Medical Equipment AED Onboard

[Nicholson58]

Originally Posted by caradow

yes, use the drill, as long as you drill on the side with the dilated pupil.
also doing it on a cat will be safer as long as you are not taking seas on the beam.

You might find this useful too - as the thread drifts----------
http://www.amazon.com/yourself-brain.../dp/0891042644

[Nicholson58]

Originally Posted by JRM

I'll suggest keeping the battery case and replacing the cells. Our units have some wonky electronics in the batteries that respond to periodic self testing. That way it can alert us to a battery problem without having to open the case. Your fake battery would put our unit in failure mode. Might want to check what embedded gizmos the unit has before buying cells, or advising someone to do so.

It might seem odd, but our models power up on case opening, so every daily check was draining batteries. It also immediately starts recording all audio and its sensors and parameters for the eventual court case. We went to a weekly / after each use check sheet so it doesn't have to be opened every day.

Also, in addition to the battery expiration, the pads themselves expire as well. Probably not as a big a deal in the private setting where the likelihood of litigation isn't as looming, but the adhesives will eventually dry out.

There have been a lot of numbers about "survivability" thrown around in this thread, and while I can only comment on our own department's stats, I will say that survival rates in absence of neurological ratings are worthless. Here in our area they grade patients on a scale of 1 to 4, with 1 being the best or "insignificant lasting deficits." We only count Grade 1 and 2 in our survival rates, as 3 and 4 rarely ever leave the hospital even though technically they "survived."

JRM

Sent from my SAMSUNG-SM-G900A using Cruisers Sailing Forum mobile app

Daily check !?!?!?!? Hokey Smokes Bullwinkle.

Our Phillips has a once/minute LED flash. Never open or start the thing. Even the unit at our business is checked only once per year by the certified techies. You will wear out the hinges long before the rest of the machine.

[hellosailor]

Batteries aren't all the same. The AED could be looking at the internal resistance of the battery to determine the charge state, in which case some other battery and different chemistry wouldn't work properly even if the amps and volts matched up. Yes, this is Arthur Clarke's "sufficiently advanced technology...indistinguishable from magic." I suspect that much like EPIRB batteries, if you open it up, find the real battery type, and look online, it may be quite reasonable to replace.

Weavis-
"There is a great health service in USA and the UK.. The emergency vehicles carry everything. All paid for by our contributions. They will be there as quick as they can."
Yes, but "quick" is not good enough. Many urban departments boast of a four to six minute response--when nothing goes wrong, there's no snow on the streets, and the directions were clear. Given that the patient has a ten minute window with a 10% further chance of death as every minute passes? Starting with a six minute delay is really sandbagging the odds, isn't it?

"In a nation of 38 million people, where 300K die of heart attacks."
By those standards (tiny country!) there must be ten people in my address book who've already died of heart attacks.

"We do our best. Today I will have worked 16 hours and "
You know, you're protesting about being required to have an AED, but no one is requiring it or even suggesting that you should make it a priority unless that's your personal decision to do so. However, if you're working 16 hour days with patients, you ARE ENDANGERING THEM. Pretty much every labor study over the past 100 years has come up with the same results, and when your workday goes from 8 hours to 12 hours, the accident and error rate DOUBLES.
Yes, I know all the reasons why the medical establishment here in the US likes to have 12 hour shifts, which normally stretch to 14 or 16. I know all about the reasons why they resist computers, and resist washing their hands, and claim that proper housekeeping staff for simple cleaning "costs too much". Horsepucky!
When all the numbers say the establishment and convention have been WRONG FOR DECADES, you can , like King Lear, rail at the heavens but that isn't going to change the numbers.

Forget the AED, the best investment you can make is to turn out the lights and go home after eight hours. You might have heard, even navies rotate their crews on shorter shifts than that. "Business" ain't combat.

[Kenomac]

Originally Posted by weavis

Its a bugger when someone invests in an AED and then is allergic to an insect bite offshore and dies because there was no Adrenaline shot.......

Y' just cant win.

Gary,

We have an epi pen.

[JRM]

Originally Posted by Nicholson58

Daily check !?!?!?!? Hokey Smokes Bullwinkle.

Our Phillips has a once/minute LED flash. Never open or start the thing. Even the unit at our business is checked only once per year by the certified techies. You will wear out the hinges long before the rest of the machine.

