A Defibrilator on Board ? Good Idea ?

[Blue Crab]

Well, 3 pages in and I can't say I know anything more useful than when I started. I am always dismayed to read conflicting info from folks who all claim to have vast expertise. I noted one poster had a plea to hear info only from posters who "REALLY" knew something about this. What a concept.

I got a chuckle, however inappropriate, about this little factual "difference": 11 people survived, I think, out of 200 MILLION passengers thru Chicago. Another poster noted that it was 11 survivors out of 19 incidents. Should we have AEDs in airports? Hell yes. On boats? Come on.

It only makes sense to me, say, in the case (if I have the facts right) of the poster who is an M.D. with the hubby with known heart trouble. I think she also had an intubater thingy, IV drip stuff, etc., and just as importantly she knows how to use it.

[SV Enough]

Originally Posted by psneeld

It all boils down to money and philosophy....and the philosophy that you will probably die of something else than a heart attack at sea isn't too far from reality...which leads to the slightly off topic post relating to DSC radio...which does relate to MEDEVACs so it isn't too far off what some have been saying here....

to the poster that thinks DSC radios are that much more important than EPIRBs/PLBs better do some research. While using DSC close to shore or popular boating areas is a good idea...the reliability of VHF radios versus the high percentage of EPIRB success is pretty clear. I'd bet my life on an EPIRB over DSC distress every day of the week and then some. 20 plus years in USCG operations centers and helos taught me that much. (although improvements like the rescue 21 radio system are helping the DSC side of rescue)

I do not for a moment suggest an EPIRB/PLB is to be discounted or ignored. However EPIRBs aren't an infallible total solution solely on their own merits. Chief among these imperfections is their initial cost and need for continued maintenance to operate when you need it (the out of sight out of mind factor). They are only required for very specific types of vessel and are optional on pleasure vessels. How may pleasure vessel vs vessels required to carry one did you respond to in your 20+ years in the USCG? Unless an EPIRB has an internal GPS ($$$) it has to be connected to an external GPS, in any case the EPIRB tells authorities where it is or was not necessarily where the vessel is/was or you are unless you hang on to it. Then there is the question of the Golden Hour, an EPIRB alert has a considerable delay from trigger through detection, referral to Miami in our case, then on to St. Pete for dispatch. Time is of the essence. But none of this is justification suggesting I take a position that an EPIRB isn't something to bother with if you have DSC.

Yes having an EPIRB with internal GPS and SPOT PLD are good options and I paid the price and have both to go along with a fully functional DSC which comes with every VHF sold in the US since the FCC required it in the mid 90's. Continued improvements until today's class D DSC VHF and rescue 21 have made it very useful for more than SAR and MEDEVAC. For instance if a DSC VHF in range of my vessel triggers a distress I get a message with the MMSI information and their position on my chartplotter. I can then relay it if the sender is out of shore range or proceed directly to the vessel to give assistance if near by, does an EPIRB do that?

If you have a VHF purchased after the mid 90's you have DSC essentially for free, the MMSI can be gotten for free. Why fight it, hook it to the ships GPS and use it, what's it going to hurt? The worst that can happen is you set off both the EPIRB and DSC Distress and they get to you in less than an hour if the DSC works or longer if it doesn't, why does there have to be a one or the other ONLY aspect to this? If you don't have an EPIRB, well triggering the DSC distress is better than nothing or talking your way through it. I listened to a local diver die on a weekend about 18 months ago when mixed up voice ship to shore comm got everyone confused about who was where, where they were headed and what everyone's status was.

If you have a class D VHF you really need to read the manual or take a Power Squadron DSC class, you would be amazed at all the stuff these new sets can do now days and you already paid for. :-)

Mark Fay

[MarkJ]

Some people take a spare Alternator too. But what 'spares' do you need on a long cruise?
If someone has a heart condition and theres other crew trained to use a defrib then it may be an option...

But there's lots of ways to die, what percentage heart attacks?

