First aid for Cape Town hikers
Call Wilderness Search and Rescue first. These notes are while you wait.
Heat exhaustion
Signs
- Heavy sweating with cool or clammy skin
- Dizziness, weakness, headache, or cramps
- Rapid or shallow breathing
- Nausea or vomiting
What to do
- Move to shade immediately — stop all activity
- Remove excess clothing and loosen anything tight
- Wet the skin and fan to promote cooling
- Give cool water in small sips only if the person is fully alert and not vomiting
- Place cold, wet cloths on the neck, armpits, and groin
- Call WSAR if symptoms worsen, the person vomits repeatedly, or they do not improve promptly
Do not
- Do not let them resume the hike that day
- Do not give fluids if they become confused, very drowsy, or unable to swallow
Confusion, seizures, collapse, or loss of consciousness may mean heat stroke — call WSAR immediately and use the heat-stroke steps.
Heat stroke — emergency
Signs
- Confusion, unusual behaviour, slurred speech, or seizures
- Collapse or loss of consciousness
- Very hot skin, which may be dry or sweaty
- Rapid breathing or a racing pulse
What to do
- Call WSAR immediately — heat stroke is life-threatening
- Move the person to shade and remove excess clothing
- Cool aggressively: soak with cool water, fan continuously, and place cold wet cloths or wrapped cold packs at the neck, armpits, and groin
- If unconscious but breathing, place them on their side and monitor breathing
- If they are not breathing normally, start CPR and follow the dispatcher's instructions
Do not
- Do not give food, drink, or medicine
- Do not wait to see whether cooling alone works
- Do not leave the person alone
Keep cooling while help is on the way. Confusion or collapse in the heat is an emergency even if the person says they feel better.
Snakebite
Signs
- A suspected bite may leave one mark, several scratches, or no obvious mark
- Pain, redness, or swelling around the bite
- Nausea, dizziness, or sweating
- Drooping eyelids or difficulty swallowing in severe cases
What to do
- Keep the person calm and as still as possible — movement spreads venom faster
- Remove rings, watches, or tight clothing near the bite before swelling starts
- Immobilise the bitten limb and, if possible, support it at least at heart level
- Note the snake's colour and markings if it is safe to do so
- Call WSAR immediately — do not wait for symptoms
Do not
- Do not cut the bite or try to suck out venom
- Do not apply a tourniquet
- Do not apply ice
- Do not give alcohol, aspirin, or anti-inflammatory medicine unless a clinician tells you to
Cape cobra bites can be fatal within hours. Antivenom must be given at a hospital. Call immediately.
Hypothermia
Signs
- Uncontrolled, intense shivering
- Confusion, slurred speech, or poor decision-making
- Stumbling or poor coordination
- Pale or blue-tinged skin
- Shivering that has stopped — this is a danger sign, not recovery
What to do
- Get the person out of the wind and rain
- Remove all wet clothing
- Insulate from the ground — use a pack, sleeping mat, or extra layers
- Cover the head and neck as part of insulating the whole body
- Place warm (not hot) packs in the armpits and groin if available
- Give warm, sweet drinks if the person is fully conscious and able to swallow
- Call WSAR
Do not
- Do not give alcohol
- Do not rub the limbs vigorously
- Do not put the person in a hot bath or against a fire
- Do not assume they are fine because shivering has stopped
Rewarm slowly. Rapid rewarming can cause cardiac arrest. Keep them still and warm until help arrives.
Twisted ankle or fracture
Signs
- Pain and tenderness around the ankle or along the bone
- Swelling or bruising
- Unable to bear weight, or significant pain when trying
What to do
- Stop moving immediately
- Sit or lie down and elevate the leg if possible
- Pad the injury with spare clothing — do not attempt to straighten
- If the person cannot bear weight at all, call WSAR
- If they can bear some weight, assist them out slowly — improvise a splint from sticks and clothing
Do not
- Do not force the boot off; loosen it and check the toes for normal colour, warmth, and feeling
- Do not attempt to straighten a suspected fracture
If you cannot tell whether it is a sprain or fracture, treat it as a fracture.
Rockfall injury
Signs
- Visible wound or bleeding
- Head injury: confusion, unequal pupils, nausea after impact
- Suspected spinal injury: neck or back pain after a fall or impact
What to do
- Move everyone out of the rockfall zone first
- Call WSAR immediately if any head or spinal injury is suspected
- Control bleeding with firm, direct pressure using a clean cloth
- Keep the person still, warm, and calm
- Do not remove a helmet if one is being worn
Do not
- Do not move someone with a suspected spinal injury unless they are in immediate danger
- Do not give food or water to someone with a head injury
Head injuries can deteriorate quickly with no outward change. When in doubt, call.
Lost on the mountain
Signs
- Landmarks do not match your map or description
- The path has disappeared
- Daylight is fading
What to do
- Stop — do not keep walking when you are uncertain of your position
- Call WSAR if you have signal: 021 937 0300
- If no signal, try 112 — it works on any network without airtime
- Stay put — a stationary person is much easier to find
- Signal your position: three whistle blasts, flash a headlamp, reflect sunlight with a phone screen
- Get out of wind and conserve warmth while you wait
Do not
- Do not keep walking downhill hoping to find a path — in the dark, this can take you off a cliff face
- Do not separate from the group
Most call-outs are for hikers who kept moving after getting lost. Stay put and make noise.