Medical Emergencies at Remote Cruising Destinations

[Littlechay]

Originally Posted by Muckle Flugga

As I said, debatable, but does the AHA specifically indicate that defibrillators in remote locations with no acute/extended care facitility within a couple of days or more is recommended? I somewhat doubt that, but would be interesting to know, certainly. I should also have included oxygen in my list. Oxygen is very important in acute cardiac care. And yes, I do carry it. (Also for diving related problems.)

But how much O2 do you carry? O2 therapy falls into the same argument you gave for a defibrillator . You simply can't carry enough for prolonged therapy so again if you can't reach port quickly there is little point.


SY Morgane
http://tweedsworld.com

[dannc]

Originally Posted by Paul L

Defining what a cruiser is of course open to debate. For us, it does mean spending much of our time in remote areas where local emergency care is not readily available. Your argument of having one on your boat in a marina doesn't hold water. Having one or two at a busy marina makes sense. Having one on each of the hundreds of boats in a marina is a very ineffective way of spending safety and medical care dollars.

Where did I say that every boat needed an AED? Nor have I said eveyone should have and AED on a boat. I think my "argument" does make sense since it could help me save someone's life. If YOU do not want that capability that is fine. I want that capability.

How busy the marina is has nothing to do with carrying an AED.

Later,
Dan

[Muckle Flugga]

Originally Posted by Littlechay

But how much O2 do you carry? O2 therapy falls into the same argument you gave for a defibrillator . You simply can't carry enough for prolonged therapy so again if you can't reach port quickly there is little point.


SY Morgane
Tweed's World | A high latitude sailor preparing for tropical cruising

Not so. Prolonged therapy is not indicated in many cases. Indeed the dangers of hyperoxaemia are becoming better understood, and many cases of emergency medical intervention call for oxygen therapy on a short term or acute basis only, until the patient is normoxaemic. This can be monitored with a simple pulse oximeter, small and cheaply available.

Such conditions include:

Medical emergencies where oxygen is likely to be required until patient is stable and within target saturation range3

Medical emergencies requiring high concentration oxygen in all cases
Shock, sepsis, major trauma
Cardiac arrest and during resuscitation
Anaphylaxis
Carbon monoxide or cyanide poisoning
Medical emergencies where patients are likely to need oxygen therapy (ranging from low to high concentration depending on disease severity), with target saturation range 94-98%
Pneumonia
Asthma
Acute heart failure
Pulmonary embolism

So Oxygen is useful in a fairly wide range of acute circumstances wherein prolonged therapy is not indicated, and may indeed be harmful. AEDs are indicated in a small fraction of coronary emergencies only, and are effective in an even smaller fraction, with poor evidence to show that they will be of use without immediate continuing medical support, as indicated above.

Of course this thread is about remote medical assistance. As I noted above, many boats including my own spend a lot of time in areas wherein medical assistance and evacuation are not in fact remote, as well as a great deal of time in which they are. Oxygen remains an effective therapy in a range of circumstances for both remote and populated areas. AEDs are likely to be effective really only in a coastal setting with immediate high dependency unit support readily available, and for small cohorts they are not statistically likely to justify their high cost, at least at present.

I carry 400 liters of oxygen in 2 separate bottles, one in the CP/Resusc kit shown in the attached photos.

[Kenomac]

Four hundred liters isn't enough O2 if you're in a remote spot. You need a concentrator if you intend to treat any of the issues listed. But for a couple of the ailments, your O2 will be useless without the AED you don't have... and don't want.

[Muckle Flugga]

Originally Posted by Kenomac

Four hundred liters isn't enough O2 if you're in a remote spot. You need a concentrator if you intend to treat any of the issues listed. But for a couple of the ailments, your O2 will be useless without the AED you don't have... and don't want.

Are you speaking as a physician? Because that is not what I understand to be the case, nor the advice remote medical authorities I trained with gave me. And as to your assertion that "...for a couple of the ailments O2 will be useless without the AED you don't have… and don't want." You are simply flat out wrong. You seem to be suggesting that all acute coronary episodes are related to fibrillation. They are not. Only a small fraction of them are, so in the majority an AED is totally useless. You apparently have not read my above careful laying out of the facts and statistics. Care to iterate your argument? What is your training/expertise in the subject or oxygen therapy? Or was that just a post for the heck of it?

[Muckle Flugga]

Oh, and you can include shock, convulsions and hypothermia to the list of indications for acute, short term oxygen therapy, none of which are chronic.

[Littlechay]

Originally Posted by Muckle Flugga

Oh, and you can include shock, convulsions and hypothermia to the list of indications for acute, short term oxygen therapy, none of which are chronic.

And remove asthma and sepsis which likely require long term therapy.

I agree with you on AEDs by the way just curious about your arguments for lugging O2 around. The expedition boats I have skippered have had O2 as part of the medical kit of course but the expedition doctors always were very dismissive if it's usefulness. All very experience remote expedition docs by the way

Like the other poster said a concentrator would be required.

Just so we know where your coming from what is your training and experience?

I'm not being dismissive just questioning because what your saying goes against advice that I have always regarded as solid


SY Morgane
http://tweedsworld.com

[Muckle Flugga]

Originally Posted by Littlechay

And remove asthma and sepsis which likely require long term therapy.

I agree with you on AEDs by the way just curious about your arguments for lugging O2 around. The expedition boats I have skippered have had O2 as part of the medical kit of course but the expedition doctors always were very dismissive if it's usefulness. All very experience remote expedition docs by the way

Like the other poster said a concentrator would be required.

Just so we know where your coming from what is your training and experience?

