A Defibrilator on Board ? Good Idea ?

[sweetsailing]

I have to weigh in with all the rest of the medical folk on the board and say nope, I would not have an AED on board. I have been a cardiac critical care nurse for 25 years. Yes, I have seen many things, no, I don't think I am used to seeing too much death.

The bottom line for me and what hasn't been stated here is that a cardiac rhythm issue is mearly a symptom of a much bigger underlying condition in most cases. There are those who do have a primary rhythm issue (overall this is not the majority). So operating with the assumption that there is an underlying condition that is causing the symptom of the cardiac rhythm issue, the AED will only resolve the rhythm issue and not the underlying condition. As many of the medical folks here have hinted at, you will still not have a good outcome, unless the underlying condition is treated quickly and appropriately. Unfortunately, this still requires RAPID transportation to a competent level 1 treatment facility. Heck, you don't even need to be at the dock or within sight of the dock. The reality is that many people who are transported to rural or secondary facilities timely still don't have a good outcome becasue of lack of training, supplies or skills (and yes, these are hospitals in the United States)

So from my perspective, having an AED is a bit like putting a band-aid on a bleeding artery, if you don't fully treat the underlying condition with the appropriate facility in a timely manner what have we done to improve the situation?

[mario f]

Jeff,
Someone with your ambulance background should understand that statement.
No, one never, never gets use to it, nor get over it. Those who claim not to be bothered by it are akin to those sailors that claim never running aground.
Most of those who do this work as a profession do not get used to death, we just get tired of beating ourselves asking if we did all we could, what if. Always believing that we have control over that thin line instead of accepting that there is a time to let go, when there is nothing we can do but hold their hand make them comfortable.
Yes I can still remember all those faces and knowing I made a difference in those last moments of life by holding a frail hand, praying with Buddhist, Jews, Christians, and some I had never heard of... they left this world with dignity, respect and love.
So I guess I have a say in the matter of what happens on that thin line between life and death.

The money invested in an AED can better be used for many other things to prevent the need of the device.

[ActiveCaptain]

OK...I'm finally done. This is my last posting in this thread.

My opinion is that there has been good discussion here to bring up a lot of information. But I also think there has been some very bad information relayed. I'd go so far as to call some of it irresponsible.

Study after controlled study shows statistically that AED's save lives. While I agree totally that an AED application offshore might not have a positive outcome, 98% of the time on our boats by most of us is spent in places where we have as good access to medical care as many shopping malls.

Again, every study has shown the same thing. One of the latest published by the Journal of the American College of Cardiology showed similar results. In short, looking only at out-of-hospital arrests, 9% of patients survived to hospital discharge if they received CPR only. 38% survived to discharge if an AED shock was delivered prior to EMS arrival.

The study is here:
Survival After Application of Automatic External Defibrillators Before Arrival of the Emergency Medical System: Evaluation in the Resuscitation Outcomes Consortium Population of 21 Million -- Weisfeldt et al. 55 (16): 1713 -- Journal of the American

For me and my wife, we'll go for the 38%.

[psneeld]

Originally Posted by ActiveCaptain

OK...I'm finally done. This is my last posting in this thread.

My opinion is that there has been good discussion here to bring up a lot of information. But I also think there has been some very bad information relayed. I'd go so far as to call some of it irresponsible.

Study after controlled study shows statistically that AED's save lives. While I agree totally that an AED application offshore might not have a positive outcome, 98% of the time on our boats by most of us is spent in places where we have as good access to medical care as many shopping malls.

Again, every study has shown the same thing. One of the latest published by the Journal of the American College of Cardiology showed similar results. In short, looking only at out-of-hospital arrests, 9% of patients survived to hospital discharge if they received CPR only. 38% survived to discharge if an AED shock was delivered prior to EMS arrival.

The study is here:
Survival After Application of Automatic External Defibrillators Before Arrival of the Emergency Medical System: Evaluation in the Resuscitation Outcomes Consortium Population of 21 Million -- Weisfeldt et al. 55 (16): 1713 -- Journal of the American

For me and my wife, we'll go for the 38%.

Don't give up!!! Internet info is just info...we all have to expand further on it to see if any, all, etc is valid. Anyone that takes internet forums for gospel...well probably needs a good jolt from an AED.

