A Defibrilator on Board ? Good Idea ?

[Boomp]

No to a defibrillator...you are not going to be w/i any golden hour if you are even a little ways out. You will also need a tube, suction and O2 and a huge part of the entire scenario is really good CPR... most first responders and even emts do mediocre cpr...you can actually see the difference on a good 12 lead or heart monitor....ask me how I know? Even perfectly executed cpr is only going to buy a little time. I did cpr once on a 'witnessed' arrest and the guy lived for 5 years in a comatose state[really not a big help to his family]....Oh, yeah, add a rolling boat, hypothermia and confusion, throw some water onto the scene and what do you think is really going to be the outcome? Sorry for the negative info but I personally 'worked' on a good friend in October[ our boat sank unexpectedly and the coasties picked us up after a half hour in rough seas. My buddy had a built in defibrillator...I got shocked 3 times while working him on the 41footer and pulmonary edema finally ended any hope. So unless you are really going to cruise very close, I think it's pretty useless. I worked as an emti for 28 yrs.....enjoy and live your life!

[osirissail]

I think what is missing here in the discussion is a sense of geography. If you are sailing in your local waters/bays/lakes/rivers and even very near coastal - say a few miles offshore at best - then advanced medical equipment as mentioned "maybe" of some possible use.
- - But if you are sailing offshore or out of visual range of your home country (exceptions being major western countries) then such equipment is practically worthless. The money might be better spent on good emergency medical classes and a really good medical kit.
- - Very few 2nd and 3rd world countries have advanced medical care or even coast guards for that matter. Forget the "golden hour" we're talking "golden week" or more to get to advanced medical care.
- - Last year I had a guest who had a heart attack on board while tied to the marina in Grenada. The ambulance could not be dispatched without a doctors order and at 22:00 at night good luck finding one - and of course you need a phone. But the ambulance did finally show up and after the attendants discussed their families with the gate guard they ambled down to the boat. The equipment they had with them was a gurney and a stethoscope - period. Nothing else with them or in the ambulance. The point being that in other than major 1st world countries advance medical care or emergency care simply does not exist and they have neither the need or the money to provide it.
- - So any decisions to carry advanced medical equipment must include where you are and where you intend to cruise.

[capngeo]

Originally Posted by Boomp

No to a defibrillator...you are not going to be w/i any golden hour if you are even a little ways out. You will also need a tube, suction and O2 and a huge part of the entire scenario is really good CPR... most first responders and even emts do mediocre cpr...you can actually see the difference on a good 12 lead or heart monitor....ask me how I know? Even perfectly executed cpr is only going to buy a little time. I did cpr once on a 'witnessed' arrest and the guy lived for 5 years in a comatose state[really not a big help to his family]....Oh, yeah, add a rolling boat, hypothermia and confusion, throw some water onto the scene and what do you think is really going to be the outcome? Sorry for the negative info but I personally 'worked' on a good friend in October[ our boat sank unexpectedly and the coasties picked us up after a half hour in rough seas. My buddy had a built in defibrillator...I got shocked 3 times while working him on the 41footer and pulmonary edema finally ended any hope. So unless you are really going to cruise very close, I think it's pretty useless. I worked as an emti for 28 yrs.....enjoy and live your life!

I have done CPR on at least 10 people a month for the last 23 years (FF/Paramedic)... I have never, nor have I ever heard of ANY provider being shocked by an implanted defibrillator... Sorry gotta raise the BS flag there!

To the OP: AED's are fine if you are minutes from Advanced Life Support.. If you are not, good Basic Life Support (CPR) is the ONLY shot you have. In fact 2 min of CPR compressions are given prior to electrical therapy (shock) in unwitnessed cardiac arrest (per current ACLS protocol). Personally as one who has the skills and knowledge to provide ALS, I would not piss away $$ to have an AED (or advanced airway adjuncts) on my boat. Even though I'll match my credential and experience against anyone on CF, it is ONLY my opinion!

