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Old 18-01-2016, 22:05   #106
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Re: Medical Emergencies at Remote Cruising Destinations

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Originally Posted by jackdale View Post
In my Adventure Medic courses, I was told the best place to have a cardiac arrest was Seattle as all EMS had advanced life support. Even the chance of survival was about 4%. (Working from memory on the percentage.)
It's that low because if you wait for EMV to arrive the patient will most likely have been deprived of oxygen for at least 4 to 7 minutes. That is brain damage territory.

By applying immediate CPR raises the survival rate tremendously. CPR along with an AED before the EMV arrives raises survival to a whole better level.

It's like having one big portable pacemaker.
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Old 18-01-2016, 22:15   #107
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Re: Medical Emergencies at Remote Cruising Destinations

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Originally Posted by GoingWalkabout View Post
.....
Perhaps we should talk to the American Heart Association regarding a special boaters education effort. 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.

Just some thoughts on this. I see nothing wrong in doing what one can within their means and ability.

Regards,
Chaya
I'd be interested in what the AHA recommends for remote medical use of AEDs. I can't find it on their website. I do see:
Quote:
What's the AHA position on placement of AEDs?
The AHA strongly advocates that all EMS first-response vehicles and ambulances be equipped with an AED or another defibrillation device (semiautomatic or manual defibrillator). The AHA also supports placing AEDs in targeted public areas such as sports arenas, gated communities, office complexes, doctor's offices, shopping malls, etc. When AEDs are placed in the community or a business or facility, the AHA strongly encourages that they be part of a defibrillation program in which:• Persons that acquire an AED notify the local EMS office.
• A licensed physician or medical authority provides medical oversight to ensure quality control.
• Persons responsible for using the AED are trained in CPR and how to use an AED.
and
Quote:
No research
is yet available that shows a threshold number
for placing AEDs. However, common sense
indicates that locations with large numbers of
employees, visitors or both have a greater need
for an AED than locations with lower numbers.
and interestingly
Quote:
Making an
AED accessible for traveling executives may also
be a consideration.
and
Quote:
Evidence supports establishment of public access defibrillation (PAD) programs in the following cases: a. The frequency of cardiac arrest events is such that there is a reasonable probability of one AED use in 5 years (estimated event rate of 1 sudden cardiac arrest per 1000 person-years).
I don't see any recommendations either way for remote medicine. Now that AEDs have come down in cost so much, the choice to have one onboard is certainly less painful. Just don't get yourself to thinking that you will be a hero and save the day, when the odds of survival are very low in a remote environment.
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Old 18-01-2016, 22:37   #108
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Re: Medical Emergencies at Remote Cruising Destinations

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Originally Posted by Paul L View Post
I'd be interested in what the AHA recommends for remote medical use of AEDs. I can't find it on their website. I do see:
and
and interestingly
and
I don't see any recommendations either way for remote medicine. Now that AEDs have come down in cost so much, the choice to have one onboard is certainly less painful. Just don't get yourself to thinking that you will be a hero and save the day, when the odds of survival are very low in a remote environment.
No argument from me Paul. Or illusion regarding how many if any would be saved by my onboard AED. For me it's like carrying my EMT kit that I used in search and rescue. I take it with me but hope I never have to use it.

I intend to have a chat with the AHA on this. It will be interesting to see their take on 1. Pleasure and coastal sailors and 2. Long distance passage makers.

Regards,
Chaya
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Old 18-01-2016, 23:48   #109
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Re: Medical Emergencies at Remote Cruising Destinations

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Originally Posted by GoingWalkabout View Post
No argument from me Paul. Or illusion regarding how many if any would be saved by my onboard AED. For me it's like carrying my EMT kit that I used in search and rescue. I take it with me but hope I never have to use it.

I intend to have a chat with the AHA on this. It will be interesting to see their take on 1. Pleasure and coastal sailors and 2. Long distance passage makers.

Regards,
Chaya
^^^Yes,

I expect, with a history of arrhythmia, a definite yes. Perhaps other predisposing conditions as well. I hope you are able to find out. This is interesting.

Ann
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Old 19-01-2016, 00:06   #110
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Re: Medical Emergencies at Remote Cruising Destinations

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Originally Posted by Ann T. Cate View Post
^^^Yes,

I expect, with a history of arrhythmia, a definite yes. Perhaps other predisposing conditions as well. I hope you are able to find out. This is interesting.

