by James Hubbard, MD, MPH
If you have a heart attack in the wilderness, it’s judgment-call time. In my last post, I talked about the fact that you’ll have to weigh walking for help with waiting for help that you don’t even know is coming. Walking could damage your heart further. Waiting could postpone care too long.
In this post, we’ll go into the details of how I’d make the decision. Of course, this is by no means individual advice, nor is it meant to cover every scenario. It’s just meant to give you an idea of some things to think about.
First: Are You Really Having a Heart Attack?
The first thing you might wonder is whether you’re actually having a heart attack rather than muscle pain, indigestion, tightness in the chest from wheezing, or another problem that can cause chest pain. The unfortunate answer is you cannot know. This is one of the most important things to remember. Without tests, even doctors can’t make a definite diagnosis.
You also can’t tell just from symptoms how severe a heart attack is. If you’re not having major pain, you could still be having a major attack. In fact, people die every day of heart attacks with no symptoms.
So if you have any suspicion that you may be having a heart attack, I recommend calling for help if you have cell service, even if the help will be via helicopter. But for your information, here are some things that indicate strongly that what you’re experiencing is indeed a heart attack:
- You have chest pain that is severe.
- You have the classic symptoms (including a crushing feeling in the middle of your chest, pain down the left arm or into the jaw, nausea, and shortness of breath). Many, many people have heart attacks without any of these symptoms, but if you do have them, heed them. Click here to learn about other symptoms of a heart attack.
- You’ve had this pain before and know it’s your heart.
- You have a risk factor for a heart attack, such older age, a smoking habit, high cholesterol, high blood pressure, obesity, or diabetes.
Should You Rest?
If you think you’re having a heart attack, I’d suggest that you immediately stop walking and rest for a few short minutes, even if you have a long way to go. While you’re resting, one of two things could happen:
- The pain could continue or get worse.
- The pain could be relieved. This doesn’t mean you’re not having a heart attack, but chances are a little reduced.
If resting relieves the pain, then perhaps you could start walking again, but more slowly, maybe leaving behind any nonessentials you’ve been carrying.
If the pain continues but you’re by yourself and there’s no chance at all of getting help unless you go for it, I don’t see much of an alternative but to walk out then as well. Leave anything you’re carrying, and go fairly slowly.
Could You Wait It Out?
If the pain continues and there’s no chance of help, you could wait it out for a while longer instead of walking out right away. This is risky, but some people do live through heart attacks without professional care. But being treated within the first hour gives you your best chance of survival.
Knowing some physiology could help you make a decision. Heart attacks kill in one of two ways:
- Damage to the heart’s electrical system (the system that causes the heart to beat) may trigger dangerous heartbeats. Sometimes these lead to the heart totally stopping. (Medicines given in the hospital can help prevent these dangerous rhythms, and shocking the heart with a defibrillator is the best bet to change a deadly rhythm or no beat at all back to something you can live with.)
- Death of heart muscle: If enough dies, the heart can’t pump enough blood for you to stay alive.
So, the dilemma: Most people who die, die from those irregular beats within the first 24 hours or so of the heart attack. And by far, the most dangerous time is the first hour. So walking out may be worth it if it means you can get help faster.
On the other hand, an argument against that idea is this: The heart requires even more oxygen with exercise. So some of the areas that might be getting a little blood, just less than usual, might be only barely hanging on with what oxygen they’re getting. If more stress is put on them with exercise, they may be damaged or die.
Certainly some people with a heart attack never get the dangerous rhythm. And sometimes, the muscle damage is small enough not to affect the pumping strength much. With time, the area just scars and the heart beats on.
So yes, many people may survive a heart attack with just rest (though that would be insane to try if you could get expert help).
If you do decide to wait it out, you’ll have to figure out food, water, and shelter. Dehydration alone makes your blood circulate less efficiently. Since the heart takes several weeks to heal, at some point, a decision would have to be made.
What If You Have Cell Service?
If you can call to request air transfer, you still may have to decide whether to walk out because a helicopter could take an hour to get there, and then the first responders would have to hike in to get you. (Remember that many preventable deaths from a heart attack occur within the first hour or so.) But hopefully the 911 operator can help you decide what to do.
What If a Friend Is With You?
If you have a friend with you, they could go for help. (You’d still need to decide whether to walk out slowly yourself as well.)
Some things to think about: If your friend leaves, you’ll have no one there to administer CPR if your heart stops. However, it is extremely rare for a person to survive with only CPR—without proper medication or electroshock (from an AED machine or defibrillator). The CPR is to try to keep blood flowing to your brain until a procedure can be done to restart the heart. It is extremely rare for the heart to start back with CPR alone.
Plus, the longer defibrillation is delayed, the less likely the heart is to start beating again, even if CPR is performed in the interim. Also, getting supplemental oxygen might help get a little more oxygen to the damaged areas.
So if there’s no chance of getting help unless your friend walks to get it, having them go on ahead might be worth the risk.
None of these are great solutions. If you have other ideas, please suggest them, for my education and other readers’.
Long-time doctor James Hubbard, MD, MPH, shares some of his best tips for surviving life-threatening emergencies in The Survival Doctor’s Emergencies Training Course. Click here for a sneak peek.
Photo of hiker: Flickr/Anthony DeLorenzo, “Hiking up Skukum Creek,” shared via CC BY 2.0. Photo of woods: Flickr/Guilhem Vellut, “Fog @ Ikusabata / Mount Takamizu / Mitake hike,” shared via CC BY 2.0. Photo of helicopter: Flickr/Airwolfhound, “Eurocopter AS350B2 – Grand Canyon,” shared via CC BY-SA 2.0.