A Defibrilator on Board ? Good Idea ?

[boatman61]

Originally Posted by IrishLass

All I can say now is that I don't want to sail with any of you other than Jeffrey (Active Captain) or S/V Moondancer. The rest of you would just give up and let me die.

I say, turn on the EPIRB ..... Pull out the Medical Kit/AED and fight like someone's life is in your hands!

Now thats a rather harsh condemnation of the rest of us... based on no knowledge other than our rejection of an instrument most are not familiar with... a bit like saying that because one does not like/use a CP they are not competent to deliver your boat...
The one has no bearing on the other... you've had experienced folk on here who've worked in hospitals/ambulances/emegency services point out certain things relevant to your statements but regardless of this they are unsafe in your view because they consider a de-fib a waste of money if not close to ancillary services... hmmmm
Now I'm not from a medical background and my 1st aid training has only been survival at sea but it was extensive and taught me how to do a tracheostomy, set bones and splint and do CPR for various things... including suspected heart failure... slightly different from CPR drowning...
If you collapsed on my boat... no I would not let you lie there and die... I'd keep battling until your blood started to pool...
A disagreement of views is a lot different to someones possible competence...

[PamlicoTraveler]

Originally Posted by ActiveCaptain

I think it's trivially easy to dump on the CG and prey on our experiences about how we see them respond to other radio traffic. But in a medical emergency, I've directly seen otherwise and any attempt to make their response seem different in a general way when a medical crisis hits is total ********.

Why does everyone's opinion have to be black and white and instinctively critical of the comment of others.

Jeff, I have listened to traffic when others had the frustration that the CG asked too many questions that were irrelevant to the issue at hand. I mentioned what I heard - I didn't make it up and I HAD NO AGENDA. This is a discussion board. And you make it sound like I was being critical of the CG ("dumping on the CG") in medical emergencies. I wasn't and I am not.

If anyone wants to prove they know more than me about the subjects discussed here I offer no resistance. That's why I come here, to talk to people that may know more than I do and to help people when they know less than me about certain subjects. Still, this is a DISCUSSION BOARD. For me what I say is not a printed editorial - it is a comment in a free flowing conversation. If every little thing one of us says has to be dissected and criticised, then there will be no "discussion," just agendas.

</rant mode>

[IrishLass]

Originally Posted by boatman61

Now thats a rather harsh condemnation of the rest of us... based on no knowledge other than our rejection of an instrument most are not familiar with... a bit like saying that because one does not like/use a CP they are not competent to deliver your boat...
The one has no bearing on the other... you've had experienced folk on here who've worked in hospitals/ambulances/emegency services point out certain things relevant to your statements but regardless of this they are unsafe in your view because they consider a de-fib a waste of money if not close to ancillary services... hmmmm
Now I'm not from a medical background and my 1st aid training has only been survival at sea but it was extensive and taught me how to do a tracheostomy, set bones and splint and do CPR for various things... including suspected heart failure... slightly different from CPR drowning...
If you collapsed on my boat... no I would not let you lie there and die... I'd keep battling until your blood started to pool...
A disagreement of views is a lot different to someones possible competence...

Yes .... it may seem a harsh condemnation and for that I apologize. I am one of those healthcare professionals and I have the credentials in training and clinical experience to speak on this issue. I have tried to avoid using medical terminology and have not cited studies (even though I am full-time in clinical research at this time) for two simple ; one, statistics can be confusing and this thread has proven that, two, this is a lay forum and I am offended when I go into someone elses area of expertise and they try and speak over my head. That is offensive behavior .... we are all proficient and I venture to say even expert in some area of life, but we are only good at what we do if we can explain it to the lay person in terms they can understand. (DRIFT)

We are not speaking of defibrillators .... we are speaking of AED's and there is no more to be said on this point. It has all been said ... and then some. LOL

CPR training and first aid trainig is essential and I cannot emphasize that enough. You should spend your money there first. You should stock a COMPREHENSIVE first aid/medical kit with the assistance of someone who has worked in emergency medicine (RN, ARNP, PA, MD, etc...) -- and not to bring up another issue of debate, but there are time constraints in suturing ("stitches") too, so supplies and basic training in this area should be considered.

