Medical Emergencies at Remote Cruising Destinations

[hellosailor]

"Ehats the percentage of people who recover after their heart has stopped? About 10%. Doesnent matter of you"
Funny thing, Mark. Just about everyone in the business of teaching emergency response, including the AMA, says that there is a very simple and straightforward reason for that. If someone's heart stops (or goes wacky enough to be useless anyway) their odds of survival are 100% if you can restart it immediately. And then they decline by 10% per minute, so that if they have not been restarted (or given CPR) by the end of ten minutes, their chances of ever coming alive again are zero.


Give them a restart in 4 minutes, and they've got a 60% chance of coming out OK. In five minutes, that's down to 50%, and the chance of brain damage from lack of oxygen is now significant.


But ten percent? Could well be that only 10% survive, because in most places if you drop dead from a heart attack, no one will be immediately available to 'restart' you in any case. Which is the reason for portable defibrillators and AES training. Get that "golden window" down to a paltry two to four minutes, including time to realize that someone is down, figure out why they are down, call for help, retrieve the box....
I know one office where they were very proud to have one installed. Except, the sign was at the reception desk and just pointed "that way" for the box, which was around the corner down the hall, so it wouldn't clutter up the reception area. Where no one knew how to use it, anyway.

Is it likely to be a needed and good investment for a cruising boat? Heck no. But then again, neither is the average life raft. I don't think many of us have ever had a real use for that, either.


An epipen would probably be a much better investment. Although, even those have gone from $20 to $200, for something most of us will never need.

[Paul L]

Originally Posted by hellosailor

"Ehats the percentage of people who recover after their heart has stopped? About 10%. Doesnent matter of you"
Funny thing, Mark. Just about everyone in the business of teaching emergency response, including the AMA, says that there is a very simple and straightforward reason for that. If someone's heart stops (or goes wacky enough to be useless anyway) their odds of survival are 100% if you can restart it immediately. And then they decline by 10% per minute, so that if they have not been restarted (or given CPR) by the end of ten minutes, their chances of ever coming alive again are zero.


Give them a restart in 4 minutes, and they've got a 60% chance of coming out OK. In five minutes, that's down to 50%, and the chance of brain damage from lack of oxygen is now significant.


But ten percent? Could well be that only 10% survive, because in most places if you drop dead from a heart attack, no one will be immediately available to 'restart' you in any case. Which is the reason for portable defibrillators and AES training. Get that "golden window" down to a paltry two to four minutes, including time to realize that someone is down, figure out why they are down, call for help, retrieve the box....
I know one office where they were very proud to have one installed. Except, the sign was at the reception desk and just pointed "that way" for the box, which was around the corner down the hall, so it wouldn't clutter up the reception area. Where no one knew how to use it, anyway.

Is it likely to be a needed and good investment for a cruising boat? Heck no. But then again, neither is the average life raft. I don't think many of us have ever had a real use for that, either.


An epipen would probably be a much better investment. Although, even those have gone from $20 to $200, for something most of us will never need.

In the context of remote medicine, such as cruisers out in remote areas, you are overstating the stats. While those stats are based on time to getting initial help they also include getting the patient quickly to an equipped trauma center. Without the additional treatment given in the immediately following hospitalization, the stats would look much, much worse. In addition stats are usually based on a success being the patient was discharged from the hospital -- those that go to a nursing home, with limited mental or physical capabilities are all put in the success column.

On the OPs subject, When cruising in remote areas you certainly take some additional cautions. We tend to try and have another dinghy with us when we are in sketchy diving areas. We always try and find out what nasties are in the area, land and sea, before we show up. Excellent book on inderstanding specifically what dangers lurk in the tropical sea and treating them is All Stings Considered.
For me I think our biggest risk is taking third world (and some 2nd world) taxis.

[chuckr]

I was a isolated duty medic in the Air Force and became a backcountry EMT in Idaho with Mountain Search and Rescue.
Now out 8 years and around the entire Caribbean and now in the Med - I was more worried about a medical issue in the backcountry or high in the mountains than I am out here. In the backcountry you can only carry a limited medical stuff but on a boat we carry a lot including some prescription drugs for emergencies that we get refreshed on occasion when we go to docs in various countries for routine stuff.
I am allergic to aspirin and there is no way anything containing asa is allowed on this boat and I wear a bracelet for it. When I was in no where Tunisia got a bad tooth ache and went to pharmacy where no one spoke English and showed the guy my bracelet and he smiled and nodded his head and gave me some stuff that contained no asa.

I have been stung by a lion fish in Panama in the San Blas and a lot of hot water worked to kill the poison.

[rabbi]

Originally Posted by Saleen411

BTW, I'm not trying to make a big deal about sting ray injuries.....I know they are rarely fatal. My concerns are things like anaphylactic and septic shock from exposure to a plethora of bad stuff. Years ago my ex wife would have died from the former if not for IMMEDIATE medical treatment.

So many critters, so many toxins.....

The worst we ever had happened was coral scratches that needed some good treatment. And the odd broken little toe (myself and sister in law) but there is not much one can do about that anyway.

My biggest concern was dehydration of the kids. They were 3 and 4 when we left so two days of vomitting in tropical sun could have cause severe issues. So we had some liters of medical NaCl solution with us and the equipment and knowledge to apply it.


Maybe something like the "Anapen" might reduce your concern on the anaphylactic shock. They have a limited shelf life and are not exactly cheap.
Our doc introduced it to us and showed us how & when to use it.

