Cardiac Arrest in the Boundary Waters  

A Story of Survival - July 2005

There we were, four guys looking forward to the trip of a lifetime.  For Curt, Mark, and Jerry, the adventure was their first visit to the Boundary Waters Canoe Wilderness Area.  Me…I'd been there before to enjoy the natural beauty of the BWCA.  We'd planned for nearly a year and it was finally time to dip our paddles in the water as we pushed ourselves away from the routines of day-to-day life. 

Jerry, Curt, and I had known each other for years.  Mark, though new to the group, was a natural fit.  Our personalities were similar – none of us was looking for extreme thrills or life-threatening risks…just a week of paddling, fishing, and Northwoods exploration.  What we hoped for and what we experienced were certainly not the same.   

Our entry point was the Mudro Lake Access (#23) at the Chainsaw Sisters Saloon north of Ely, Minnesota.  By air the access doesn't appear to be too far into the "wild."  By truck we were nearly 18-miles away; many miles were a single-track road.  On the water though, we'd be four lakes and four portages from civilization. The reality of our situation was that we'd hardly be alone after reaching Horse Lake, yet if trouble were to occur, help would be hard to find.  But, who ever has trouble in the Boundary Waters?  We certainly didn't expect any…after all, trouble only seems to happen to others, or so we thought.  You read about it, or hear it on the news, but never think it will happen to you.

Mudro Lake presented little challenge at 1¼ miles across.  Though scenic and inviting for anglers, we paddled straight across so we could complete what we knew would be our most difficult portage.  Covering 84-rods (slightly more than ¼ mile), you wouldn't expect the portage to amount to much.  Nothing could have been further from the truth.  The path was an obstacle course over and around rocks and tree roots, compounded by a steep, strenuous climb up and back down to Sandpit Lake.  If any part of the outing was going to challenge someone's ability, that portage should have done the trick.  

Sandpit Lake posed no paddling problems, and neither did the portage between Sandpit and Tin Can Mike Lakes.  In fact, the portage of 137 rods (just less than ½ mile) was our longest portage of the entire adventure.  The trail was smooth with virtually no elevation gain.  A sizeable segment of the trail near Tin Can Mike Lake consisted of doublewide boardwalk through a wet, marshy area.  If it's possible to be comfortable with a portage load on your shoulders - gear or kayaks - this portage is the best around for covering ground. 

Tin Can Mike Lake, with its combination of lily pad-covered shallow water and steep, rock abutments, proved to be a serious temptation for our angling urges.  Since we didn't know for sure where our campsite on Horse Lake would be, and since we were so close to camp, we opted to forgo the fishing until after camp was established.  Perhaps we should have paused in our paddling to toss a lure or two.  Maybe a rest would have done us good.

It wasn't until we had completed the portage between Tin Can Mike and Horse Lakes that our first hint of impending trouble developed.  I was already on the water in search of a campsite and Jerry had just put his kayak in the water when Curt subtly mentioned to Mark that he was dizzy.  With no reason to suspect anything serious, Mark encouraged Curt to drink more water and take a break.  Mark didn't suspect anything unusual, they both started paddling, and our day continued on without incident, for a while.

My search for a campsite was over in less than twenty minutes.  A site near the Horse River was unclaimed, at least until I found it.  I enjoyed a cool swim in Horse Lake as I waited for Curt, Jerry, and Mark to reach the site.  We used FRS radios to relay the information on where the camp was located.

Mark, Jerry, and Curt arrived within an hour and the four of us went about the business of establishing camp.  Curt even went for a swim after our wilderness homes were readied.  By this time Mark had pretty much forgotten Curt's "dizzy" comment and Curt's swim certainly didn't seem to cause him any problems.  The afternoon continued to be uneventful as we basked in the beauty of Horse Lake and Minnesota's Northwoods.

The setting of the sun was our cue to fire up the camp stove.  An evening meal in the Boundary Waters with a warm sun, a gentle breeze, and good friends should have been a relaxing endeavor.  For reasons unknown to us our evening turned bad and there was nothing we could do but react to our circumstances.

Our group of four was sitting around the stove solving the world's problems when Curt stood up and began walking around camp.  After just a few steps, he suddenly fell to the ground.  There was no warning, no moaning, not even a breathtaking gasp…just a sudden drop to the ground.  He crashed down as if his legs had been blown out from under him.  Compounding Curt's sudden collapse was the rock located precisely where his head slammed to the ground.  The dull, hollow thud of Curt's head hitting the rock resembled the sound of a strong thump on a watermelon. 

The rock Curt hit his head on resulting in a severe concussion. 

