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Old 09-07-2010, 19:23   #46
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dgz3, no offense taken. The AEDs I have trained with analyze the heart rate and then self-adjust the shock level it determines is correct for the patient depending on what their heart is doing. However, the ones I have seen will not shock if there is no reading. In fact, the older models used to say, "Dead patient."

The newer ones say, "No pulse, continue CPR." I'm guessing that's because "dead patient" was a little upsetting to people.
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Old 09-07-2010, 19:48   #47
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When it's your time, it's your time! At least it's your time doing what you love and not at some high stress job or in some rut. Enjoy you life while you can and take care. Hope to see you out there!
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Old 10-07-2010, 07:36   #48
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An AED costs around a grand, requires updates and maintenance, and is vulnerable to failure. CPR costs nothing, the last full class I took was two hours long. I doubt that the 5-year updates in protocol really make a lot of difference (and most cruisers won't stay current in CPR certification if they;re away from home), and has the same success rate (without an EMS system) as an AED.

Most people can find better uses for that grand. If you have the room, the cash, and the understanding that it's not a magic device, go for it.
We've already heard that an AED can be obtained for far less than a grand. What maintenance? Change the battery every five years?
I don't know where you get free CPR training - St John's Ambulance charges about $60 for the basic course and says it takes 4-6 hours. They don't put an expiry on it, but I believe they recommend retraining every 3-5 years. The reality is that most people start forgetting the minute they leave the classroom, and unless they get frequent opportunities to use it, the quality of their CPR goes downhill from there. I'm not advocating against learning CPR, just putting it into perspective. Once you've learned to use an AED your effectiveness with it is not likely to depreciate much - after all you just need to follow the simple instructions that come with the machine. CPR training has a much shorter "expiry time" imho.

Sure, you might have better uses for the money, but that money might otherwise just go to a larger flat-screen tv, or another laptop, or a few nights in a hotel. They don't really take up a lot of room, do they? And I don't believe anyone here has likened an AED to a magic device. Even with CPR, the chance of survival after 10 mins in VF is virtually nil. An AED dramatically increases the survivability chances where EMS is more than 10 minutes away, don't you agree?

You brought up the point that even with an AED, hospitalization is still required - actually you said it will only keep you alive a few minutes. I think that's a bit misleading, but there doesn't seem to be a lot of data to prove or disprove that statement. AEDs seem to have had some record of success on airplanes and in other remote locations, so I'd like to know if there are any studies of survivability with extended delays between defibrillation and hospitalization?
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Old 10-07-2010, 08:46   #49
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so I'd like to know if there are any studies of survivability with extended delays between defibrillation and hospitalization?
I doubt there is much out there because they just haven't been used much. The frequency of use is small and then there is the number of uses that it cannot treat. I hope someone can bring stats and not anecdotes.

I do know that within the acute care hospital setting the chances of being discharged (alive) after CPR is very low. My last memory of the number is below 10%.

But like others have said, it is up to the individual.

Lots have life rafts too, even though the percentage of time "out there" where it might be needed is pretty darn low for most all and if it is needed the failure rate is pretty high. That is, the number of people actually saved by one is low for a variety of reasons.
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Old 10-07-2010, 13:08   #50
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This article claims that after a decade of use on their planes, American Airline's AEDs have saved 80 people for a survival rate of 63%. Of course they don't go into how many occured over the middle of the Atlantic and how many were on a jetway. Daily Herald - American Heart Month - 2008
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Old 10-07-2010, 14:08   #51
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This article claims that after a decade of use on their planes, American Airline's AEDs have saved 80 people for a survival rate of 63%. Of course they don't go into how many occured over the middle of the Atlantic and how many were on a jetway. Daily Herald - American Heart Month - 2008


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They estimate that 95 percent of sudden cardiac arrest victims die before reaching the hospital, but that when defibrillation is provided within five to seven minutes, the survival rates rise to 49 percent. Since equipping its aircraft with AEDs, American has achieved a survival rate of 63 percent.
"Seconds do count," Campbell says. "We found that even if our aircraft was directly over the airport when the cardiac emergency happened, it still would take 20 minutes to land the plane. Surviving a sudden cardiac arrest is largely dependent on how quickly a victim is defibrillated."
Better sounding than I thought.

When is the pocket version going to come out?

Actually since implantable pacemakers now have that feature, probably not long.
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Old 10-07-2010, 18:59   #52
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We've already heard that an AED can be obtained for far less than a grand. What maintenance? Change the battery every five years?
I don't know where you get free CPR training - St John's Ambulance charges about $60 for the basic course and says it takes 4-6 hours. They don't put an expiry on it, but I believe they recommend retraining every 3-5 years. The reality is that most people start forgetting the minute they leave the classroom, and unless they get frequent opportunities to use it, the quality of their CPR goes downhill from there. I'm not advocating against learning CPR, just putting it into perspective. Once you've learned to use an AED your effectiveness with it is not likely to depreciate much - after all you just need to follow the simple instructions that come with the machine. CPR training has a much shorter "expiry time" imho.