I love the notion that there's probably more cruisers out there that know more about medical care than properly installing a through hull!

[Pete7]

Originally Posted by psneeld

Don't give up!!!

If you don't mind me quoting you totally out of context, this piece of advice was always rammed home when we were doing first aid training.

I agree with Mario, there may be underlying causes and normally you might consider age and life style but equally they could be electrocution, drowning or even an impact injury. There is a world of difference between an elderly patient in a hospital with serious underlying problems who is at the end of their life and someone you might find sailing whose time isn't up yet. Don't give up.

Pete

[IrishLass]

Okay .... I cannot take it anymore. I have to have one final post and ask this question for the THIRD time. For those of you who so adamantly oppose AED use at sea for your stated reason being .... because the patient is more than minutes [and maybe hours or days] from a level I treatment facility for the required follow-up care ---- what is your suggested action plan for those who are onboard and witness an apparent heart attack (MI)?

Please .... the obvious statements about underlying conditions, the need for immediate transport, etc.... do not warrant repeating. They are just that -- OBVIOUS. But again .... we are trying to address the best way to deal with life and death issues at sea. This is the Cruisers Forum, is it not? If you have a suggested alternative plan of action or best practice, I would be very grateful to hear it. However, my years of clinical practice suggest that this (CPR/AED/First Aid Training/Medical Kit) is the best option for the lay person. I cannot, in good consciousness, suggest that a person sit by and do little or nothing when they witness what appears to be a heart attack.

So, what is your suggested action plan?

[s/v Moondancer]

I am a cardiac anesthesiologist who has been present for 3,000 defibrillations, 2,000 with the chest open and the heart in full view. I have read the medical studies and accept that 'blind' defibrillation saves lives and improves outcome. I also know that even though I sail 4,000 miles a year I spend most of my time at anchor no more that an hour from a hospital.

I repeat my previous statements;

We do not have a defibrillator but will buy one if either of us becomes a member of a high risk group. But being a 62 yr-old western male might already place me in a high risk group!

[mario f]

what is your suggested action plan for those who are onboard and witness an apparent heart attack (MI)?

So, what is your suggested action plan?

Your mate appears pale a bit diaphoretic and complaint of chest pain. He is 45yo with no known medical history. You are cruising 10 miles of the coast, minimal medical training (layman). We are talking lay person right?
(by no means all inclusive, nor meant for medical advice)
Lay the person down, elevate legs, loosen clothing. If you by chance carry oxygen, administer it (if you carry I hope you know how to use when, whom, where, rate). No known hx and no medications he is on . do you have bp cuff/stethoscope. Take a radial pulse (rate, quality, rhythm)
Bp 115/70, pulse weak, irregular 50bpm, respirations shallow 10bpm

Make your distress call relay information and continue to monitor.

ABC- Airway, Breathing, Circulation - in that order, place head/body in position to maintain open airway - air is going in and out - you have a pulse you have circulation. All is well for now. Ok you have IV supplies, start one(if you have it I hope you know how to use it, type of fluid, rate, complications, signs, symptoms…)

If he stops breathing you breath for him. If the pulse stops, start pumping for him. Keep calm, warm, etc. CPR
call relay information and continue to monitor. Wait for rescue.

AED in place the little voice said shock advised, does its thing three times, results in systole. Start CPR. call relay information and continue to monitor. Wait for rescue.

My fear with AED in this situation….1. Signs and symptoms could be cardiac, could be a vagal response, can epigastria, dehydration… do you know ?
Shock advised because of rhythm or faulty cables or pad placement( I have wiggled cables on AED to shock when I wanted and not the machine, they can be fooled easily)
With your assessment skills do you feel comfortable making that decision or better yet letting a machine that knows no more than 1’s and 0’s ?
Or the outcome can be your mate survives and you saved a life.
As with everything else sailing there are a lot of variables and chances we take when we sail and encounter medical emergencies.

It is your decision your money, just make it a well informed one.
By the way what would a cardiologist do in the same situation? Not much different than you...ABC's
Fair winds,

Mario

[osirissail]

Originally Posted by mario f

what is your suggested action plan for those who are onboard and witness an apparent heart attack (MI)?. . .

