Medical Emergencies at Remote Cruising Destinations

[crabcake]

One-third of deaths in the United States are caused by heart disease, stroke and other heart-related diseases, a report released Wednesday says.


Heart disease and stroke are also the leading causes of death worldwide, the report showed.


In 2013, cardiovascular disease killed 801,000 Americans, the American Heart Association (AHA) report found. These are deaths from stroke and all heart-related conditions, which include heart attacks, heart failure, and valve and artery diseases. Coronary heart disease alone caused 370,000 deaths in the United States that year, the AHA said.


About 795,000 people in the United States had a stroke in 2013. These strokes caused nearly 129,000 deaths. Approximately 750,000 Americans had a heart attack in 2013. Those heart attacks resulted in 116,000 deaths in 2013, the researchers said.


The report also noted significant racial differences. The risk of first-stroke in blacks is nearly twice that of whites, according to the report. The research found that almost half of all black people have some form of heart or stroke-related disease.


The researchers looked at heart disease risk factors, too. They found that despite a 30 percent fall in smoking since 1998, nearly 19 percent of men and 15 percent of women in the United States still smoked in 2014. In that year, about one-third of adults said they didn't do any physical activity outside of work.


Between 2003-2004 and 2011-2012, the proportion of Americans eating a healthy diet rose from 0.2 percent to 0.6 percent among children and from 0.7 percent to 1.5 percent among adults. Even so, nearly 160 million Americans were overweight or obese (69 percent of adults and 32 percent of children) in 2009-2012, the research revealed.


During that time, about 17 percent of adults (13 million) were obese, according to the AHA's 2016 Heart Disease and Stroke Statistics Update.
From 2009-2012, almost half of Americans had total cholesterol of 200 mg/dL or higher. And, one-third (80 million) of Americans had high blood pressure, the report said. Nine percent of Americans have been diagnosed with diabetes and 35 percent have prediabetes, the AHA noted.
Forty-six percent of black women and 45 percent of black men have high blood pressure, according to the report.


The researchers also found that 31 percent of all deaths worldwide are caused by heart or stroke-related disease. Eighty percent of such deaths occurred in low- and middle-income nations. Stroke causes nearly 12 percent of all deaths worldwide, the report noted. Nearly 17 million people had a first stroke in 2010, according to the AHA report.


"We've made progress in the fight against cardiovascular disease, but the battle is not won," said AHA President Dr. Mark Creager, director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.


"We need to maintain our vigor and resolve in promoting good cardiovascular health through lifestyle and recognition and treatment of risk factors such as high blood pressure, diabetes, high cholesterol and smoking," he said in an AHA news release.

More information
The U.S. National Institutes of Health explains how to reduce heart risks.

[hellosailor]

Of course the AMA endorsed leaches, then said that was wrong, and now has found uses for them again. And the AMA told us to use margarine not butter, then said the transfats in margarine were worse than butter. And now...aren't they also agreeing with the FDA that cholesterol is unimportant, that we're allowed to eat eggs again? It's so confusing...


If I add up all the "leading cause of death" stats that I see every year, somehow, it seems like the death rate is higher than the population. Urgh?


I'll have more faith in them when they get the "collateral damage" deaths in hospitals down under 200,000 per year. Little things, you know, like what did that fellow call it? Antisepsis? Washing things, and people, and not passing around th diseases? Oh, right, and not putting the staff on 12 hour shifts, since their own studies have all said that going from an 8-hour shift to a 12-hour shift increases the accident and error rates by 50%. In any trade.


At least witch doctors put on a colorful show! And they make much less paperwork.

[crabcake]

Originally Posted by hellosailor

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.

Just looked via Google - how about US $469 to $over $600 for a 2 pen kit? Highway robbery......

Better alternative: Get your Doc to give you a script for a Vial of Epinephrine and a Hypo. Vial will cost you between $12.00 and $30.00. Sealed syringe and needle will cost you less than $10.00. Keep Epinephrine in fridge in lightproof container.

Hellmans Mayonnaise Jar and Funk and Wagnals optional.

