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Backcountry Cardiac Emergencies

This article was published July 2013 in the "Backcountry Safety" column of the Hunt Alaska Magazine.

Story and Photos by Jon Hunt

“Is the anything else I could have done?”

This was the question that an avid hunter recently asked when he approached my booth at the Great Alaskan Aviation Gathering where we were displaying a CPR manikin, AED (Automated External Defibrillator) and other first-aid \ safety items.  He recalled recent events of a friend who had a heart attack on a remote fly-in brown bear hunt.  This hunter recognized that his friend was having a cardiac emergency.  He immediately called the Alaska State Troopers on the satellite phone and initiated the cardiac chain of survival.  His prompt response included administering aspirin, having his friend sit down and rest, keeping him calm, and eventually performing CPR.  Within a couple of hours help arrived, but it was too late.

Is there anything else I could have done?  This is the question posed to me by the surviving hunting partner and by numerous participants in CPR training and Wilderness First-Aid courses that we offer throughout the State.  This hunter’s response was textbook-perfect in my opinion; the only other thing that may have changed the outcome was the use of an AED.

The American Safety and Health Institute reports a harsh reality: your chance of survival diminishes 10% every minute that CPR and the use of an AED is delayed.  If all a responder does is CPR, the patient’s chance of survival is very small. When an AED and high-quality CPR is performed, your chance of survival doubles or even triples.  This is why an increasing number of businesses, lodges, remote guiding services and even private individuals are choosing to purchase an AED.

Dr. Matthew Schnellbaecher, an Alaska cardiologist and avid hunter, was kind enough to share some wisdom with us. He reminds us that an ounce of prevention is worth a pound of cure.  In other words, prevention is the best medicine; don’t ask for a heart attack.  Maintain a healthy lifestyle and body weight.  Don’t smoke, and exercise regularly!

In a recent Wilderness First-Aid course I was pleased to meet Karl Braendel, the owner of Nin Ridge Guides. Karl owns an AED and has brought it on his hunts for the past 10 years. He usually keeps it at basecamp.  However, when clients disclose that they have a history of heart disease they carry the AED with them.  On one occasion, they backpacked 15-days with the AED because the client was at high risk of a heart attack. Karl is grateful that he has never had to use it, but acknowledges that his clients are usually quite pleased that this proactive effort to maximize safety has been taken by a Kodiak brown bear guide service.

Question: What is an AED? How does it work?

Answer: AED is an acronym that stands for “Automated External Defibrillator.”  This portable electronic device diagnoses the patient for potentially life-threatening cardiac arrhythmias.  If the device recognizes a ventricular fibrillation or ventricular tachycardia it administers an electrical shock with enough to amps to stop the heart, thus allowing it to restart on its own.  In essence, an AED is much like a reset button on a computer.  It is quite successful when used promptly with CPR.  It is easy to be trained in how to use this device, especially since the devices are accompanied by verbal and visual prompts.  AED’s are relatively compact, lightweight and affordable.

Question: What are the signs / symptoms of a heart attack?

Answer: Typical signs of a heart attack are often described as a squeezing pressure, tightness or discomfort in the chest.  A smaller percentage of patients experience other signs such as a radiating pain in the arm, neck, shoulder or jaw.  Other less frequent symptoms are sweating, light-headedness, or shortness of breath.  Dr. Schnellbaecher offered an important distinction.  He says that most people expect a heart attack to be “painful,” but this is not an accurate description.  It doesn’t hurt as much as it is a discomforting or squeezing sensation.  Men rarely acknowledge that they are in pain, but may identify with the other sensations such as discomfort, pressure, etc.  People with a history of heart disease are more likely to be at risk of reoccurrence.

Question: Are men or women having more heart attacks?

Answer:  Men are still having more heart attacks.  However, heart disease is the leading cause of death in women. Risk factors are the same for women, but symptoms may vary.  Symptoms for women less typical: indigestion, weakness, fatigue, sweating, light-headedness, and shortness of breath are common symptoms for women experiencing cardiac emergencies.

Question: What is the suggested backcountry treatment for a heart attack?

Answer:  Aspirin is an essential medicine to pack. Give one adult aspirin or four baby aspirin if you suspect a heart attack.  Read the label to identify reasons that aspirin should not be taken.  Rest; do not try to self-evacuate.  Call for help immediately.  Keep your patient warm.

Question: What proactive effort should you take if you have a heart condition, or if you are hunting with people who do?

Answer: Consult with your physician to be sure what emergency procedures are best for you.  Bring aspirin (and nitroglycerin tablets if prescribed).  Bring enough medicine to last for longer than the planned duration of the hunt. Have a plan on how to call for help.  Consider bringing an AED on your trip.  Make sure the people you hunt with are trained in first-aid, CPR/AED.  Lastly, be sure to disclose to others that you have a heart condition, or are on medication.

Question: What are some common precipitating factors that increase the risk of cardiac emergencies for hunters?

Answer: Extreme physical exertion by hunters that have not exercised regularly.  This is especially true in cold weather situations when blood vessels are more constricted.  Smoking and obesity and hunters running out of heart medicine because their trip was extended due to weather delays are also major contributors to cardiac emergencies.

Question: Is it worth having an AED in the backcountry?

Answer: There are no definitive data points or studies on this topic that I am aware of.  This is certainly a controversial issue.  The overall consensus seems to be that if you have no significant risk factors or history of heart disease then there is generally no need to have an AED accessible.  However, if there is a history of heart disease, or if significant risk factors are present, then it is certainly a great idea to consider having one accessible.

Question: What is the best brand AED on the market.

Answer: My favorite AED, and the only one that we train with, is the ZOLL Plus unit (we can sell any AED if people want it, but ZOLL is our favorite).  There are several reasons for this favoritism.  First, ZOLL is the only AED on the market that offers live CPR feedback on your CPR compressions.  This is a great feature because you do not always need to have a shock delivered, but you always need chest compressions.  Most people rarely do CPR or use an AED, so the live feedback is an amazing breakthrough in technology.  A recent study shows that this feature makes the victim 2.7 times more likely to be resuscitated.  Secondly, the adult pads/electrodes have a five-year shelf-life (most manufacturer’s products are only good for two-years).  Thirdly, the device is powered by ten Lithium 1-2-3 batteries, which are easily accessible and hundreds of dollars cheaper that most AED replacement batteries.

So, is there anything else I could have done?  Hopefully you can answer yes to this question by now.  Choose to live a healthy lifestyle.  Honestly communicate your limitations to the people you are hunting with. Bring extra medications. Pack aspirin in your first-aid kit; you never know if it may save a life. And get trained in First-Aid, CPR and AED!

Jon Hunt, an avid hunter and fisherman, is an Alaska resident and licensed Wilderness First Responder.  He is the owner of Frontier Safety and Supply, which offers training in Wilderness first-aid, CPR/AED and standard first-aid.  The company also offers a web-store that sells first-aid kits, survival gear, emergency preparedness supplies and high-end outdoor products.  Visit the store at or call Jon at (907) 301-5155