Make your distress call relay information and continue to monitor. . . .
Mario

Here's where the idea of having an AED and reality clash big time. I was sailing south down the eastern coast of the USA passing by Jacksonville when up on the radio comes a MayDay call from a sport fisherman boat.
- - The person on the radio was a friend of the owner and had never been out before. He only knew that to talk on the radio you squeezed the microphone and spoke into it. After a minute of hysterical screaming into the microphone the USCG answers and asks him to switch channels. No way this guy can do that. So the whole thing plays out on channel 16.
- - The guy shouts that the captain is lying on the deck and looks like he had a heart attack. So the USCG proceeds to spend literally 30 minutes asking the guest 50 questions (+/-) about the boat, where it is registered, the colors, how many people are on board, is everybody wearing their PFD's to which the guy asks "what's a PFD." It goes on and on while the guy is screaming that his friend is having a heart attack and he needs help - now! That didn't phase the USCG radio operator and he keeps asking questions.
- - Luckily, just a few miles away was a US Naval warship who was also listening in to this travesty and came up telling the poor guy they are dispatching a medic and fast boat to help him and for the USCG to forget it.
- - So from the professionals answering on these CF threads, the scenerario's where an AED might be of some use seem to also require immediate follow up with advanced medical care within a very limited time span which is simply not available if you are more than a stone's throw from a marina dock.
- - I sense a thread of thought amongst the pro-AED on board folks that these "wonder-machines" can do everything and anything all by themselves and like in the movies, nothing else is needed. Real life isn't that way. Stopping CPR, etc. for 30 minutes to answer a litany of stupid questions while on the radio probably guarantees your buddy will be dead by the time you get off the radio. Then it's going to be another hour - plus before any responders can get a boat/helo/whatever underway to you.
- - Common sense dictates that if you have a history of bad health you stay on land. Or, you accept the fact that you may expire offshore but with a smile on your face and a tiller in your hand and the wind behind you. That is your free-will choice. Just be sure anybody with you knows how to get the boat back to land safely.

[boatman61]

Originally Posted by osirissail

Here's where the idea of having an AED and reality clash big time. I was sailing south down the eastern coast of the USA passing by Jacksonville when up on the radio comes a MayDay call from a sport fisherman boat.
- - The person on the radio was a friend of the owner and had never been out before. He only knew that to talk on the radio you squeezed the microphone and spoke into it. After a minute of hysterical screaming into the microphone the USCG answers and asks him to switch channels. No way this guy can do that. So the whole thing plays out on channel 16.
- - The guy shouts that the captain is lying on the deck and looks like he had a heart attack. So the USCG proceeds to spend literally 30 minutes asking the guest 50 questions (+/-) about the boat, where it is registered, the colors, how many people are on board, is everybody wearing their PFD's to which the guy asks "what's a PFD." It goes on and on while the guy is screaming that his friend is having a heart attack and he needs help - now! That didn't phase the USCG radio operator and he keeps asking questions.
- - Luckily, just a few miles away was a US Naval warship who was also listening in to this travesty and came up telling the poor guy they are dispatching a medic and fast boat to help him and for the USCG to forget it.
- - So from the professionals answering on these CF threads, the scenerario's where an AED might be of some use seem to also require immediate follow up with advanced medical care within a very limited time span which is simply not available if you are more than a stone's throw from a marina dock.
- - I sense a thread of thought amongst the pro-AED on board folks that these "wonder-machines" can do everything and anything all by themselves and like in the movies, nothing else is needed. Real life isn't that way. Stopping CPR, etc. for 30 minutes to answer a litany of stupid questions while on the radio probably guarantees your buddy will be dead by the time you get off the radio. Then it's going to be another hour - plus before any responders can get a boat/helo/whatever underway to you.
- - Common sense dictates that if you have a history of bad health you stay on land. Or, you accept the fact that you may expire offshore but with a smile on your face and a tiller in your hand and the wind behind you. That is your free-will choice. Just be sure anybody with you knows how to get the boat back to land safely.

Amen..............

[PamlicoTraveler]

Originally Posted by ActiveCaptain

The study is here:
Survival After Application of Automatic External Defibrillators Before Arrival of the Emergency Medical System: Evaluation in the Resuscitation Outcomes Consortium Population of 21 Million -- Weisfeldt et al. 55 (16): 1713 -- Journal of the American

For me and my wife, we'll go for the 38%.

