A medical emergency while sea kayaking round Knoydart.

My recent posts on FB of an idyllic trip round Knoydart have brought to mind a very different past trip to the area. One that was very painful to experience and even think about until now. The following was an article I wrote after the event, which I would have submitted to Ocean Paddler magazine for publication. Unfortunately the passage of time has meant that Ocean Paddler is no longer published and only now do the four of us on the trip feel like throwing our experience open to wider discussion. So sharing here might help others learn from our experience.

Although we are experienced sea kayakers, most of our paddling group are retired (and two of those that are still working are 75 and 80!) and each of us has medical problems. I had chosen not to go on most the group's outings in the year prior to this trip and two other members did not come on this trip due to health problems. (Indeed, as I write this, I am at home in the sun while others are enjoying a group trip through the Corryvreckan to West Loch Tarbert in Jura, my favourite destination, but I am not fit enough to go!) 

Four of us, Ian, Maurice, Norrie and myself arranged to meet at Mallaig near the entrance to Loch Nevis that bounds the south shore of the remote Knoydart peninsula. When we arrived, on a beautiful summer Wednesday morning, we received a text from Norrie that he had to go and see his GP that morning and we were to carry on without him. We paddled into Outer Loch Nevis where spent Wednesday night camping and paddled right into the Inner Loch and back on the Thursday before returning to the previous night's camp site. 

At 18:50 on Thursday we received a text from Norrie to say he had arrived in Mallaig would paddle round and join us at our camp. Then at 19:38, a second text told us he had been unable to find a parking spot near the launch site so he would sleep overnight in the car outside Mallaig. He planned to cross over the mouth of Loch Nevis to Sandaig Bay on Knoydart the following day (Friday) and meet us about 10:00.  We planned to pass that way from our camp in Loch Nevis up the west coast of Knoydart to the Sandaig Islands, north of the entrance to Loch Hourn. We planned to camp there on Friday night.

Norrie got a parking space in Mallaig at 06:00 on Friday and despite a bad knee, managed a single handed launch down the steep rocky embankment on the south side of Mallaig harbour. It was a calm morning and he launched at 09:15.  We met as arranged at Sandaig Bay at 09:30.  Straight away it was clear that Norrie was very tired. Despite his age, he is usually a fit paddler and has 55 years of sea kayaking experience. He was lagging behind so we matched our pace to his and took an early extended break on a delightful shell sand beach at Airor Island. 

Talking to Norrie, it was apparent he was not his usual energetic self and we decided that we would cut the planned day short by landing and setting up a camp at the first suitable place on Knoydart, rather than cross the mouth of Loch Hourn to the Sandaig Islands. We had arranged to camp with my brother (who was travelling separately)  at the Sandaig Islands but felt it would be unwise for us to attempt that distance with Norrie being out of sorts.

Norrie really appreciated the early stop for the day and we carried his kayak and gear up the beach for him. During Friday evening Norrie felt much better. He told me he had seen his doctor for some “bumps in the chest”. The doctor did an ECG and found nothing but an occasional ectopic heart beat. The doctor had arranged for him to have a 24 hour ECG in a week or two in case there was an underlying episodic cardiac abnormality that his ECG had missed. The doctor also told Norrie to take it easy for a day or two. 

The following day, Saturday, was forecast to be calm in the morning but with fresh to strong winds from the north increasing in the afternoon. We decided to get up at 6am and paddle the short distance north to the Sandaig Islands where we could catch up with my brother. We would be more sheltered  there and could spend a day or two on short day paddles. Norrie finally managed to get up at 8am. He had had a bad night. He felt tired and had had more bumps in his chest. He made a coffee then after we carried his gear down the beach he started loading his boat. He was determined to paddle on. I was concerned and said we could just sit tight and have a rest day on land but Norrie would have none of it. At 09:30 he disappeared along the beach for a toilet break and the other three of us had a chat. I thought we should consider calling the coastguard but we all recognised the psychological importance of this paddle to Norrie. He had shown great determination to come despite a visit to the doctor, not finding a parking place, having to camp out a night in the car and the single handed launch. 

When he returned, some 15 minutes or so later, the effort of going to the toilet showed on Norrie’s face.  He looked ashen and had to sit on a rock because he felt dizzy and so tired. He said he would need a “wee rest” before starting paddling. I asked if I could give him a check over. The first thing I examined was his pulse. It was very fast, at over 160 bpm (tachycardia). The beat of his pulse also varied in rate and volume. I had no doubt this was atrial fibrillation and was no longer a few harmless ectopic beats. Sudden onset atrial fibrillation with tachycardia and symptoms is a medical emergency.  Untreated it can cause a stroke or death. I said to him I thought we should call the coastguard so that he could be evacuated to hospital for urgent medical treatment. 