I won't speak for Mark or Jerry, but I thought Curt was messing with us.  Somehow my mind ignored the sound of his head hitting the rock.  Maybe I was thinking his version of a practical joke had gone bad when he intended to fake a fall, but didn't realize he was going to hit a rock.  It didn't matter, for a few seconds I thought he was messing with us.  Then the EMT in me took control - I wasn't thinking consciously anymore - instead I went into autopilot mode.  I quickly ran the few feet to reach Curt who was lying face up, still on the rock.  His eyes were fully dilated and non-reactive.  A pulse check revealed the worst possible situation - Curt was in cardiac arrest.  (Note: I have nearly 25-years of EMS experience, I am a CPR instructor, and I am a trained Medical Examiner Investigator.)  The joke was over…Curt wasn't messing with us and if we didn't do something quick, Curt wouldn't ever be with us again.

Time has a way of slowing to a crawl during the worst of times.  Our scenario seemed to run in slow motion.  I was preparing to do CPR, Mark was moving my direction - planning to help I suppose, and Jerry was facing a terrible emotional crisis.  Of the four of us, Jerry was probably the closest friend to Curt.  Over the years they had kept in frequent touch, paddled together, and shared similar interests.  Seeing Curt's condition created a tough situation for Jerry.  How do you react to a friend in arrest?  Each of us handles stress differently - some exhibit calming confidence while others react unpredictably.  Until a person has lived through such an emergency, their reaction will be unknown. 

Months have passed since the episode and I still can't explain why, but instead of immediately performing CPR, before I gave Curt his best chance for survival, I smacked him hard on his right shoulder.  I don't know, maybe I was hoping that if I treated him like we didn’t think he was funny, maybe he would stop the joke.  For whatever reason, I hit him hard on his shoulder and yelled his name.  To our relief, he slowly began to respond.  Understandably, Curt didn't bounce right back to his normal "self."  Instead he blinked a few times and slowly tried to sit up.  Due to his probable head injury and brief arrest, I insisted that he remain flat on his back.  Another pulse check told me Curt's condition wasn't good.  First his pulse would beat at a rate close to 150 beats per minute and then it would stop entirely.  There was nothing regular about his heart rate and experience told me to expect him to arrest again at any time. 

Curt had no memory of what happened after he fell to the ground.  In fact, Curt had no idea where he was, who Mark was, or what he was doing.  In what seemed like another slow-motion movement Curt's eyes scanned the area as he studied his surroundings.  "There's trees… there's water…there's kayaks…I always wanted to go to the wilderness" were Curt's first words.  It was obvious that Curt wasn't completely with us.  We tried to explain to him where he was and what we were doing, but it was no use.  Curt simply didn't comprehend anything we said. 

Due to the nature of Curt's head injury and his possible cervical spinal injury, Jerry was positioned at Curt's head to maintain stabilization.  Curt recognized Jerry, but didn't really listen to him.  I continued to monitor Curt's pulse while Mark, Jerry, and I tried to determine what our next move should be.  Our biggest obstacle was a lack of communications - we had no cell phone with us and the FRS radios were getting no response.

Options for Curt's care were limited to paddling back to the trucks, do nothing and hope Curt survived the night, or find help from someone on Horse Lake.  Darkness eliminated paddling back.  Waiting until morning put Curt at unnecessary risk.  His heartbeat was very irregular and he had suffered a head injury.  One of his pupils was no longer reactive so the decision was made that Curt needed immediate medical care.  We agreed that I would paddle around Horse Lake until a campsite was found that had both a cellular telephone and enough signal to make contact with 911.

Luck seemed to be on our side when the first campsite I reached had both a cellular telephone and intermittent signal.  After explaining our dilemma the family at the camp readily loaned me their phone so I could attempt a call to 911.  I don't think I've ever had more of a sinking feeling than when the call to 911 went through and then I lost them.  Technology is great, but in the wilderness of the Boundary Waters, we were stretching the limits.  After six or seven calls, I was finally able to relay "cardiac arrest, head injury" and our GPS coordinates.  The voice on the other end said they would send help, but we had no idea how or when.

As an EMS provider I knew how we strive to provide as fast of a response as possible.  I also realized that being miles from the closest airstrip would likely cause a delay in receiving medical care.  What I didn't know was Forest Service approval was required to fly a floatplane based in Ely to our location on Horse Lake.  Thirty minutes passed with no signs or sounds from a plane.  Mark made a signal flag with a bandana and kayak paddle as we waited for the plane.  Jerry continued to keep Curt calm while I monitored his vital signs and wrote a medical history.  An hour passed and Curt continued asking the same four or five questions over and over.  Two hours passed and the sun was beginning to set.  None of us knew whether or not the plane would fly after dark and if it did, would they be able to find us.  Finally, two and a half hours later we heard the sound of a floatplane approaching.  We knew the plane was coming to our site when the aircraft slowly circled our general area.  Of course Mark was ready and waving the bandana to draw the pilot's attention.

