by James Hubbard, MD, MPH1355858013_477fb03f7d_o

Many years ago, my wife and I were in Arizona to attend a conference. We had several hours to kill until the first meeting that night, so I decided we’d make a quick trip to the Grand Canyon. Then, I calculated we had three hours to kill before we had to leave and decided we should hike the trail down the Canyon, at least for a bit.

Well, I miscalculated the extra time and effort it would take to walk back up, so the hike became a speed walk. With about a mile to go, I heard my wife from behind me yell, “I think I’m having a heart attack.”

I replied, “You can’t be.”

“Why not?”

“No one can get to you. We’re on the edge of one of the steepest canyons in the world. And we’re behind schedule. You can’t have a heart attack until we get back to the top.”

Well, that wasn’t my finest moment as a doctor (or husband), and I reaped the consequences of my words for quite a while, but seriously, what if you find yourself on a hike, far from help, and begin to have chest pain? What would you do?

Before I answer that, please check out my previous post on what you can do for a heart attack in a survival situation. You’ll learn about some elements that may help you survive, including an aspirin, rest, oxygen, warmth and an AED.

But that post doesn’t cover the dilemma of being in the wilderness, where your only chance for help is calling in a helicopter that’s an hour away—and maybe you don’t have cell service anyway. In that scenario, your best chance of survival may mean walking to get help. But the walking itself could kill you.

I don’t think there’s a one-size-fits-all solution here. But I thought it would be helpful to go through my thinking process for deciding what to do so if you ever face this problem, you’ll know some things to consider.

To Walk Out or Not?

During a heart attack, your heart needs as little extra stress on it as possible. Blood flow to part of it has been stopped or slowed, so it’s already not getting enough blood and oxygen. Any exertion just increases the amount it needs—and therefore increases the chance it will sustain more damage or die.

So normally, when you’re having a heart attack, you need to lie down and let your heart rest. But what if you’re lying down in the middle of nowhere, with slim to no chance of help coming? Are you just waiting for possible death? This is when the judgment calls start.

In my next post, I’ll give you my thought process for making a decision, but until then, I challenge you to think through the following scenarios. What would you do and why? (When thinking through these, keep in mind that being treated within the first hour of a heart attack gives you the best chance of surviving.)

  1. You’re alone with no chance of help coming and no cell service. Do you wait out the heart attack and hope for the best, or do you try to walk out?
  2. You have no cell service, but you do have a friend with you. Do you send the friend for help even though you might need CPR?
  3. You have cell service, but first responders can’t reach you for a couple of hours because they’ll have to hike in to get you. Do you start walking out?

Next week, I’ll give my thoughts on all these questions. I’ll be interested to know how they compare to yours. Subscribe below to be notified when that post is published.

Photo: Flickr/Rick McCharles, “hiking John Muir Trail,” shared under CC BY-NC 2.0.