[frantzjoe]

I would also suggest looking into DAN (Divers Alert Network) Insurance. DAN is headquartered at Duke University. Originally it was for diving accidents, but now it covers most things in the water including swimming, snorkeling, surfing, SUP, windsurfing, etc. It does not cover parasailing and other dangerous activities. The insurance covers hospital and medical costs as well as the costs of evacuations to medical centers.
We used it once in the BVI. One of my friends had numbness and lack of strength in his left arm. According to his dive computer, he had dived beyond the safety limits - too deep for too long. However, his symptoms could as easily been angina pectoralis.
We were on the way in to Roadtown where an ambulance met us at the dock. He was transported to the local clinic where they did blood tests and EKG, ruling out a heart problem.
They then sent him by helicopter to St. Thomas where there is a hyperbaric chamber. He had 3 treatments there without relieving symptoms.
So DAN booked him on a first class flight to Los Angeles, his home city. There he was analyzed by a neurologist. It turned out he had some type of nerve damage. They also discovered along the way that he had prostate cancer (at the age of 48).
They also covered a hotel in St. Thomas. He had his 14 year old son with him and they covered that also.
So the DAN insurance covered everything, all the medical, hotels, chamber, helicopter, flights back to LA for both of them.
Today, the nerve damage has been resolved. However, he had to undergo a prostatectomy and is still undergoing hormone therapy and radiation therapy for the cancer.
The DAN insurance is reasonable. I believe I pay about $380 per year for two of us.

[alctel]

The chance of restarting a heart without a AED and from just CPR is around 1%-3%

With an AED in normal conditions (not too long etc) it jumps up to around 60%-70%

[Paul L]

Originally Posted by alctel

The chance of restarting a heart without a AED and from just CPR is around 1%-3%

With an AED in normal conditions (not too long etc) it jumps up to around 60%-70%

And then you immediately transport the patient to a trauma center -- the required part that is missing in remote cruising (and most not so remote cruising).

[TKDSailor]

Originally Posted by Saleen411

My girlfriend stepped on a stingray a few days ago and wound up in the emergency room due to a severe reaction to the venom. There she was pumped full of steroids, Benadryl and morphine. Her foot was x-rayed and bandaged and then she was given prescriptions for Cipro and pain killers upon being discharged.

This REALLY got me thinking. Just before this happened, we had spent a day visiting a good friend who recently got back from an 8 year circumnavigation. My friend who was an avid diver said that he didn't dive much at all during his cruise because of medical issues associated with being bitten, stung, cut etc. In fact it didn't sound like he spent much time in the water at all.

So, what to do while cruising. I've read threads about medical supplies one should carry onboard including a debate on AEDs. I'm obviously no doctor but it seems the likelihood of death is REAL if for instance a person has a severe allergic reaction to a number of toxins one may encounter if not near a competent medial facility. Not to mention all the other bad stuff that can happen.

I'm curious if other cruisers avoid water activities while at remote locations.

Thanks...

Two very good books to buy- "Where there is no doctor" and "Where there is no dentist". Both are inexpensive...

[zeehag]

and no one hears your radio call for assist. ok.. someone hears but is 2 days away?? same bucket as not having damn machine on boat to suck up all your boat electricity . yeah they have battteries but for how much time will they function as you wait for assistance and extrication ??
cruising, long term and out of range of allegedly normal places to receive delivery of health care?? you sign on for the death at sea, sorry, not up for that?? donot go.
chances are the individual suffering cardiac arrest in ocean has experienced the problem of angina or vertigo or intractible heartburn or other symptom before the big one. dehydration causes electrolyte imbalances not tolerated by many with cardiac history, especially arrhythmias.
it might be a better idea to prevent the need for the aed than to feel a need to carry it on board for whatever purpose.

[Tetepare]

Seems to be a lot of concern, even amongst boaters, about sharks (submerged logs of meat) and stingrays (sub-sediment pancakes of meat). Avoiding the water isn't going to help anyone.

So you avoid the water and wind up in Raro and rent a cheap motor scooter go explore the island, right? Raro has the highest per capita highway death rate in the WORLD.

What do you do if you bust your knee in heavy weather? Do what I did, buck up and keep going.

