Medical Equipment AED Onboard

[Paul L]

I hear the anecdotal info put out in this thread, but it still isn't clear to me that there is any evidenced based info that AEDs in the remote (from advanced medical) situations like a cruising boat are effective.

The clinical benefits and practical superiority of the AED are well established. Early defibrillation is recommended as a standard of care for EMS except in sparsely populated and remote settings, where the frequency of cardiac arrest is low and rescuer response times are excessively long

FRom an AMerican Heart Assoc. Journal article

Part 4: The Automated External Defibrillator

There are some studies that show decent results on commercial airlines. But they are much closer to advanced medical care than a cruising boat.

[Kenomac]

Originally Posted by Paul L

......
There are some studies that show decent results on commercial airlines. But they are much closer to advanced medical care than a cruising boat.

Thank you Paul for the excellent link on your post to the data and recommendations by the American Heart Association Journal article.

Nearly all of our cruising is coastal somewhere in the Med or Western Europe where we have access to emergency medical services. Our concern is the time delay due to language barrier or proximity of the boat to the nearest harbor, which is usually within 50 miles. I wouldn't expect miracles from the AED unit if we were in a remote location.

[socaldmax]

There has been a lot of great debate so far, and I'm not in the medical field, so let me ask a basic question.

Is there any other way to bring a heart back into a regular rhythm besides a defibrillator?

My understanding is that these devices are very easy to use, even a child could save your life with it. They automatically monitor and administer shocks as needed, correct?

While all of you know what you're doing and could operate a more advanced machine in a hospital, this device is aimed more at the general public to give us a fighting chance, correct?

I don't see anything wrong with that, especially at that price. I have thought about one for a couple of years now (I'm 54, many of my friends are older and some of my younger friends have died unexpectedly.) I thought they were worth it at $1,000, for less than $400 it seems a no brainer.

As long as it doesn't kill anyone, and might give someone a second chance, there's no downside to it that I can see.

[crazyoldboatguy]

Originally Posted by socaldmax

There has been a lot of great debate so far, and I'm not in the medical field, so let me ask a basic question.

Is there any other way to bring a heart back into a regular rhythm besides a defibrillator?

My understanding is that these devices are very easy to use, even a child could save your life with it. They automatically monitor and administer shocks as needed, correct?

While all of you know what you're doing and could operate a more advanced machine in a hospital, this device is aimed more at the general public to give us a fighting chance, correct?

I don't see anything wrong with that, especially at that price. I have thought about one for a couple of years now (I'm 54, many of my friends are older and some of my younger friends have died unexpectedly.) I thought they were worth it at $1,000, for less than $400 it seems a no brainer.

As long as it doesn't kill anyone, and might give someone a second chance, there's no downside to it that I can see.

If a person has had a heart attack and they are in an arrhythmia such as ventricular fibrillation, the only way to have hope of restoring a more normal rhythm is with a defibrillator. Doctors used to try thumping on the chest - you see that in the TV shows - I don't think that is likely to work.

And even if you can convert the fibrillation to a more normal rhythm after a heart attack, the person needs immediate acute cardiac care very soon or their condition will only get worse.

I see an AED on board a vessel in a remote area possibly being able to restore a heartbeat in the rare instances of shallow water blackout/drowning, an electrocution or in the very rare instance where a person gets hit in the chest at the precise moment of a heartbeat where it can actually cause your heart to stop beating. Others can chime in as to whether these situations can be helped with an AED. I know they are kept at schools/athletic fields for that rare chest hit incidents and lightening strikes but I wonder if they are there just to make folks feel better,

If you are in a remote area and suffer a heart attack and your heart stops, the AED may restart the heart but I don't think your prognosis is very good due to the lack of access to critical follow up care.

[Leo Ticheli]

I had been considering one for a while now, and this thread pushed me past just thinking about it.

In my view a slim chance beats the hell out of no chance at all.

Just ordered one and am waiting for it's arrival. Hope I never have to report that it's been used.

Fair winds,

Leo

[socaldmax]

Originally Posted by crazyoldboatguy

If a person has had a heart attack and they are in an arrhythmia such as ventricular fibrillation, the only way to have hope of restoring a more normal rhythm is with a defibrillator. Doctors used to try thumping on the chest - you see that in the TV shows - I don't think that is likely to work.

And even if you can convert the fibrillation to a more normal rhythm after a heart attack, the person needs immediate acute cardiac care very soon or their condition will only get worse.

I see an AED on board a vessel in a remote area possibly being able to restore a heartbeat in the rare instances of shallow water blackout/drowning, an electrocution or in the very rare instance where a person gets hit in the chest at the precise moment of a heartbeat where it can actually cause your heart to stop beating. Others can chime in as to whether these situations can be helped with an AED. I know they are kept at schools/athletic fields for that rare chest hit incidents and lightening strikes but I wonder if they are there just to make folks feel better,

If you are in a remote area and suffer a heart attack and your heart stops, the AED may restart the heart but I don't think your prognosis is very good due to the lack of access to critical follow up care.