[ActiveCaptain]

Originally Posted by s/v Moondancer

'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.

Of course having a defibrillator onboard, in close proximity both space and time to the event (as would happen on a boat) would bring your specific chance of survival significantly up from the 10-30% quoted. Add training to the mix and the numbers grow even higher. And that's the point of having an AED onboard.

Spinning the numbers another way...

The quoted article states that there are about 300,000 deaths in the US alone due to cardiac arrest. For simplicity of math, that's about 1,000 every day or the equivalent of 4-5 jet airplanes crashing every day killing everyone onboard.

If there were a single jet crashing every month, a billion dollars would be put into fixing it. Maybe more. Besides some diet and exercise changes, is there anything better than having an AED considering the real magnitude of the issue? And given that most of the people reading this can certainly afford an AED, can you afford to not have one?

[boatman61]

Rather than load up a defib.... why not load up on health beneficial foods etc... there's a lot of natural stuff out there... give up the crap that created your health problems in the 1st place is the way to go... fatty junk food like pizza's, burgers etc... you know... food for lazy people who can't be bothered.. or blame lack of time for their unhealthy diet...
You are what you eat and drink.... its like being a heavy smoker and carrying a spare lung in the freezer in case you get cancer...
Most emergencies on board can be managed with something you already have....

[Blue Crab]

My post above was merely to note the differences in opinions from folks with experience in this field. I don't know jack about this stuff nor did I follow any of the links. I certainly meant no disrespect to any poster who really is qualified to post on this subject and purposely did not go back to see who said what. Poor forum-manship to be sure. I know my sense of humor isn't for everyone (3 ex wives).

I'm not spending $1200 for a defib as I'm a one man band and won't have anyone to administer it. I read the thread because I have had two pacemakers for 15 years now (this is all "free time" to me) and have had some rapid heartbeat episodes lately.

Don't recall how epirbs came up above but I'm against them as well. Assume the risks or don't go IMHO.

[capngeo]

Originally Posted by IrishLass

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

Med school IS advanced life support training no?

To further clarify my position, an AED is only an aid in the incipient stages of cardiac arrest during ventricular fibrillation.... and THAT rhythm ONLY. IF an AED (or an implanted one) is actually "fired" it is because VF was detected. Definitive care beyond that is ACLS (Advanced Cardiac Life Support).

AEDs applied by laypersons will guide the layperson by voice prompts... One of the instructions is "Begin CPR" IF the layperson does not have that training what good is the AED? AEDs that detect VF and shock, shock the heart into asystole (cardiac standstill)..... the classic "flat line" in the movies. Without PROPER CPR the statistical chance of spontaneous return of circulation is low from that rhythm.

American Heart (the standard of care) recognizes the benefit of AEDs by laypersons in early cardiac arrest..... BUT still first requires 2 minutes of CPR by ALS providers when they arrive on scene!

As to the comment about the rescuer being shocked by an IMPLANTED defibrillator, I still raise the BS flag! Now an EXTERNAL defibrillator is a different story... that WILL knock you on your arse if you let it! It is apples and oranges to compare the two devices. Any of the electrical engineer types here on CF (and there seem to be many) can explain why it is IMPOSSIBLE for a rescuer to be shocked by an implanted device.

Once again, I have the experience of providing ACLS to hundreds of patients over my career. As a paramedic, I have done more ACTUAL CPR than most physicians and nurses ever will, the exception of course being cardiac care or emergency department staff. I can tell you from that experience that if you are more than MINUTES from real Advanced Life Support, and suffer a heart attack.... you are statistically doomed! If you want to fight that prediction, GO GET ACLS TRAINING for yourself and crew, so you can become the provider to your shipmates... AND buy a fill complement of ACLS adjuncts (about a $40K investment).

[IrishLass]

Originally Posted by Wannafish

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.

