"It Was Like Turning Off a Light Switch"

When Ryan Haseldaen suffered a sudden cardiac arrest in the middle of her 1.20m class, disaster was averted with fast action and a life-saving AED.

By Debbie Elliot

In the middle of her 1.20m course on her 14th birthday while competing at Fox Lea Farms in Venice, Fla., Ryan Haselden suddenly stopped responding to her horse, Hector Du Gue, and allowed him to veer awkwardly past Fence 4. As the gelding reached the other side of the ring and stopped at the rail, the accomplished teen rider slumped in her saddle and slid off, hitting the ground limply.

“She had been upright, she was there, but nobody was home,” said Ryan’s dad, Will Haselden, who was watching from the stands. “She put up no defenses. She just went down ... it was just like how a bag of grain would fall off the side of a saddle.”

While everyone in the grandstand — including her parents — initially thought that Ryan had fallen off, she had actually suffered a sudden cardiac arrest and collapsed mid-round. Even after she came off, Will and his wife, Lindsay (who was on her own horse outside the ring when it happened), hesitated before running into the arena because “watching kids grow up riding, they’ve fallen off plenty of times. It’s the nature of the sport,” Will said. But when Ryan didn’t move, it quickly became clear that something was seriously wrong.

Miraculously, physician and amateur jumper Dr. Karley Koch, of Tulsa, Okla., was showing at Fox Lea and was sat in the stands waiting for her friend to ride. When Ryan’s horse, Hector, first went off track, Dr. Koch thought she had forgotten her course or was trying a weird inside turn. But then she realized Ryan had stopped riding. “By the way she fell, I immediately knew something was wrong,” Dr. Koch said.

“I don’t usually like to gallantly run into a ring when someone falls off and declare myself a medical professional, that’s why shows have EMTs,” she said, but having witnessed Ryan’s strange behavior and now seeing she wasn’t moving at all, Dr. Koch knew she needed to assess the situation.

The show’s EMT, Katy McPhee, also rushed in to help. “Ryan was cyanotic, which means her lips and face are turning blue, and she was agonal breathing,” which are end of life gasps that occur when death is imminent.

Dr. Koch checked for a pulse, when none was found and after making a full assessment of the scene, she told McPhee that they should start compressions.

With events unfolding so rapidly, Will was still in shock.

“There’s no part of you that thinks this is where it ends ... I thought, ‘Of course she’s going to be OK,’” he said.

“She had never had any kind of heart problems or any signs in her medical history to suggest this might happen. At that point, we still thought it was from the fall.” Will, who is CPR-trained, was prepared to step in to help with compressions, but was “very thankful that my turn never came,” as that would have been even more emotionally traumatizing. As Will has since learned, if you suffer a sudden cardiac arrest outside of a hospital setting, your odds of survival are about 10 per cent, “which is a horrific statistic,” he said.

Dr. Mark Hart, a cardiologist and the USEF Human and Equine Safety & Welfare Committee Chair, said that sudden cardiac arrest is “relatively “rare” in young people, and in Ryan’s case, there was no way of knowing ahead of time that she was at risk.

“The important thing is that if it does happen, you evaluate the patient to see if they are breathing and if they have a pulse (the easiest place to check is the carotid artery, located on each side of the neck),” he explained.

“If there is no pulse, then you need to initiate lifesaving techniques, with an AED (Automated External Defibrillator) and/or by starting CPR until the AED or emergency services arrives.”

The longer it takes to get the heart rhythm back to normal, the higher the risk of significant brain damage, neurological symptoms or death.

Dr. Koch was well aware of the urgency of the situation unfolding at Fox Lea.

“Every second that you’re not getting blood circulation is seconds of no oxygen, and your body only has a few minutes of reserve in which you can intervene before it’s too late,” she explained.

“As healthcare workers, we go into algorithm mode: we follow what we’re supposed to do in the moment, it just became rhythmic. There’s no panic and there’s no freaking out.”

Dr. Koch is no stranger to handling medical emergencies.

“I’m a hospitalist, which means if you go to an ER and you’re so sick that the doctor doesn’t think that you can go home safely and you need inpatient hospital care, then I am the doctor they will admit you to,” she said, explaining that part of her job is running codes in end of life situations.

"By the way she fell, I immediately knew something was wrong.” - Dr. Karley Koch

As Dr. Koch and McPhee continued CPR, they gave instructions for someone to call 911, and to bring an AED. Once it arrived, they put the pads on Ryan’s chest, and it immediately identified a shockable rhythm. “We cleared the area and let it shock her, and then resumed CPR,” at which point Ryan let out a gasp, coughed and regained consciousness. Once they confirmed that she had a pulse again, Dr. Koch and McPhee moved into a secondary assessment, stabilizing her cervical spine and neck.

“Even though that did not contribute as to why she fell off, she still fell off her horse and hadn’t been conscious to tell us if something hurt,” she explained.

They then asked orientation questions such as “Who are you? Where are you? What year is it?”

