Medical Emergencies at Remote Cruising Destinations

[Paul L]

Originally Posted by anacapaisland42

To add another dimension to this conversation, I just heard, on the radio, that if you had a heart attack/stroke/cardiac event and you live on the 1st/2nd floor of a high rise your chances of survival are 4.8%.
However, if you live on the 3rd floor or above your chances drop to 2.6%.

Now how that relates to a boat

Bill

Whew, I a live on the first deck on my boat -- so only a 95.2% chance of not surviving.

[GoingWalkabout]

Originally Posted by Paul L

You are clearly on the side of going to the nth degree to attempt to save anyone medically barring no expense - even the expense of being prepared for an unlikely event. Since this is a cruising site, how does that follow on with the number of EPRIBs and liferafts and MOB Starts you should have onboard - is one enough or should we really have backups for all -- maybe a few backups for the backups . We all make cost-benefit analysis when setting up and maintaining a cruising boat -- OK there are a few with unlimited funds, but that is not any where near the majority out cruising. It is all about risk management -- in the end with medical care or not, we all get out of here the same way.

I understand. And you are right. Ones finances does lead to spending trade off decisions. At the end of the day we all have different perspectives and that's OK. Buy an AED or don't. It's a private decision. What I find upsetting is when people try to talk other people out of having an AED. That's all.

[mcarling]

I agree that an EPIRB is much more likely to save lives than an AED onboard and also probably costs less. I have an EPIRB but not an AED. My own opinion is that people should assess the risks and make an informed judgement. I'm vegan and keep fit, so my risk of cardiac problems is very low, despite a family history of cardiac problems. Everyone's situation is different.

[Muckle Flugga]

Originally Posted by GoingWalkabout

I understand. And you are right. Ones finances does lead to spending trade off decisions. At the end of the day we all have different perspectives and that's OK. Buy an AED or don't. It's a private decision. What I find upsetting is when people try to talk other people out of having an AED. That's all.

I really hope that wasn't referring to me. I was simply repeating what I had been taught by the primary medical emergency training organisation in the UK. This was backed up by a similar quote relating to evidence of actual lifesaving in remote locations with out immediate hospital support. If you have evidence that AEDs do contribute to survival in remote situations without hospital support then it would be good to know. But I have yet to see it.

I did specifically state that the presence of such a device in a coastal cruising environment is a differnet matter and does make sense, if you can afford it. However the statistics calling for the presence of an AED refer to the likelihood if its being in proximity of around 100,000 people or similar numbers over a 5 year period. Does that translate to the case on a boat? Of course if you have the money there is no reason not to have one aboard, particularly in a coastal environment. No one is trying to talk anyone out of having such a device. But it is not advised by the medical authorities I have dealt with as the primary line of defense against cardiac events for remote medical assistance. Apparently you have been taught otherwise or have data to back this up?

In a way you are saying that you can't believe that anyone should try to argue that there should not be fully equipped medical centres every 100 meters worldwide… well it is about cost/benefit. In a perfect world with no costs to consider, of course this would be great. But frankly I would advise people to carry aspirin, morphine, nitrolingual, and oxygen BEFORE they carry an AED, and this accords with the advice I have been taught as a ship's medical officer qual (MCA). If they have unlimited funds, heck why not carry a full time consulting surgeon?

[Muckle Flugga]

Originally Posted by GoingWalkabout

Yes Paul. I would encourage all sailors and power boaters to have an AED as well as complete a Red Cross course. I don't think though that it should be required by Government mandate. I'm apposed to that kind of thing.

As far as safety trade offs and best economic return it is my view that such thinking has no place in medicine. I know. It is the way hospital administrators now think and the way national government health planners think. But it's not the way I think. Every life is worth whatever you can do to save it. Heaven help us if the Coast Guard ever started to think along the lines of cost benefit analysis like so many beauracrats and even some doctors think of providing life saving services these days.

Did you know that hospital administrators in Australia are told not to allow overly expensive intervention in the ER or ICU if the person is over 55 with the exception of VIPS. This policy was implemented some 17 years ago based on the cost benefit to society. The beauracrats had worked out that if 55 or older your ability to contribute economically to society was greatly reduced (paying taxes ) therefore it didn't make economic sense to spend an awful lot of money on you. So when I hear people talking about cost benefits when it comes to saving lives I get very upset.

Well… yes but this is rather magical thinking. In a perfect world every person in any medical event would suffer that medical event in a fully equipped ICU.