Sure, you might have better uses for the money, but that money might otherwise just go to a larger flat-screen tv, or another laptop, or a few nights in a hotel. They don't really take up a lot of room, do they? And I don't believe anyone here has likened an AED to a magic device. Even with CPR, the chance of survival after 10 mins in VF is virtually nil. An AED dramatically increases the survivability chances where EMS is more than 10 minutes away, don't you agree?

You brought up the point that even with an AED, hospitalization is still required - actually you said it will only keep you alive a few minutes. I think that's a bit misleading, but there doesn't seem to be a lot of data to prove or disprove that statement. AEDs seem to have had some record of success on airplanes and in other remote locations, so I'd like to know if there are any studies of survivability with extended delays between defibrillation and hospitalization?
The batteries need to be replaced on a regular basis (how often depends on the manufacturer, and the age of the batteries). They are custom batteries, not off-the shelf, and are expensive. The protocols for shocking change about every 5 years, and AED's usually aren't upgradeable (I've never seen one that is: They all were replaced, at our expense, the manufacturers didn't have an upgrade path defined).

That site quoted has (right now) one AED for $150 that "Powers up and appears to work fine. Does not come with the pads". Nor does it have a fresh battery, a case to carry the unit and pads, etc.

The next lowest price is seems to be $750. The one after that is $995. All for used equipment, that will need accessories (at least they don't claim that the accessories like pads and leads are included). Nor do they have any sort of certification that they work correctly. You pay your money, and take your chance. Personally, I don't trust safety equipment that isn't rebuilt to manufacturers specs and certified as such.

BTW, guess what happens if you're drenched in sea water when the AED is trying to decide if you need to be shocked? It won't. Just one more reason why they're not necessarily a good choice for sailors in smaller craft.

As far as CPR costs, I've seen and taught many courses that are either free, or a very nominal cost (like $10, for the cost of the expendable materials). It pays to shop around. But then I've taught EMT-B and WEMT classes basically for free (buy your own books) and standard and advanced ARC first aid (using my books and materials) absolutely for free (I've even supplied the coffee and donuts). My Fire Department will train in CPR for free, my hospital trains all staff (including volunteers) for free.

St. John's (one of my BIL's is very involved with them in Canada, an officer of some sort) rolls their own way.

As far as the length of the course, we show the movie, give the test, demonstrate the use of the AED, have everyone practice CPR on adult, child and infant mannequins, and when they're all done (ie, demonstrated CPR to the standard in my presence) and passed the written test, the class is over. It's not hard if people stay awake. The days of 40 hour CPR classes (or even 8 hour CPR classes) is long gone: Studies have shown that they don't do any good (no measurable change in CPR performance dependent on length of instruction: Also there is no measurable difference in recurrent instruction other than that required by changing standards), and even children as young as 9 can learn and RETAIN CPR skills. Even St. John's offers an 8-hour FA/CPR course, hopefully not all of the FA is dial 9-1-1. Since it is a physical skill, practice helps but the basics remain the same.

As far as survivability, there are LOTS of studies that show the faster an individual gets to a catheterization lab following an MI, the better the outcome (defined as survival to discharge from the hospital, with no cognitive or physically - activities of daily living - altering sequalae). Lesser definitions of survival skew the results tremendously. There are few if any studies that show that anything less than the standard of care is effective, because physicians are sued for delivering less than the standard of care. However, no other treatments, prehospital or hospitalized, including rest, MONA (morphine, Oxygen, Nitrates, Aspirin) or plasminogen activators (clot busters) or external pacing, or anything else, works as well as stenting (physicially opening blocked cardiac arteries) or embolectomy (physically removing the clot) for restoring the most cardiac muscle function. You never get it all back, cardiac muscle cells don't regenerate, and the goal is to prevent as much damage to the heart wall as possible before permanent damage results.

Finally there is a critical period from 3 to 5 days post MI where the heart wall is the weakest, and most likely to rupture even in a hospital setting. This is very often fatal, unless you're already in surgery. It's caused by the weakened heart muscle, going through the normal healing process causes apoptosis (programmed cell death) of damaged heart muscle cells, prior to development of scar tissue, and is more likely to happen in those who have not had any prior incidents of MI. Also, the heart itself is hyper-sensitive following an MI (due to ischemia) and can easily go into fibrillation again. When that happens at sea, then what? Say you're 1000 miles offshore, and what would you do? If you're near shore, then fine - but this is the cruisers forum.

