Friends, Knowledge Help Save Heart Attack Victim at Sea

Looking back, Terrell Smith remembers the experience as even more searing than it was. He was miles out to sea, on a deep-sea fishing boat off Mexico’s southwest coast. He suffered a heart attack. The nearest hospital was hundreds of miles away.

The seizure hit at 2 a.m. Oct. 31--Smith’s introduction to Halloween. The next 18 hours were a blurry odyssey, with Smith ending up in intensive care at Sharp Memorial Hospital.

He prefers to remember the long dark night not for the pain, but for the memory of being helped by a multitude of Good Samaritans.

His physician, Dr. Sidney C. Smith Jr., director of cardiology at Sharp, said the Terrell Smith story is important for what it teaches about heart attacks.

“You can have all the technology in the world,” Dr. Smith said. “You can have boats, planes, helicopters, but without the patient knowing the symptoms and onlookers knowing what to do, you haven’t got a chance. Those are the important things. Then technology is useful--or rather, it’s imperative--especially in remote locations.”

Smith, 52, is a broad-shouldered, linebackerish man with a lifetime of early-morning work in construction. He has a doughy, craggy face that suggests having lived a full life, not without adventure, or for that matter, high-seas excitement. Married with three grown children, he lives in Long Beach and spends much of his time in the waters off San Diego doing his favorite thing, which happens to be deep-sea fishing for his favorite fish.

“I love wahoo,” he said. “Wahoo is my all-time favorite fish. I guess you could say I’d risk a heart attack for wahoo.”

During the trip, Smith had caught 15 to 17 fish--he can’t remember exactly--when he awoke in the middle of the night feeling chest and shoulder pains and a kind of ominous tightening throughout his sizable body. From what he had read, Smith was sure he was having a heart attack. He alerted his roommate aboard the Qualifier 105, a San Diego-based boat dealing mainly in long-range sportfishing trips.

“Fortunately, he knew the symptoms,” Dr. Smith said of the patient. “Some people have heart attacks without knowing the symptoms, and they’re the ones who usually die. Out at sea that far, you’d better know the symptoms.”

“It’s like an elephant standing on your chest, shooting the pain into your arm, through your neck,” the physician said. “You may have nausea and vomiting. It’s a crushing, deadweight kind of pain, not a needling, pricking pain as some people seem to think. It’s heavy-handed, squeezing pain.”

“It was like somebody sucking my heart with a vacuum cleaner,” Terrell Smith said.

Terrell Smith’s adventure involved the 30 passengers and eight crew members who helped him in the manner of a huge paramedic team. Instead of heading from Isla Clarion to Roca Partida--part of a chain of Mexican islands called Revilla Gigedo--the boat was rerouted to Isla Socorro, where a Mexican naval base is located.

That trip took 12 hours.

John Klein, co-owner and operator of the boat, took his instructions from the U.S. Coast Guard, which sent word that a plane was on its way to fly Smith from Isla Socorro. (Klein had radioed the Coast Guard for help as soon as Smith reported pain.) Once arriving near the island, Smith was moved to a smaller boat then to a truck, which took him to a dusty airfield from where he was flown to Lindbergh Field. From there, an ambulance sped Smith to Sharp. He arrived around 8 p.m. on Halloween.

Smith praised the Coast Guard, which telephoned his wife and kept her abreast of up-to-the-minute developments. He praised the Mexican naval crew, which calmed and reassured him and provided morphine for pain before the Coast Guard and its plane arrived. He praised the crew on the boat, especially a doctor and his wife, who checked Smith and remained by his side throughout the ordeal.

Smith said he never needed CPR, since in his doctor’s words it wasn’t the kind of heart attack that stifled the ability to pump blood. He also didn’t need open-heart surgery, although he did require four separate catheter procedures to monitor and treat the damage he did suffer.

Dr. Smith said the main lesson of the experience was how having a heart attack in remote locations needn’t be any more terrifying than having one anywhere else--provided you know “the ground rules.”

Had 2 Cardiac Arrests

“I remember a guy having one at Mt. Laguna,” Dr. Smith said. “He had two cardiac arrests before they could get him to a (rescue) helicopter. Fortunately, he understood the symptoms--he recognized them-- and had a friend skilled in CPR. He did need CPR, and it saved his life. Rather, the friend saved his life.”

“There’s a kind of seductiveness in people thinking the technology saves live in such situations,” he added. “Usually, it’s the intelligence, the knowledge, of the people nearby--including the victim. Understanding the symptoms and knowing what to do until technology arrives, that’s everything.”

Dr. Smith said 500,000 heart attack victims die annually in the United States. Of those, he said 350,000 are people who die before making it to a hospital.

“That’s 1,000 people a day dropping dead,” he said. “That’s like two jumbo jets crashing every day. You can bet that would make news. In this case, we’re talking every day .”

War Helped Technology

Dr. Smith said the Vietnam War had been good for one thing: It radically improved the technology used in transporting heart attack victims from remote locations.

“We perfected that technology--helicopter technology, if you will--in Vietnam,” he said. “And it is invaluable in saving lives, particularly those of victims in remote locations.

“People on trips such as these should keep the faith. The technology to save does exist, but they first ought to know the symptoms of heart attacks and how to take temporary measures to save themselves and others. Then let the experts go to work.”