What to Do in a Trekking Emergency in Nepal, Step by Step

In the first hour of a trekking emergency, the order of actions matters more than speed. Make the scene safe, check the person, shelter and warm them, send for the guide or call the agency and insurer with the facts, descend if it is an altitude problem and safe to do so, and record times and symptoms. Nobody is expected to be a doctor. The job of a trekker is to keep the casualty alive and warm, to get qualified help moving and to avoid making a second casualty. This guide sets out the sequence, how it changes for altitude illness, injury and cold, and how partners can divide the jobs so that nobody freezes.

This is general information, not medical advice or first aid training. A recognised first aid or wilderness first aid course is worth more than any web page, and our first aid kit guide lists what to carry. For numbers, see emergency and rescue numbers.

Step 1: stop and make it safe

Stop the group. Look around: is the casualty in the path of falling rock, on a narrow bridge, in a flooded stream or on an icy slope? Do not rush in and become the second casualty. Move people out of danger only if you can do so without more risk, and do not move someone who may have a neck or back injury unless they are in immediate danger. Put on a warm layer yourself first, as the rescuer who gets cold is no help. Assign one person to be in charge, usually the guide, or the most experienced person, and make sure everyone knows who it is.

Step 2: check and keep the person alive

Check whether the person is awake and responds, whether they are breathing and whether they are bleeding heavily. Control bleeding with firm pressure. If they are unconscious and breathing, keep their airway open and on their side; if they are not breathing, the guide or anyone trained should start resuscitation while others call for help. For a fall, check the head, neck, back, hips and limbs gently without moving them more than you must. Note times and symptoms: they will be needed by anyone who takes over.

Step 3: shelter and warmth

Cold turns small injuries into big ones. Get the person out of the wind, onto an insulating layer such as a pack or a mat, and add dry clothes, a sleeping bag or a blanket, with the head covered. The NHS advice for hypothermia is to move the person to shelter as quickly as possible, remove wet clothes, wrap them in a blanket or sleeping bag and give a warm, non-alcoholic drink if they are fully awake; avoid hot baths, heat lamps and rubbing limbs. Our cold health guide covers it in more detail. Shade a casualty from the sun on a bright slope and protect their eyes.

Step 4: send for help and call

In most cases the guide, or the lodge owner, is the link to the agency and insurer. If you are alone, call the insurer's emergency number or the agency. For crimes, harassment or lost documents in Kathmandu or Pokhara, the Tourist Police hotline is 1144 (Department of Tourism). State the facts: who, where, what happened, how many, how serious, how to reach you. Ask whoever you speak to to repeat the information back. If there is no signal, send two people to the nearest lodge or village, where a phone or radio may be available, and to a higher point for signal if it is safe; the UK FCDO notes limited mobile coverage on long stretches of the Annapurna Circuit. Do not leave the patient alone. Our numbers guide gives the details.

Step 5: altitude illness changes the plan

If the problem is altitude illness, descent is the main treatment. The NHS says to rest at the same altitude and not go higher if symptoms are mild, and, if they worsen or do not improve after a day, to go to a lower altitude, around 300 to 1,000 m lower if you can. The CDC lists descent first for severe forms, with oxygen and medicines under medical direction and a portable pressurisation bag where available for remote groups. Signs of the severe forms, such as confusion, loss of balance, breathlessness at rest or a wet cough, are an emergency; see HAPE and HACE warning signs. Descend with the patient, never send them down alone, and keep them warm and hydrated on the way. If walking is impossible, ask for a helicopter, as described in helicopter evacuation.

Step 6: injuries and bites

For a fall or sprain, immobilise the area with a bandage or a splint made from poles or a pack frame, and treat for shock by keeping the person warm and lying down. For a deep wound, apply pressure, dress it and get to a clinic. For a bite or scratch from a dog or other animal, wash it well and get medical advice quickly; the CDC says rabid dogs are common in Nepal and that post-exposure vaccine may only be available at larger urban facilities. For a serious injury, a helicopter or a carry-out is likely; the guide and agency will decide. Keep the person warm and avoid giving food or drink if surgery may be needed.

Step 7: decide: wait, walk or fly

The guide, the doctor on the phone and the insurer will help you decide. Waiting suits a patient who is stable, in shelter, with a helicopter expected; walking down suits a mild altitude case with a clear path and daylight; a carry by porters or a pack animal may be possible on some routes. Weather decides what is possible. Never walk a casualty into the night or over a pass in bad conditions. A spare day in your plan is a safety margin, as buffer days explains.

Step 8: record and communicate

Write down what happened, with times, symptoms, what was done and who was told. Take photos of the location if it helps. Tell the group what is happening and what the plan is. Tell the people at home when you can, briefly and calmly. Keep every receipt and medical document for the insurer. If the group is splitting, agree who stays with whom and when to call again. What if your partner cannot continue covers the money and plan afterwards.

Dividing the jobs between partners

In a group, jobs get done when they are named: a leader who decides, a carer who stays with the patient, a caller who contacts the guide, agency and insurer, a scribe who writes times and symptoms, and a gear person who finds layers, food and the kit. In a pair, split it into two: one stays, one goes. Agree this on the first evening, as the trekking partner safety guide suggests, and practise the first steps once. On routes such as the Annapurna Circuit, Everest Base Camp and the Manaslu Circuit, the guide knows the nearest post, lodge and landing site; tell them early and follow their lead.

The guide rule and emergencies

A licensed guide through a registered agency is required in restricted areas (Department of Immigration) and, under the Nepal Tourism Board rule of April 2023, in national parks and conservation areas, where 2026 operator reports say checkpoints enforce it in Annapurna and Langtang but not in Khumbu (checked 19 October 2026). The Manaslu Circuit is a restricted area, so a guide is part of the permit there. Where you are free to go without one, remember who will call for help if you are the casualty. See the guide rule by region, the partners and safety hub and the Everest Base Camp partner page for related guides.