You seem to be ignoring the oldest and most useful calculation in emergency medicine: Triage. I mean, honestly, NO medical authority would consider it reasonable to equip EVERY vessel in US, let alone global coastal waters with an AED. Frankly that would be a colossal waste of precious medical reasources, and in the real world, these are limited. I can't speak to the Australian decision, and as it happens I do not think lives over 55 are less worthy than lives under 10 (contrary to what even you may suppose), but your appeal is rather a political gesture in itself. The simple matter of fact is there are NOT unlimite medical resources in any situation or country (certainly not the US!) and spending in one area limits spending in another. This is likewise true of the overwhelming majority of cruising sailors. Triage is the calculation you are not making. So, the provision of AEDs to every coastal and offshore vessel in the developing world alone, would unequivocally lead to a net dramatic rise in mortality, since the high resources involved in such machines, for small cohorts, do not equate to much benefit overall, at all, and far less expensive and simple devices and procedures (and yes, as Paul says this is training, which is an expense as well) are far more effective in general at life saving.

[jackdale]

Originally Posted by Muckle Flugga

Well… yes but this is rather magical thinking. In a perfect world every person in any medical event would suffer that medical event in a fully equipped ICU.

I mean, honestly, NO medical authority would consider it reasonable to equip EVERY vessel in US, let alone global coastal waters with an AED. Frankly that would be a colossal waste of precious medical reasources, and in the real world, these are limited.

I guess I should carry an AED in my car, especially when I am out of the city limits. My wife does have standard first aid and CPR as a part of her job.

[dannc]

Originally Posted by StuM

"Muckle Flugga is a small rocky island north of Unst in the Shetland Islands, Scotland. It is often described as the northernmost point of the British Isles"

I have this very strong desire to see the Shetlands, Fair Island and Muckle Flugga. I don't know why but I do. There is this weird call for me to see these places and I do not know why.

There is a chocolate shop I would like to visit as well as Valhalla at Saxa Vord. Valhalla in this case is a brewery in the old RAF radar station.

Every post I see from Muckle Flugga reinforces all of this. He drives me nuts.

Later,
Dan

[GoingWalkabout]

Originally Posted by Muckle Flugga

Well… yes but this is rather magical thinking. In a perfect world every person in any medical event would suffer that medical event in a fully equipped ICU.

You seem to be ignoring the oldest and most useful calculation in emergency medicine: Triage. I mean, honestly, NO medical authority would consider it reasonable to equip EVERY vessel in US, let alone global coastal waters with an AED. Frankly that would be a colossal waste of precious medical reasources, and in the real world, these are limited. I can't speak to the Australian decision, and as it happens I do not think lives over 55 are less worthy than lives under 10 (contrary to what even you may suppose), but your appeal is rather a political gesture in itself. The simple matter of fact is there are NOT unlimite medical resources in any situation or country (certainly not the US!) and spending in one area limits spending in another. This is likewise true of the overwhelming majority of cruising sailors. Triage is the calculation you are not making. So, the provision of AEDs to every coastal and offshore vessel in the developing world alone, would unequivocally lead to a net dramatic rise in mortality, since the high resources involved in such machines, for small cohorts, do not equate to much benefit overall, at all, and far less expensive and simple devices and procedures (and yes, as Paul says this is training, which is an expense as well) are far more effective in general at life saving.

Hi. In answer to your earlier question. No I wasn't talking about you in particular.

It's often hard to change what you have been taught. Particularly in medicine. It is a huge problem of Docs who have been practising for 10 years to change their ways based on new ways of doing things. Change in medicine based on new research and facts is a constant issue. But knowledge does evolve and what was true 20 years ago is not necessarily true go day with regard to procedures etc.

I found this in doing some research that you have instigated me to. For which I thank you.

"Germany is the first flag state worldwide that legally requires to carry AEDs on seagoing merchant vessels by September 2012 at the latest."

AED training is part of USCG certification approved courses.
Coast Guard Approved STCW-95 Basic Training

STCW-95 Basic Training (formerly Basic Safety Training) includes.
Red Cross FIRST AID/CPR/AED. USCG approved Red Cross First Aid/CPR/AED Certification

An interesting account of a life saved aboard a ship.

Young man saved with AED on cruise ship

January 2, 2002

It was December 26th and Mike Robie, 29, of Natick, Massachusetts, was on a cruise to Mexico with his fiancé. Dinner was just getting underway when he collapsed in cardiac arrest. A nearby physician provided cardiopulmonary resuscitation (CPR) until the ship’s crew arrived with their automated external defibrillator (AED). After two shocks, Robie was resuscitated.*

"I exercise regularly, I eat right, I’m not overweight," said Robie, according to a report in*The Boston Globe. "I wouldn’t be talking to you if that thing wasn’t on the ship."

So please tell my where the USCG, Germany and now most merchant ships as well as passenger ships are being foolish in having onboard AED's.

[Paul L]

A cruise ship with 5,000 passengers and 2,000 crew is not really comparable to a cruising yacht with 2 onboard. The USCG is essentially a first responder and I would certainly expect them to be well equiped for medical issues.

Anyway, this is getting beat to death. It is clearly a personal choice.