Ann
I'll report back to this thread Ann.

Regards,
Chaya
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Old 19-01-2016, 04:33   #111
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Re: Medical Emergencies at Remote Cruising Destinations

https://www.gov.uk/government/upload...440070/297.pdf

So, despite the claims, in some cases, on this thread that the success rate is extremely high:

"3.0 Limitations and Aftercare
3.1 All those who may use defibrillators should be aware that their success rate in terms of lives saved is relatively low.
3.2 Even where a patient’s heart rhythm is restored, the patient will remain very ill and may require continuous assistance and support with breathing and other essential functions until arrival at hospital. The patient will therefore need to be transported to hospital as urgently as possible and the master or vessel operator should wherever possible make suitable arrangements for transport to be available on arrival, as soon as the incident has occurred."

And the boats recommended for consideration of carriage of AEDs are those who are in regular operation with passenger numbers exceeding 100 persons, especially where those passengers are likely to be elderly.

Clearly these devices offer some assistance in approximately one quarter of out of hospital cardiac arrest cases. The assistance they offer over CPR alone in that quarter (actually 23%) is approximately a 10% increase in the chances of survival. These figures are from the AHA and a study cited in a recent Harvard publication. This equates in effect to an approximately 2.3% increase in the chance of surviving a cardiac arrest event if an AED is rapidly available (over CPR alone: figures from the AHA and a recent Harvard publication, which latter actually states only 9% improvement) and hospitalisation and continued advanced acute care are not long delayed.

The incidence of cardiac arrests in the US, for example, is one in one thousand person years (almost exactly one thousandth of the population has a heart attack in any given year). 23% of these involve a type of cardiac arrest which might be assisted by an AED. So the incidence becomes one in somewhat more than four thousand person years for these devices to be of use. And then they improve chances by around 10 percent above CPR.

If your budget allows, and you already have all the other equipment and drugs and training which are more likely to save life at sea, then by all means add an AED.
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Old 19-01-2016, 08:19   #112
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Re: Medical Emergencies at Remote Cruising Destinations

Muckle Fugga, I was happy to read your conclusion. Some of your information is a little off. For instance the German law requiring ALL merchant vessels to carry an AED. Even ones that have crews of 10 or less. It's not just vessels with a 100 or more or elderly.

It is worth reading about a Scandinavian country that put AED'S throughout their downtown. Virtually on every street corner. Over the first 12 months the program saved lives. Lots of lives.

Happy sailings.

Regards,
Chaya
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Old 19-01-2016, 09:41   #113
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Re: Medical Emergencies at Remote Cruising Destinations

I googled for half an hour and could not find any reference that over the course of 9 years these madatory AEDs on German merchant vessels have saved just one single life.


I found a paper about the airport Frankfurt. Over the course of 5 years they had 14 incidents where AEDs were applied. 11 survived, 6 of which with permanent damage.
That is a 60+ million passenger airport per year, and they have AED units on every corner and an emergency doctor is <5 minutes away.

Now think about the math. 300 Mio passengers caused 14 incidents in a location that is perfectly suited for rescue...
How are the odds on a sailbaot with a crew of 2?


If a crew has known heart rythm issues its a no brainer. for anyone else these AEDs are just an example of excellent marketing.


I'd rather buy a backup Epirb or liferaft than spend money on a AED. Or just spend it on better healthy food.
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Old 19-01-2016, 09:45   #114
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Re: Medical Emergencies at Remote Cruising Destinations

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Originally Posted by GoingWalkabout View Post
Muckle Fugga, I was happy to read your conclusion. Some of your information is a little off. For instance the German law requiring ALL merchant vessels to carry an AED. Even ones that have crews of 10 or less. It's not just vessels with a 100 or more or elderly.

It is worth reading about a Scandinavian country that put AED'S throughout their downtown. Virtually on every street corner. Over the first 12 months the program saved lives. Lots of lives.

Happy sailings.

Regards,
Chaya
That's the thing about epidemiology: the devil is definitely in the detail. You don't specify how many lives per capita, and what does "throughout" mean? In large cohorts there will be some lives saved. In small ones? The details I laid out for you mean that an AED in a crew of 4 on a boat in remote location (this thread is about remote cruising) would have an opportunity for effective use of the device once in 10,000 years, on average, for the crew in question. Or once in 20,000 for a cruising couple, on average. Obviously age is a factor which will change this to some extent, and certainly a pre existing severe arrythmia, as rabbi observes, but the occasional effectiveness of deploying AEDs to large population centres (however that may be?) is radically different from the effectiveness of deploying them in small cohorts.