Norrie was shocked at the idea of calling the coastguard as he did not think there was very much wrong with him that a sit on the rock would not fix. I asked him what he would do if he was at home and felt like this. “I’d call the doctor” he said “but this is different.” I then explained to him about the risk of having a stroke, if his heart rate and rhythm were not controlled. So he said maybe I should just sit tight until it goes away, you guys go on ahead, I will be fine to get back to Mallaig myself.” I told him the only way we were going to split up was if he left in a helicopter.  His reply was “Please do not call the coastguard, after all these years it will be so embarrassing”.

Myself and Ian then went down to the boats where our phones and VHFs were. We left Maurice doing a very good job of comforting Norrie. As I am deaf, I decided that if we were going to contact the coastguard I would do so using my phone and bluetooth hearing aids so I put my standard hearing aids on top of the bow hatch of the boat and made sure my bluetooth hearing aids were connected to the phone. Ian got his VHF ready and we walked back to Maurice and Norrie. Maurice had done a good job and Norrie was beginning to feel a bit better. I checked his pulse but it was still very rapid atrial fibrillation. I now said to Norrie that I thought it was time to phone the coastguard. “Please don’t do that, I will be fine and I don’t want any one to be put to trouble”. I said “Norrie we have been friends for so long that I can talk bluntly. Even If you go in the kayak and do get to Mallaig you will not be fit to drive the car once you get there. If you suffer a stroke out on the water we will all be in trouble. There is nowhere to land and the wind is now picking up. A helicopter rescue at sea will be very difficult.” After a long pause Norrie at last said “You are right I don’t want to put you three at risk, please phone the coastguard”. He seemed to find peace from having finally made the decision but ultimately I would have ultimately phoned the coastguard anyway as Norrie would have risked a stroke or sudden cardiac death if he had exercised his heart in that state and if that happened on the water, it would have put us and rescuers at risk. This knowledge came from my medical experience.

If Ian and Maurice had been there without me, they would have had to phone the coastguard "for advice" and let the coastguard decide whether a helicopter was necessary or not. When the coastguard asked them how Norrie was feeling, they would have been able to say that he had sudden onset of bumping of the heart in his chest, extreme tiredness, feeling sick and dizziness on standing, all made worse by going for a poo. With that history, the CG would have called the helicopter, even without my diagnosis of new and sudden onset of symptomatic AF.

So at 10:07 on the Saturday I phoned Stornoway coastguard. They were were very calm and asked for information, which Ian and I had already prepared. The nature of the emergency, ashore or afloat, details of medical problem, how many in the party, our grid reference, Norrie’s name and date of birth, wind speed and direction, visibility, anywhere a helicopter could land, VHF call sign, mobile phone number check. After a few minutes the operator called back to say Rescue 151 helicopter would come from Inverness (100 km away to the NE) and that the Knoydart First Responder Coastguard Team would be coming overland from Inverie to guide the helicopter in. The operator said he was very pleased we had not gone to sea as an emergency rescue afloat would have been much more difficult. I returned to Norrie and Maurice. Ian scouted the best place to land the helicopter, which was not the shingle beach as it was very steep and soft in places and had a lot of loose flotsam. He thought a firm flat grassy area on a raised beach above us would be more suitable and checked it for loose objects. 

Ian tried to contact the coastguard using two Icom handheld VHFs but the coastguard could not hear his sea level transmissions. So Ian climbed about 150m up a hill behind the beach where he established VHF  contact with the coastguard and helicopter. At 10:52 the helicopter was 5 minutes away but there was still no sign of the land based coastguard to help guide the pilot in. Ian is a former Royal Marine and latterly a communications officer in the Royal Fleet Auxillary, so he knew how to talk the helicopter down over the VHF. The helicopter arrived above us at 10:57, just 50 minutes after we had first called the coastguard.

Two paramedics arrived from the helicopter and assessed Norrie. They then explained if they had to get the stretcher out it would add 30 minutes to the evacuation and they already had another emergency call. They asked if would it be possible to support/carry Norrie to the helicopter. Norrie was done by this stage and he also has a bad knee and found walking over the steep shingle beach very difficult. As if by a miracle, local farmer, Callum Wilson arrived on a quad bike from over the hill. He transported Norrie to the helicopter. It took off at 11:10, after just 8 minutes on the ground. It is just as well we had secured the gear to the sea kayaks as the downdraught from the helicopter would have blown anything loose away, especially our sails! Sadly, I had forgotten about my non bluetooth hearing aids, which were blown completely off my deck where I had left them. There was not a chance of finding them. 

Just as the helicopter left, the local Coastguards, Paul and Tom, arrived from Inverie after a very arduous 10km 4x4 journey on a rough track through the mountains of the Rough Bounds of Knoydart, with the last kilometre on foot. They checked we were all right and safe to make our journey back to Mallaig. They wondered how we would get Norrie’s boat back to Mallaig and I told them we would tow it.

