Clockwork – The Craig Scott story

Posted on 15 December 2019

When Craig Scott collapsed due to heat illness during a mountain bike race in November 2018, he was miles from the nearest hospital. Minutes from a heart attack. At the mercy of a miracle. 

I’ve been racing mountain bikes for years. Leading up to the race, we’d been training hard for months. We started in Batch B, just behind the pros. But I started taking strain pretty early. I couldn’t drink enough. I was pouring water over myself. I was burning up. Eventually I got off my bike; started pushing and walking. Then I fell over. That’s the last thing I remember.”

Paul Knoesen, ER24’s Events Manager, was part of Mediclinic’s medical assistance team on the day. “Most of the time at these events we see small things: dislocations, or guys fall and cut themselves. These things are treatable on the scene. Craig was different. Right from the first moment we saw him, we knew this was something serious.”

By the time medics reached him, Craig was as grey as sheet metal, barely responsive. As they moved him onto the golf cart, his body started seizing so violently that three paramedics had to hold him in place as they fought to insert a line into a vein, any vein they could find.

“I’ve been in emergency medicine for 20 years,” Knoesen says. “I’ve never seen anyone with a body core temperature of 43 degrees.”

Craig Scott is the founder of Scott Attorneys, a successful law firm in Johannesburg. He’s also a committed mountain biker who signed up for his third Wines2Whales in 2018. Even with his experience, he’s the first to admit he knew little, if anything, about heat illness – until it almost killed him.

But he did know what he was in for. Craig’s training involved an intensive programme of virtual cycling classes four timesa week, with long rides on the weekend. “I’d done Berg and Bush, a three-day stage race in the Drakensberg. I’d finished a half-Ironman and this would have been my third Wines2Whales,” he explains. “But something didn’t feel right. I was working harder than usual, and I couldn’t stop drinking water. At about halfway, it felt like I was on the verge of overheating.”

Wines2Whales is a punishing three-day stage mountain bike race that begins in the Hottentots Holland mountains above Lourensford Wine Estate in Somerset West, passes through Oak Valley Wine Estate in Grabouw and ends in Onrus, outside Hermanus. Each stage is a little over 60km, with some monstrous climbs – in total riders can expect an elevation gain of just under 5km over the three days.

Extreme distances and ruthless uphill terrain apart, the event is traditionally held in November. “Heat is usually a factor, and that year was particularly warm,” explains PN Caroline Murray, Clinical Logistics Coordinator: Corporate Events for Mediclinic Southern Africa. “I remember in the morning we actually had the heaters on. As the day began we put them off, and I said, bring the ice, it’s getting hot. The temperature just went up and up, and we knew, we had to start preparing for heat illness.”

Heat illness is a spectrum of disorders that become steadily more serious the longer it is left unrecognised or untreated. This means anyone who spends time outdoors in summer is at risk, but athletes who spend prolonged periods exercising in warm or humid weather are particularly susceptible to overheating.

Early symptoms of heat illness include a reddening of the skin, followed by muscle cramps. These can progress rapidly to more advanced stages, including heat exhaustion and heat stroke. Whereas heat rash is only mildly irritating and can betreated simply by moving out of the sun, cramps occur as the body begins to lose minerals, electrolytes and fluids through heavy sweating.

Craig remembers struggling to move forward. “We were riding in the middle of a heat wave,” he says, “so I thought, Okay, I’m hot, that’s normal. I’m naturally competitive. I’ve suffered before. I’ll push through.” It’s only in the last few kilometres of the first stage, when he began to feel dizzy and almost delirious, that he began to think something was seriously wrong.

Heat exhaustion is a serious condition that requires urgent intervention. Symptoms include heavy sweating, rapid breathing and a fast, weak pulse. Without immediate treatment, the body is at risk of suffering from heat stroke: a disorder of the central nervous system in which the body is no longer able to regulate its own temperature.

Typically, heat stroke is defined as a body core temperature of over 400C. Nausea, dizziness, confusion are all common. As the temperature rises, multiple organs begin to function abnormally, or fail altogether. This is a major medical emergency.

Craig’s race partner, Michael, managed to alert the ER24 crew, who sped up into the trail to meet him. When they arrived at his side, Craig was awake, but barely. Knoesen remembers thinking there was no time to lose. “With seizures like that, there was a high chance he could stop breathing, his heart could stop beating and he could go into cardiac arrest.” Mediclinic’s corporate events team is made up of nurses, medics and doctors from various hospitals and a range of disciplines. The team provides world-class medical assistance and a fully functional field hospital at the Cape Town Marathon, the Absa Cape Epic, and almost 20 other top-level mass-participation events across South Africa.