But don't be a dumbass like me. Don't attack sharks, don't pick up live Cones backwards (oops), and don't play where crocs are clearly abundant.

Keep in mind, in many countries it doesn't matter if you get to the hospital or not- Tonga, Solomon Islands, PNG come to mind. In fact, so far as I'm concerned, you're better off to self-treat than go the the "hospital."

The suggestion about DAN is a very good one, it's an inexpensive policy that will cover lots of activities.

Learn to be smart. Stay off coral. Shuffle your feet in sand. Don't touch it if you don't know what it is. Learn to look for things- like the hundreds of stonefish off Waikiki beach. Watch the ground, and know what snakes are local. Be keen to beehives and such.

Whether cruising or adventure hiking, know how to treat injuries. Take EMT courses. Carry meds and know how to use them. Know which antibiotics to use, and when. Travel with others when possible.

Life is fuller with new experiences, and that also means risk. Risks can be mitigated with intelligence, training, experience, and supplies.

[crabcake]

Originally Posted by Tetepare

Life is fuller with new experiences, and that also means risk. Risks can be mitigated with intelligence, training, experience, and supplies.

[Montanan]

Originally Posted by Kenomac

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%.

I have justed edited this reply, embarrassing amount of typos, in my initial post. I had surgery a couple of days ago on my forehead near one of my eyes and can't presently see very well, all puffed up. I apologize for my poor writing. Likely some errors still.

I have had AEDs utilized on me several times. Been there done that, thankfully. The first time as an emergency immediately after entering cardiac arrest when I was an inpatient under the intense care of the cardiac care unit of a regional hospital having been in an atrial fibrillation for several days at the CCU, where they were trying to convert me back to normal pattern with the use of cardiac drug treatments; and the other times in a controlled basis at the hospital so as to convert my heart when I was in atrial fibrillation when the initial treatment by cardiac drugs was not resolving the situation promptly.

I can attest that the devices work well and are they are simple and quick to use. And they are now not very expensive.

I have not had the opportunity to utilize one on others, but would be readily willing to use it on myself if needed, if I was alone, or if the rest of the crew was reticent to "push the button" on me.

If any person on the boat is prone to arrhythmia or has an experience of heart disease, or is otherwise has an at risk profile, I would advocate that an AED be standard equipment on board. If everyone on board is young and known to be cardiac healthy then it is a device which likely has little chance of being used and would seem to be an "optional" equipment.

As always, evaluate those that will be on-board and equip appropriately for all personal issues they may have, allergic reactions, diabetes, depression, asthma, COPD, malaria, etc. Albeit my first incidence of atrial fibrillation, leading to ventricular tachycardia before arresting occurred when I was in my early twenties while still in undergraduate school, but I had congenital heart disease and had two prior heart surgeries, at age five and again at sixteen, to repair a coarctation of the aorta so the development of an arrhythmia was not unexpected, let's say I was just such an at risk person.

Older cruisers are clearly at more risk, age is correlated to heart issues.

If someone is found to be in cardiac arrest, i.e., asystole, complete heart stoppage, the likelihood of successful AED response without concurrent CPR and cardiac stimulant drugs is considerably less than a person that is experiencing an arrhythmia which is treatable by AED.

A person in arrest, especially if located outside a hospital, is highly likely to die. Actually, technically an arrest is one of the typical defined states of death, so by restarting the heart one is actually bringing someone back from death, well at least as from one of the defined states of death. There being dead, and then being dead, dead.

It is best to use an AED, before the heart is arrested, while they are in arryhythmia, but if someone is arrested, and unless the person is known to have dictated "Do Not Resuscitate"[DNR], I for one would by all means give them a jump start, ASAP and also utilize cardiac pulmonary resuscitation, CPR. They will not typically complain to you later, if they are lucky enough to be revived. If they do complain later, I recommend return their gratitude, or lack there of and tie an anchor to them and toss them overboard, burial at sea.

FYI. I can't attest to the accuracy of the wiki information pasted below.

Automated external defibrillator

From Wikipedia, the free encyclopedia

An automated external defibrillator ready for use. Pads are pre-connected. This model is a semi-automatic due to the presence of a shock button.
An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm.