I know, crazy eh? I check my equipment at the beginning of each shift and I take it very seriously. I'd rather not show up and need to put that thing on your parent / spouse / child and it not be ready. Our AED units get used a lot (I've used one twice in the last week or so myself). One of those times was on a person over a decade younger than myself, while their entire family (mother and children) watched. Not the time to realize the battery was low or the pads didn't get replaced (yes there's a supposed to be a second set in the box).

Now I've only administered shocks with an AED once in the last month or so. It was quite literally in the middle of the street (the victim collapsed in the crosswalk of a major thoroughfare half a block from the station) so it's probably on YouTube somewhere. I don't know whether that patient lived, or what his neurological status was if he did. But we did have to shock multiple times, with ALS interventions, because it's hard to maintain a pulse even if you get one back.

At those prices I'll consider snagging one for the house, as I have relatives with cardiac histories. But even with one in my posession, I doubt I would take it on the boat, even coastal cruising. The time lines just aren't practical.

JRM

Sent from my SAMSUNG-SM-G900A using Cruisers Sailing Forum mobile app

[weavis]

Originally Posted by hellosailor

Batteries aren't all the same. The AED could be looking at the internal resistance of the battery to determine the charge state, in which case some other battery and different chemistry wouldn't work properly even if the amps and volts matched up. Yes, this is Arthur Clarke's "sufficiently advanced technology...indistinguishable from magic." I suspect that much like EPIRB batteries, if you open it up, find the real battery type, and look online, it may be quite reasonable to replace.

Weavis-
"There is a great health service in USA and the UK.. The emergency vehicles carry everything. All paid for by our contributions. They will be there as quick as they can."
Yes, but "quick" is not good enough. Many urban departments boast of a four to six minute response--when nothing goes wrong, there's no snow on the streets, and the directions were clear. Given that the patient has a ten minute window with a 10% further chance of death as every minute passes? Starting with a six minute delay is really sandbagging the odds, isn't it?

"In a nation of 38 million people, where 300K die of heart attacks."
By those standards (tiny country!) there must be ten people in my address book who've already died of heart attacks.

"We do our best. Today I will have worked 16 hours and "
You know, you're protesting about being required to have an AED, but no one is requiring it or even suggesting that you should make it a priority unless that's your personal decision to do so. However, if you're working 16 hour days with patients, you ARE ENDANGERING THEM. Pretty much every labor study over the past 100 years has come up with the same results, and when your workday goes from 8 hours to 12 hours, the accident and error rate DOUBLES.
Yes, I know all the reasons why the medical establishment here in the US likes to have 12 hour shifts, which normally stretch to 14 or 16. I know all about the reasons why they resist computers, and resist washing their hands, and claim that proper housekeeping staff for simple cleaning "costs too much". Horsepucky!
When all the numbers say the establishment and convention have been WRONG FOR DECADES, you can , like King Lear, rail at the heavens but that isn't going to change the numbers.

Forget the AED, the best investment you can make is to turn out the lights and go home after eight hours. You might have heard, even navies rotate their crews on shorter shifts than that. "Business" ain't combat.

I left out a 1. Its important... it should have read 318 million.

Sigh.
The system is what it is. Lots are things are wrong. But Id still bet you would prefer to go to a sleep deprived dr for treatment when sick. You know why? Because, like commercial pilots and special professions, the correct and automatic response to every situation has been repeatedly practiced over and over again until it can be done without thinking.

Y'awl know best.

I wonder which one of you would complain the loudest if I went to an 8 hour day?
If y'awl would quit smoking. drinking, fighting, having venereal infections eating too much, stop being overstressed and looked after yourself..... then I could cut down my hours. Until then, go lobby government because its obviously their fault and demand more of them magic boxes cos somebody might just have a heart attack.

As JRM said: "Now I've only administered shocks with an AED once in the last month or so...... I don't know whether that patient lived, or what his neurological status was if he did. But we did have to shock multiple times, with ALS interventions, because it's hard to maintain a pulse even if you get one back".

We deal in the realities, not the dream

[boatman61]

Originally Posted by weavis

I left out a 1. Its important... it should have read 318 million.

Sigh.
The system is what it is. Lots are things are wrong. But Id still bet you would prefer to go to a sleep deprived dr for treatment when sick. You know why? Because, like commercial pilots and special professions, the correct and automatic response to every situation has been repeatedly practiced over and over again until it can be done without thinking.

