Medical Equipment AED Onboard

[GoingWalkabout]

Originally Posted by Leo Ticheli

Thank you for your comment, but I'm not so sure about agreement; what we have here is grudging acknowledgement that an AED can be useful. What bothers me is what seems to be a strident, persistent effort to dissuade others from having an AED on board. How should we categorize such behavior? In my case, it's not favorable.

What would the critics have to say to someone who lost a loved one for want of an AED? "They don't work in most cases, anyway." Or, "Sorry Mary is dead, but aren't you glad you saved the money?"

I don't know anyone who's life is worth less than the cost of an AED, even an AED bought at full retail price.

Fair winds,
Leo

[GoingWalkabout]

Originally Posted by Kenomac

It might be time for the two of you to agree to disagree.

Obviously since we've outfitted our boat and now our home with an AED, we're firmly in the camp that it's better to have one and not need it, than it is to need an AED and not have one... I guess that's also why we have guns for protection. It's highly likely they'll both sit around (AEDs) for many years unused, but that's our choice as to how to spend our money. If we ever need to fire one up.... then hopefully it'll be used on one of the 30% who can benefit by it's use and I'll consider it money very well spent. If used on one of the 70% where it wouldn't have made a difference, we can feel confident we did our best.

[GoingWalkabout]

Originally Posted by caradow

I know how to get around the writing scripts part.
As far as the practicing medicine without a license goes I would think there is a big difference between teaching someone how to do something outside the boundaries of territorial waters and treating an actual patient in a specific area.
However I am not an attorney and you do bring a very important aspect to the table......ah ahahah LAWYERS!!!!!!

BTW I met this guy in Cuba and he taught me a lot about "ED"

I think your ideas in your last post are great. I also think that an Atlantic or Pacific cruiser is in a somewhat different situation to a regular coastal sailor. I would think an advanced EMT type cause for ocean sailors would be a great thing and something I would hope would never be used. Your suggestion of a specialist kit is also great. Having EMT training I have an amazing kit myself including a small portable oxygen tank. But I am happy if even just one person after reading this thread decides to go get an AED. Training can be found through the American Heart Association or Red Cross. In fact thinking about it perhaps talking with the Red Cross about developing a special long boating industry course may be the way to go.

[JRM]

Originally Posted by caradow

Well I had deleted this thread after the cowboy comments on having TPA on a cruising boat.
However, probably due to the fact my environment has become a frozen tundra here on the US east coast, I dared to reopen the discussion.
I truly feel that Kenomac et al in their persistence have done a tremendous service to the cruising community who took the time to read these threads. Several have stated they are now getting AEDs so hopefully more lives will be saved. Others will at least appreciate their potential and seek further training.
Many others here have made very valid statements. A lot has been discussed with some humor along the way and that was good.
So I have a question and maybe Kenomac, Weavis and others would want to comment or even potentially get involved.
My question is, DO YOU THINK A SERVICE IS NEEDED TO TEACH ADVANCED MEDICAL CARE TO THE CRUISING COMMUNITY ? I know there are Wilderness Courses that are available but this would be geared to a boat.
Not only teach it but even help design advanced medical kits that would supply the long range cruiser with knowledge and the tools (within reason) to go beyond normal first aid ? Also supply them with medications only an MD can provide?
The lectures would be set in various venues dependent on the level of interest. I think the cruising community as a whole yearns for more knowledge and after reading some of your statements on this forum it is certainly needed.
I do not want to offend any of you who may disagree with the statements I have personally made but they came from sincerity and a lot of experience.
I am an ex Special Forces Medic and Vietnam Vet (68-69) who had to deal with many mass causality situations. Gained a tremendous amount of knowledge that eventually led me to go to medical school and become an ED doctor. I have worked in a large inner city Trauma Center for over 20 years.
Ironically I have never used an AED but have personally shocked a great number of patients with regular defibrillators. I have seen some remarkable recoveries in those years outside the statistics stated in this thread. I have learned that that the only thing in medicine that is a 100% is death itself. By the way I started using TPA when it first came into being many years ago. Also I have taken time off from my regular job and worked in the Caribbean on numerous occasions and have enjoyed that immensely. So I also have knowledge of what is available in areas without the technology that is available in the US and Europe. Maybe this teaching is not for me personally to do but if these courses are already available certainly they are being underutilized.
So..... any of you think this would be a worthwhile venture ?