With simple audio and visual commands, AEDs are designed to be simple to use for the layperson, and the use of AEDs is taught in many first aid, certified first responder, and basic life support (BLS) level cardiopulmonary resuscitation (CPR) classes.

Usage

Conditions that the device treats

An automated external defibrillator is used in cases of life-threatening cardiac arrhythmias which lead to cardiac arrest. The rhythms that the device will treat are usually limited to:

Pulseless Ventricular tachycardia (shortened to VT or V-Tach)

Ventricular fibrillation (shortened to VF or V-Fib)

In each of these two types of shockable cardiac arrhythmia, the heart is electrically active, but in a dysfunctional pattern that does not allow it to pump and circulate blood. In ventricular tachycardia, the heart beats too fast to effectively pump blood. Ultimately, ventricular tachycardia leads to ventricular fibrillation. In ventricular fibrillation, the electrical activity of the heart becomes chaotic, preventing the ventricle from effectively pumping blood. The fibrillation in the heart decreases over time, and will eventually reach asystole.

AEDs, like all defibrillators, are not designed to shock asystole ('flat line' patterns) as this will not have a positive clinical outcome. The asystolic patient only has a chance of survival if, through a combination of CPR and cardiac stimulant drugs, one of the shockable rhythms can be established, which makes it imperative for CPR to be carried out prior to the arrival of a defibrillator.

A personal note: It is rather interesting to awaken to having persons performing CPR on you. As I recall, after having been converted to normal heart action, I was attempting to speak to them with a single word between each of there pulses while being "bagged" to inflate my lungs and squished on my chest to pump my heart that, "I . . . am . . . O . . . kay . . . please . . . get . . . off . . . of . . . me." all along the medical team was paying no attention to me and likely not even hearing me speak as the doctor was relaying orders and the nurses and hospitalists were busy preparing and pushing drugs. I had to punch the nurse that was compressing my chest to get the team to quit and to take notice that I was fine.

Prior to being revived from arrest, I had become feeling ill while lying in my bed in the CCU and vomited into the little tray they had at my disposal at bed side and I pushed the call button to have the nurse come so as to dispose of the vomit filled tray. When she arrived at the door she asked me, "What's the matter, Dan?" Just then I felt my heart stop, so I answered her calmly with a clear voice that, "My heart has stopped." Her eyes grew wide open, we both looked toward the heart monitor and sure enough it changed to a flat line and the alarm sounded. With one hand she pushed the Code Blue button just inside the doorway, and with her other hand she grabbed the crash cart that was located just outside my CCU room, prepositioned so as to be readily available just in case I was in need of such equipment and stimulant drugs.

After the medical team stopped the CPR, and the nurse was able to pick herself up from the floor having fallen from receiving my upper cut blow to her chin, she was able to tell the medical team about my having called for her assistance and my self-diagnosis that "My heart has stopped". The doctor said that he wished he had been there to hear that, and said to the medical team, "As I have told you before, don't be afraid to ask the patient what they perceive the medical issue is as they often can provide you with guidance as to what needs to be treated." Later he said that my self-diagnosis was likely the best that there ever was or could be. I agreed with him stating "Well it was the best that I could give at the moment."

In later incidents of arrhythmias, I have taken to instructing the doctors at the ER, which drugs to provide me, which not to give me, in what amounts and in what rate and in what sequence which is not something that an emergency room cardiologist is used to receiving from a patient. They follow orders very well, but do discuss and debate the options with me, but I make the ultimate decision taking into account their perspective and recommendations, it being my body, not theirs.

By the way, when your heart stops, or at least as to my heart stopping, I felt no pain and remained cognizant for about 8 to 10 seconds before lapsing. My vision just went gray, just before I passed out and was not aware of anything until awakening with the CPR occurring. Did not feel the shock treatment, but did have an itchy chest for a few days after, kind of like having a rash on the inside of the muscles. The use of proscribed Novicane numbing jell eased the itching considerably. I suspect the blast of current fried the nerves in my chest muscles a bit and caused the itchy symptoms.

