Automated External Defibrillator ?

[Dedzaboy]

Originally Posted by osirissail

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...

...unless you're cruising in Europe, Australasia, large parts of Asia etc etc...

[Therapy]

Originally Posted by osirissail

. The locals don't live long but they do live healthy.

LOL.

I like that one for sure.

[ChamiJ]

It was ten years ago when the American Heart Association suggested that hospitals put AEDs in hospitals. It was believed by AHA that the effectiveness of these devices would be proven in clinics, and they had been in the outside world. But as to what I heard lately this year, Automated defibrillators could be costing lives in hospitals, really these are effective and useful to be used in hospitals in saving lives but they are not necessarily the best option in hospital cardiac wards, where staff and nurses are trained in emergency cardiac care. :3

[feelsgood]

my advice as a trained royal marine medic is that if you are more than 200 miles from land spend the money on a bottle of whiskey and toast the poor fellows health as you will not save him. I once had to give CPR to a man for 20 mins and I am bloody fit but I couldnt give any more after that its just not posible

[stinkboat]

I'm wrestling with this myself, and it strikes me as a classic cost-benefit analysis.

First, the cost of an AED. Start with the number of dollars. $500? $2500? Whatever the number, you have to restate it in terms of the importance of those dollars to you ("a lot" or "a little"). $2500 is a significant amount to some people, possibly requiring sacrifices or budget adjustments; to others, $2500 is relatively meaningless, comparable to 4 (good) tickets to a NY Yankees game. Add in the additional costs, such as required storage space, maintenance, training, and how burdensome those costs are in your situation.

Next, the benefit calculation. If you're able to save a life with the AED, that's got to be a pretty big benefit, especially to the person you save and his/her family. But we're told over and over that the odds of saving a life with an AED are very small. Here, I think the concept of "expected value" from probability theory is helpful. (As an over-simplified example, consider a lottery with a $1000 prize. If a ticket has a 1% chance of winning, then the expected value of the ticket is $10. Would you pay $2500 for a ticket? What if the prize was $100 BILLION?)

Here's my view of the range of outcomes, benefit of each outcome, and the probability of each, in the case of an on-board AED:

1. You never use the AED, no benefit, 95% (very high probability).
2. You use the AED, patient does not recover for transport to ACLS, no benefit to the patient (but at least you have the peace of mind of knowing that you tried), 4%.
3. You use the AED, you save a life, 1% (or some very low probability).

Note that the probabilities sum to 100% ... covering the full range of outcomes. Perhaps case 3 should be split into 3a people who would have survived without AED, and 3b incremental people "saved" by AED, but let's keep it simple.

So for the expected value of the AED benefit, we have:

(95% x no benefit) + (4% x tiny benefit) + (1% x HUGE benefit) =
0 + ~0 + (1% x HUGE benefit)

In my view, some tiny probability times the priceless benefit of saving a life is still a very large benefit, one that probably justifies, for me, the attendant costs.

This narrow analysis is focused on the AED vs. no-AED decision. I agree with others that there are additional steps necessary in preparing to handle medical emergencies.

I think this sort of approach may also be useful in considering the question of weapons on board, but that's a different thread.

[Paul L]

Stinkboat
Where do you plan to do your boating? This will have a large bearing on whether "transport to ACLS" could likely occur within 1 hour. If the answer to 1 hour (or there abouts) is likely No, then you'd need to reduce your odds yet again. Just restarting with the AED is not sufficient in most cases to end with a happy outcome.

[stinkboat]

I understand.

But regardless of where I do my boating, regardless of how small that percentage gets, as long as the percentage is positive, there is SOME number of patients who can be helped by AED, independent of availability of ACLS. (Tiny percentage times huge benefit of saving even one life is still a pretty big benefit ...)

I can't control whether or not a crewmember has an MI, whether or not a crewmember's problem can be helped by AED.

All I can control is whether I have an AED and other med supplies on board and whether we've had proper training (and in CPR and first aid). Do I really want to sit in my cockpit with a dead patient, wondering if he's one of the tiny percentage of people who could have been saved if I'd had an AED? Wondering why I have $2500 my bank account rather than an AED on my boat?

Sorry if it sounds like I'm arguing. I'm still arguing with myself on this, wondering if it's worth the cost ...

[Rakuflames]

Originally Posted by stinkboat

I understand.

But regardless of where I do my boating, regardless of how small that percentage gets, as long as the percentage is positive, there is SOME number of patients who can be helped by AED, independent of availability of ACLS. (Tiny percentage times huge benefit of saving even one life is still a pretty big benefit ...)

I can't control whether or not a crewmember has an MI, whether or not a crewmember's problem can be helped by AED.

All I can control is whether I have an AED and other med supplies on board and whether we've had proper training (and in CPR and first aid). Do I really want to sit in my cockpit with a dead patient, wondering if he's one of the tiny percentage of people who could have been saved if I'd had an AED? Wondering why I have $2500 my bank account rather than an AED on my boat?

Sorry if it sounds like I'm arguing. I'm still arguing with myself on this, wondering if it's worth the cost ...

Is it worth the peace of mind?

[Cheechako]

I think they are about $1500 or less now. They are automated and wont "jump start" unless the internal electronic diagnosis is correct. As mentioned... they just get you going again.... if not close to cardiac help... may be a moot point.

[nautical62]

Deciding whether an AED is worth it or not is not just weighing how likely it is to save a life vs the cost and time of training. One also needs to weigh that against the safety of other things one can do with that time and money, including prevention.

For some, spending the money on better ground tackle, better navigation, etc. might improve overall safety more than an AED. In my opinion, knowing how to stop bleeding and treat hypothermia, are probably much more cost-effective safety returns than an AED.

I'm arguing against AED's, just saying one needs to consider trade-offs.

[Brob2]

I don't think it's possible for anyone to quantify the value of having a AED on board; the point is moot except for the purposes of stimulating discussions on a forum . I'll give you 2 if you try that on a gun thread, and I look forward to it.

There is no dollar cost/ benefit ratio. There is the simple litmus test of life: if 'it' happened, would I be able to live with myself afterward.

I might, just might, think that somebody with a 80' boat or more would consider having one aboard, but I sure wouldn't expect it. On anything less I'd think 'man, that's dead weight and will never win a race with that aboard', or carrying stuff like that just burns more fuel.

I say this as a Dilated Cardiomyopathy patient, always wondering when that last breath is gonna be. I sure prefer having one last gasp soon then 10 years of them in a wheelchair being dumber than I already am.


FWIW, as noted in a very old preceding post, a very large part of the low recovery rate for hospital patients who experience sudden cardiac arrest is because they are a hospital patient because they are already very sick, and thus AED use outside of medical facilities would very likely provide more positive outcomes in comparison. Regardless, my medic alert tags read DNR. Let go me in peace. And if I do fall over (dead sober) for Gawd's sake, unless your name's Ingrid, don't press your lips against mine and breathe 'cause it's gross and it's no longer part of CPR. Please, no.

As above, I suggest focusing on safety gear and safety procedures is our priority. Maybe pack an extra flag for proper burials at sea and perhaps some Jamieson's with which to toast the late crew member.

[Paul L]

Originally Posted by stinkboat

I understand.

But regardless of where I do my boating, regardless of how small that percentage gets, as long as the percentage is positive, there is SOME number of patients who can be helped by AED, independent of availability of ACLS. (Tiny percentage times huge benefit of saving even one life is still a pretty big benefit ...)

I can't control whether or not a crewmember has an MI, whether or not a crewmember's problem can be helped by AED.

All I can control is whether I have an AED and other med supplies on board and whether we've had proper training (and in CPR and first aid). Do I really want to sit in my cockpit with a dead patient, wondering if he's one of the tiny percentage of people who could have been saved if I'd had an AED? Wondering why I have $2500 my bank account rather than an AED on my boat?

Sorry if it sounds like I'm arguing. I'm still arguing with myself on this, wondering if it's worth the cost ...

Is it worth the peace of mind?

Who are doing this for the? The potential patient or you? It sounds more like you want to be comfortable with personal self-delusion that you will be able to save the MI victim on your boat on a remote tropical island. There are many, many things that are way ahead of an AED in terms of crew safety. Fire protection systems, advanced medical training, etc. Ijust don't think that something with a tiny chance of making any difference should make you feel comfortable that you are prepared.

[stinkboat]

Assuming that an AED necessarily implies sacrificing other useful measures only complicates the discussion needlessly. If buying an AED requires certain sacrifices, then factor those in as "costs".

Go ahead and flame away, but I'm outta here ...

[hellosailor]

Stinkboat, you can probably get one for grand these days. Most of them will never be used, most folks will never need one. (And ignoring the expense of any upkeep.) If you are planning to use it on strangers, well, a grand is a grand, they can bring their own if you have to question whether you want to make that investment.

But the numbers are basically 10/10. That is, ten percent of heart attack victims will die for every minute in the first ten minutes after an attack. If you can get an AED to someone within 3 minutes they've got a 70% chance of recovery. 5 minutes, they've now got a 50% chance of recovery. Eight miuntes? They're already down to 20% and after ten minutes, their odds range from slim to none.

So says the guys who gave me training with one. Which, reassuringly, was the special "demo" unit which (ahem) refused to operate when they tried to get it going. So you might want to invest in two of them, if you really want one to work.

[Pblais]

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.

You just won't get clinical trials to determine how well you survive without quick followup medical attention. No doctor in their right mind will suggest an AED to the heart and you are good to go. There usually is a reason you needed it and an AED won't ever cure that.

Bang for the buck a general Red Cross Basic First Aid course will cover CPR using and AED and other stuff that you could die from. The idea that you pick and choose what to study is pretty foolish when the basic stuff will in most cases get you to a port in the best shape possible. If you have done the Basic then the Red Cross offers a great deal more all the way through EMT training. It's as good as you get without being a physician. Even that isn't going to cure patients. It's just to get them stable until better medical assistance can be obtained. It's the best you can ever hope for.