I don't think so. I don't think there is a need, nor is it practical. The reason being that the skills beyond first aid and BLS CPR are perishable. They wane rapidly without regular practice. That's why lots of county EMS agencies won't certify Paramedics unless they are employed with an ALS provider. Even EMT-1 requires CE hours. I took anatomy over ten years ago, and while I remember the basic stuff I use regularly in my day to day, I'd say a good 95% of that material has leaked from my brain. With the proliferation of SSB and sat-phones, I can consult an M.D. for the pharmacology aspects without having to sit through years of training or remember what the suborbital foramen is.

A Wilderness EMT course is great, not just because of the skills that it teaches, but because of the mindset. The idea that YOU can help fix a problem, and that you can do it with what you have on hand. But the idea that the lay person is going to be doing hospital level work while isolated at sea is a stretch. I'm sure everyone can whip out some ancedotal incident, but it's by far the exception and not the rule. But setting a fracture with an improvised splint, now that's a skill I'd like people on my boat to have. Maybe even starting an IV. But if I get appendicitis at sea, I'm probably going to die. That's just reality. Luckily the odds are exceptionally low. Low enough that most Doctors recommend against prophylactic appendectomy. The odds of post-surgical complications outweigh the odds of appendicitis.

Now, maybe gearing a Wilderness EMT course to be more marine oriented, that would be something I'd be interested in just for the perspective. I spent a few years working down in the harbor station and I can tell you that just extricating a non-ambulatory patient from below decks in a sailboat is a real chore, and that's sitting in the slip with a full crew of responders to help.

To the person who can't understand why I feel an AED is a low priority. Here's an analogy:

We once had a sailboat wash up on the beach upside down. In the debris pile was a bunch of baby stuff, and one of the thinkers on scene felt we needed to access the interior to make sure it was unoccupied. So we took a chainsaw to the hull, made some holes, and made access.

I can make an argument that should I come upon a capsized boat at sea, a chainsaw is a really good piece of safety gear to have, so that I can cut a hole in the hull and rescue anyone who might be trapped inside. So in my hypothetical world, I jump on the forum and ask those smarter than I what they think of the shiny new Stihl I bought and put on the boat. I'm dumbfounded to discover that lots of people think I wasted my money. I don't get it? Wouldn't they feel bad if they came upon someone trapped in a capsized boat and they didn't have a chainsaw to save them? Isn't a human life worth the cost of the chainsaw? Would you recommend that I keep the saw or return it and buy something more practical?

So, the answer to your question is that being familiar with the devices, their practical application, and the odds of successfully using one at sea, I consider them slightly more useful than the hypothetical chainsaw in the above example. It's your money, and if you want to buy one then feel free. I'm not saying that there is zero chance it could be useful. Like I said, I'm now looking into getting one for the house, because I have family with a cardiac history, and if I can find one for the same price as Kenomac I'll buy it (although it may have to wait since the refit is bankrupting me at the moment).

JRM

[Kenomac]

Here's a video of the actual model Cardiac Science Powerheart G3 Automatic we purchased to equip our boat and home. They are different than the one shown in the original post. The automatic version features CPR prompts along with hands off automation of the shock being administered and the heart analysis. Purchased one unit for $175 delivered with two green bars remaining on the battery plus one set of pads and the second unit for $340 delivered with one green bar and two sets of pads. Neither unit had ever been used.


Watch the short video, it looks like even trained monkeys like us can do it. The video will also answer most of the questions which have come up on this thread. (I didn't make this video, it was already posted on youtube.)


One important feature... the machine checks the patient for a pulse BEFORE administering a shock AND/OR allowing the rescuer to begin CPR. Eliminating Gary's concern for the hypoglycemic diabetic patient receiving unnecessary broken ribs. It does a heart diagnostic first.

https://www.youtube.com/watch?v=fRDAnrCon8A

[caradow]

JRM since I am responsible for the drift away from AEDs I sincerely apologize and this will be my last post.
I am also sorry you miss interpreted my intentions and it quickly jumped from teaching minor surgical techniques such as suturing, abscess drainage procedures, staring IV's and rehydration techniques, taking care of someone in acute urinary retention, etc. to performing an appendectomy at sea. Also no need to memorize the anatomy you gave as an example and I am not quite sure what you mean by a prophylactic appendectomy and post op complications
But that is ok and totally irrelevant. However now that you do mention it there are several current papers in the medical literature stating success with treating acute appendicitis with antibiotics alone and therefore negating the need for surgery. Also I don't know about your experience with SSB and sat phones but I have both on my boat and they don't always work the way you would like them to. Also calling for help to an MD to discuss "pharmacology" may not be much help if you do not carry the necessary pharmacology on your boat.
Maybe despite this we are on the same page when you state a Wilderness EMT course would be good.....I am just taking it a little higher. I have taught many of my sailing mates how to suture etc. and they have been grateful and honestly were very keen to learn many of the things I have listed. So probably I will keep it at that level and also just keep my day job.
Last but not least if you do happen to come upon an overturned hull in the middle of the ocean just knock on the hull.....if no answer just keep sailing and forget the chainsaw.
Again my apologies for the drift.