Effect of delayed treatment

Uncorrected, these cardiac conditions (ventricular tachycardia, ventricular fibrillation, asystole) rapidly lead to irreversible brain damage and death, once cardiac arrest takes place. After approximately three to five minutes in cardiac arrest, irreversible brain/tissue damage may begin to occur. For every minute that a person in cardiac arrest goes without being successfully treated (by defibrillation), the chance of survival decreases by 7 percent per minute in the first 3 minutes, and decreases by 10 percent per minute as time advances beyond ~3 minutes.

Requirements for use[edit]
AEDs are designed to be used by laypersons who ideally should have received AED training. However, sixth-grade students have been reported to begin defibrillation within 90 seconds, as opposed to a trained operator beginning within 67 seconds.[5] This is in contrast to more sophisticated manual and semi-automatic defibrillators used by health professionals, which can act as a pacemaker if the heart rate is too slow (bradycardia) and perform other functions which require a skilled operator able to read electrocardiograms.

Bras with a metal underwire and piercings on the torso must be removed before using the AED on someone to avoid interference. American TV show Mythbusters found evidence that use of a defibrillator on a woman wearing an underwire bra can lead to arcing or fire but only in unusual and unlikely circumstances.

A study analyzed the effects of having AEDs immediately present during Chicago's Heart Start program over a two-year period. Of 22 individuals 18 were in a cardiac arrhythmia which AEDs can treat (Vfib or Vtach). Of these 18, 11 survived. Of these 11 patients, 6 were treated by bystanders with absolutely no previous training in AED use.

[Saleen411]

Thank you all for the education on AEDS....

Lots of GREAT advice and resources....

So far it appears that most everybody is jumping into the water in remote locations.....with appropriate precautions. I like that as I was quite bummed for my cruising friend.

As an aside...my cruising buddy and his wife were quite disappointed at the lack of sea life they encountered in their travels. They figured they weren't missing much by limiting their time in the water. They sailed everywhere too...Started in Florida, across to the Med for 2 years...then back across to the Caribbean, thru the Canal westward island hopping to New Zealand, then SE Asia across the Indian Ocean around the Horn of Africa to home.... 8 years on a Stevens 47 CC.

[roland stockham]

Some good advice. I agree the key is training. People who always live in urban area are used to thinking of medicine as a 'specialist' subject they cannot access. Not true, anyone can learn it. You need at least a good advanced first aid course that should take around 5days to complete. Some further study of how the human body works and a basic study of drugs and how they work which can be done online. A good reference book (I use the ships captains medical guide, free online from the UK) and a good medical kit including prescription pain control and antibiotics. It is also a good idea to study the local wildlife, most of it is predictable and safe if understood but can be a major hazard if not. If a bear thinks your lunch is his guess who is right!! Finally long range reliable communications that will get you advice when needed. It is a big plus for SSB as you can tap directly into the coastguard service from almost anywhere who will have a doctor on call who understands medical emergencies at sea.
On the plus side you are much less likely to get run down, mugged, shot (if in the USA) suffer a heart attack, get diabetes or one of the midrid other plagues of modern urban life.

[MarkJ]

Originally Posted by Saleen411

my cruising buddy and his wife were quite disappointed at the lack of sea life they encountered in their travels. They figured they weren't missing much by limiting their time in the water.

1) if they were not in the water they couldn't see much sea life.

2) the circuit they did began with areas without much marine life... so by the time they got to the Caribbean or the Pacific they had probably made up their minds there was nothing to see.

3) I am anchored next to a large rock reef. When I meet people I say snorkel on the outside of the reef. But they always snorkel on the inside of the reef. What's the difference? On this reef there is no life on the inside and an abundance on the outside. So you gotta get advice where to go and TAKE THE ADVICE!

[model 10]

Originally Posted by MarkJ

1)
3) I am anchored next to a large rock reef. When I meet people I say snorkel on the outside of the reef. But they always snorkel on the inside of the reef. What's the difference? On this reef there is no life on the inside and an abundance on the outside. So you gotta get advice where to go and TAKE THE ADVICE!

Yeah but it's scary on the outside.