Seizure in the Thailand Backcountry

Today I had the unfortunate event of witnessing a Tonic–clonic seizure (also / formally known as a grand mal seizure) while hiking in Thailand.

The reason for writing this post is both to educate and seek reference on what happened, how we responded and the aftermath.  The pictures were taken thinking a timestamp would be good to have.  Also, this is an outlet to just write.

Right after high school I took a 45 day Outward Bound course which featured a Wilderness First Responder certification. The WFR is a very basic style EMT course made for those that will be in the wilderness and happen on situation where immediate care is needed. Although the main point of the course is really to not get hurt away from roads as there is very, very little that can be done if you break your femur five miles from the road. I was also around the wilderness and first aid as a Eagle Scout.  All this means I have a very basic knowledge of what should be done, but no where near the knowledge base I should have.

We were on a three day jungle hike outside Chiang Mai, Thailand. 11 of us from a hostel and two nice folks from other guest houses set off and had a great two days. About an hour into the hike on day three one of the guest house guests, a nice Italian about 50 years of age who we should call Tizio, started stumbling and convulsing.

11:34- Seizure. Tizio starts convulsing while walking.  He trips and starts falling down the slope to his left.

11:34- First Contact. The last two hikers, myself and Taylor, stop his fall (also helping stop his fall is a bamboo cropping). The fall was two slow flips, all while convulsing. We keep his head from hitting anything (else) and try to get him to talk to us.  I remember the whole ‘don’t let them chew their tongue’ advise but his eyes are rolled back, he isn’t breathing and not responding to verbal commands.  He is laying on his side (good) and has a log keeping him from falling more that has caused a scratch on his back (bad).

Oh yeah, he is Italian, and a bunch of guys speaking English might not be the best choice to get him to calm down once he wakes up.  Gwen happens to be on the trip, a twenty something Italian, who steps in as a translator / friendly accent.  We stay calm and say things like “Hello, you had a fall, we are your friends from the trip, it would be great if you would wake up.”

After what feels like a minute but is really twenty seconds his eyes come back, he starts coughing, he is very uncomfortable on the trail slope, and wants to go somewhere.  We try to convince him to lay down, he doesn’t want to, and then wants to hug us all.  Being Italian, he also wants to touch heads.

I’ve been told that after having a seizure, you feel a amazingly strong need for affection.  He was wanting to touch heads, we all kinda took it as a wanting to kiss, let’s just say it was odd.  He was hugging us and telling us he loved us and acting very, very confused.  Gwen said he was acting like a child, another thing I am told is common.

We tell the guide, a nice Thai man, to call an ambulance.  His response, thinking it was just a fall was “All OK, just fall, hike out this way.”  We get him to call an ambulance, but he has no concept of what a seizure is, we find out later.

We started a SOAP note, noting the times you see from here on out.  We used the only paper we had, a toilet paper roll.  WFR instructors are proud I’m sure.

Horrible but effective SOAP note.

He is confused and standing up and sitting down often.

Here is a picture of the fall area (note I’m standing on the place where his head was):

11:46- Tizio gets back to the trail. He has leveled ou He  is talking to Gwen.  Still confused, and acting as a child.  Most of his talk is about loving everyone around and his family.  I smell whisky on our guides breath, begin to not trust him.

11:52- Weak pulse. I remember that I should check that type of thing.  I could get it, but it was weak.  Our guide asks us if he was using any illegal drugs. No.  We pick through his bag and find two prescriptions.  One is a seizure medication.

12:00- Tizio takes his medication.  We double check the labels, seems to be the right dosage (again, Italian).

12:10- Walked out to road.  We walk around 200 yards to the road.  Tizio is walking on his own and seems to be freaked out but doing fine.  There is blood on his back, legs, head and arms, but all seems to be stopped.  It is decided that

12:40- First truck.  The first truck arrives and takes us down to the nearest village.  There isn’t a huge rush to get him off to the hospital.

12:41- Heart Rate of 104 at a village. We get to the village, out of the first truck and get Tizio to lay down and drink some water.  Lots of cryptic messages from the guide such as “all ok, we go back up” and “we pay for scrapes, not head.”  The calls have not been to get help, but to check on the insurance that the company has.  They have concluded that a seizure is something they don’t cover, so if he goes to the hospital (what I wanted to do) it would be on his dime (what he didn’t want to do).

Although we said to call an ambulance, the guide didn’t he called his boss who checked the insurance.  This feels horrible.  We kept on trying to get out of them when the truck to Chiang Mai (hospital) would be, responded with a quick ‘soon, no worry.’

Worry we did.

After he agreed not to go to the hospital, the guide asked us to sign a paper saying that we are leaving the trek, that they don’t have to refund any cash.  Gwen and I don’t sign, as the ‘we are helping’ crew, we don’t think we should have to sign any rights away.  Not that we are looking for anything, just don’t want to sign.  We get some lunch by the village cook.  His back scratches were treated with Tiger Balm and he generally seemed fine, although very shaken up.

1:30- In a truck back to Chiang Mai.  By this time, he seems fine. He decides to not go to the hospital, we say goodbye to him as his guest house.  When he comes out, the host asks him how his day was, and it looks as if she is going to keep checking on him.

3:00- Back and safe. Gwen and I get back to the hostel, decompress over a smoothie. We take showers and hang out reading.

Just a few short hours ago we stood as a group having a normal vacation day. Hours later, we all had a different view on what was life, love and what it means to take a deep breath of air.

  • I'll tell a story of my own: a couple of years ago while traveling in Scotland an elderly gentleman had a heart attack on our bus (a coach) from Fort William to Inverness. Even though my friend and I were a little slower to react because we were in the back of the bus and confusion traveled faster than comprehension, we were the only 2 people to respond to give help. We gave CPR for about 20 minutes until medics came (who then took over on CPR), and once the doctor arrived about 5 minutes later pronounced him dead. His son, traveling with him, was understandably distraught.

    After a bit of a pause, everyone got back on the bus (except the son), and we left in silence, back on the road. Eventually people returned to what they were doing, and when people got on and took the gentleman's and son's former seats, it was if nothing had happened.

    My friend and I decompressed at a bar, followed by another bar. (Your method was definitely better 🙂

    What I learned from the experience is how people respond, who steps up to help, and how people deal with tragedies.

  • Wow Andrew what a frightening experience. I'm glad everyone was okay in the end.

  • Thanks for sharing Andrew. You acted very well and appropriate in the situation. Being able to stay calm and keep a record of time and events is amazing in the heat of the moment. You were able to balance being a living-caring-human with a record keeping medical professional. The Thai culture is very odd when it comes to injury and death, very different than Western Thought. It's really heard not to judge, but the pace, and priorities are maddeningly slow and inefficient.

    Love from Boulder as we prepare for IB13 here. We miss you.

    Your help to Tizio was far better than all but the most experienced medical professionals. I doubt a doctor would have done anything different.

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