I'm not being dismissive just questioning because what your saying goes against advice that I have always regarded as solid


SY Morgane
Tweed's World | A high latitude sailor preparing for tropical cruising

That's the thing about advice, it varies eh? I have several iterations of old form Ship Captain's Medical, now Medical First Aid and Medical Care Aboard Ship. My current is getting to the end of its five year lease, so due for renewal this Spring. That one was by the Haven Ambulance service, but others have been by other groups previously. FWIW I also grew up with a father who was a physiologist and biochemist, as well as being an MD who specialised in remote medicine (Nepal and East Africa where I was born. He worked for the Flying Doctors). Not completely a stranger to this kind of thing myself as I am PhD in Medical Ethics (philosophical branch… used to teach general philosophy but publish in Biomedical Ethics specifically, and sat on various Editorial boards of Biomedical journals). I have sailed all my life, first ocean passages when I was in my early teens rather too far over thirty years ago, and I gave up Academia when it had given me all I needed, to pursue my truer vocation: sailing. I am also a commercial skipper and have likewise skippered a research vessel a few years back, though have not had sufficient of that kind of work and would love more!

With regard to asthma and sepsis… you are not really correct. Asthma is of course chronic, but is episodic with acute episodes, and sepsis can be chronic, though is usually only acute in fact. The use of oxygen is indicated to support the patient through a severe hypoxemic event, which in either case may last only a few minutes though this is more likely in Asthma. Infusable antibiotics are a must in conjunction with regard to the latter.

You will find that there are strong opinions in various directions on this issue. Did you notice that despite the opinions of the doctors aboard, the oxygen kits were standard... That is not accidental, but based upon other doctors' views. Doctors do not always agree , and in fact I have rarely met one who doesn't like to dissent from the prevailing view in one way or another, just like all of us. All these decisions are about triage and a calculation of cost/benefit. My calculation with regard to oxygen falls on the side of benefit, particularly as I do a great deal of diving, as well as believing it to be an excellent tool to bridge a crisis which might otherwise cause a casualty to die, when they may have recovered.

[GordMay]

Originally Posted by GoingWalkabout

... Another crazy idea would be to have a standard flag for "AED Onboard". And who knows it could be a great way to let other boaters in the marina know you have this life saving piece of equipment ...

Not so crazy.
There seems to be some standardization for AED signage, which could be adapted to a flag/burgee.
➥ https://www.google.ca/search?q=aed+s...w=1366&bih=609
➥ https://www.resus.org.uk/defibrillat...sign-for-aeds/
➥ https://shopsafetyproducts.ca/descri...&cid=23&id=135

[Kenomac]

Originally Posted by Muckle Flugga

Are you speaking as a physician? Because that is not what I understand to be the case, nor the advice remote medical authorities I trained with gave me. And as to your assertion that "...for a couple of the ailments O2 will be useless without the AED you don't have… and don't want." You are simply flat out wrong. You seem to be suggesting that all acute coronary episodes are related to fibrillation. They are not. Only a small fraction of them are, so in the majority an AED is totally useless. You apparently have not read my above careful laying out of the facts and statistics. Care to iterate your argument? What is your training/expertise in the subject or oxygen therapy? Or was that just a post for the heck of it?

I'm a registered nurse who deals with this sort of stuff daily and who doesn't wish to argue about this matter any longer. A portable O2 concentrator is what's needed. Your bottle of O2 is nothing more than a short term bandaid.

[Muckle Flugga]

[QUOTE=Kenomac;2028187]I'm a registered nurse who deals with this sort of stuff daily and who doesn't wish to argue about this matter any longer. A portable O2 concentrator is what's needed. Your bottle of O2 is nothing more than a short term bandaid.[/QUOTE]

Well of course that would be wonderful, but very expensive and rather awkward. The bottle of O2 being a short term bandaid is correct, but sometimes that is what is needed to bridge a crisis.

[Paul L]

Originally Posted by dannc

Where did I say that every boat needed an AED? Nor have I said eveyone should have and AED on a boat. I think my "argument" does make sense since it could help me save someone's life. If YOU do not want that capability that is fine. I want that capability.

How busy the marina is has nothing to do with carrying an AED.

Later,
Dan

The focus of the thread title is Remote Medicine, not Marina Medicine. In the past year we've sailed about 8,000 miles in the South Pacific over 10 months. In that time we were probably in areas that had access to advanced cardiac care within 1 hour for 2 weeks, while in Papaete. The rest of the time any advanced care would have been anywhere from 1 to many days away. This would lower the already very low survival rate to fall off the charts.

[Kenomac]

[QUOTE=Muckle Flugga;2028204]

Originally Posted by Kenomac

I'm a registered nurse who deals with this sort of stuff daily and who doesn't wish to argue about this matter any longer. A portable O2 concentrator is what's needed. Your bottle of O2 is nothing more than a short term bandaid.[/QUOTE]

Well of course that would be wonderful, but very expensive and rather awkward. The bottle of O2 being a short term bandaid is correct, but sometimes that is what is needed to bridge a crisis.

The new portable oxygen concentrators are no larger than your bottle and cost around $300.

[Muckle Flugga]

[QUOTE=Kenomac;2028244]

Originally Posted by Muckle Flugga

The new portable oxygen concentrators are no larger than your bottle and cost around $300.

Oh! Well that is news (to me) and very interesting and useful information. Thanks! That would certainly be better than the bottle! Will look into it. Thanks again.

[Kenomac]

I don't know this particular product, but here's just one example: New Intelligent Portable Oxygen Concentrator Generator 24HOURS Home Health Care | eBay

Add a used high quality AED with a new battery for around $250, and you'll be all set. We have a Cardiac Science fully automatic AED onboard which includes audio instructions for CPR during an emergency.

https://www.youtube.com/watch?v=MMhSWnu0ST8