After Paul and Tom left, the wind was now blowing from the north at the top of F4 with white horses to the horizon. We set off in a still increasing wind at 12:36 on Saturday. I was towing Norrie's kayak as I was the only one with a deck mounted tow. The others made sure  the skeg on Norrie's boat was down to make it easier to tow in the wind. The first 7km were SW to to the western most point of Knoydart and I paddle sailed with an 0.8sqm sail. I averaged 6.2km/hr. The sail was on a broad reach and it provided plenty drive while being relatively easy to control. The towed boat was weaving back and forth making holding a course somewhat challenging. 

Before we reached the point, the wind was averaging F5 gusting F6 and the others dropped their sails. I kept mine up until after rounding the point.  We now beared away off the wind onto a run heading for Mallaig some 6.5km away across the mouth of Loch Nevis. I soon had to drop the sail because it was not so easy to control on the run due to increased pressure in the sail when my boat was slowed by the towline stretching taught. It was now in the 3rd hour of the tide and increasing wind over tide in the Sound of Sleat made for short steep seas. Norrie’s boat was now veering back and forth even more and it was tough when a wave caught my boat and the towline pulled taught. 

By 14:10 we had managed 1.5 km across the mouth of  Loch Nevis but despite the strong following wind, my speed had dropped to 4km/hr. The wind was now averaging F5-F6 and to cap it all Norrie’s boat rammed me twice in the chest. It was time to abandon the crossing to Mallaig and to seek shelter. We turned to port to get into the lee of Knoydart. We landed on a small beach at 15:00. We discovered Norrie’s boat’s skeg was up, It must have been pushed up paddling through a kelp bed shortly after launching. My stern hatch also had 50 "sponge fulls" of water in it which certainly did not help the handling. We were all so tired by the physical and emotional challenges of the day that as soon as we got the tents up, we went for a sleep for a couple of hours. 

The following day, Sunday, we still had another windy crossing from Knoydart to Mallaig but then we were safe home. Ian and Maurice celebrated with double bacon rolls with egg and flat sausage on the side. Having haemochromatosis, I settled for sour dough toast with peanut butter, banana and sesame seeds on top!

There are a lot of things to think about. Emergency situations are often the result of multiple small events that lead up to the critical point of the emergency.  Action at any of those points could avert an emergency or prevent a worse situation. In our case, age and health were major factors. In a younger group, it might be various levels of experience. Peer pressure is also a great driver to press on regardless but in our group of mostly oldies, there is no peer pressure. Embarrassment was certainly a factor in Norrie’s initial reluctance to accept external help. I am a retired doctor so I was able to make a medical diagnosis about the cause of Norrie feeling out of sorts. This undoubtedly helped decision making but despite Ian and Maurice not being doctors and they could clearly see something was up. So if you suspect a medical problem, don't listen to "I'll be fine” seek professional help before it is too late. Whatever, it is best to seek help earlier rather than later. 

With profound thanks to all the professional and local people who so expertly helped us.

Post script.
As the helicopter left Maurice said “I now see why you asked for everyone’s shore contact number.” Norrie was admitted to Raigmore Hospital Inverness and given a drug through an IV infusion for several hours. This restored normal heart rhythm and rate. He has since been given standard long term drugs for atrial fibrillation to control his heart and prevent a stroke. He has taken a long time to get over this but is very glad to be alive.

Post script 2 from Ian
As I suspect we all have, I've reflected a lot on the events.

I don't believe I'd change any of the decisions we collectively made. 

Key for me was having Norrie fully engaged in the decision process, the decision being made with and not done to Norrie. All if us would have been extremely reluctant for a helo medevac had it been us, but it was absolutely the right solution.

My thinking re suggesting the grassy embayment as the landing site for Rescue 151:

The shingle spit was level and spacious with a clear approach route but had two disadvantages. It had a lot of loose material (dried weed, plastic, driftwood) and was also soft (the quad had left big wheel ruts). The loose material was a "FOD" (Foreign Object Damage) hazard and the AW189 aircraft has limited ground clearance on the undercarriage.

The grassy embayment was more confined but had level ground which could be FOD cleared to a decent level. I looked at a potential approach route too; a helo will usually prefer an into-wind approach and landing, even better if it can be a "red wind" i.e. from the aircraft's port side. That's why I positioned myself well upwind of the suggested landing site and could pass my suggestion to the aircrew before they were overhead.

The aircraft will also appreciate an estimate of the surface wind direction and speed.  CG aircraft monitor VHF #16 when on SAR operations. The preferred working channel is #0. VHF handhelds don't usually have this channel so the secondary working channel is #67

Post script 3. Ian has asked me to say that he does not identify as an oldie… he only paddles with oldies!!!