Medical Emergencies at Remote Cruising Destinations

[Kenomac]

Originally Posted by Ann T. Cate

Yes, but was that for demonstrating that you did all that was possible for the courts? or was it for the infinitesimal chance it might save someone's life?

Ann,

It has nothing to do with legality or the court systems, nor is it for some " infinitesimal chance." But it has everything to do with getting someone who has a potentially fatal arrhythmia back into a productive sinus rhythm. Not all heart attacks are created equal as I and others have explained many times on this forum to the anti-AED crowd. For those attacks which involve a blocked coronary artery or involve a pulmonary embolism (which in most cases presents itself as a heart attack)... nothing can be done.... they're dead, light's-out. :-( But in many other cases, the heart which is simply not pumping efficiently due to an arrhythmia, the AED will be able to diagnose and treat the problem. Life saved! :-)

So... if you happen to be one of the unfortunate individuals who suffer from an arrhythmia (a not-so-uncommon heart problem), would you rather be on our AED equipped boat when it happens.... or buried at sea?

[StuM]

Originally Posted by Kenomac

Every time I glance at your forum name without my reading glasses I see Michael Fuggle. LOL

Mr. Fuggle, here is your "'55 Sloop" located at present?

"Muckle Flugga is a small rocky island north of Unst in the Shetland Islands, Scotland. It is often described as the northernmost point of the British Isles"

[Kenomac]

Originally Posted by StuM

"Muckle Flugga is a small rocky island north of Unst in the Shetland Islands, Scotland. It is often described as the northernmost point of the British Isles"

With my reading glasses on, he is a "small rocky island." Without the glasses... he is Michael Fuggle.

[Muckle Flugga]

Originally Posted by mcarling

I don't recall any mention of legal liability as a reason, but my memory is not what it used to be. Certainly there are some causes of heart stoppage that will result in death without timely hospitalization that a defibrillator will not prevent, but there are others for which defibrillation will suffice.

In the 1970s, I saved a choking victim using CPR. That was before defibrillators were used outside hospitals. Hospitalization was not required. A defibrillator might have saved the victim several broken ribs and reduced the extent to which the brain suffered from lack of oxygen.

I don't believe the chance that a defibrillator might save someone's life at sea is necessarily infinitesimal. I would be infinitesimal if the cause is arterial blockage, but not for other some causes.

Another point is that defibrillators have improved a lot in recent years. They now have much better auto-diagnostic capabilities than they had 5-10 years ago.

Not wishing to be pedantic, and well done for saving a life, but this seems rather muddled. Defibrillators electrically intervene in the condition of ventricular fibrillation, which is an abnormal electrical state preventing proper electrical regulation and synchronisation of cardiac cells, resulting in a chaotic, extremely rapid and uncoordinated contraction of heart muscle and therefore the failure of the pumping action. The electrical impulse of an AED may sometimes reset the abnormally firing cells and allow them to resynchronise. Your story involves choking, which is not a cardiac event, but I suppose may lead to loss of oxygen to the heart and therefore coronary damage due to anoxia, but this is quite a different event. Equally CPR may assist in supporting a heart which has undergone trauma due to choking, but CPR and defibrillation are two entirely different things. Since you appear to confuse them (perhaps I am misinterpreting?) I am now wondering whether you are quite clear on the MCA advice? It is obviously the case that CPR, oxygen therapy, the use of nitroglycerin etc. can be useful in cardiac support even in remote areas. The latter type of intervention is what you describe in your experience. The use of an AED/defibrillator is really very different and treats what is generally an entirely different issue. CPR is thought to have little effect on ventricular fibrillation. So no, the defibrillator would not have saved your patient from the injuries they sustained in your CPR related actions. They would have had no effect at all, likely, and would have distracted from CPR, so possibly resulting in death. This at least is my understanding of the facts. Perhaps I am missing something about this particular case?

[Muckle Flugga]

Originally Posted by StuM

"Muckle Flugga is a small rocky island north of Unst in the Shetland Islands, Scotland. It is often described as the northernmost point of the British Isles"

Exactly, it is the true Northernmost part of the British Isles at 60 Deg 48 Min N (well, part of the same formation as technically there is a small rock, the Out Stack, to the North of it, a stones throw away) and it is one of my favorite sailing vistas. It represented an early sailing achievement of mine in my first owned sailing vessel, and always has a place in my heart. It comes from the Old Norse meaning "Big Rock" or "big steep islet". Attached is a photo of Muckle Flugga I took around 12 years ago rounding her just before a powerful Westerly gale had me beating into Balta Sound to be locked down there for 4 days. And Ken, currently Thailand.