“It was very scary for Ryan at that time because she didn’t know what was going on,” Dr. Koch revealed.

Ryan said she cried when she woke up and “had no idea what was happening — it took me a second to breathe. The last thing I remembered was thinking I had jumped the fourth jump, which I didn’t luckily, and then I woke up and there was a ton of people around me. It felt like seconds ... I went to sleep and then woke up and was in a different place,” she recalled. When it comes to the actual cardiac arrest, Ryan said, “I had no pain in my chest, absolutely nothing. It was like turning off a light switch.”

Once she was breathing on her own again, Dr. Koch let Lindsay and Will comfort Ryan.

“That’s when I really felt good about it. I thought ‘OK, we are out of the bad part.’”

“The fact that she came out of it as readily as she did and with no ongoing issues is an incredibly miraculous result,” Will said. “I think a lot of the feelings that we have experienced about the situation have come on much heavier after the fact as we’ve realized exactly what it was that we got away with. It hits you like a truck.”

The family has video of Ryan’s jumping round and subsequent fall, which ironically is not very dramatic to watch.

“It shows you that this sort of event doesn’t always look like fireworks going off. It happens very quietly,” Will said. “When you see it in the movies, someone’s always clutching their chest and knocking things over — that’s not how things happen. You’d almost call it a fainting spell. You’re there and then you’re not there.”

Ryan was airlifted by medics to Tampa General Hospital and then later transferred to Johns Hopkins All Children’s Hospital in St. Petersburg, Fla. Dr. Koch ensured that she passedon her report to the accepting ER physician so they knew what had happened. She told Will that it was important that he told Ryan’s doctors that this was not a horse-riding accident, that she had blacked out while riding rather than simply suffering from a fall.

“I knew something underlying was wrong, but I didn’t know what it was yet,” Dr. Koch said.

Ryan’s medical team subsequently diagnosed her with catecholaminergic polymorphic ventricular tachycardia, a rare heart rhythm disorder that is characterized by a fast, abnormal heart rhythm and can be triggered by exercise, stress, or strong emotions. She now has a defibrillator implanted into her chest to detect and correct life-threatening heart rhythm problems.

“CPVT is a genetic mutation that is sensitive to adrenaline,” Will explained.

“When she’s doing something fast-paced and she gets that adrenaline spike and her heart rate goes up, it leads to an electrical malfunction in her heart.” The condition primarily affects young people, most often aged eight to 12.

“The defibrillator is a safety net,” he said. “It is not doing anything on a constant basis other than measuring her heart rhythm, but if something were to happen, it’s there and she would be saved before we even realized she needed an AED.”

Ryan will also be on medication for the rest of her life to limit how high her heart rate can go.

Will is forever thankful that Dr. Koch was in the stands when Ryan suffered her cardiac arrest, because if she’d been anywhere else on the showgrounds, it would have increased the amount of time before someone noticed what was happening. Ryan was also fortunate that Fox Lea had an easily accessible AED in good working order. The average emergency services response time in the U.S. is seven minutes (even longer in rural areas), and every minute an AED is not used, a patient’s chance of survival goes down significantly. USEF strongly recommends AEDs at show grounds and for staff to undergo training, but it is not a requirement at all competitions. However, it is a requirement for Hunter competitions at all levels and Jumper competitions at Level 2 and above. The rules state that the AED must be operable and placed in a designated, safe location. All qualified medical personnel must be informed of the AED’s location prior to the start of competition. Based on their licensed ratings and levels, Fox Lea was required to have an AED.

”Sudden cardiac arrest can happen at any age with no prior history of heart issues.”— Dr. Mark Hart

The Haselden family is sharing Ryan’s story in the hope that more shows, barns, and non-equestrian sporting events will ensure that they have AEDs — and that the staff knows where they are located.

“An AED is of no use if the batteries are dead, or it is locked up in a concession stand and nobody present has the key,” Will said. “If you’re required to have an EMT on site, make sure the EMT has an AED as part of their ring bag,” he advised.

He would also like to see more trainers certified in CPR/AED, as they are often ringside and focused on their clients.

Dr. Hart said that AEDs are now commonplace in airports, malls, schools, and other public areas, as they are easier to use than performing CPR.

“Some CPR is better than no CPR,” but it is exhausting to perform compressions for a prolonged time, even for medical professionals. “A lot of times, CPR doesn’t necessarily revive you, but it keeps the blood flow to the brain going until you’re revived or until the heart rhythm comes back,” he explained.

With an AED machine, “you don’t even need to know the rhythm. It’s smart enough that it will know when the heart needs a shock and will deliver it,” Dr. Hart said.

“The instructions are so simple ... you can’t really do any harm to a patient because the machine makes the decision whether to shock or not. Basically, all you do is put on the pads where it tells you to, press the button and the machine talks you through the process.”

The Haseldens, of Alpharetta, Ga., have since hosted open CPR/AED classes in their community to encourage people to get certified. They are also in conversation with Georgia’s representatives to increase the accessibility of AEDs in youth sports.