Wannafish ..... I assume that you have a ICD (implantable cardioverter device). While it would be inappropriate for anyone to give you medical advice through this venue. I can tell you that if I were you I would feel quite comfortable having this device, because it provides a great backup for the electrical function of the heart. If your heart has "failure" the ICD is designed to "kick-in." NHLBI (National Heart Lung and Blood Institute) has an excellent website to provide information for patients who have and ICD or who are considering placement of an ICD:
Implantable cardioverter defibrillator (ICD)

I hope you find this helpful. Moreover, I apologize for this thread and any confusion or worry it may have caused you. I will make my final point about AED's and then resign from this thread. Yes, coronary artery disease is sometimes caused by poor lifestyle choices (lack of exercise, smoking, poor diet). However, more times than not .... we have a genetic predisposition to CAD (or Peripheral Artery Disease or Acute Coronary Syndrome) and it is exacerbated by our lifestyle choices. Many cruisers are middle aged or older. Most live a rather healthy lifestyle, but consume too much alcohol and this is not heart healthy ... and we have too much sun exposure, but this is another issue. Cruisers/Sailors are typically very safety conscious individuals and they like to prepare for the "unexpected expected." Well, when you consider the number of people (especially Americans) who die each year from CAD ....this will be the "unexpected expected" event in many of our lives. Now ..... the debate in this forum has been should it be used in the absence of access to immediate advanced medical health care (ACLS - Advanced Cardiac Life Support) and I say .... you have to do what ever you can do to save someone and CPR/AED, First Aid/Medical Kit, and a good communications system is your best bet of survival. If you remove AED from the "mix" you reduce your chances of survival significantly and there are many reasons for this (poor CPR technique, some arrythmias will require a "shock," etc...). Finally, the AED requires minimal training and is what I call, "idiot proof" -- meaning that when you are in a panic an cannot remember your name, you can still use it. The AED does talk to you, it reads the heart rhythm and will not fire unless the rhythm requires a "shock."

I agree with my one advocate in this thread .... it is surprising the number of people who are in healthcare who are discouraging individuals from having AED's onbaord and yet they offer no alternative to treating an apparent heart attack. But you must make this decision for yourself ... discuss these issues in advance, have a Healthcare Directive for when you are home and make it clear how certain issues are to be handled on a cruise. Yes, there is some risk involved in saving a person's life. But, consider the alternative.

Above all ...........
May God hold you in the palm of His hand.

[zeehag]

allthis talk of defibs on board is moot when you realize the follow up to defib is intensive care. internal defibs are just that-- they keep ye in a rhythm conducive to life. you dont have to give up and die. is an extension of living. bionic action. my dad has one and i worked in a special arrhythmia unit during 1986 when that was the trend of the moment....we dealt exclusively with arrhythmias and heart disease. and arrhythmisa without heart disease.
thereis no follow up immediately available at sea. nothing. defib is worthless without follow up.
have fun . i will save the space on my boat for spares and other usable ccessories. defib is useless without IMMEDIATE follow up. I WOULD PREFER TO DIE AT SEA THAN BECOME A VEGGIE DUE TO LACK OF FOLLOW UP CARE.

[ActiveCaptain]

Originally Posted by zeehag

there is no follow up immediately available at sea. nothing. defib is worthless without follow up.

You are one of the few cruisers I've seen who is at sea all the time. Most of the cruisers I know make a passage and spend most of their time at the destination of their desire, close to land, services, population, and even hospital care.

I guess there was that one guy who stayed out for 1,000 days. He's sort of an exception though.

[chris_gee]