The AHA (American Heart Association) shows that even with the full gamut of EMS ACLS and appropriate medical care post MI, the survival rates are fairly bleak. While the AHA claims that in certain specific situations (the city of Seattle, with high numbers of CPR trained citizens, a very good and fast-responding EMS system, small city with good hospitals, etc; or at Chicago-Ohare Airport with lots of CPR/AED trained staff, and lots of AEDs available, and a pretty good EMS system, and lots of hospitals) survival (which they don't consistently define) can be as high as 50%. However that doesn't comport with my experiences - the number of patients who have survived to discharge from my hospitals (or survived to transfer to the CCU) is poor, on the order of 20-25%.

Do AED's save lives? It depends on the time frame you look at. Most people who die from a heart attack (which is most people who have their first heart attack) die right there, with no obvious earlier warnings. All AED's do is give you more time (a few more minutes) to get to definitive medical care.



CPR, or AED are not a panacea. They are just two of the available modalities that may help people survive an MI, if used with appropriate care.
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Old 11-07-2010, 01:14   #53
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Spot On

Healer52

Thanks for the excellent analysis. I think the bottom line is that if you have unlimited money to spend....and if you can arrange to have your heart attack nearshore and close to a good EMS system (Puget Sound maybe?) then go ahead and buy an AED. There is a very very very slim chance that it might help.

However, for most of us, the money might be better spent on a health club membership, or fitness equipment, or statins, or an inflatable pfd, or a survival suit, or a life raft, or a bigger anchor, or replacing those old lifelines.....?

AED's are wonderful devices and do save some lives in certain situations, but the odds of them helping you when at sea are (as my old math prof used to say) "vanishingly small". When they come out with a pocket size AED and a cath lab for home use then maybe I'll consider one for the boat.
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Old 11-07-2010, 07:56   #54
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CPR, or AED are not a panacea. They are just two of the available modalities that may help people survive an MI, if used with appropriate care.
It's only an "available modality" if it's available.
Anyway you've brought up a lot of good discussion points, but I think the cost factor has been beat to death - it's really up to the individual to determine their own cost/benefit analysis.
Quote:

As far as survivability, there are LOTS of studies that show the faster an individual gets to a catheterization lab following an MI, the better the outcome (defined as survival to discharge from the hospital, with no cognitive or physically - activities of daily living - altering sequalae). Lesser definitions of survival skew the results tremendously. There are few if any studies that show that anything less than the standard of care is effective, because physicians are sued for delivering less than the standard of care. However, no other treatments, prehospital or hospitalized, including rest, MONA (morphine, Oxygen, Nitrates, Aspirin) or plasminogen activators (clot busters) or external pacing, or anything else, works as well as stenting (physicially opening blocked cardiac arteries) or embolectomy (physically removing the clot) for restoring the most cardiac muscle function. You never get it all back, cardiac muscle cells don't regenerate, and the goal is to prevent as much damage to the heart wall as possible before permanent damage results.

Finally there is a critical period from 3 to 5 days post MI where the heart wall is the weakest, and most likely to rupture even in a hospital setting. This is very often fatal, unless you're already in surgery. It's caused by the weakened heart muscle, going through the normal healing process causes apoptosis (programmed cell death) of damaged heart muscle cells, prior to development of scar tissue, and is more likely to happen in those who have not had any prior incidents of MI. Also, the heart itself is hyper-sensitive following an MI (due to ischemia) and can easily go into fibrillation again. When that happens at sea, then what? Say you're 1000 miles offshore, and what would you do? If you're near shore, then fine - but this is the cruisers forum.
If you're 1000 miles offshore you might be done in by appendicitis. Or numerous other ailments. Let's be realistic - most 'cruisers' spend the majority of their time in port - the commonly stated ratio is 10% at sea to 90% in port. By extension a large portion of that 10% at sea will be near to port. Ultimately, very little time is spent a long way from shore.

Can you offer any data/studies that gives an idea of comparison between decreased survivability and delayed catheterization? Or better yet, as a professional can you recommend strategies that could maximize someone's odds of surviving - giving aspirin (how much?) and oxygen for instance? Surely morphine is contraindicated? Are there clot-busting drugs that could be given? (Can they be carried in a first aid kit?)

Let's also consider that most of the statistical cases may not be representative of the cruising community. What's the median age - 70? Probably sedentary. Most full-time cruisers are likely to be reasonably active, and most likely eat better than landlocked suburbanites. Would you say that someone mid-forties, who keeps fit, eats right, doesn't smoke, drinks only in moderation and basicly does all the right things, is more likely to survive a SCA? Would these factors help increase survivability where catheterization will be delayed?