“This could have happened at any kind of youth sporting event where there’s physical activity,” Dr. Koch said. The incident, “has really opened my eyes, and I encourage everyone to get certified,” she continued. “Everything I did, you can learn in a basic non-healthcare worker, CPR and AED class. I don’t want people to look at Ryan’s situation and think, ‘she’s alive because there was a doctor there.’ I’d rather people say, ‘she’s alive because someone knew how to do CPR, and they had an AED.’”

Once you’ve been trained, if you find yourself in an emergency situation, “Trust that the information is in there in your brain” and calmly follow the steps.

Dr. Hart concluded, “sudden cardiac arrest can happen at any age with no prior history of heart issues. However, you can save a life with no neurological consequences if CPR is carried out and an AED is available.”

Ryan, who owns three horses, was given the all clear by her doctors to ride again. “I feel pretty normal and am ready to get back to everything,” she said.

Her fatigue and stress levels are being monitored to ease back into it carefully and safely. She returned to showing in May, three months after her sudden cardiac arrest, on her horse Nour Alain (Carla). Ryan also planned to return to Traverse City in July to compete in the North American Youth Championships (NAYC) on Hector.

Identifying and Treating Heart Issues in Horses

While sudden cardiac arrest is not nearly as common in horses as it is in humans, there have been cases of sudden cardiac death afflicting racehorses and eventers, and any horse in any discipline can potentially be affected. The symptoms of heart issues most often seen in horses are murmurs and arrhythmias, said Dr. Meg Sleeper, VMD, DACVIM, a Clinical Professor of Cardiology in Gainesville, Fla.

“What makes diagnosis challenging in horses is they can have benign murmurs, which do not affect heart function. However, it may be difficult to differentiate a benign murmur from a murmur associated with disease that negatively impacts the horse’s cardiac output, and diseases can worsen over time,” she warned.

“A murmur should always be evaluated by a veterinarian, who can then determine whether it is likely to be benign or not. Sometimes it’s hard to tell without further testing,” she added.

A heart murmur can be detected by listening to the horse’s heart sounds with a stethoscope, however, “unless somebody actually listens to the heart, the owner wouldn’t necessarily know anything was wrong,” Dr. Sleeper explained.

“Horses often don’t show any symptoms unless they’re actually decompensating [meaning that heart’s ability to pump blood to meet the body’s needs is significantly impaired] and approaching heart failure. If there is significant underlying disease, the horse may display poor performance and fatigue earlier than usual.”

The best prevention against heart issues is regular examinations by a vet, along with good nutrition to maintain healthy body condition.

“Every horse should get at least one thorough physical exam per year,” Dr. Sleeper said. “If they’re not acting normally, if they seem to be tiring earlier or acting out of character, then you should immediately get a cardiac exam. It is a simple screening test that can identify potential problems before they become major problems. A cardiac exam is basically listening to the heart and assessing the cardiovascular system (such as pulse quality), so it is quick and doesn’t have to be expensive.”

Horses do not suffer from coronary disease the same way people do, but general good healthcare is still important, according to Dr. Sleeper.

“Parasite issues can cause cardiovascular damage to the blood vessels, so deworming is essential, as are vaccinations because if they develop certain viral infections, that can cause myocarditis (inflammation of the heart muscle).”

Arrhythmias, the broad term for any irregular heartbeats, also may indicate heart disease, and they too can be identified in a physical examination through auscultation with a stethoscope.

“Arrhythmias can lead to sudden death, so abnormal heart rhythms should not be ignored,” Dr. Sleeper said.

For horses in atrial fibrillation (A-fib), a common heart rhythm disorder where the upper chambers of the heart beat rapidly and irregularly, the longer horses are left untreated, the harder it is to convert them back to sinus rhythm, Dr. Sleeper warned. To convert the horse’s heart rhythm to at a normal, regular pattern, they can be treated with medication or shock treatment.

“A-fib conversions are most commonly done with high performance horses, as many can’t compete successfully if they’re in atrial fibrillation because they need to have every bit of cardiac output to be successful,” Dr. Sleeper explained. “However, some horses that either cannot be successfully converted back to sinus rhythm (perhaps they have been in A-fib too long) or their job is not one that requires maximum cardiac output, can actually compete in atrial fibrillation.”

In order to determine whether this is the case, an exercise test would be performed by your veterinarian. Thoroughbreds and Standardbreds are particularly predisposed to A-fib. “The bigger the heart is, the higher the risk,” Dr. Sleeper said.

Horses in congestive heart failure, a chronic condition where the heart can’t pump blood effectively leading to fluid buildup in the body, can often be treated with antiarrhythmics medications to keep them comfortable for many years, but they should no longer be ridden or worked, Dr. Sleeper said. If your horse is on heart medication and still competing, please refer to the USEF 2026 Equine Drugs and Medications Guidelines to check if the medication is allowed in competition.

Photos: Winslow Photography, courtesy of Will Haselden, and Andrew Ryback Photography