Y'awl know best.

I wonder which one of you would complain the loudest if I went to an 8 hour day?
If y'awl would quit smoking. drinking, fighting, having venereal infections eating too much, stop being overstressed and looked after yourself..... then I could cut down my hours. Until then, go lobby government because its obviously their fault and demand more of them magic boxes cos somebody might just have a heart attack.

As JRM said: "Now I've only administered shocks with an AED once in the last month or so...... I don't know whether that patient lived, or what his neurological status was if he did. But we did have to shock multiple times, with ALS interventions, because it's hard to maintain a pulse even if you get one back".

We deal in the realities, not the dream

LOL... they all believe in Heaven.. but no one wants to go....

[GoingWalkabout]

Originally Posted by weavis

I left out a 1. Its important... it should have read 318 million.

Sigh.
The system is what it is. Lots are things are wrong. But Id still bet you would prefer to go to a sleep deprived dr for treatment when sick. You know why? Because, like commercial pilots and special professions, the correct and automatic response to every situation has been repeatedly practiced over and over again until it can be done without thinking.

Y'awl know best.

I wonder which one of you would complain the loudest if I went to an 8 hour day?
If y'awl would quit smoking. drinking, fighting, having venereal infections eating too much, stop being overstressed and looked after yourself..... then I could cut down my hours. Until then, go lobby government because its obviously their fault and demand more of them magic boxes cos somebody might just have a heart attack.

As JRM said: "Now I've only administered shocks with an AED once in the last month or so...... I don't know whether that patient lived, or what his neurological status was if he did. But we did have to shock multiple times, with ALS interventions, because it's hard to maintain a pulse even if you get one back".

We deal in the realities, not the dream

I just don't get it. There is no question that the earliest intervention with an AED DOES save lives. What is wrong with saving lives? I don't think an increase in survival of between 25% to 30% with the use of an AED is a bad thing. It is a great thing. I understand people having to make choices based on their own economic circumstance but please don't try and use your "professional " status to pooh hooch a device that has saved so many outside of a clinic and hospital. If you want to get into passing contest of who's opinion is more valid I can do that. Lets start with my emergency search and rescue record. But that is not necessary. Just read the facts front the American Heart Association and the Red Cross. I do understand new technology and way of doing things does take a lot longer for adoption in different cultures. Given that you are from England your resistance to these new fangled contraptions is very understandable. But my friend all I will say is that they DO save lives. And if you can afford it, it is well worth having.

[Kenomac]

Goingwalkabout & weavis,

OK, break it up guys... no fighting, we're all on the same side. All three of us agree on the key points:

1. If one can afford an AED, it's a good idea.
2. AED used prior to EMS services is a good idea.
3. Both of you would prefer to be on our boat equipped with two nurses and an AED if and when you go down (we can tell the difference between low blood sugar and heart stoppage), rather than the boat without the AED or the trained nurses.
4. At $1800 an AED is an expensive item where the money might be better used for other items... provided one doesn't already have them. But at $175... they look more appealing.
5. Calling 911 for EMS to come handle a medical emergency involving a cardiac arrest is hopeless.

[Leo Ticheli]

Originally Posted by Kenomac

Goingwalkabout & weavis,

OK, break it up guys... no fighting, we're all on the same side. All three of us agree on the key points:

1. If one can afford an AED, it's a good idea.
2. AED used prior to EMS services is a good idea.
3. Both of you would prefer to be on our boat equipped with two nurses and an AED if and when you go down (we can tell the difference between low blood sugar and heart stoppage), rather than the boat without the AED or the trained nurses.
4. At $1800 an AED is an expensive item where the money might be better used for other items... provided one doesn't already have them. But at $175... they look more appealing.
5. Calling 911 for EMS to come handle a medical emergency involving a cardiac arrest is hopeless.

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

[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.

[Leo Ticheli]

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.

Thank you, Kenomac,
QED

Fair winds,
Leo

[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 ?

[hellosailor]

"and become an ED doctor"
I didn't know anyone specialized in Erectile Dysfunction. Can you be board certified for that??


I think you'd also find that writing rxes and teaching medical seminars in various venues might be construed as practicing medicine without a license, unless you were certified to practice in each venue.


Which would leave you to offer classes maybe twice a year, more if you got comers, but they'd have to fly in to you. Some few would pay, very few recreational sailors I'd think.

[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"