[IrishLass]

[QUOTE=capngeo;631361] " ..... To the OP: AED's are fine if you are minutes from Advanced Life Support.. If you are not, good Basic Life Support (CPR) is the ONLY shot you have."


Hmmmm? This differs from what they are teaching in medical school.

[ActiveCaptain]

The one thing that boating has taught me is that you have to be a generalist in many different disciplines. I never thought I'd ever replace plumbing fittings, re-wire major electrical systems, or adjust the clearances of valves on my diesel engines. Before I started serious liveaboard life, I didn't know about fiberglass repair or how to take care of anchor ground tackle.

It seems the more you're cruising, the more self-reliant you naturally become. There's no reason to assume that learning and experience should stop right before emergency medicine and first aid.

There have been a lot of things said here that I thought were shocking. Some were total BS. And some were brilliant. If you're at all confused by what was written, then go learn more. Go take a CPR class. Learning about how to treat trauma is no more difficult than rebedding an exterior fitting.

Sticking your head in the sand and ignoring a lack of knowledge works about as well here as ignoring that little hydraulic leak in the steering ram. Knowledge is the key and becoming that generalist is one of the best and most valuable aspects of cruising.

[IrishLass]

Originally Posted by ActiveCaptain

The one thing that boating has taught me is that you have to be a generalist in many different disciplines. I never thought I'd ever replace plumbing fittings, re-wire major electrical systems, or adjust the clearances of valves on my diesel engines. Before I started serious liveaboard life, I didn't know about fiberglass repair or how to take care of anchor ground tackle.

It seems the more you're cruising, the more self-reliant you naturally become. There's no reason to assume that learning and experience should stop right before emergency medicine and first aid.

There have been a lot of things said here that I thought were shocking. Some were total BS. And some were brilliant. If you're at all confused by what was written, then go learn more. Go take a CPR class. Learning about how to treat trauma is no more difficult than rebedding an exterior fitting.

Sticking your head in the sand and ignoring a lack of knowledge works about as well here as ignoring that little hydraulic leak in the steering ram. Knowledge is the key and becoming that generalist is one of the best and most valuable aspects of cruising.

Well Said!

[s/v Moondancer]

Some facts to go with the discussion; below are three article from the New England Journal of Medicine on public use of defibrillators.

MMS: Error

MMS: Error

MMS: Error

Sudden Cardiac Arrest: Don't Try It At Home : Shots - Health Blog : NPR

11 of the 200,000,000 people traveling through Chicago's in a two year period were 'saved' by the public defibrillators.

Bottom line is that if my wife or I had known cardiac problems we would carry a defibrillator but until then we will not.

[zeehag]

i worked icu and emergency rooms way too long as an rn to even think about having an aed on my boat--for all of the reasons mentioned,and then some

[IrishLass]

Based on my training and my clinical experience, I still consider it a prudent decision for my husband and I to have an AED onboard when cruising at sea. Neither of us have hypertension, CAD, PAD, hyperlipidemia, or DM and we are non-smokers. However, we both have a family history of CAD. He is 58 and I am 49. Hopefully it (the AED) will never be needed. Moreover, it is impossible to anticipate what the circumstances could be, but thank God we don't go this alone.

[Wannafish]

Originally Posted by capngeo

I have done CPR on at least 10 people a month for the last 23 years (FF/Paramedic)... I have never, nor have I ever heard of ANY provider being shocked by an implanted defibrillator... Sorry gotta raise the BS flag there!

Question - as one who has a defib implanted, what should my wife know that may help me if mine goes off. The only thing I was told - by both my primary care physician and my cardiologist is to get to the hospital immediately. That's nice and all, but what about when we are out on the boat; working in the field; hunting; or all the other things that life offers? It almost seems as if the only thing it's good for is to give me time to say "goodbye"...hopefully.

I'd REALLY appreciate any input from those that truly know.

