Wow. This has been entertaining to say the least. One thing is for certain, you can tell who has had any real field experience.
I may not have CapnGEO's 23 years, but I've got six in a busy department (and 1 in rural with extended transport times). I do a lot of CPR. I'm not real bright, and I may not be doing medical research
or designing medical equipment
, but I know the difference between a "heart attack" and full arrest, and what an AED is. It's the same problem we have when one of those supersmart MD, RN, FACS, whatevers shows up on scene. Total chaos. I don't come into your ED and order you around, so why do you think you know my job better than me? I can't tell you how many nurses have told me that a patient's O2 sat is less than 85% when they're pink and flush and talking to me unlabored. I may not know what that fancy term you're throwing around means, but I can tell when a machine is giving bad data. I treat the patient, not the monitor
This may be the Internet
, but folks should really listen to the people who know prehospital, and it ain't the research folk, or the ED docs and nurses, it's the guys in the field. And all of them have agreed that an AED on board anything less than a cruise ship
is unadvisable. And whoever said that such an opinion was irresponsible *really* needs to apply some common sense to the situation.
I'm blessed to work as a FF in a department that also has an ocean rescue
unit, and I've worked at that station for two years assigned and lots additionally. If it makes you feel better to carry an AED, then by all means do so. Who knows, lightening may strike and the stars align such that it might make some difference in the outcome. But the odds of that are so astronomically small to border on the ludicrous.
Think it through. If you're having a symptomatic MI, then go with O2 and as rapid a transport as you can manage. If you have access to ALS medications (and in my state everything beyond O2 and oral glucose is an ALS med) then toss them in and make as rapid a transport as you can manage. What you need is a CCU, not an AED. Getting to the cath lab as quickly as possibly is one of the primary indicators of outcome.
If someone is in full arrest, they've got about seven minutes (give or take) without intervention. You've got the BLS CPR going. Hopefully you've got O2 flowing, because otherwise even perfect CPR is about 21% as effective without it. Part of the protocol for terminating CPR is if transport time will exceed twenty minutes. Assuming witnessed arrest, you apply the pads immediately. If they're in a shockable rhythm that the unit can recognize, the AED will deliver. Assuming that the shock is successful, now what? You still haven't fixed whatever problem caused the VF in the first place. And from personal experience, if you do get a pulse back (not just from defibrillation) it isn't back for long outside the hospital. Those same MDs and RNs who make life interesting in the field are really the bees knees in their own environment
. You need to get to them as quickly as possible.
Let's assume that the helo is already spun up and is overhead, that you the operator are familiar with the procedure required of you for the hoist, that you don't have any rigging
aloft (sailboats are right out), conditions are perfect, and the helo team executes perfectly first try, and the patient is completely packaged and ready to go. It's still going to be about ten minutes just for the hoist. You're the average coastal cruiser, so figure around 15 minutes flight time. You can see where I'm going, it's going to be way over 20 minutes even if the planets are aligned.
I was a back country guide for a lot of years, and it was just understood that if you end up in full arrest, you're going to die. It's harsh, but true. I think you need to look at the same for sailing. Having a heart attack is not the same as full arrest. My father, who I own the boat with, had a massive MI about five years ago. He understands the risks involved with going out to the islands. However, I trust that if he has symptoms unresolved by Nitro, that he'll let me know before it gets to the full arrest level. We don't have an AED onboard because, honestly, it doesn't merit even a second thought.
AED's are wonderful, life saving devices. The early application of the machine in the little red box that I drag everywhere has assisted with a couple of people leaving the hospital under their own power (whoever threw out 38% is an order of magnitude or two on the high side). But in the transport time scale of even the most perfect boating
adventure, it's not going to help you. I have a whole host of cool lifesaving toys that are wonderful on the fire engine
, and useless on a boat.
Sometimes you just have to accept the risk.
-- If I was going to blow that kind of money on boating safety
, I think I'd put in lightening protection. Shows you what I know...
-- And it's nothing personal about the office types. I see it regularly. They make the classic mistake of smart people: they think because it's simple that it's easy.