OK, so it could be used for drowning or electrocution victims, both of which are possible on a boat.

Let's say a person suffers a heart attack, the AED restores a normal rhythm, aside from a stent, is there anything else that a person could learn to do that would increase their chances for survival? Any way to thin the blood, or break up clots or increase oxygen to the heart? Oxygen bottle perhaps or an oxygen concentrator?

Every heart attack is different. My stepdad was suffering from chest pains for 3 weeks before the big one dropped him to the floor and he was practically dead by the time the EMTs arrived 20 min. later. I don't know if an AED would have helped him.

A friend of mine felt chest pains, told his wife he was going golfing, jumped in his car and drove 150mi from his home to his favorite hospital, shaking, sweating, and wondering if he was going to make it. He did, just barely. He got chewed out hard by the doctors, his wife, and everyone else. I doubt an AED was warranted in that instance.

But, since the potential for drowning or electrocution is far higher on a boat (IMHO) then at home, I think this thing is well worth the money.

Honestly, it's going to cost me probably $500 to stock up my liquor cabinet. I think $400 for an AED is a wiser choice (but I'm still stocking the liquor cabinet!)

[Leo Ticheli]

I'd like to add to the request of additions to the AED. What other emergency medical equipment would add to a heart attack victim's chances and can be used by laymen?

Fair winds,
Leo

[crazyoldboatguy]

Aspirin and other NSAIDS (non-steroidal anti-inflammatory drugs - eg: ibuprofen & naproxen sodium) can thin the blood. Folks who have had a heart attack are sometimes advised to take a low dose aspirin each day to thin the blood a bit. I have heard that folks who are having chest pains who have heart disease are told to take an aspirin immediately as that may help prevent a larger clot from forming.

I have heard some folks mention TPA - a blood thinner that are given to folks with an eligible condition (blood clot in the body/heart/brain) in the ER. Where it can be dangerous is if the CVA (brain "stroke") can be either a clot or a broken, bleeding vessel. If the stroke is caused by a clot, the TPA can reverse the condition and save the patient's life and prevent serious disability. If the TPA is given to a stroke patient who has a bleeding vessel in the brain, they will most likely die from the increased, uncontrollable bleeding. I can't see bringing that drug with me offshore, IMO.

Sailing offshore has risks. Being far away from the high level medical care available close by when living onshore and near a city is a reality. It's all about managing the risk in the most practical way. If a person has a serious heart condition (multiple bypasses, congestive heart failure, cardiomegaly, for example) I would bet the doctor would strongly discourage an offshore cruse on a small vessel. But, it's your life. Your risk

[hellosailor]

"Just read today that only 8% of CPR" We were taught that it is basically ten percent per minute. That is, if someone's heart stops and you can apply CPR within the first minute, they have a 90% chance of recovery. Second minute, 80%. Third minute, 70%. And so on, until ten minutes at which point there is a zero percent chance of recovery. Now, if you figure it takes a minute for anyone to say "Hey, Bob, quit clowning around. Hey, Bob? Bob! Someone get help, Bob's not clowning around" and then until someone knows what to do or who to do it...I wouldn't be surprised if four or five minute, going on 50% recovery, is as good as most get.


I know one office where there was a "AED" marker on the reception wall, but none of the current staff knew it meant the AED was in an alcove around the corner. Some help that is.


As for TPA, I'm the fellow brought that up. Apparently an ER can do tricky things like look for signs of internal bleeding to tell whether a "stroke" is an aneurism (in which case there is internal bleeding) or a clot (in which case there isn't) and they can be fairly certain about which is happening. IF you can be certain that it is a clot, and you administer TPA within a 4 hour window, you can and will prevent an incredible amount of damage.


No, this is not as simple as "put a bandaid on his finer, he has a cut" but given the right education in the use of the tool (TPA) there's no doubt it can do a job that nothing else, including aspirin, will do.


Medical thinking, best of practice, and reversals in recommendations, happen all the time. Three(?) years ago, the AMA came out and said CPR is more effective WITHOUT mouth breathing, counter to the past 40+ years of training standards. Unless you're a professional, in which case the opinions and training are now split.


Tourniquets were standard 40 years ago. Then they were strongly Unadvised. Until combat vets started coming back alive because of them in recent years. The tourniquet may cause loss of a limb, but that beats the patient bleeding to death, so now tourniquets are back in the list of things to do and use--with more specific policies on how and when to use them.


And all the folks who were "wrong dead wrong" about these things for 40 years or longer? Funny how they're now vindicated and proven right. Medicine is a bit like blackjack, you can work the odds, but you never know precisely what the winning hand will be.