This issue of an AED has been debated here and obviously will not be resolved here. However, hopefully it will cause readers to consider the option and to make up their own mind. For me .... you know, I am PRO AED.

Finally .... this is not an issue of money and we all know it! We all know that $1200 pales in comparison to the cost of other items our boats and many of those purchases, you dont' even give a second thought because it is something you WANT. I am not minimizing the money, I just know that is a poor excuse on this point. Furthermore, this is not about the USCG and their response time or their radio communication protocols. As it has been pointed out repeatedly .... you are still not going to be within minutes of ACLS (Advanced Cardiac Life Support). Moot point ...... my postings are about what can we ..... independent sailors do for ourselves to try and make the best of a bad situation -- for that very reason -- BECAUSE WE ARE FAR FROM THE ASSISTANCE OF OTHERS!

In closing ..... an AED is not a "magic machine" or a "panacea." It might not even help at all. It is a gamble, a risk, and investment that you choose (or choose not) to make. Like all other investments .... does the risk outweigh the potential beneift?

To all whom I have offended ... my sincere apologies!

[IrishLass]

Addendum: I was remiss in not suggesting that you might also ask the assistance of an experienced EMT/EDT or Paramedic in putting together your Medical/First Aid Kit.

[boatman61]

LOL.... no offence taken by me personally Irish....
I've a thick skin and hard jaw... but there are some sensitive souls on here...
Do your thing gal... if it feels right... it often is...

[sweetsailing]

I am not opposed to AED in the right circumstances and yes, I believe everyone of the medical studies sited and linked in this thread. And I do believe AED do save lives. Having said that I still would not purchase one for my boat.

Several have asked what the alternative would be then if no AED. Here's what I would do. I would save the couple of thousand dollars that would be spent on an AED and instead invest that money in having an angiogram and echocardiogram before I leave for cruising and pay for it out of my own pocket whether or not my insurance would pay for it. My approach is prevention, testing and treatment and not pinning all my hopes on an AED in the middle of the ocean. Prevention - eat right, exercise, don't do all the bad things your not supposed to do. Testing - get an angiogram and echocardiogram before you leave if you are concerned. Treatment - treat any found risks or condition with medication and interventions before you leave. If I do all that, I think the chances of me needing an AED go down considerably.

From my perspective, this conversation seems a bit akin to carrying an extra mast on board because what would happen if your rig failed and you get dismasted. Of course, most of us would not carry an extra mast to deal with this situation. What would we do instead? Check the rig frequently and maintain it. Take weather classes, check weather forcasts and avoid conditions that would put us in a situation that would create increased risk for dismasting.

Why would we not take the same approach when it comes to heart conditions and the like?

[IrishLass]

Originally Posted by sweetsailing

I am not opposed to AED in the right circumstances and yes, I believe everyone of the medical studies sited and linked in this thread. And I do believe AED do save lives. Having said that I still would not purchase one for my boat.

Several have asked what the alternative would be then if no AED. Here's what I would do. I would save the couple of thousand dollars that would be spent on an AED and instead invest that money in having an angiogram and echocardiogram before I leave for cruising and pay for it out of my own pocket whether or not my insurance would pay for it. My approach is prevention, testing and treatment and not pinning all my hopes on an AED in the middle of the ocean. Prevention - eat right, exercise, don't do all the bad things your not supposed to do. Testing - get an angiogram and echocardiogram before you leave if you are concerned. Treatment - treat any found risks or condition with medication and interventions before you leave. If I do all that, I think the chances of me needing an AED go down considerably.