PN Murray has been a part of this team since 2011. Craig’s story stands out. As the ER24 paramedics carried Craig into the finish-line hospital tent, he became completely unresponsive, and PN Murray began to worry. “Heat illness escalates at a scarily rapid pace. We had to act fast,” she says. “Getting his temperature down – that was the only thing that was going to keep him alive.”

Craig was lowered into an inflatable dinghy, which the events team keeps on hand to act as a makeshift ice bath. But that was only partially effective. Even submerged, doctors had trouble stabilising Craig’s temperature: a sign that his body had become unable to thermoregulate.

“At that point we realised we needed to get him to a tertiary facility, and fast,” PN Murray says. “That’s when the call was made to see if there was a helicopter available, to fly him out to the nearest hospital.”

ER24 partners with air rescue and evacuation specialists Skymed to provide medical rescue helicopters to patients in rural or remote locations. Once PN Murray made the decision to dispatch the chopper, she called ahead to notify the Emergency Centre at Mediclinic Vergelegen that there was an incoming patient.

One problem: a construction crane was parked on the helipad. Being a Friday afternoon, no crew members were on site. “When I called I said, you’ve got about 15 minutes to move that crane,” she remembers. “They moved it in 10.” Effective emergency medical care is about relationships, says Dr Jaclyn Prim, Emergency Centre Manager: Mediclinic Vergelegen. “We know each other well, as I’ve worked with the events team before. And we were prepared beforehand: we knew the event was taking place, we knew that it was incredibly hot that day. We knew, in the back of our minds, that something like this could happen.” Something – but not this bad. “The brain is an organ,” she says. “It is primarily made up of proteins. The extreme heat had triggered an inflammatory response. Essentially, when we saw him, Craig’s brain had already begun to boil.”

Dr Prim received Craig directly off the helicopter. At that stage he was breathing through a ventilator, and had been intubated, meaning he’d been given a form of sedative and a paralytic to induce a coma and control the seizures. “He was stable, but critically ill,” she explains. “His temperature had begun to drop, which shows how effective the team’s emergency measures were – but we still needed to halt the overheating process to prevent further damage. The challenge then was to increase his core temperature back to the normal range, slowly, without sending his body into shock.” Mediclinic’s Emergency Centres utilise a multidisciplinary approach to treat patients in a holistic way. Dr Prim called on the expertise of an anaesthetist and an emergency physician in the hospital’s intensive care unit, Dr Jacques Janse van Rensburg. “As a team, we worked together to conduct a range of blood tests and scans, to assess the extent of the damage that had been done to his body.”

It is this teamwork that saved Craig’s life. Unconscious, seizing and helpless, Craig was rescued and brought back to life by a network of experts. The paramedics who picked him up off the trail, the doctors and nurses who attended to him in the finish line tent, the doctors who treated him at the Emergency Centre, the specialists who monitored his recovery in the days after the event: each played a vital and interconnected role.

“When I woke up, I panicked,” says Craig. “I was hooked up to machines and I thought, Wait, this isn’t the race tent.” Next to him was his brother. The hospital had notified his family, and some of them had taken the first flight down from Johannesburg to be with him as he recovered.

The story of Craig Scott’s survival is extraordinary. In the Emergency Centre, says Dr Prim, not all days are good days.“We won in this case. Why? We had experienced medics, passionate nurses, prepared, working together, communicating well. We were able to ensure smooth transitions from one step to another. It was seamless.” From the moment he passed out on that trail to when he woke up in the hospital, Craig remembers nothing. “I’ve been piecing it together for almost a year,” he says. “And what’s become abundantly clear is that, if it wasn’t for the amazing treatment I got, or if it had taken just five extra minutes for them to get me to the medical tent, I wouldn’t have made it. The ER24 paramedics, the Mediclinic doctors – without them, I wouldn’t have made it.” Knoesen remembers a moment from the morning of the race. “One of our nurses was blowing up the dinghy and someone passing by asked, ‘What are you planning on doing with that?’ It looked quite funny: we were on the top of the mountain, with a rubber boat. But she just said, ‘This could save someone’s life today.’ And it did.”

In June 2019, Craig and his fiancée, Sheena, flew to Cape Town to meet the medics who had saved him for the first time. “To me, they’re heroes. I’m eternally grateful for what they did for me. I cannot thank them enough.”

Published in Emergency

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