[PamlicoTraveler]

I guess it's debatable whether it makes sense or not. We have the epi-pen and I have thought about the nitroglycerine tabs. Even though a heart attack at sea is unlikely it does provide a level of comfort.

[Boomp]

Originally Posted by capngeo

I have done CPR on at least 10 people a month for the last 23 years (FF/Paramedic)... I have never, nor have I ever heard of ANY provider being shocked by an implanted defibrillator... Sorry gotta raise the BS flag there!

To the OP: AED's are fine if you are minutes from Advanced Life Support.. If you are not, good Basic Life Support (CPR) is the ONLY shot you have. In fact 2 min of CPR compressions are given prior to electrical therapy (shock) in unwitnessed cardiac arrest (per current ACLS protocol). Personally as one who has the skills and knowledge to provide ALS, I would not piss away $$ to have an AED (or advanced airway adjuncts) on my boat. Even though I'll match my credential and experience against anyone on CF, it is ONLY my opinion!

Don't be an idiot. I was zapped a/w 2 coastgaurdsmen. We reacted and asked my friends son "what was that?" Then he informed us. We were unaware of the device, we were wet, having just been pulled out of the sea. I was the most highly trained ems provider and did mouth to mouth and a coastie did compressions. As I said we then got zapped two more times but had no other choice given the circumstances. Maybe with all your vast experience, you recall the importance of drying a victim off before using a defib from one on the many re-cert classes you took. That's why you dry em off.

[s/v Jedi]

I find the personal attacks in this thread disgusting. We suddenly have a lot of experts and even designers of EAD devices but even they seem to be unaware of fully automated versions etc. A statistic like only 11 out of 200k people in Chicago were saved should also mention that only 19 out of those 200k needed an EAD and 6 of the 11 were saved by un-trained bystanders.

I read that early defib is the accepted advice by the whole medical community and that for every minute of delay your chances go down by 10%. Still, it sounds like some would deny to use it even when an EAD is there, ready for use, deciding what's best for another person who clearly needs help but is unable to say so.

ciao!
Nick.

[ActiveCaptain]

Originally Posted by s/v Jedi

We suddenly have a lot of experts and even designers of EAD devices but even they seem to be unaware of fully automated versions etc.

Who's unaware of fully automatic AED's and what bearing does that have on the discussion? I don't understand the point of your post.

It didn't seem like anyone was discussing the merits of the different types of defibrillators. It was more a discussion of whether you should have one on board.

Someone else mentioned having nitro onboard. I'd be very careful about just downing a few of those for a suspected heart attack if you've never taken the drug before. At least in Maine, we're required to have an IV in place before providing nitro to a patient for the first time because of the immediate drop in BP it will cause. It causes dramatic results in many people.

These things are all fairly complex unless you've been playing in this area and it's second nature.

As an aside, I find it really interesting that many of the contributors to this discussion who obviously had careers in the medical field feel that they don't' want to carry these types of devices. I wonder if that's because day-in and day-out they were confronted with these terrible situations and just want to get away from it, or if they think the devices just don't work. As a volunteer for the times I've been doing EMS work, I definitely haven't lost the feeling that a difference can be made. But that's possibly because I haven't seen the volume of patient flow that they've seen. There's an interesting discussion in there...

[s/v Moondancer]

Nick, that statistic was not 11 in 200 thousand but 11 in 200 million.

While it is not really possible to extrapolate the data to cruisers an approximate order of magnitude of the annual chance of a general population having a 'cardiac arrest' that can be helped by a defibrillator is 1 in 1000 to 2000 but even with the close proximity of good medical care only about 30% of people getting to hospital survive to be discharged. Some studies show a 10% discharge rate.

'Best guess estimate' from the data is that if you are an middle aged cruiser you have a 1 in 1000 chance of needing the defibrillator per year and a 10-30% chance of survival if you are close to good medical care.

Which indicates that if you are in a high risk group you probably should have one on board. You should also have repatriation insurance to get you back to a good medical facility.

Ventricular Fibrillation: eMedicine Cardiology