I researched this and posted this on sailnet in a thread call singlehanders please read.
"The death rate from a heart attack within 28 days is 50%.
The other side of the coin is SCA sudden cardiac arrest which is due to an arrhythmia. While the heart attack victim is conscious and the heart is beating, with SCA the patient loses consciousness rapidly and the heart goes into an ineffective rhythmn called ventricular fibrillation which leads to the heart stopping. The deathrate is 95% with survival decreasing by 10% per minute treatment is delayed. For this CPR may help keep the person going but the only treatment is defibrillation. Portable automatic defibrillators are available for about a thousand dollars or so. They increase survival to about 50%, more if used within 3 minutes. Cruisers and large workplaces should consider them.
A heart attack can lead to SCA.
On a boat Nitrolingual spray is better than tablets which will very likely be expired and ineffective. It won't help a heart attack much, but may help distinguish angina and relieve that.
Cartia is helpful both in prevention and as a first treatment.
CPR may help until aid is available but for SCA the defibrillator is required."
Rather than get bogged down in the details of statistics with all the caveats they require I make the point that it is not the heart attack as such which kills you but the ventricular fibrillation which often follows. The defibrillator deals with that.
As to the comment that it works by inducing asystole and recovery from asystole ie the heart being stopped is slight I suspect that is misleading. The point is to stop chaotic beating and then hopefully a normal exciting pulse is generated by heart node. If not then one might be induced by cpr.
There is some truth to the idea that if the heart is stopped it will not usually spontaneously resume in the sense that if it has been stopped for some minutes. However I understand that there are many instances where there is a short pause in beating and sponataneous restarting. I was told by a med professor of one doctor at a local hospital who had this and learned to handle it and restart her heart by falling to the floor. Quite likely one would fall down anyway unless one was prone beforehand.
A high proportion of cardiac deaths occur in the first minutes before someone can reach a hospital or even before an ambulance can arrive. From memory this is around 50%. CPR plus a defibrillator can make a significant difference. However relatively few would need to carry them. Our Coast guard boats do.
As for the need for follow up care, yes but not having a full ER on a boat doesnt mean one should do nothing.
Incidentally I saw a 50 year old man admiited some hours before after what sounded like a brief indigestion attack, die some hours later while being examined by a dr and with a crash cart and full team around him within less than a minute.
No guarantees either way obviously. But for those at risk a portable defib may be a good idea even if it is needed for the boat next door and even if in coastal areas follow up is required. Here this could be by Coastguard transport or even helicopter.

[mario f]

Lass'

you wrote - .... it is surprising the number of people who are in healthcare who are discouraging individuals from having AED's onbaord and yet they offer no alternative to treating an apparent heart attack.

Yes here is where you are missing the point, when the majority if not all the medical persons agree, it must mean something no?
As far as the alternative, again prevention ABC's and face the reality that we are mortal, do not last forever, medicine is not an exact science(lots of guess work), the miracle electronic machines work only in the movies. And most important if you are not near full ACLS you are dead, expired, gone to the other side, muerto, kaput, all done.

Believe me after years of working ER in level 1 trauma centers and 1 tour Vietnam medic........

Remember my responses apply to the what good is a AED on a boat.....not the efficacy of the AED

for the others that state most of the time they spend in a marina and that justifies having one, then I assume you carry one in your automobile also?
Also it would make more sense for the marina to have one not the boaters...
With all due respect I continue to agree to disagree with you.

Surprise the topic of the legal ramifications has not come about...

[MarkJ]

Originally Posted by boatman61

give up the crap that created your health problems in the 1st place is the way to go... fatty junk food like pizza's, burgers etc...

Not a chance, Sunshine. Where do I buy one of them Deflibrators and how do I give myself a good whacking?




Do they help with Gas?

[ActiveCaptain]

Originally Posted by mario f

And most important if you are not near full ACLS you are dead, expired, gone to the other side, muerto, kaput, all done.

I think that attitude is just...sad.

I'd like to think that a difference can be made. I'd like to know that there is always hope. I'd like to hope that sometimes, I have a say in the matter of what happens on that thin line between life and death.

I think the reason a few vocal medical providers have come out so against AED's here is because they've gotten too used to seeing too much death.

[s/v Jedi]

What if the implanted defibrillator delivers a shock while the responder is
administering CPR?

If the implanted device delivers a shock during CPR, the responder may feel a tingling sensation on the patient’s body surface. However, the shocks delivered by the implanted defibrillator will not pose a danger to the person administering CPR. The unpleasant tingling sensation can be prevented by wearing gloves during CPR.

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