Medical Information

The following information is presented as a GUIDE to prepare our members for the eventuality that one of the group has an accident or becomes ill during a hashing event.

 Exercise induced chest pain is not normal at any age. If it occurs, get the sufferer to a  hospital FAST!

WrongWay of the City of London Hash House Harriers - In Upper Plaka, central Athens.
Died of Cardiac Arrest a short while after this photo taken.
The hashers administered CPR but sadly, to no avail.
Later we learned that he had a heart condition.

Heart Attack   

Cardiac Arrest   

Checking for a pulse  

Checking for breathing  

CPR Technique  

How to Survive a Heart Attack when Alone


Further Information (Links)


A heart attack occurs when one of the coronary arteries becomes severely or totally blocked, usually by a blood clot. This causes the heart muscle to be deprived of the oxygen-rich blood it requires (cardiac ischemia) - so causing it permanent damage.

Because different coronary arteries supply different areas of the heart, the severity of the damage will depend upon which artery was blocked, and the degree to which it was blocked.

Someone's chance of surviving a heart attack depends on the treatment that is given within the FIRST HOUR of the heart attack. While waiting for professional help to arrive or on the way to the hospital, have the patient chew ASPIRIN a known blood clot inhibitor (washed down with water, or better, a carbonated soft drink -which speeds absorption), which can decrease the risk of death by about 25 percent.

Symptoms of a heart attack can include:

Discomfort or heartburn-like symptoms, which can easily be ignored or mistaken for indigestion may also be a sign of an impending heart attack. The pain will not necessarily be jarring or obvious. So it is safer to assume the worst case scenario.

Remember, a heart attack is a process that builds up over a period of a few hours. With each minute that passes, less oxygen is reaching the surrounding heart muscle and the risk of permanent damage (and cardiac arrest) is rising. So rapid action is required.


This is an event in which the heart abruptly and immediately stops. It is not the same thing as a heart attack or "massive heart attack", in which the heart is severely deprived of oxygen but is still beating. However, a heart attack can progress to cardiac arrest.

Cardiac arrest is almost always caused by an underlying heart disease or by heart damage that eventually progresses to the point where a critical situation develops. This may result in ventricular fibrillation in which the heart's ventricles quiver rather than pump, due to abnormal electrical activity. This results in a heart rate of 350 beats per minute or higher. The heart cannot keep that rate up for more than a few minutes, after which the person will go into cardiac arrest.

Without immediate medical assistance, the person cannot survive a stopped heart and will succumb to sudden cardiac death in minutes. The BRAIN can only remain undamaged for about FOUR MINUTES from the time that oxygen deprivation to the brain begins.

Symptoms of cardiac arrest include:

It is essential that resuscitation (CPR) be started immediately. CPR does not correct a heart in cardiac arrest or ventricular fibrillation but can keep a victim alive until a defibrillator can be used to shock the heart back into a normal rhythm.

Checking for a pulse   Top

Use the tips of the index and middle fingers to locate the victim's larynx (Adams apple). Then slide the fingers laterally into the groove between the trachea (windpipe) and the muscles at the side of the neck where the carotid (artery) pulse can be felt. The pulse area must be felt gently, not compressed.

Note: The carotid pulse is the best pulse to test for as the carotid arteries are central, and sometimes these pulses will persist when more peripheral pulses are no longer palpable.

Checking for breathing   Top

Look, listen, and feel to determine if there is respiratory arrest (i.e. breathing has stopped) or if spontaneous respiration is still present (i.e. the victim is still breathing).

Place a cheek close to the victim's mouth and nose to listen and feel for exhaling of air while looking at the chest and upper abdomen to see if they rise and fall. Check for the absence of respiratory effort on the part of the victim.

If available, a mirror can also be used to test for exhalation of breath from victim's nose or mouth.


There must be a maximum sense of urgency in starting basic life support!

The A-B-C steps of CPR are:

A - AIRWAYS OPENED (by head tilt method)

B - BREATHING RESTORED (by mouth-to-mouth breathing)

C - CIRCULATION RESTORED (by external cardiac compression) [but only if necessary]

The objective of CPR is to restore and maintain the flow of oxygenated blood to the brain and the rest of the victim's body. To achieve this, (1) oxygen must be supplied to the lungs (2) the blood must be pumped around the body.


The most important factor for successful resuscitation is immediate opening of the airway. In an unconscious victim, relaxed muscles may allow the tongue to obstruct the back of the throat. This anatomic obstruction of the tongue can easily be relieved by tilting the head back as far as possible.