[Therapy]

Here is something else to carry along.

$34 iPhone dongle allows 15-minute HIV test with similar accuracy to ‘gold standard’ lab test | 9to5Mac

If they can do that then they can do standard lab tests too I bet.

[hellosailor]

Considering that a number of the AED batteries are 12-volt batteries....


Yes, for someone on a boat, it mightn't be unreasonable to install a plug and make up a 50' set of cables, so it could just be powered off ship's power, wherever the battery is. Especially for true cruising, where AED batteries may be about as easy to replace as unicorn saddles. No air shipping on hazmats, wait for de boat mon.

[Terrapin]

Originally Posted by Stumble

We looked at these in detail for my yacht club, and frankly I never saw the point.

Sure in the small subset of cases where they are useful they are worth having, but that is a very small group of people. They don't work for most heart attacks, and are useless for 'jump starting' a heart post diving accident. They are ONLY useful for particular types of rare cardiac arythmias.

I guess if you have already bought and stored every other type of medical equipment you might use they might be a decent next purchase, but despite their popularity they really aren't that useful. A much better buy is a very large oxygen tank, or even a portable hyperbaric chamber (if diving).

To treat any of the medical stuff you guys are talking about requires a full defibulator, and a lot of training to really be able to use it properly.


Frankly I just see them as the medical device of the week. Sure it's sexy to install one, but it is incredibly unlikely you would ever contemplate using one, and even when you might think of it an AED won't work anyway. UNLESS you have a history of V-Tach in which case it mightbe helpful, but your doctor should be screaming at you for considering be this far away from a hospital.

I agree whole-heartedly. I see AEDs for sale at boat shows and people flocking to the booth for some reason, but I don't think the typical purchaser of an AED realizes the limited efficacy of the things. Drowning tends not to produce a shockable rhythm, although a defibrillator with a pacing function might be somewhat more useful. I haven't yet seen a defibrillator/pacer on the market though. Someone who IS in a shockable rhythm typically needs transport for advanced cardiac life support -- and I'm talking minutes away, not days away. Even hours may be too long.

As a CCU/Cardiac ICU nurse for 35 years, I've seen what happens after someone who was shocked in the field (cruise ship, camping trip, cruising boat, hiking, golf course, etc.) gets transported a good, long way to the hospital. Many of them "survive" -- at least long enough to get transferred out of the ICU -- but we have to talk about what "surviving" means. There are a lot worse things than dying, and my husband (also a nurse) and I have seen them. I'd much rather drop dead in paradise than spend an eternity in a nursing home with an anoxic brain injury.

For someone who does have a history of VT, an automatic implantable defibrillator would be of far more use than an AED. At least then they wouldn't have to rely on someone else to recognize and be clear-headed enough to treat the problem.

The $250 spent on an AED could buy an awful lot of bandages and burn cream!

[Terrapin]

Originally Posted by CarlF

At the risk of thread drift, what other supplies do people consider keeping on board for "life at risk" medical emergencies?

EpiPen
QuickClot sponge for bleeding
Aspirin (heart attack?)
Benedryl
Seasickness suppositories
Antibiotics?
Heavy duty pain killer?

Others?

EpiPen -- an excellent idea and one that for some reason hadn't occurred to us! If you can get your PCP to prescribe a wide spectrum antibiotic for use as needed, that would be great. Heavy duty (I'm assuming narcotic) pain killers are much more problematic these days unless, as I do, you have some left over from a recent surgery.

[Kenomac]

Originally Posted by Terrapin

I agree whole-heartedly. I see AEDs for sale at boat shows and people flocking to the booth for some reason, but I don't think the typical purchaser of an AED realizes the limited efficacy of the things. Drowning tends not to produce a shockable rhythm, although a defibrillator with a pacing function might be somewhat more useful. I haven't yet seen a defibrillator/pacer on the market though. Someone who IS in a shockable rhythm typically needs transport for advanced cardiac life support -- and I'm talking minutes away, not days away. Even hours may be too long.