In all of my backcountry preparations I had never given much thought to how rescues were accomplished.  I expected the plane to fly in, EMS personnel would jump out with thousands of dollars of high-tech equipment, the rescue would be successful, and somebody would receive a sizeable bill.  We quickly learned differently.  The first person out of the plane was a member of the Sheriff's office.  I asked if EMS was on board and the officer promptly explained that due to abuses of rescues, particularly because of cell phones, all calls for help were verified by a member of law enforcement before any EMS care would be provided.   A quick hike to Curt's side convinced the officer that Curt needed immediate medical attention.  Even with a plane flying in and the sudden appearance of strangers, Curt continued asking the same questions as earlier; he still didn't recognize an emergency was underway.  An EMT climbed out of the plane with basic equipment and began performing an assessment on Curt.  I retrieved a backboard and cervical collar from the plane and we packaged Curt for the flight to the hospital in Ely.  None of us had any idea how difficult it would be to move Curt, on a backboard from where he fell, down the rocks, through the struts of the plane's wings, and into the back of the plane.  All the while Curt continued repeating himself over and over and over!  Within less than twenty minutes Jerry, Mark, and I were watching the plane fly off into the sunset with Curt on board.

To describe the rest of the night as solemn would be an understatement.  I expected the hospital to confirm that Curt had two problems - a cardiac arrhythmia and a head injury, possibly with bleeding in the brain.  Either condition had the potential to kill him during the night.  The three of us spoke hardly a word, yet the thoughts and feelings were clearly communicated.  We shared in the sad duty of taking Curt's tent down, rolling his sleeping bag, and packing his equipment.  There was no staying up to gaze at the stars, no listening for wolves, and no watching for northern lights.  No, on this night each of us went to our tents, but there was little sleeping.

Daybreak couldn't have come early enough for any of us.  Was Curt dead or alive?  If he was alive, what condition would he be in?  As much as I cherished my time in the Boundary Waters, I hated where we were.  Why did we have to be so far away?  How could we possibly get back to Ely any faster?  Our plan was to break camp and I would tow Curt's kayak and gear toward the trucks.  We struggled quietly to paddle in a "missing man" formation toward our first portage. 

It didn't take long to realize that the double portages we used the day before wouldn't be enough to move Curt's gear, along with our own, back toward the Mudro access.  The first portage strained us to our limits - emotionally and physically.  We struggled back and forth across the portage before we had all of our gear and Curt's gear moved to Tin Can Mike Lake. 

Sometimes, even in dire situations, good luck appears from nowhere.  As we approached the Tin Can Mike/Sandpit Lake portage we met Boy Scout Troop 909 from Tulsa, Oklahoma.  The troop was finishing a High Adventure in the Boundary Waters.  After explaining our situation we soon had scouts and their leaders helping us move all of our gear across the portage.  What could have taken hours was completed in a fraction of the time.  At each portage the troop was there to carry gear or kayaks - whatever needed to be moved - to the next lake.  Needless to say, our appreciation for Troop 909 is immeasurable.

I'm not sure I can accurately describe the emotions we faced as we entered the hospital in Ely.  Each of us was hoping for the best, expecting the worst, and uncertain of anything in between.  We soon learned that yes, Curt was at the hospital in Ely.  His condition appeared stable, but he was still in trouble.  We learned that Curt had continued asking the same four or five questions over and over, non-stop, for nearly nine hours! 

Probably the most interesting detail we learned at the hospital pertained to legal guidelines.  Due to patient privacy regulations, Curt's doctor and nurses were not able to discuss Curt's condition with us until Curt granted permission to the hospital staff.  We learned that his heart had stabilized some and was being monitored.  The nursing staff confirmed that Curt had suffered a severe concussion when his head hit the rock.  After his condition stabilized and family arrived, Curt's care was transferred to a doctor in Iowa.  Each of us was relieved and willing to accept that although he had a serious injury, Curt's prognosis was good. 

Curt's condition took several unusual turns following his return home.  His cardiac study proved inconclusive with no apparent cause for his initial arrest and subsequent cardiac irregularities.  Most disturbing were the changes to Curt's mental state.  For several weeks following the incident Curt suffered memory lapses and an inability to focus on tasks.   Following several weeks of recovery his life began to return to some sense of normalcy and he has returned to work. 

Now, one paddling season after Curt's incident, routines have returned for Jerry, Mark, Curt and me.  Jerry has enjoyed a much more pleasant paddling experience in the Boundary Waters.  Mark hasn't made it back to the Boundary Waters yet, but will soon with his son.  I too have returned to the Boundary Waters for a very memorable experience.  Curt has taken up running and paddles around home.  The four of us remain friends and have discussed the experience many times.  Each of us remembers different details, but all agree we had more than our share of good luck with someone powerful watching over us.