To perform the head tilt, position the victim on his back. The rescuer places one hand beneath the victim's neck and the other hand on the forehead. Then lifting the neck with one hand, the head is tilted back by pressure from the other hand on the forehead. The head must be maintained in this position.

The rescuer should now check for signs of breathing.


If the victim is in a state of respiratory arrest (i.e. not breathing) the rescuer should begin artificial respiration.

To perform mouth-to-mouth resuscitation, the rescuer uses his hand behind the victims neck to maintain the head in a position of maximum backward tilt.

He continues to exert pressure on the victim's forehead with his other hand and rotates this hand so that he can pinch the victim's nostrils together with his thumb and index finger.

The rescuer then opens his mouth wide, takes a deep breath, makes a tight seal with his mouth around the victim's mouth, and blows into the victim's mouth.

He then removes his mouth and allows the victim to exhale passively while he watches the victim's chest fall.

This cycle is repeated once every 5 seconds as long as respiratory inadequacy persists.

The rescuer may be assured that adequate ventilation is being provided with every breath if he-

The INITIAL ventilation maneuver should be FOUR QUICK, FULL BREATHS with no time allowed for full lung deflation between breaths.

Then, while maintaining the head tilt with one hand on the forehead, check to see if the victim has a pulse by palpitating the carotid artery with the other hand.


External cardiac compression must ALWAYS be accompanied by artificial respiration (otherwise the blood is not being oxygenated). So, ideally two persons are required (working from opposite sides of the victim). If the rescuer finds he is alone, he may alternate the tasks such that he applies ONE breath for each FIVE cardiac compressions.

For external cardiac compression to be effective, the patient must be laid horizontally on his back, on a firm surface.

The rescuer positions himself close to the side of the victims chest (kneeling on the ground) and locates the tip of the xiphoid - (the tip of the sternum or breastbone that extends down over the upper abdomen) with his finger.

He measures two finger widths up from this point and places the heel of his other hand on the lower half of the sternum, such that the side of this hand starts about 1 to 1.5 inches ( 2.5 to 4 cm ) away from the tip of the xiphoid and towards the victim's head. He then places the other hand on top of the first one, slightly interlocking & raising the fingers so that only the heel of the bottom hand is in contact with the sternum.

He then brings his shoulders directly over the victim's sternum, keeps his arms straight, rocks back and forth slightly from the hip joints and exerts pressure almost vertically downward to depress the lower sternum 1.5 to 2 inches ( 4 to 5 cm).

Relaxation must immediately follow compression and must be of equal duration. The heel of the rescuer's hand should not be removed from the chest during relaxation but pressure should be completely released.

A rate of 60 compression / relaxation cycles per minute (i.e. 1 per second) should be maintained (with 1 lung inflation for each 5 chest compressions - so COUNT OUT LOUD: One, Two Three, Four, Five / One, Two Three, Four, Five /, ... etc.) without pause until professional medical help arrives and takes over.

NEVER Compress over the xiphoid at the tip of the sternum. The xiphoid extends downward over the abdomen. Pressure on it may cause laceration of the liver, which can lead to severe internal bleeding.

How to Survive a Heart Attack when Alone      Top

Let's say it's 6:15 P.M. and you're driving home (alone of course), after an unusually hard day on the job. You're really tired, upset and frustrated. Suddenly you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home; unfortunately you don't know if you'll be able to make it that far. What can you do? You've been trained in CPR but the guy that taught the course neglected to tell you how to perform it on yourself.

Since many people are alone when they suffer a heart attack, this article seemed to be in order. Without help, the person whose heart stops beating properly and who begins to feel faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. Deep breaths and a cough must be repeated about every two seconds without let up until help arrives, or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital.

From Health Cares, Rochester General Hospital via Chapter 240s newsletter AND THE BEAT GOES ON ... (reprint from The Mended Hearts, Inc.publication, Heart Response)


Sometimes the symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer brain damage when people nearby fail to recognize the symptoms of a stroke. Now doctors say a bystander can recognize a stroke by asking three simple questions:

*Ask the individual to SMILE

*Ask him or her to RAISE BOTH ARMS.

*Ask the person to SPEAK A SIMPLE SENTENCE (Coherently) (i.e. It is sunny out today.)

If he or she has trouble with any of these tasks, call an ambulance immediately and describe the symptoms to the dispatcher.

After discovering that a group of  non-medical volunteers could identify facial weakness, arm weakness and speech problems, researchers urged the general public to learn the three questions.

Widespread use of this test could result in prompt diagnosis and treatment of the stroke and prevent brain damage (if the victim is treated within 3 hours of the onset of the stroke).

Further information & Links   Top

Further information may be found at:

For our American members: