Automated External Defibrillator ?

[RestlessWind]

TampaBayFireman;
I am assuming that as a fireman, you are trained in Advanced Cardiac Life Support (ACLS). If you feel the need for that level of preparation you might want to forego an AED in favor of a full-blown defibrillator which would also give you the ability to perform external pacing, cardioversion and continuous monitoring as well as record rhythm strips for diagnosis and documentation. This would allow you to perhaps increase the odds of survival until you could reach emergency services, especially if offshore.

These can be found on the net for around $1,200 used. Just Google "used defibrillator"
If I were going to this extreme, I would be sure to include a supply of the most common cardiac meds in the ships medical kit.


Just be careful of using the thing on wet decks

[Lodesman]

Originally Posted by Tampabayfireman

I own one. Not from Ebay, but a national reseller for AEDs and a far less than 2k. (more like 250).

Care to advertise for them?

[Tampabayfireman]

I am not typically in the habit of just advertizing for sites, and this one is no different. It is a medical site similar to Ebay. If you are interested, send me an email and i will forward the link. I did send Lodesman a reply with the link. I also will send the mod the link in case he would like to post it.

[Tampabayfireman]

Ok, given permission from mods to post link... just like ebay, buyer beware, but items listed are real.. www.dotmed.com

[cal40john]

Found an article written by a doctor. Basically he says if you have enough money why not, you might get lucky and save someone. As others here have said, he says when there is an underlying cause, i.e. MI, probably not going to help because you're going to need additional intervention. Only if there is no apparent cause, some people's wiring is just messed up and you only go into VF will it be likely to help.

http://www.healthline.com/blogs/outd...lators-in.html


More on the study referenced in the above link. (I can't believe people didn't even know to take the shirt off!)

From:

http://hubpages.com/hub/home-automat...-defibrillator
Can The General Population Effectively Use An AED?

An exploratory study[1] was performed to investigate whether the general population can use AEDs successfully.
Five categories of individuals (ranging from the general population to highly trained surgeons) were identified as subjects, to represent varying degrees of health care training.

1. : General population (None of them had ever seen or operated an AED prior to this study).
2. : First-year dental students (May or may not have had experience with an AED).
3. : Third-year dental students (All been certified in CPR).
4. : Dentists, registered nurses, and registered dental hygienists (Certified in the use of an AED).
5. : Anesthesiologists and surgeons (ACLS certification with AED training).

A CPR mannequin was used as the fibrillating patient. The testing room was set up with the mannequin lying on top of a table, T-shirt on, and the AED lying adjacent to the mannequin.


Results

Category one showed an 80% failure rate, category two a 60% failure rate, category three a 30% failure rate, category four a 20% failure rate, category five a 10% failure rate.
Of the fifty operators tested, 42% failed to successfully defibrillate the victim. Of those failing, 52.4% did not remove the patient’s T-shirt. 28.6% did not place the defibrillating pads correctly, the remaining 14.3% failures were a result of the operator touching the patient while defibrillating.
The data suggests that a person in the general population may not be able to successfully operate an AED, especially in a stressful situation.
As AEDs become more commonplace, the public must be educated on their purpose and use.


Home Automated External Defibrillator

The home is the most common location out of hospital of sudden cardiac arrest. It's a challenge for the emergency medical services in such situations to provide timely care. Consequently for patients at risk, home use of an AED might offer an opportunity to improve survival.
In a study which included more than 7,000 patients at risk due to previous heart attacks, it was found that access to a home AED did not significantly improve overall survival.
Despite the study’s findings, in remote areas where quick emergency response was unlikely, home defibrillators might be a worthwhile investment combined with an appropriate preparation.
AED can be bought with or without a prescription.

[Pete7]

We used one on a boat handling course I was running about 5 years ago on a yachtie. He was very lucky, we had the right equipment and people in the right place at the right time.

Part of the course was to load up the club dive rib with all the equipment as a test to see what the students miss. Having done this in the afternoon we launched the boat and whilst moving from the slipway to the pontoons noticed a 25ft yacht drifting around the pontoons. Moving over to it we could see the sailor looking very grey and a faint "HELP" was all that was needed for us to react.

We towed and moored the yacht quickly to a spare pontoon whilst one of the students an experienced nursing teacher who taught intensive care started on the patient. Because we had practised loading the boat we had the full extensive first aid kit on board and a full oxygen set. Runners were sent to phone for an ambulance which turned up after 10 minutes whilst CPR was started.

