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Old 28-02-2011, 14:26   #16
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Re: A defibrilator on board? Good idea?

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Originally Posted by speciald@ocens. View Post
We carry one - I have had 2 heart attacks in the past. BUT - my wife is a nurse anesthetist and can handle drugs, intubation, etc. A friend of ours arrested in the Bite at Norman Island - luckily there was a cardiologist on the beach and VISAR arrived quickley with the difibralator and the needed cardiac meds. He survived.

I am so glad to hear that you had such a great outcome. It's a shame that everyone can't sail with a lovely and smart CRNA! Blessings on your continued good health!
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Old 28-02-2011, 15:04   #17
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Re: A defibrilator on board? Good idea?

Ok, I'll leave you with another point to ponder....
You are coastal 15 mi out, one of your crew goes down and you are able to diagnose the problem.
tic-toc-tic-toc the Golden hour has begun....

1. If you are good and calm collective within 5 minutes you have the AED connected and ready to go.. zap zap zap.
Miracle Joes heart starts beating... can you assess the rhythm, or tell if it is pro fusing? what was the arrhythmia?
By now we are going on 20 min (if you are good) Remember how big is the person, where on the boat they are, safety to others prior to using AED, ever try to move dead weight around a boat? So you see I am generous with the time allotted here.

2. Radio contact has been established with CG by now and they initiate a rescue mission... Lets see, at 20 kts they can cover 20 mi in 1 hour... that is assuming they were in the boat fired up ready to go.

Joes heart is still beating, remains unconscious, unresponsive(typical scenario.) Is his brained getting enough O2, you do have that on your boat right?
At best I'll give you 2hrs from time of event to ALS on scene.... Your chances at this point less than 5%. Let us assume at this point he gets drugs O2, ALS etc. We still have the trip back to the hospital.

3. You make it back to port and go see your pal in the ICU (again being generous here.) You feel like a hero after all you just saved a life. When you arrive are informed he has been low on the O's for too long and has lost many, many brain cells.
Congratulations the life you saved is now a veg for the rest of his life... and you are the one who has to live with it.

Ask me, I've gone thru this many times.. My oath was to do no harm....

Just my personal insight
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Old 28-02-2011, 15:23   #18
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Re: A defibrilator on board? Good idea?

Mario ..... A discussion better held in private and over a bottle of wine, no doubt. And most likely something we will never agree upon. However, I am ACLS certified, have full access to a crash kit, defibrilator, and O2. That is not the point. We are addressing real-life issues, for the lay person. The corollary .... how can my train me to handle our Tartan alone in the event of an emergency .... with the finesse and sailing ability with which he handles her? Absolutely not, but I have to make do. If nothing more, I have to be able to get the sails down and radio for assistance. Back to MY scenario .... what is the alternative. Does the partner sit quietly and hold his/her hand and tell him/her that because s/he is concerned about his/her "brain death" that there will be no intervention? I am not talking about ABG's, pro fusion, perfusion, asytole, or any other medical terminology ..... I am talking about preparing loved ones make good choices and good decisions and to be prepared for what the possible outcome would be. So, my question remains ..... what is your suggested alternative to an AED?
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Old 28-02-2011, 15:29   #19
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Re: A defibrilator on board? Good idea?

Amazing thread... most of you are describing a defibrillator from the hospital or ambulance, NOT an AED.

From wikipedia:

Quote:
AEDs, like all defibrillators, are not designed to shock asystole ('flat line' patterns) as this will not have a positive clinical outcome.
But they treat more heart problems that arrest. I read about people putting the electrodes on their body themselves and the AED told them to relax (it talks) and they never even got the shock as the AED just monitored and told them they were fine.
These units can work as an external pace maker.

Read the wiki: Automated external defibrillator - Wikipedia, the free encyclopedia

ciao!
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Old 28-02-2011, 15:59   #20
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Re: A defibrilator on board? Good idea?

I've been a licensed EMT for 17 years - still have an active license. I've been on hundreds of ambulance calls and now have been cruising for the last 8 years. Over the last year my wife (past CPR instructor and current EMT for 17 years also) have been teaching classes at rendezvous about medical emergencies onboard. I've been on multiple ambulance calls responding to boats in our harbor in Maine. Before starting ActiveCaptain, I built a company that created medical devices. Among the 9 FDA approved products we built, I designed multiple cardiac monitors and an AED. Needless to say, this subject is close to my heart (heart, get it?).

The first thing to realize is that in almost all cases, most of us cruisers most of the time aren't in the middle of the Atlantic Ocean. We're near coastal communities where medical care, ambulance help, Coast Guard assistance, and other on-the-water help is available.

The second thing is that having an AED onboard is worthless unless you've had at least one CPR course and understand really well how to perform it and what the issues are when performing it. And one course is just the beginning. You should take a couple of them and some more advanced first aid classes. Anything else is just throwing away $1,200.