Yeah, I realize survival chances are slim, but slim is better than none, and at that point trying anything is better than just accepting you're a goner. "Can you crawl up on deck and zip yerself into this body-bag? That's a good lad - don't want you stinkin' up the boat now"
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Old 11-07-2010, 08:54   #55
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On the boat I Captain, we carry an AED and the crew are required to take basic first aid. When we bought the AED we got crew training but it wasn't much. Our AED, like most I believe, do an evaluation and won't allow operation unless things are right.

Since I tend to sail solo or short handed, the AED probably won't be as useful. If I were in the charter business, I'd definitely have one. CPR is one of the hardest tasks you'll ever do, and if the AED improves the chance of survival bu 20% then it's worth the money.
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Old 11-07-2010, 10:38   #56
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On the boat I Captain, we carry an AED and the crew are required to take basic first aid. When we bought the AED we got crew training but it wasn't much. Our AED, like most I believe, do an evaluation and won't allow operation unless things are right.

Since I tend to sail solo or short handed, the AED probably won't be as useful. If I were in the charter business, I'd definitely have one. CPR is one of the hardest tasks you'll ever do, and if the AED improves the chance of survival bu 20% then it's worth the money.
Isn't that number from;

Quote:
However that doesn't comport with my experiences - the number of patients who have survived to discharge from my hospitals (or survived to transfer to the CCU) is poor, on the order of 20-25%.
where all the resources are available on the spot?

But if you have the money, what the hey.
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Old 11-07-2010, 11:01   #57
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BTW, guess what happens if you're drenched in sea water when the AED is trying to decide if you need to be shocked? It won't
Whether you have an AED on board or not -- you do have TOWELS, right?
The course I took specifically directed us to dry off the chest if necessary before sticking down the pads. That was through the Red Cross.
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Old 13-07-2010, 20:43   #58
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What good is getting the heart jump-started if you do not have medical oxygen available? I carry medical oxygen primarily for diving situations but it is also useful in situations where CAD reduces blood flow and the body is oxygen starved.
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Old 13-07-2010, 21:38   #59
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I started this thread to ask the opinion on how many actually carry an AED, not really to push its use or not. There is a variety of ideas on if they would or not.

As I read over them, I notice a trend that most are sitting in port. No different that being in a high rise buildin. So, if the EMS has 4 minute response time to your door, but 10 mins to get to you, then would you scream to have the building add an AED? Or the Gym? Yes, it is but one item in many, but how many spend days either within stones throw of land, or cruising the bays, close enough to call for help, but more than a few mins from it? Look at the guidelines for American Heart Assoc or the Red Cross on CPR and early shock. And as far as healthy lifestyles or Gym memberships, there is a reason they call it Sudden Death Syndrome.

I asked the question to provoke thought not to cause controversity. As they say your mileage my vary, but having been in the "Business" for 25 yrs in running the medical calls, seeing what did work and didnt, Yes, i will carry one. And I have taught over 1000 people over the years CPR, and one thing that I usually stressed, was that you typically will use it on someone you know, not the stranger in the food mart.

Lets take the same people that dont agree on AEDs and ask if they carry medications for future medical problems, Allergic reactions, antibotics, and why do they carry them? Or why not? Again, not throwing gas on the flames here, but giving wind to different ideas and points of view.
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Old 14-07-2010, 05:58   #60
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To finish up the AED discussion please beat it into your heads that the standards of medical assistance inside the USA does NOT exist anymore when you go cruising outside the USA. When you ask the local island country's ambulance driver where his AED is you get a blank stare. What is that, he will ask. In the ambulances are only a guerney, an oxygen bottle and a body bag. That's it. You will have to make the ride back to the hospital alive on your own systems.
- - The same with the "exotic" medications you may be taking by the mouthful inside the USA. For all the other "little" things like allergic reactions, antibiotics, antiseptic solutions, even bandaids and dressing pads/tapes - be sure you have a good supply before you leave North American waters. What is available in the islands is really very basic "plasters" which is what they call the bandaids, ancient gauze pads, and fabric adhesive tape.
- - If your doctor and dentist are savvy to international travel/cruising they will take the time to write you some prescriptions for general purpose medications/antibiotics and give you some advice to get things like clove oil and emergency dental kits that are available. I did not know such things existed but they do and having them on board is a very good idea especially when your are several days from any reasonable medical/dental facilities.
- - Medications and supplies in the little island countries is rather basic and tailored to the needs of the local population that is not subject to "chemically manufactured" foods, stress-inducing political/local environment, and other uniquely North American hazards to your health. The locals don't live long but they do live healthy.
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