Jeff puts it correctly I think. And his study is people from the Mayo Clinic and John Hopkins and others accessing the effectiveness of contemporary automatic external defibrillator (AED) use. It doesn't get more credible than that.
That said, I am sure a defibrillator is not a cure for a heart attack, but if it helps you survive, why not have one.

Also, what osirissail mentions with the CG is a big problem. I have heard this happen on a less catastrophic scale.

The guy shouts that the captain is lying on the deck and looks like he had a heart attack. So the USCG proceeds to spend literally 30 minutes asking the guest 50 questions (+/-) about the boat, where it is registered, the colors, how many people are on board, is everybody wearing their PFD's to which the guy asks "what's a PFD." It goes on and on while the guy is screaming that his friend is having a heart attack and he needs help - now! That didn't phase the USCG radio operator and he keeps asking questions.

Often an operator is a rookie and is told to go through a checklist rather than use his/her brain to evaluate the situation at had.

[ActiveCaptain]

Originally Posted by PamlicoTraveler

Also, what osirissail mentions with the CG is a big problem. I have heard this happen on a less catastrophic scale.

Damn. It would have been so much cooler if I actually didn't come back. Seriously, this is my last.

I'm sure that emergencies involving the CG depend heavily on the specific CG personnel at the microphone. But to think that the scenario described is common is quite contrary to my direct experience.

Sure, someone has engine trouble, calls for the CG on channel 16 and we've all heard to silly list of questions get fired off from "are you taking on water" to "what did you have for lunch". I just haven't ever seen that in a medical emergency situation.

I've been involved with 3 emergencies on the water as an EMS responder where the CG was involved. In two cases, I called the CG and in one case, they called me/us. In those 3 instances, they were extremely professional, direct, and helped the situation. In all 3 cases, having it become a medical emergency bumped the response to someone else standing by. There was never the list of questions asked until after everything was over - except for the proper EMD (911 type of dispatch training) questions. In 2 cases, I called back the CG hours later to provide extra information for their reporting.

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 ********.

[psneeld]

Originally Posted by PamlicoTraveler

Jeff puts it correctly I think. And his study is people from the Mayo Clinic and John Hopkins and others accessing the effectiveness of contemporary automatic external defibrillator (AED) use. It doesn't get more credible than that.
That said, I am sure a defibrillator is not a cure for a heart attack, but if it helps you survive, why not have one.

Also, what osirissail mentions with the CG is a big problem. I have heard this happen on a less catastrophic scale.




Often an operator is a rookie and is told to go through a checklist rather than use his/her brain to evaluate the situation at had.

Usually this is not what really happens...while some young radio operator is going through some checklist that was forced upon the USCG but a suit happy legal system...the real backbone of the USCG is already springing into action.

While it may happen on occasion...the vast majority of rescue responses aren't waiting for the finish of the checklist. MEDEVACs can be tricky...because as is being pointed out...a helo crew that waits for a flight surgeon and medic with the right tools/medecine and arrives just shortly after the guy has been defibbed...then what's the outcome? Yes... US coastal waters...but that's where a huge number of cruisers are...

Based on some opinions here...no need to even launch the helo...you are just gonna die anyhow.

[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!

[capngeo]

Just because everyone else is having a LAST POST in this thread, I wanted to jump on the bandwagon.......

• An AED is an expensive machine.... If you are the type that blows $3K on a sextant: By all means PLEASE feel free to buy an AED as well... it can't hurt!
• The alternative for the rest of us poor folks is learning GREAT CPR TECHNIQUE and investing <$100 in BLS adjuncts
• Spend the $1200 you would have spent on the AED on a damn good radio system with a distress feature built in... At least IT can still keep radioing for help while you are doing your GREAT CPR
• For the average cruiser, in average situations, an AED is a waste of money

The AED is not a panacea. If you routinely sail in excess of 30 minutes from ALS (USCG/ Fire-Rescue whomever) assistance the patient's survival is EXTREMELY unlikely... AED or not! Why do I say this???? BECAUSE Even a person in good physical condition on stable ground (not a pitching boat) has difficulty performing GREAT CPR for more than 30 minutes... BTDT, I know!

Now if you routinely sail coastal areas, or spend 90% of your time dockside, and have a bunch of extra cash... BUY an AED; It might save my life.