[Paul L]

Originally Posted by Kenomac

I don't agree. There are some cases where a heart simply needs to be shocked back into a rhythm. Think in terms of a pacemaker with a built in defibrillator. We have an AED onboard for this sort of circumstance. I agree that a complete heart stoppage caused by a blockage cannot be revived using an AED. But how does one know ahead of time which type of heart attack someone plans to have onboard your boat?

Sounds like you plan to allow someone who can easily be saved "to die with dignity" onboard your vessel instead of trying to do much of anything. Bravo.

I happen to know of several people who've been saved using an AED. One is a fellow registered nurse who essentially died at age 32 but was brought back to life five minutes later by emergency services using their brand new AED. She's still a nurse and doing just fine now at age 49.

How would she have done on your boat? Burial at sea ... I suppose?

If you or crew had known arrhythmia issues and did not already have an implanted defib then I could see having an AED onboard. But that's a long way from a general suggestion that offshore cruisers should have one - which is what many of the posts here sound like. In any case we are talking very small numbers of victims and even smaller number of survivors. As you said, the heart blockage type heart attack has very low positive outcomes in a remote environ!ment.

[GoingWalkabout]

A few corrections of fact are warranted.

1. Cardiac fibrillation is one of the most common heart events that left will lead to death. An AED will in almost all cases lead to a recovered normal heart state.

2. If more than one person is available to attend then CPR should be initiated immediately while the other person is fetching and preparing the AED. Minutes matter. Applying immediate CPR causes already oxygenated blood to circulate in the brain reducing that chances of brain damage. This immediate CPR advise is from the American Heart Assiciation.

3. I would also have in my kit a mouth piece for hygienic mouth to mouth and administer mouth to mouth at the same time as CPR by another person if at all possible. But the main thing is to get onto the chest ASAP.

4. Apply the AED and let it read the heart and automatically shock if required.

5. If you have oxygen on board administer. Oxygen has been shown to have repairative results to the heart muscle.

6. Mayday Coast Guard and ships if offshore. This should be being done ASAP by someone not involved in the resuscitation.

7. Arrange for transportation to a hospital by the quickest means available.

8. If offshore beyond Coast Guard flight range keep hailing merchant ships for assistance. Some have better equipped medical facilities onboard.

9. Important. Keep AED leads attached in case of second or third event.

I will conclude by saying that it is the duty of all trained medical persons to Do No Harm. I would suggest that you may well decide it isn't worth the trouble to have an AED but talking others out of it in my view goes against doing no harm.

[jackdale]

Originally Posted by GoingWalkabout

6. Mayday Coast Guard and ships if offshore. This should be being done ASAP by someone not involved in the resuscitation.

Use a sat phone (if available) to call the nearest Rescue Coordination Center to speak to their fight surgeon. The RCC can contact the nearest appropriate AMVER volunteer vessel and arrange for a rendezvous.

[Paul L]

Originally Posted by GoingWalkabout

A few corrections of fact are warranted.
...............I will conclude by saying that it is the duty of all trained medical persons to Do No Harm. I would suggest that you may well decide it isn't worth the trouble to have an AED but talking others out of it in my view goes against doing no harm.

So are you then recommending that all cruising boats have an AED onboard? I just picked this off the NIH site

Among the total US and Canadian population the AED would be expected to save 474 lives per year.

We are really talking small numbers here. There is a lot of push on CF to get safety offshore by buying technology. It isn't always a cost-effective tradeoff. The money and time spent on a better remote medical care training would probably a lot more effective.

[GoingWalkabout]

Originally Posted by Paul L

So are you then recommending that all cruising boats have an AED onboard? I just picked this off the NIH site

We are really talking small numbers here. There is a lot of push on CF to get safety offshore by buying technology. It isn't always a cost-effective tradeoff. The money and time spent on a better remote medical care training would probably a lot more effective.

Yes Paul. I would encourage all sailors and power boaters to have an AED as well as complete a Red Cross course. I don't think though that it should be required by Government mandate. I'm apposed to that kind of thing.

