The loss of lives following cardiac arrest during Sabarimala pilgrimage continued to be high this season also, despite the Health Department’s best efforts to augment cardiac care facilities at the hill shrine by arranging more cardiologists and emergency intensive care units.
More than additional cardiac care facilities at Sabarimala, some awareness and understanding of the effect a strenuous trek of this magnitude can have on the body and some common sense can prevent the loss of many lives, cardiologists point out.
Official figures reveal that this season, between November 15 and January 14, 36 cardiac arrest deaths were reported at Sabarimala. This is slightly better than previous years, when the figure used to be over 40.
Most of those who died were pilgrims from the neighbouring States but one common factor tied all these deaths together – all persons were brought dead to the cardiac care facilities along the Sabarimala route, much past the golden hour when some life-saving measures could have been adopted.
“We have full-fledged cardiac care facilities, including good coronary care units, medicines for thrombolysis (clot-busting therapy) and a team of doctors, including cardiologists, at four places en route to the temple, at Appachimedu, Neelimala, Pampa and at Sannidhanam. Yet, we are unable to prevent loss of lives due to cardiac arrest because too much time seems to be lost between identifying the sickness to be of a serious nature, the police receiving and transmitting the message on the wireless and for the volunteers of the Ayyappa Seva Sangham to reach the spot and bring the patient on a stretcher to the cardiac facilities,” a senior Health Department official who had been on duty at Sabarimala says.
Cardiologists point out that it might not be possible – short of an evacuation by helicopter – to move a sick person to a cardiac facility faster, given the crowd situation or the difficult terrain. “But many of these deaths can be avoided if people are made aware of a few commonsense facts and made to take precautions before they attempt the strenuous four-km trek to the Sannidhanam,” says Rajesh Rajan, cardiologist and president of the Indian Association of Clinical Cardiologists.
“We have observed that the people who die en route the pilgrimage are not those who had any heart problems before, but people who seem to be apparently healthy. If you generally lead a sedentary life and are unused to regular physical activity, then you are more at risk of a sudden heart attack during the trek than a person who might have had a history of cardiac events,” Dr. Rajan says.
“Often when people come for the pilgrimage as a group, they will all try to keep the same pace, which is not very wise. People need to be told to give themselves at least three hours for the climb, without letting the heart rate go up,” says a doctor who regularly does Sabarimala duty.
He recounts the helplessness he felt during last season’s pilgrimage, when a 35-year-old, who had come with his young son and aged mother, was brought dead to one of the cardiology centres. He had been carrying his child and assisting his mother climb, when he collapsed.
Sudden and strenuous physical activity can precipitate heart attacks, during the exertion or within an hour after the activity.
Most of the cardiac events during the pilgrimage are triggered when people try to climb briskly and the unusual strain can lead to angina or heart attacks. or sudden arrhythmic deaths, points out Tiny Nair, a senior cardiologist.
He says that those who have had some cardiac issues would invariably seek the advice of their doctor before planning on the pilgrimage. He concurs with Dr. Rajan that people who believe themselves to be healthy should consult a doctor too before attempting the trek, especially if they lead a sedentary life.