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Therapy · 14-02-2015, 13:21

If having an AED with it's costs on an Oyster 53 makes you feel better go ahead. You can afford it.

The percentages of need > use > results are astronomically low, but go ahead with your argument about which boat one would prefer to fall off of.

I would spend on other things.

Plus. Read the to-have or not-to-have a life raft thread. Same stuff.

In years here and many other forums, blogs, web pages etc I have never heard of a single case where an AED was needed, wanted or used. Maybe yours will be the first so the cost can be justified.

Statistics do mean something.

Yes I have done CPR multiple times. Even while cardiac output was being measured - no one else could perfuse for squat so I ended up "on it" for 45 min of the hour plus. I know that is horn-tooting but I want you to know my qualifications. I have only broken ribs on one. Nope, none of them survived. I will admit all were in-house patients though.

The post about just how much mitigation for what type of emergency one plans and equips for is accurate.

The old adage about if it saves one life (yours maybe!) it is worth it no matter the cost simply does not work in the real world.

Kenomac · 14-02-2015, 13:59

I guess every medical emergency involving a cardiac arrest is different, no way to really come up with good statistics to apply across the board. If gathering data on the effectiveness of an AED in a hospital environment, the statistics will be skewed based on the poor health and pre existing ailments of the hospital patients who arrest. I remember once doing CPR for 20 minutes on a 90 year old woman in the hospital.... like that was really going to work, but the family insisted on her full code status.

Or if the statistics are gathered from an EMT perspective, where the AED and CPR don't even begin until the person is already clinically dead from having been without oxygen to the brain for usually 10 minutes..... Basically, as my brother the ER nurse pointed out... most emergency services are just trying to resurrect dead people. But it seems to make the taxpayers and family feel good, plus looks good on TV.

So we'll see.... not looking for magic from the unit, just a fighting change for a some unfortunate nearby person who suffers an arrhythmia, electrical shock or drowning. If someday the worst happens and someone is able to be revived, then our statistical success rate will be 100%, if they don't survive.... at least we tried and they had a chance.... even if it was a small one.

Cheechako · 14-02-2015, 14:41

Just read today that only 8% of CPR are successful and a large percentage of those saved survive only with continuing mechanical/medical help. Written by a doctor; he specifies to NOT be given CPR.

Rapport · 14-02-2015, 16:06

Sitting reading this during a quiet time on acute medical call.
I already carry on my boat extensive expensive equipment that I am never planning using, like a liferaft, EPIRB etc. At $250 if I am a liveaboard, it sounds perfectly reasonable to me. Even at 8%, which must count in hospital arrests to be that successful.
Having tPA on board for a clotbuster in stroke however is a terrible idea unless the boat is big enough for a CT scanner, and a staffed neuro ICU, to exclude the 20% hemorrhagic strokes, who you would kill.

Therapy · 14-02-2015, 18:48

Kenomac,
We all see through only our eyes in the end.
I, and others here I am sure, wish you well with fair winds.

Sailor g · 14-02-2015, 19:54

I'm not in medicine and don't know the stats but know from personal experience that CPR does work sometimes-and I would always give it a chance if possible.

About 20 years ago, I was an Scuba Assistant Instructor helping students sketch a map of the Blue Hole in New Mexico for a Rescue Diver course when we saw the husband (big guy about 250 lbs) of another student sinking down. He had passed out and by the time I got to him, it was about 70 ft (I have the dive log but the depth is from memory). He had lost his fins and the regulator was hanging out of his mouth. I was able to get him to the surface and get help pulling him up on the cement entry.

After assessment, I did chest compressions while another gave oxygen and rescue breaths. We were able to keep it up until he came to-his color coming back & him spitting water just as EMT's arrived from town. He was released the next day-luckily doing ok.

I've heard it said that those needing CPR are gone-so even if one is brought back, it's a win.

Kenomac · 15-02-2015, 06:23

I did some digging into the statistics regarding the success rates in the use of an AED, and it looks like the probability of success when used within a couple of minutes along with CPR is somewhere between 25-30 percent. The study was done with randomly placed AED units stationed in public places.

During the time period studied, around 31,000 heart attacks took place involving a cardiac arrest and nearly all of the victims died following normal calls to 911 emergency services by onlookers. Of the 31,000, a publicly placed AED was used on 1,170 victims along with CPR prior to the arrival of EMTs. 275 of those victims survived. So it seems the success rate is higher than most people think when the AED is applied early on with CPR, even when applied by an untrained stranger.

The key elements seem to be speed and the type of cardiac arrest suffered, where in over half the cases, nothing would have helped due to the blood blockage going to the heart.