[dannc]

Originally Posted by GoingWalkabout

I understand. And you are right. Ones finances does lead to spending trade off decisions. At the end of the day we all have different perspectives and that's OK. Buy an AED or don't. It's a private decision. What I find upsetting is when people try to talk other people out of having an AED. That's all.

I agree.

The same costs and benefit issue always pops up when AEDs are discussed. For some reason there seems to be an argument to NOT carry AEDs because of cost and limited usability away from a hospital.

A quick search shows that Amazon has EPRIBs from $400 to $700 and AEDs are $1,200 to $1,500.

Certainly an EPRIB is the right choice if one only has the money to buy one of the two devices. No question. But if one does have the money for an AED why not buy one?

I am puzzled with the argument that an AED is not useful on a boat because the AED is not likely to be helpful crossing an ocean or otherwise away from more advanced care. How often is this really the case? Are not most cruisers eventually sitting near a cell phone connection and in many cases more advanced care?

Time matters in a heart attack. Even if one is at a marina that HAS an AED, the time it takes to run to the AED and return to the patient is very critical. Of course if the marina has no AED...

The assumption in these discussions always seems to be that the AED would be used on the poster's crew. Not to help someone on another boat or someone on the dock. Frankly, I doubt we would ever use an AED on us and it would be more likely we would use the AED on someone else.

Later,
Dan

[Paul L]

Originally Posted by dannc

I agree.

The same costs and benefit issue always pops up when AEDs are discussed. For some reason there seems to be an argument to NOT carry AEDs because of cost and limited usability away from a hospital.

A quick search shows that Amazon has EPRIBs from $400 to $700 and AEDs are $1,200 to $1,500.

Certainly an EPRIB is the right choice if one only has the money to buy one of the two devices. No question. But if one does have the money for an AED why not buy one?

I am puzzled with the argument that an AED is not useful on a boat because the AED is not likely to be helpful crossing an ocean or otherwise away from more advanced care. How often is this really the case? Are not most cruisers eventually sitting near a cell phone connection and in many cases more advanced care?

Time matters in a heart attack. Even if one is at a marina that HAS an AED, the time it takes to run to the AED and return to the patient is very critical. Of course if the marina has no AED...

The assumption in these discussions always seems to be that the AED would be used on the poster's crew. Not to help someone on another boat or someone on the dock. Frankly, I doubt we would ever use an AED on us and it would be more likely we would use the AED on someone else.

Later,
Dan

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.

[GoingWalkabout]

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.

It's all a matter of time. A shopping mall for instance has more than one usually. Spread throughout the large mall. So it depends on the size of the marina. Remember if you don't get that heart pumping within 3 to 4 minutes you are looking at brain damage. 8 to 10 minutes you are looking at brain death.

If more than one person available. One starts CPR immediately while the other fetches the AED. If it's onboard your boat that will of course be quicker than running to the marina office. Then of course there's the situation odontologiamaipu@gmail.com being in the ocean.

Regards,
Chaya

[Tientos]

Originally Posted by Ann T. Cate

Saleen,

The presence of crocs does make us modify our behavior, though. So, for us, it partly depends on which hazard you're facing.

Ann

Hi Ann
Have the crocs moved to Tassie now?

cheers
Lea

[GoingWalkabout]

Originally Posted by Paul L

A cruise ship with 5,000 passengers and 2,000 crew is not really comparable to a cruising yacht with 2 onboard. The USCG is essentially a first responder and I would certainly expect them to be well equiped for medical issues.

Anyway, this is getting beat to death. It is clearly a personal choice.

Maybe what I wrote wasn't so clear. USCG licensing for merchant mariners includes mandatory first aid which includes training in the operation of an AED. It is not just for Coast Guard sailors.

Someone said that merchant sailing vessels don't have AED'S. That is not the case. I brought up the case that ALL German flagged commercial vessels must have an AED onboard. While the USA doesn't mandate like the Germans they do mandate you learn how to operate one. Presupossing that the merchant sailor will be on a vessel with an AED.

The international seafaring union has called on all merchant vessels to carry an AED.

So the above dispelled the misconception that AED'S aren't recommend for vessels.

OK my boat won't have 10 or 20 crew like a freighter. It will be a midget in comparison to size. But a heart attack on my boat is just as important as one by a sailor on a large vessel. If it makes sense for the much larger vessels to have AED'S then I see no reason why I shouldn't seriously consider having one as well.

No I don't think everyone in a marina will have one. As I said earlier I don't like the idea of such things being mandatory. But gee if every marina had one or more vessels with AED'S onboard I am sure lives may or will be saved.

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

[GoingWalkabout]

Originally Posted by Tientos

Hi Ann
Have the crocs moved to Tassie now?

cheers
Lea

I remember walking on the beach at Townsville and seeing Strange foot marks with a smooth sand in the middle. Then I saw the sign beware of the crocodiles. Put me off swimming. :-)