CPR isn't going to revive anyone no matter what the results shown on NBC's ER television show (80%+ revival - reality is less than 2%). But CPR will keep someone viable until an AED can be used. An AED will save lives and does so every day.

I completely disagree with the assertion that it's worthless to have an AED onboard because you'll need advanced life support who won't be there. In almost all of our cruising situations, they will be there. I had an ALS license back in Maine and I've been in the galleys of boats performance lifesaving operations, usually within 20 minutes of the event. And that's a tiny coastal town in Maine.

The subject of EPI pens was also brought up. It would be incredibly rare for someone to have an allergic reaction and go into anaphylactic shock without knowing long ahead of time that they had a major issue with some allergen. It just doesn't happen the first time and in fact, it can't happen the first time. Anaphylactic reactions get worse and worse with each exposure. If you need an EPI pen, you already know you need one because the last exposure got your attention. For most cruisers who have no known allergies, Benadryl is a much better thing to have onboard. But no matter what, for the purpose of carrying medicine onboard, don't listen to me or anyone else on this forum. Talk to your doctor who knows your history and can help assess what you need.

My wife and I are both in our early 50's. Neither of us has any cardiac history and neither of us are on any cardiac medications. We carry an AED onboard and we both know very well how to use it - and we both have used it in real situations. We both know that there are a lot of conditions that could cause either of us to go into cardiac arrest. We're also always ready to run to the next boat in the anchorage to help if needed.

You never know who's in that next boat over. Learn the basics, get the proper equipment, practice, and be ready to help others.
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Old 28-02-2011, 16:23   #21
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Re: A defibrilator on board? Good idea?

Jeffrey: Thank you for sharing this important information. I could not agree more with your commentary on the importance of CPR training and, obviously, having an AED onboard. However, I somewhat disagree with your statments on the importace of having an EPI PEN. I practiced BC Allergy/Immunology for more than 17 years. True, if you have an IgE mediated allergy, it will not manifest itself in the first exposure. However, you can have had a similar protein exposure/ingestion in the past that can have caused you to produce IgE to that allergen. Additionally, when you are not preparing all of your own food items and foods have different names in different parts of the world, and different languages are being spoken .... you are not always certain what you are consuming. What's more, by suggesting and EPI-Pen, I was not eliminating Benadryl (diphenhydramine) from the suggested list of medications. They are both important in an allergic reaction. But, in an anaphylaxis you NEED epinephrine. THE MOST IMPORTANT ADVICE YOU GAVE -- CONSULT YOUR PRIMARY CARE PHYSICIAN ..... AND DISCUSS YOUR TRAVEL PLANS WITH HIM/HER. HOPEFULLY, YOU HAVE A GOOD RELATIONSHIP AND S/HE WILL ASSIST YOU ON PUTTING TOGETHER A COMPREHENSIVE FIRST AID/MEDICAL KIT.
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Old 28-02-2011, 16:58   #22
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Quote:
Originally Posted by speciald@ocens.
We carry one - I have had 2 heart attacks in the past. BUT - my wife is a nurse anesthetist and can handle drugs, intubation, etc. A friend of ours arrested in the Bite at Norman Island - luckily there was a cardiologist on the beach and VISAR arrived quickley with the difibralator and the needed cardiac meds. He survived.
If this is as important as this would seem I would strongly advise getting your DSC VHF hooked to your GPS and get an MMSI to activate the DSC. That way if the unthinkable happens while underway just pressing the DISTRESS button will alert the nearest USCG facility in seconds rather than hours as is the case with an EPIRB. The radio will continue to send where you are, which way you are headed and how fast your going there automatically until the USCG responds. They can continue to poll the radio on get fixes where you are. If you give the MMSI authority health information, help will show up with the proper equipment and ready to help. Further there is no need for 40 questions about your vessel, length, type, color etc as that is in the MMSI. We include our Dr. Phone number in our MMSI information so they can call him to alert him. This can all be done with no interaction from anyone aboard other than pressing DISTRESS while the crisis is upon you.

You may also want to look into getting a SPOT satellite device.
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Old 28-02-2011, 16:59   #23
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If this is as important as this would seem I would strongly advise getting your DSC VHF hooked to your GPS and get an MMSI to activate the DSC. That way if the unthinkable happens while underway just pressing the DISTRESS button will alert the nearest USCG facility in seconds rather than hours as is the case with an EPIRB. The radio will continue to send where you are, which way you are headed and how fast your going there automatically until the USCG responds. They can continue to poll the radio on get fixes where you are. If you give the MMSI authority health information, help will show up with the proper equipment and ready to help. Further there is no need for 40 questions about your vessel, length, type, color etc as that is in the MMSI. We include our Dr. Phone number in our MMSI information so they can call him to alert him. This can all be done with no interaction from anyone aboard other than pressing DISTRESS while the crisis is upon you.