25% success rate is better than zero. And since coronary artery disease does not run in either of our families and a more likely senario onboard requiring the use of an AED would be an accident, our statistical success rate would be higher which justifies in our minds having an AED onboard. Coronary artery disease accounts for most of the arrests which can't be helped using an AED.

Mr. Kenomac said, "why don't we get another one for the house?"

farmall.dude · 15-02-2015, 07:58

Quote:

Originally Posted by Kenomac

Please comment, you won't make an enemies. I welcome your input, and no we don't have any TPA onboard, nor do we plan to.

I'm at the point where I can still return the unit for a full refund if I change my mind. I agree with your not going to hurt a dead person with CPR or the use of an AED comment, I use the same expression myself. Fire away...

That TPA statement wasn't directed at you. I just find it highly suspect that a real medical professional would even consider having TPA aboard. I like the commend someone else posted about having room for a CT Scanner, exactly what I was thinking. TPA is a VERY DANGEROUS drug, but used in an ICU with extensive pre-qualification, it works very well. However, it's use (at least where I've worked) in the last 10 or so years has diminished quite a lot. Instead they go straight to cath lab to open the artery. Much less dangerous with much better results.

Stumble · 15-02-2015, 08:05

Kenomac,

As I ready your post that seems to indicate .8% (275/31,000) of cardiac arrest patients who recieved prompt emergency room care survived thanks to the AED. Not 25%. Since in only 3% (1170/31,000) of arrests was the AED useful to begin with. Without access to immediate health care the likelyhood of meaningful intervention would be even lower.

Get one if you want, but the likelyhood of it every being used are vanishingly remote. The best numbers I could find indicated that 1% of airport installed AED's are ever used. With million of people passing them a year.

**weavis** · 15-02-2015, 08:09

I just asked myself one question.

'What are you going to do to keep the patient alive after the unit has done its job?'

Kenomac · 15-02-2015, 08:46

Quote:

Originally Posted by Stumble

Kenomac,

As I ready your post that seems to indicate .8% (275/31,000) of cardiac arrest patients who recieved prompt emergency room care survived thanks to the AED. Not 25%. Since in only 3% (1170/31,000) of arrests was the AED useful to begin with. Without access to immediate health care the likelyhood of meaningful intervention would be even lower.

Get one if you want, but the likelyhood of it every being used are vanishingly remote. The best numbers I could find indicated that 1% of airport installed AED's are ever used. With million of people passing them a year.

You misread the statistics. 31,000 people suffered heart attacks and nearly all of the ones who simply called 911 and waited for EMS died. Of the 31,000, only 1,170 received the immediate administration of CPR and AED mostly via inexperienced people who happened to be nearby. Of the 1,170 who received this treatment 275 survived.

The survival rate among the victims who received immediate AED plus CPR was 25% which is very good considering more than 50% of those 1,170 victims suffered from heart attacks where there wasn't anything that would have worked to save them.

One more point related to your post: Personally, I did't even know airports had AED stations and I travel all the time. So the airport reference is meaningless, because people have to first know an AED is available, where to find it quickly and then what to do with it when the time comes. On our boat, we will both know where it is and what to do with it... an entirely different situation than the airport scenario.

Thank you for your contribution to my thread, it brought up excellent points.

Kenomac · 15-02-2015, 08:48

Quote:

Originally Posted by weavis

I just asked myself one question.

'What are you going to do to keep the patient alive after the unit has done its job?'

Hand them over to an MD like you asap.

Since most of our cruising is what most consider coastal, we're only looking at opening up that first hour window in order to get the victim to a hospital and give them a fighting chance. Not expecting to be half way across the Atlantic and be able to save someone and get them successfully to a hospital.

**weavis** · 15-02-2015, 08:53

Quote:

Originally Posted by Kenomac

Hand them over to an MD like you asap.

OK........... thats 2 screen washes..... Im not reading any more of this thread today.

I'll give you a list of equipment I need for 200 miles offshore patient care.....

Therapy · 15-02-2015, 09:44

Quote:

Originally Posted by Kenomac

Mr. Kenomac said, "why don't we get another one for the house?"

And one for the car too!

I think I will wait a bit and an app for the phone will be along.

I know you are convinced and will remain that way and many are not convinced and will remain that way too.

I am pretty sure that the people that lived had CPR started and AED applied in a very short period of time. I am going to say it was in under 6 min. Actually I bet it was under 4.

I think that unless someone falls off your boat while you are watching you won't make the 6 minute mark. I bet it takes you three or more to just get them in a position to start CPR. And we all know what happens at around 6 minutes. Electric shock sure. But do you know when peoples heart stop from shock? Mostly it is high tension lines. Not 110v nor 220v and certainly not 12v. All vanishigly rare. So rare that someone in the business may go a whole career without ever seeing it. Like a cop carrying a gun. Oh wait.........

Never mind. Have at it.