Our doc was very helpful when preparing for our trip (and envious). He also gave me his private mobile number so I could call him day & night which we luckily never had to use.

[rabbi]

Originally Posted by Paul L

For me I think our biggest risk is taking third world (and some 2nd world) taxis.

+1

...and most other forms of public transport

[hellosailor]

" dehydration...medical NaCl solution"
Back in the 60's the answer to dehydration was indeed water and salt tablets, every gym coach knew that.
Except now, we know that the electrolytes should be a little more complex than just salt. The UN standard recipe includes basically citrate and potassium salt. And then, you need a great deal of sugar in order to trick the intestinal wall into thinking this is "nourishment" or else most of the water, or salted water, is simply flushed out of the system. The UN standard hydration recipes (old or new) are online in many places, but you can also easily pack a couple of liters of a Pedialyte type product, each being sterile and sealed.
The sports drinks ("Food don't come in that color!") have questionable additives, not to mention, often two days worth of sugar in one bottle. Not designed for use outside the stadium, really.
The standard hydration mix, self-made, tastes totally unappealing. But it is cheap, and way more effective than just drinking water, fwiw. Even for a healthy sailor on a hot humid day, just trying to bottom sand the boat.(G)

[dilligaf]

We carry a full medical kit and a defib. so when in distant places in the South Pacific with no medical help we can call on the Sat phone or Hf and get instructions for using the kit. We have also had some good training in.
Aside from the Kit, we also subscribe to Divers Alert Network for evac. of distant places with no medical help and to fly/ship to a Good Hospital. You don't have to be a Diver to buy the insurance.

[dwedeking2]

Outsiding is scary. Thank god for Xbox.

[rabbi]

Originally Posted by hellosailor

" dehydration...medical NaCl solution"
Back in the 60's the answer to dehydration was indeed water and salt tablets, every gym coach knew that.

My worry was about our small kids getting diarrhea and vomitting, possibly in combination with seasickness. Situations in which oral application would be pretty much useless. Something like that far away from civilization (e.g. in the middle of the Atlantic) could be a desaster. Small kids in tropical climate have a relatively short period before dehydration becomes a serious (read: deadly) problem.


We had medical NaCl solution with us including the equipment for subcutaneous infusions (plus the knowledge how to do that).

That plus the anapen was the only special medical equipment we took with us.

Everything else was just normal stuff: Painkillers, some antiseptics and antibiotics, wound equipment like clip plasters, bandage, etc

Of course we did not use anything except local antiseptic and antibiotic ointments.

[MarkJ]

Originally Posted by hellosailor

"Ehats the percentage of people who recover after their heart has stopped? About 10%. Doesnent matter of you"
Funny thing, Mark. Just about everyone in the business of teaching emergency response, including the AMA, says that there is a very simple and straightforward reason for that. If someone's heart stops (or goes wacky enough to be useless anyway) their odds of survival are 100% if you can restart it immediately.

"less than eight percent of people who suffer cardiac arrest outside the hospital survive."
http://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRFirstAid/CPRFactsAndStats/UCM_475748_CPR-Facts-and-Stats.jsp

If you have stats/research to show AED is different please post the link.
Anyway for me its not much use ... solo sailor

[Kenomac]

Originally Posted by MarkJ

"less than eight percent of people who suffer cardiac arrest outside the hospital survive."
CPR Facts and Stats

If you have stats/research to show AED is different please post the link.
Anyway for me its not much use ... solo sailor

Mark,

You first need to fully understand the various reasons why a heart stoppage takes place before posting an opinion so broad opposing the use of an AED. The opinion of the other poster claiming 100 percent success is way off, but so is 10%.

[anacapaisland42]

I did read somewhere, about sandals that have really tough soles would be ideal for the water.
Bill

[hellosailor]

Since no AED's are actually going to be deployed and used within that first minute--you're right, 100% is unlikely. Nevertheless, the CPR instructors all teach that you start at 100% and lose 10% every minute as it goes by. So, after just a one minute delay to unpack the AED and tear open the victim's shirt? Right, you're starting at 90%.


Ten percent overall? Dunno. There must be some basis for all the courses re-iterating that you start with a 100% chance, and after ten minutes that's neatly down to zero.


Rabbi, if you were planning on an IV for dehydration....I think that's also a symptom of what's wrong with western "hospital medicine". The hospitals and EMT's all like to start an IV line and pretty much all charge over $100 per liter for the Ringer's or plain saline that costs them $1 per liter. Nice profit margin, but IF the patient is conscious and able to imbibe? You save a lot of pain and eliminate the chances of infection and bad punctures by making haste slowly. If the patient can drink, the fluid can be gotten in orally, especially if you've started in a timely manner.
If the patient is already collapsed and unconscious...that's something else again.


Our "Western medicine" gets carried away with thoughts of zebras and unicorns, when sometimes, the hoofbeats just mean horses.


IVs and oxygen...two of the many things they are very fast to apply, even when the studies and literature say there's no need or benefit to them. But great profit.

[seasick]

I tell all of those interested in long distance cruising to first get their general class Ham license or at least the transceiver. This augments a complete medical kit very nicely and allows a person not only to get the answers they need in a hurry but often to get help and to document in real time what the nature of the emergency is lest the injured dies.

Can't recommend practicing enough. Practice stitching up your chicken before cooking it. Read emergency medical manuals from cover to cover and understand them. Correct diagnosis is paramount and so many ailments present similar symptoms that having the opinion of doctors hundreds of miles away is more than prudent.

[Canibul]

A ship in harbor is safe, but that is not what ships are built for.
John Shedd.