You may also want to look into getting a SPOT satellite device.
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Old 28-02-2011, 16:59   #24
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Re: A defibrilator on board? Good idea?

My vote is for a AED aboard my vessel. I had an heart attack and I would rather be zapped than not.. what would I have to lose if I needed assistance from an AED and it didn't help? Common Sense answer...
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Old 28-02-2011, 17:12   #25
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Re: A defibrilator on board? Good idea?

We have had one on board since 2005, cost us $2100 AUD.
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Old 28-02-2011, 17:19   #26
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Re: A defibrilator on board? Good idea?

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My vote is for a AED aboard my vessel. I had an heart attack and I would rather be zapped than not.. what would I have to lose if I needed assistance from an AED and it didn't help? Common Sense answer...
That logic would mean, youd have everything from ballastic vests to crash helmets, X-ray units etc etc on board. all in the possible event of some future catasrophie that might happen and help might be to hand in the future on some planet somewhere.

Common sense, says that we evaluate risk and discount the improbable, even if the improbable turns out to be the unfortunate.

dave
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Old 28-02-2011, 17:40   #27
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Re: A defibrilator on board? Good idea?

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That logic would mean, youd have everything from ballastic vests to crash helmets, X-ray units etc etc on board. all in the possible event of some future catasrophie that might happen and help might be to hand in the future on some planet somewhere.

Common sense, says that we evaluate risk and discount the improbable, even if the improbable turns out to be the unfortunate.

dave
He has already had a heart attack, so he already knows that it is probable that he will have another. It all comes down to this .... some people wear the motorcycle helmet and some don't. Some people take reasonable precautions and some don't. No one has yet suggested a reasonable alternative to an AED (and I am not suggesting AED as an alternative to CPR, they are to be used in tandem). Some think it is a good choice and others do not. This is an information forum .... to inform and to become informed. In the end ... we all make our own decisions.
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Old 28-02-2011, 17:40   #28
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Re: A defibrilator on board? Good idea?

It all boils down to money and philosophy....and the philosophy that you will probably die of something else than a heart attack at sea isn't too far from reality...which leads to the slightly off topic post relating to DSC radio...which does relate to MEDEVACs so it isn't too far off what some have been saying here....

to the poster that thinks DSC radios are that much more important than EPIRBs/PLBs better do some research. While using DSC close to shore or popular boating areas is a good idea...the reliability of VHF radios versus the high percentage of EPIRB success is pretty clear. I'd bet my life on an EPIRB over DSC distress every day of the week and then some. 20 plus years in USCG operations centers and helos taught me that much. (although improvements like the rescue 21 radio system are helping the DSC side of rescue)
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Old 28-02-2011, 18:23   #29
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Re: A defibrilator on board? Good idea?

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thread drift,but unless you are qualified to use an aed a vibrator might be a better choice,with a good nurse..............
These things talk to you now and guide one through the process. But for offshore its best to get an exam before heading out.

I'll stick with my aspirin in the morning and a shot of rum in the eve!

If nothing else you could keep an AED around as an emergency starter battery.
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Old 28-02-2011, 19:04   #30
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Re: A defibrilator on board? Good idea?

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But they treat more heart problems that arrest. I read about people putting the electrodes on their body themselves and the AED told them to relax (it talks) and they never even got the shock as the AED just monitored and told them they were fine.
These units can work as an external pace maker.

Read the wiki: Automated external defibrillator - Wikipedia, the free encyclopedia

ciao!
Nick.
Please, please..... These units do not 'TREAT' anything, defib is the hearts reset button, you are stoping the heart so it can hopefully resume a normal rhythm on its own, that is all. That it talks to you and tells you to calm down, that is for the user not the patient
Your average layperson would not have the required knowledge nor training to even go and mess with pacing a heart .

There are other more common emergencies we as cruisers may encounter but know absolutely nothing about, two simple as we call monkey skills.
1. what are the chances of having a heart attack vs getting hit on the chest or back with boom, a fall etc. causing a pneumothorax, a life threatening condition. Or for that matter a spontaneous pneumothorax, no trauma needed, just a good cough.
Solution- large bore IV needle midclavicular, third intercoastal space with flutter valve(cut tip of latex glove with small slit)
2. A cricothyrotomy you still have the needle you did not use on the chest, and with all tyhe concerns about allergic reactions and epi pens, this one is a no brainer, airway closes, open a new one
For both of the above you have the golden minute not hour to act.

It is all a matter of personal choice as has been stated before. My point is there are more probable scenarios that yield a better result with minimal investment.

This sounds like the gps/sextant thread. And no I do not have a sextant either, I invested in good set of binoculars with compass, maintain DR and my coastal nav skills..
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