling in a group and the injury is not too severe, you can modify the trip to allow the injured person to rest or avoid using the injured area.

Most of these injuries cannot be properly treated in the backcountry; the best you can do is to make the patient comfortable and extract them so they can seek proper medical attention.

Heat-related Illness

When paddling in the heat, prevention is the best medicine: use sunscreen, UV protective clothing, and hydrate frequently.

Aside from sunburn, the most common heat-related illnesses are heat cramps, heat exhaustion, and heat stroke. Heat cramps are the first indicator of being in danger in hot weather. If not treated, cramping can turn to heat exhaustion, which can finally lead to heat stroke.

The Centers for Disease Control and Prevention offers an extensive list of symptoms and treatments for heat-related illnesses, but we’ll just share a simplified version below.

Heat Cramps

  • How to Recognize Heat Cramps: Symptoms of heat cramps are exactly what they sound like: Muscle cramps, usually in legs or abdomen.
  • Treatment of Heat Cramps: Begin by massaging the cramping muscles and having the patient sip water. If patient is nauseated, they should NOT drink water.

Heat Exhaustion

  • How to Recognize Heat Exhaustion: Symptoms of heat exhaustion include dizziness, thirst, heavy sweating, nausea, and weakness.
  • Treatment of Heat Exhaustion: You need to move quickly if someone shows symptoms of heat exhaustion. Move the patient to a cooler area, loosen clothing, and have them sip cool water.

Remember, heat exhaustion can be life threatening and lead to heat stroke. If the patient’s symptoms do not improve, seek medical attention.

Heat Stroke

  • How to Recognize Heat Stroke: Symptoms of heat stroke include confusion, feeling dizzy, and at the extreme, becoming unconscious.
  • Treatment of Heat Stroke: Heat stroke can lead to death or permanent disability. If someone shows signs of heat stroke, call 911 immediately. While waiting for medical help, move the patient to a cooler area, loosen their clothing, and cool their body with water or ice.

Take a First Aid Training Course

Educating yourself on common first aid emergencies is a great start. To be a truly valuable member of your paddling group, consider taking a first aid course. General first aid courses are available through your local Red Cross chapter. For more specialized outdoor classes, check a regional outfitter or large outdoor retail store like REI.

Some common first aid courses include:

Red Cross: Basic First Aid – This hands-on class will teach you to address common first aid situations such as dealing with cuts, sprains, etc.

Red Cross: CPR – This class will certify you in the basics of providing CPR.

Wilderness First Responder (WFR) – This 8–10-day hands-on course trains students to respond to an array of backcountry emergencies. Offered through a variety of different schools and outfitters.

Don’t Be Scared. Get Prepared.

Preparation is the key to handling many emergencies. First aid situations are scary for most people, but with some education and a properly prepared first aid kit, you can minimize your fear and be a more valuable member of your paddling group.