As far as safety trade offs and best economic return it is my view that such thinking has no place in medicine. I know. It is the way hospital administrators now think and the way national government health planners think. But it's not the way I think. Every life is worth whatever you can do to save it. Heaven help us if the Coast Guard ever started to think along the lines of cost benefit analysis like so many beauracrats and even some doctors think of providing life saving services these days.

Did you know that hospital administrators in Australia are told not to allow overly expensive intervention in the ER or ICU if the person is over 55 with the exception of VIPS. This policy was implemented some 17 years ago based on the cost benefit to society. The beauracrats had worked out that if 55 or older your ability to contribute economically to society was greatly reduced (paying taxes ) therefore it didn't make economic sense to spend an awful lot of money on you. So when I hear people talking about cost benefits when it comes to saving lives I get very upset.

[GoingWalkabout]

Originally Posted by jackdale

Use a sat phone (if available) to call the nearest Rescue Coordination Center to speak to their fight surgeon. The RCC can contact the nearest appropriate AMVER volunteer vessel and arrange for a rendezvous.

I agree if you have one.

[anacapaisland42]

To add another dimension to this conversation, I just heard, on the radio, that if you had a heart attack/stroke/cardiac event and you live on the 1st/2nd floor of a high rise your chances of survival are 4.8%.
However, if you live on the 3rd floor or above your chances drop to 2.6%.

Now how that relates to a boat

Bill

[DumnMad]

Originally Posted by GoingWalkabout

Yes Paul. I would encourage all sailors and power boaters to have an AED as well as complete a Red Cross course. I don't think though that it should be required by Government mandate. I'm apposed to that kind of thing.

As far as safety trade offs and best economic return it is my view that such thinking has no place in medicine. I know. It is the way hospital administrators now think and the way national government health planners think. But it's not the way I think. Every life is worth whatever you can do to save it. Heaven help us if the Coast Guard ever started to think along the lines of cost benefit analysis like so many beauracrats and even some doctors think of providing life saving services these days.

Did you know that hospital administrators in Australia are told not to allow overly expensive intervention in the ER or ICU if the person is over 55 with the exception of VIPS. This policy was implemented some 17 years ago based on the cost benefit to society. The beauracrats had worked out that if 55 or older your ability to contribute economically to society was greatly reduced (paying taxes ) therefore it didn't make economic sense to spend an awful lot of money on you. So when I hear people talking about cost benefits when it comes to saving lives I get very upset.

If you care that much about saving lives you would be firing al your energy into lowering the road toll and speed limits. (Do you have shares in medical equipment?)

[GoingWalkabout]

Originally Posted by anacapaisland42

To add another dimension to this conversation, I just heard, on the radio, that if you had a heart attack/stroke/cardiac event and you live on the 1st/2nd floor of a high rise your chances of survival are 4.8%.
However, if you live on the 3rd floor or above your chances drop to 2.6%.

Now how that relates to a boat

Bill

It is all about minutes.

[Paul L]

Originally Posted by GoingWalkabout

Yes Paul. I would encourage all sailors and power boaters to have an AED as well as complete a Red Cross course. I don't think though that it should be required by Government mandate. I'm apposed to that kind of thing.

As far as safety trade offs and best economic return it is my view that such thinking has no place in medicine. I know. It is the way hospital administrators now think and the way national government health planners think. But it's not the way I think. Every life is worth whatever you can do to save it. Heaven help us if the Coast Guard ever started to think along the lines of cost benefit analysis like so many beauracrats and even some doctors think of providing life saving services these days.

Did you know that hospital administrators in Australia are told not to allow overly expensive intervention in the ER or ICU if the person is over 55 with the exception of VIPS. This policy was implemented some 17 years ago based on the cost benefit to society. The beauracrats had worked out that if 55 or older your ability to contribute economically to society was greatly reduced (paying taxes ) therefore it didn't make economic sense to spend an awful lot of money on you. So when I hear people talking about cost benefits when it comes to saving lives I get very upset.

You are clearly on the side of going to the nth degree to attempt to save anyone medically barring no expense - even the expense of being prepared for an unlikely event. Since this is a cruising site, how does that follow on with the number of EPRIBs and liferafts and MOB Starts you should have onboard - is one enough or should we really have backups for all -- maybe a few backups for the backups . We all make cost-benefit analysis when setting up and maintaining a cruising boat -- OK there are a few with unlimited funds, but that is not any where near the majority out cruising. It is all about risk management -- in the end with medical care or not, we all get out of here the same way.