The two teenage girl paramedics seemed to lack the sence of urgency as they walked down the pontoon. I grabbed the oxygen set off the paramedics and handed it to our nurse, who promptly discovered the cylinder was empty so we carried on using the clubs oxygen set. She called for a defib which we fetched from the ambulance. However before using it she was adamant that everyone let go of the boat and the rigging as the casualties arm was resting on the guardwires. She managed to restart his heart and we patched him up enough fo the ambulance to take him off to the hospital. The yacht looked like a bomb had hit it. During the heart attack the viens in his nose had ruptured due the excess blood pressure, so the white GRP was covered in blood, bandages and sticky things from the defib etc. He survived and sent our nurse a large bunch of flowers plus a card each year on the anniversary

Later we discussed the incident and wondered if we should carry a defib on board. However, untrained crews and saltwater everywhere on a dive boat meant we decided not to. However we always carry oxygen.

Pete

[cvondo]

As a practicing anesthesiologist for 20 yrs and just finished attending an emergency conference which this was discussed, my opinion is an emphatic no. CPR and defib even in the hospital setting has very poor outcomes. Being on a boat cruising there is no way I would ever consider such a device. If you really want to be prepared for a serious life threatening event which is rapidly reversable and fairly common learn how to use epinephrine in the case of an anaphylactic reaction. The only exception to having an aed would be if you had a previous problem with arrhythmias. There Are so many other areas of medicine to learn and prepare for other than an aed use. If you have cad sure learn how to treat a mi in the field. Good luck. Chris v

[Lodesman]

Originally Posted by cvondo

If you have cad sure learn how to treat a mi in the field.

cad = coronary artery disease
mi = myocardial infarction


PS - Tampabayfireman - thanks for the link.

[Centauro97]

Hello all. I'm new here, this is my first post. I don't have much to offer on sailing issues but an AED discussion is something I've worked on.

I'm a Navy physician working at Navy Medicine's headquarters, Bureau of Medicine and Surgery. SECNAV wanted a policy for AEDs in non-clinical buildings so I was the medical representative to writing that policy. Just so you know my background.

An AED without Basic Life Support (BLS/CPR) is of limited value. You can't "buy" lifesaving without any training and expect a good outcome. That's an important point. If the "heart attack" is actually a chocking victim electricity (AED) isn't going to fix the problem. Correctly identifying what the victim needs is critical and BLS teaches the process.

The scientific data overwhelmingly supports that electricity is the only thing that "treats" ventricular fibrillation (Vfib). An AED will only enable shocking Vfib. Shocking someone with hypoglycemic (low blood sugar) shock would be bad because the electricity would harm an otherwise good heart and you'd be missing a simply "cure", give glucose (sugar). I agree that CPR alone is not likely to provide a good outcome if someone's heart has stopped beating effectively (Vfib) and only application of an AED within the first few minutes will save that person.

The dot.med site is interesting. Defibrillators are medical devices and you shouldn't be able to buy one without a prescription. Wonder if that's why many are sold without batteries or paddles. Regardless, several AEDs (LIFEPAK 500) are for sale. I wouldn't advise the other non-automatic defibrillators. Look for the "analyze" button. I'm not sure if you could determine whether an AED is actually is working condition without an arrhythmia simulator to test the analysis function. The 500 won't shock unless it is convinced Vfib is present.

As noted in other posts, there are a lot of reasons someone may collapse, be prepared for them as well. Bee sting kits, glucose gel (if anyone is on diabetes medications), and a good first-aide kit are things I'd buy first.

Sorry for the long post,

David

[Tampabayfireman]

The initial reason behind this post was I have been seeing several venders at boat shows offering AED as part of a package of first aid kits. Again, the average lay person may or may not have the rational background for use. I was trying to get a feel on how many actually carried one. Its similar to the community based AED units in retirement communities we have here in Florida.

[Healer52]

Originally Posted by Albro359

regarding physicians on board using them...I would say from my experience a well trained lay person or a paramedic would do a better job...once the patient's heart is beating in an organised rhythm, then let the physicain ahve a go...too often they don't appreciate the absolut urgency and the need to follow a strict protocol which has been proven to work

As well as the AED we also carry a bag mask resuscitator, guedal airways, adrenalin etc

It rather depends on the physician. I'm a board-certified emergency physician, I teach ACLS to paramedics and have been the medical director for county EMS systems, fire departments, and a couple of search and rescue teams.

I sailed with a monitor/defibrillator (not an AED) on a circumnavigation 5 years ago, based on the crew demographics and budget. I also had advanced airway intervention ability and all the ALS drugs.