From my perspective, this conversation seems a bit akin to carrying an extra mast on board because what would happen if your rig failed and you get dismasted. Of course, most of us would not carry an extra mast to deal with this situation. What would we do instead? Check the rig frequently and maintain it. Take weather classes, check weather forcasts and avoid conditions that would put us in a situation that would create increased risk for dismasting.

Why would we not take the same approach when it comes to heart conditions and the like?

SOME of this is good advice SWEETSAILING. Healthcare maintenance is very important and you are right .... we should take BETTER care of our bodies than we do our boats/yachts. We should not assume this is an either or situation.

I suspect if someone is inclined to spend the money on an AED, they are already health conscious enough to have a good health maintenance plan/preventative care lifestyle in place. The latter and owning an AED are not mutually exclusive.

However, you did not answer the correct question. The question is: "what is your suggested action plan for those who are onboard and witness an apparent heart attack (MI)?"

[Don1500]

I get the feeling that some of the posters here believe the Defib works exactly the way they see it done on TV. Hit 'em again, Danno.

[mario f]

Lass, you wrote...
I agree with my one advocate in this thread .... it is surprising the number of people who are in healthcare who are discouraging individuals from having AED's onbaord and yet they offer no alternative to treating an apparent heart attack

1. Your one advocate on this thread vs the many more qualified medical professionals that have given their opinion and why's
2. No alternative given.. Try first aid, cpr. several scenarios have been presented.
3. discouraging individuals- It is your money do what you want, we have only stated facts, real world experience and alternatives.
4. You have presented no valid arguments. Studies must be taken with a grain of salt and knowing the specifics of the study not just quote the results.
5. Your first post was everyone over 40 should have one ?????
6. The original question was - is it a good idea to have one on a boat.
It appears you have not recieved the answers you want, but your questions have been answered by many qualified to opine on this issue.

Again with all due respect, placebos have their effect, so by all means if you got the money, get one. If it gives you peace of mind and feel that strong about this particular device, it will be the best spent boatbucks in YOUR situation.

And this will be my last post on this subject... while everyone is still happy and friendly...

[s/v Jedi]

Sooooo, we shouldn't buy EAD's because the marina's should buy them. I think this is the trend many think about it. What I don't know for sure is if they mean "let others spend the $$$ so they can help -me-" ??

That's just an observation. I'm also a bit worried that many state the cruisers as avg. layman. Where does that come from? The cruisers I meet know way more and often have extensive medical supplies aboard. I know that many Dutch cruisers follow a course for sailors (in a specialized hospital) where they learn how to treat (serious) wounds, set broken bones, suture, CPR, etc. I also find that in most marina's and anchorages there's at least one boat with a doctor aboard. IV's, oxygen etc. might be closer than at the hospital 100 miles away.

We were in one particular anchorage for 2.5 years. In that time 4 cruisers had a cardiac arrest. One was found in the morning (solo sailor) and of the other three, one survived it (was in the dinghy with cruiser/doctor/EAD within 10 minutes and in the ambulance within 30 minutes). That's one out of three and I don't know if an AED was available for the two that didn't make it.

Something to remember: you can't do CPR in a soft bottom dinghy, nor in a very small one !

cheers,
Nick.

[NavyBlue]

American Heart says that for every minute you wait for a shock your survival goes down 10%. So you do the math. As an EMS professional I can tell you that CPR is about 90% ineffective by itself. An AED is pretty cheap but battery replacement every two years will add up. If your family has a history of heart disease then maybe a good buy. Otherwise, depends on how deep your pockets are....

[Bash]

Originally Posted by MarkJ

Do they help with Gas?

Sometimes. But only if you survive the explosion.

[JRM]

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.

JRM

-- 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.

[JanetGroene]

On a related note, one of our physician friends advised us to have appendectomies before we went off to worlds unknown. We didn't but it's something to think about.

[kenny chaos]

I'll ask what they think about a defib over on the $500/month thread.

Could any of you guys do a hip replacement for me? Maybe just add a
zirk fitting?

Thanks-
Kenny