Akita, Japan: Hajime Nakae, Japan's leading medical expert in treating bear attack victims, knows all too well the damage that the powerful animals can inflict on humans.

With a record 13 people killed this year in Japan, the professor of emergency and critical medicine at Akita University Hospital advises what to do in an encounter.

Keep facing the bear

When in the woods people are advised to make noise, to attach bells to bags, and not to hike alone -- especially at dusk and dawn.

But if you do see a bear, Nakae said to back away slowly while still facing the animal.

When people turn their backs,“the bear tends to attack aggressively, probably because it perceives them as still ready to fight back,” Nakae told AFP.

"Bears tend to leave once they sense their opponent won't resist and that they're stronger."

Crouch

Retreating may not work however, and the bear may follow and in some cases attack, especially if it has cubs.

The best thing to do is to crouch face-down, bend the legs underneath the torso and clasp both hands behind the neck, Nakae said.

“You can protect the blood vessels in your neck. It also helps shield your trachea in front,” he added.

"When you crouch like this, bears often try to knock you down from the side. They flip you over to get at your face, so to prevent being turned over, spread your knees a little."

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Mind your face

It's important to hide your face because this is what bears typically go for, Nakae said.

“They seem to know that if they damage the eyes, the victim can't fight back. That's why around 90 percent of bear attack victims sustain facial injuries,” he added.

The resulting deep cuts in victims' faces can become infected and cause long-term pain, he said. Some lose their eyes.

The jaws of a bear are also capable of crushing bones and a single swipe with their paws can cause serious damage and even kill.

Stay put

It's vital to remain in the crouching position until the bear leaves the area.

“There was a case where someone saw a bear charging from about 10 meters (yards) away, quickly got down, but then lifted their head too soon,” Nakae said.

"The bear was right in front of them, resulting in facial injuries. They moved too early."

Don't panic

Kakeru Matsuhashi, a traditional "Matagi" hunter, also offered advice and said that the most important thing is not to panic.

“Bears living in the mountains are usually intelligent, so if you calmly back away little by little, the bear will likely retreat as well,” Matsuhashi told AFP.

“The more dangerous ones are the bears that come down into villages or towns. Those bears are often disoriented, they don't know where they are or what's happening,” he said.

"If you encounter one of those, never approach it. Instead, immediately contact the police or the local hunting association. Reporting it quickly is crucial."

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