For my wife (a pharmacist) and I sailing by ourselves? I might carry an AED, but it wouldn't be high on my list of medical equipment (and I carry a lot of it). As you said, the chances of surviving an MI are pretty poor, even with PERFECT CPR beginning immediately, AED within 3-5 minutes of the MI, ALS within another 3-5 minutes of the AED. In typical cruising situations? Good luck.

AED's are kind of sexy these days, I guess. They're not terribly effective, if you look at the cost (across a large population), unless it's you or your loved one they save. But don't count on them actually working the way they do on TV.

[SaucySailoress]

CPR simply keeps blood circulating so a limited amount of oxygen can feed the brain and organs - the faster a fibrillating heart is restarted with a defibrillator, the better the chances of survival.

In the last ten years, I know of two local sports coaches in their forties, who dropped dead of heart attacks. Who knows if having had an AED to hand would have made a difference - I think it would have. My husband is in his forties and fit, and I know I don't want to lose him. Maybe we should buy one now.

One year ago now, I was being held in hospital for nearly a month after being released from ICU. I 'knew' I was going to die, and my last thought before I woke up in ICU was that none of that work crap, and toeing the line so as not to offend the powers that be etc all was a waste of time - all that really mattered was that I hadn't had time to sail the world yet.

So, is life precious enough to invest a thousand dollars in an AED? I think so.

[Healer52]

I'm glad that you're doing better.

But, an AED will only, like CPR, keep you alive for a few minutes: True, it's a few minutes more than CPR, but without the resources of a hospital (cath lab), an EMS system with drugs, and the rest it's not going to come anywhere close to 'fixing' the underlying problem.

Say someone is at sea, and has a heart attack. Their crewmate starts CPR, while someone else gets the AED (and lets assume that the patient isn't covered in salt water which will prevent the AED from working). The AED detects a shockable rhythm and shocks....great, the heart starts up again.

Now what? The underlying problem is still there: The coronary artery that is occluded is still occluded, the damage is still occurring to the heart muscle, which is weakened from the heart attack AND the shock (they're not at all benign).

If you're close enough to call for, and get help (less than 200 miles offshore from the US, Canada, the UK, Aus) and the weather is not bad you might be able to get him evacuated (within the next 24 hours). Most of the rest of the world? Better hope there is a US Navy Carrier Battle Group or Marine Amphibious Unit nearby.

AED's, when used correctly, within an appropriate EMS AND medical system can save lives. Not as many as you might think however, even when everything is going just right. Change any of the parameters of that system including evacuation to definitive care (BTW, US Naval vessels don't have cath labs - not even the hospital ships) and the odds of survival to discharge from the hospital go down, down, down. AED's and CPR are not a magic treatment.

[zeehag]

realistically speaking--you are out in the middle of the pacific on way to nuku hiva from santa barbara or some other weird west coast locale---and --smack in the middle of 3000 miles of cean, omg--chest pain. --what ye gonna do--turn on the defib then? it doesnt work that way. by the time the lay person is aware of an impending fatal arrhythmia--YER DEAD!!!!!! ye gonna walk around on deck with the electrode patches in place for the defib to be used?/ how do ye kno wis gonna even happen?/ why waste of money that could be used on more functional items in the lockers or med kit???/ i am not understanding this--i have been icu and emergency room rn and triage rn for many many years----generally arrhythmias occur in sleep unless associated with mi -- is the individual sailing as a lay person--not a health care provider--going to know exactly what to do ??? NO!!!!! why buy ?? no reason to . oh yes, and the cpr being done in the middle of the blue sea--where are you going to find relief for the cpr giver as that individual sails the boat to the destination closest ?? good luck--doesnt work that way. why is everyone so in love with aed? to tell the truth--they dont even work all the time in hospitals--why bother!!!!!and--tell me how to save life in mid ocean with only you and the victim as sailors of the boat?? aint happening--do your best, but be real about it. aed is a useless added expense for the long distance short handed cruiser.

[speciald@ocens.]

We carry one. My wife is a nurse anesthetist and ALS certified. I've had 2 heart attacks in the past. Two Winters ago, a friend of ours suffered a heart attack in the Bight at Norman Island. S he called on the VHF, and a cardiologist eating dinner ashore imediately came to the boat. Serch and rescue out of Roadtown also showed up quicky. He was defifbed with their AED, recieved CPR, and survived. He had no cardiac history. So - it does happen!