As a CCU/Cardiac ICU nurse for 35 years, I've seen what happens after someone who was shocked in the field (cruise ship, camping trip, cruising boat, hiking, golf course, etc.) gets transported a good, long way to the hospital. Many of them "survive" -- at least long enough to get transferred out of the ICU -- but we have to talk about what "surviving" means. There are a lot worse things than dying, and my husband (also a nurse) and I have seen them. I'd much rather drop dead in paradise than spend an eternity in a nursing home with an anoxic brain injury.

For someone who does have a history of VT, an automatic implantable defibrillator would be of far more use than an AED. At least then they wouldn't have to rely on someone else to recognize and be clear-headed enough to treat the problem.

The $250 spent on an AED could buy an awful lot of bandages and burn cream!

If you had taken the time to read through the thread you would have seen quite a few examples shared by fellow boaters of their AED saving someone with a good outcome. My wife and I are also Registered Nurses trained in the proper use of an AED and we choose to have one onboard and one at home... just in case.

I actually substitued as a school nurse 20 years ago for another nurse who arrested at home, and was saved by an AED used by the fire department. She spent two weeks in ICU before returning home and coming back to her job six weeks later. Just four weeks ago, one of my patients at the hospital was also saved by an AED and retained his full mental faculties. Of course all of his ribs were broken, but in his mind.... it was better than the alternative. He even shared a story of seeing his recently deceased wife during the event telling him "it's not your time, go back."

[Terrapin]

Originally Posted by Kenomac

If you had taken the time to read through the thread you would have seen quite a few examples shared by fellow boaters of their AED saving someone with a good outcome. My wife and I are also Registered Nurses trained in the proper use of an AED and we choose to have one onboard and one at home... just in case.

I actually substitued as a school nurse 20 years ago for another nurse who arrested at home, and was saved by an AED used by the fire department. She spent two weeks in ICU before returning home and coming back to her job six weeks later. Just four weeks ago, one of my patients at the hospital was also saved by an AED and retained his full mental faculties. Of course all of his ribs were broken, but in his mind.... it was better than the alternative. He even shared a story of seeing his recently deceased wife during the event telling him "it's not your time, go back."

Arresting at home, where hospitals are mere minutes away is quite different from arresting offshore or even on the ICW in the marshes of Georgia or Lake Superior or anywhere an ambulance ride is not immediately available. But it's your money, and your peace of mind. You should spend the money and do as you see fit.

[Cheechako]

AED's do save lives. Well over twice as effective as waiting for an aid car. But I agree it is dependent on the particular type of event.
One thing about them, they are automatic, it doesn't take much to operate one one at all. You really just need to know where to put the contacts and push the button. The AED will not shock a patient that doesn't meet the proper criteria. Once you push the button, it analyzes that criteria prior to shocking. If you are a likely candidate for an event, not a bad thing to have aboard. A man died on a boat in Georgetown Bahamas right next to us of a heart attack.


"Between 2005 and 2013, the number of bystander-witnessed events in which an AED delivered a shock increased linearly from a mere 40 patients to 829 patients. Overall good or moderate cerebral performance at hospital discharge in those patients was 38.5%, including an astounding 46.6% in non-elderly adults. By comparison, bystander-witnessed OHCA patients found to be in ventricular fibrillation whose first shock was delivered by EMS demonstrated a CPC good or moderate of only 18.2%."

[Kenomac]

Cheechako,

I think you nailed the difference. In the hospital, we as nurses primarily see victims where EMS was called which always includes a wait time before anything was done. It takes several minutes just to call and mobilize EMS personnel, so of course the outcomes regarding brain death would be statistically high. But in the same situation, if two nurses, EMS personnel, an MD or really anyone with an AED happens to be on site when the event happens, the outcome could be very different when seconds matter.

If it happened to me, I don't want people just standing around waiting ten minutes for an ambulance.

[Paul L]

Originally Posted by Kenomac

Cheechako,

I think you nailed the difference. In the hospital, we as nurses primarily see victims where EMS was called which always includes a wait time before anything was done. It takes several minutes just to call and mobilize EMS personnel, so of course the outcomes regarding brain death would be statistically high. But in the same situation, if two nurses, EMS personnel, an MD or really anyone with an AED happens to be on site when the event happens, the outcome could be very different when seconds matter.

If it happened to me, I don't want people just standing around waiting ten minutes for an ambulance.

Certainly outcomes improve if the AED is applied very early. But the real issue in a cruising environment is the time to get the patient to primary care after the AED is applied. If it is hours, then the outcomes from early AED use will not be good. You have to have sophisticated CCU care within a short period to get good outcomes. Something that might happen at the marina, but doesn't happen when cruising 'away' from the crowd. Now that the price of AEDs have come down so much it is less of a trade-off for those that like to feel prepared or have a real need.