Likewise, Happy Sailings!
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Old 19-01-2016, 09:47   #115
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Re: Medical Emergencies at Remote Cruising Destinations

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Originally Posted by rabbi View Post
I googled for half an hour and could not find any reference that over the course of 9 years these madatory AEDs on German merchant vessels have saved just one single life.


I found a paper about the airport Frankfurt. Over the course of 5 years they had 14 incidents where AEDs were applied. 11 survived, 6 of which with permanent damage.
That is a 60+ million passenger airport per year, and they have AED units on every corner and an emergency doctor is <5 minutes away.

Now think about the math. 300 Mio passengers caused 14 incidents in a location that is perfectly suited for rescue...
How are the odds on a sailbaot with a crew of 2?

If a crew has known heart rythm issues its a no brainer. for anyone else these AEDs are just an example of excellent marketing.


I'd rather buy a backup Epirb or liferaft than spend money on a AED. Or just spend it on better healthy food.
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Old 19-01-2016, 09:49   #116
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Re: Medical Emergencies at Remote Cruising Destinations

Quote:
Originally Posted by rabbi View Post
I googled for half an hour and could not find any reference that over the course of 9 years these madatory AEDs on German merchant vessels have saved just one single life.


I found a paper about the airport Frankfurt. Over the course of 5 years they had 14 incidents where AEDs were applied. 11 survived, 6 of which with permanent damage.
That is a 60+ million passenger airport per year, and they have AED units on every corner and an emergency doctor is <5 minutes away.

Now think about the math. 300 Mio passengers caused 14 incidents in a location that is perfectly suited for rescue...
How are the odds on a sailbaot with a crew of 2?


If a crew has known heart rythm issues its a no brainer. for anyone else these AEDs are just an example of excellent marketing.


I'd rather buy a backup Epirb or liferaft than spend money on a AED. Or just spend it on better healthy food.
Heart attack is the number one cause of death on Merchant vessels. Figures are out there. Keep googling.
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Old 19-01-2016, 10:04   #117
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Re: Medical Emergencies at Remote Cruising Destinations

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Heart attack is the number one cause of death on Merchant vessels. Figures are out there. Keep googling.
So how many lives have been saved on specifically merchant vessels by AEDs?

You really haven't anted up on figures at all there, Chaya. Time to do so. Several others have, including myself. And they don't look good for the rationale of keeping an AED aboard a boat for remote medical assistance, by and large. Why not address the figures I stated? Do you deny them? If so why?
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Old 19-01-2016, 10:14   #118
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Re: Medical Emergencies at Remote Cruising Destinations

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So how many lives have been saved on specifically merchant vessels by AEDs?

You really haven't anted up on figures at all there, Chaya. Time to do so. Several others have, including myself. And they don't look good for the rationale of keeping an AED aboard a boat for remote medical assistance, by and large. Why not address the figures I stated? Do you deny them? If so why?
OK. I give up. The Germans were crazy in passing their law mandating the installation of AED's on all merchant vessels. The USCG is equally crazy for insisting that all merchant sailors be taught how to use an AED.

Forgive me for being so silly. I have to get back to my day job. I have a big boat with AED's on deck to pay for.
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Old 19-01-2016, 10:19   #119
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Re: Medical Emergencies at Remote Cruising Destinations

I am a physician, and I found that my medical kit got smaller each year during our circumnavigation. My greatest concern was about trauma and infection offshore. After doing a circumnavigation, those still are my greatest concerns. Fortunately, in the cruising lifestyle, you are largely out of the viral soup found in "civilization", and sickness was not a problem - except for mosquito bourne illness. We had two crew members with Dengue Fever in the Red Sea.

The cruising lifestyle is inherently healthy in my experience. After an eleven year circumnavigation, my medical kit remains small, and I am comfortable with that.
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Old 19-01-2016, 10:35   #120
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Re: Medical Emergencies at Remote Cruising Destinations

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I am a physician, and I found that my medical kit got smaller each year during our circumnavigation. My greatest concern was about trauma and infection offshore.
+1. I picked up a pseudomonas infection in a small wound on my foot. It developed into osteomyelitis in a joint in my small toe. That resulted in a debridement of the joint. The recovery was the worst two months I have ever spent.
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