[GoingWalkabout]

Originally Posted by Kenomac

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.

[Paul L]

Originally Posted by Leo Ticheli

I had been considering one for a while now, and this thread pushed me past just thinking about it.

In my view a slim chance beats the hell out of no chance at all.

Just ordered one and am waiting for it's arrival. Hope I never have to report that it's been used.

Fair winds,

Leo

It isn't really a matter of a slim chance is better than no chance. This is not black and white stuff -- placebos actually work in many studies. It is a matter of putting your medical safety dollars to the most effective use. There are lots of things to spend your safety dollar on long before an AED. Remote medicine training, onboard oxygen, IV solution, fire safety equipment, .. would all come before an AED. The success rates with an AED with immediate advanced medical care are decent, but not that high. And in most studies success is defined as the patient leaves the hospital alive -- not necessarily mentally still there or with any quality of life. Without advanced medical care, the odds are very low that the patient will survive.

[GoingWalkabout]

Originally Posted by crazyoldboatguy

Aspirin and other NSAIDS (non-steroidal anti-inflammatory drugs - eg: ibuprofen & naproxen sodium) can thin the blood. Folks who have had a heart attack are sometimes advised to take a low dose aspirin each day to thin the blood a bit. I have heard that folks who are having chest pains who have heart disease are told to take an aspirin immediately as that may help prevent a larger clot from forming.

I have heard some folks mention TPA - a blood thinner that are given to folks with an eligible condition (blood clot in the body/heart/brain) in the ER. Where it can be dangerous is if the CVA (brain "stroke") can be either a clot or a broken, bleeding vessel. If the stroke is caused by a clot, the TPA can reverse the condition and save the patient's life and prevent serious disability. If the TPA is given to a stroke patient who has a bleeding vessel in the brain, they will most likely die from the increased, uncontrollable bleeding. I can't see bringing that drug with me offshore, IMO.

Sailing offshore has risks. Being far away from the high level medical care available close by when living onshore and near a city is a reality. It's all about managing the risk in the most practical way. If a person has a serious heart condition (multiple bypasses, congestive heart failure, cardiomegaly, for example) I would bet the doctor would strongly discourage an offshore cruse on a small vessel. But, it's your life. Your risk

All great suggestions. Thank you. The only thing I would question is about TPA and I still have an open mind about it. This is what I'm thinking. If a victim of stroke is in say the middle of the Atlantic then one of two things are primarily going on. Either a blood clot or a brain bleed. Flip a coin and you have just the same odds of being right or wrong. In the case of a brain bleed out in the middle of the Atlantic your toast. In this case I would recommend a living trust that directs your burial at sea. If a blood clot then as each half hour goes by you have the high probability of suffering irreversible brain damage and possible death or at the least severe functional deficits. We also know that if given in the first half hour to 1 hour TPA a brain clot victim can not only be saved but walk away from the situation unimpaired in a lot of cases.

So if you have an intracranial bleed miles from anywhere your prognosis is as good as dead. If you have a clot then you have a very good chance of surviving if you are immediately administered TPA. So I can see the clear logic of administering TPA because if you've got a serious bleed from a ruptured vessel your going to die anyway. Unless you have a good Neuro sailing with you and he/she brought along his cranial saw. Mind you, you could use your boat drill to relieve the pressure but its a little difficult to use a drill on a persons head in high mid Atlantic waves. Unless of course your on a cat.

This probably leads to another important thread. The pros and cons of blue water brain surgery. . Or what medical instruments should you bring on your boat? And is a cat a safer sail boat for brain surgery? Just asking.

[Leo Ticheli]

Originally Posted by Paul L

It isn't really a matter of a slim chance is better than no chance. This is not black and white stuff -- placebos actually work in many studies. It is a matter of putting your medical safety dollars to the most effective use. There are lots of things to spend your safety dollar on long before an AED. Remote medicine training, onboard oxygen, IV solution, fire safety equipment, .. would all come before an AED. The success rates with an AED with immediate advanced medical care are decent, but not that high. And in most studies success is defined as the patient leaves the hospital alive -- not necessarily mentally still there or with any quality of life. Without advanced medical care, the odds are very low that the patient will survive.

Are you suggesting that the purchase of an AED prevents one from also having other safety and emergency equipment? There are a few things I need to add to my boat, oxygen, for example, but the purchase of the AED will not prevent me from obtaining them; I would hope that's true of most others who choose to add an AED, but that's just my feeling.

I don't think I'll ever need my life raft, or my fire extinguishers, or the laser signaling device, or the QuikClot, or the pain meds, or the hand-operated water-maker, or all the other stuff that's usefully only in a nightmare situation, but I feel better having it all on board.

If one's budget is so constricted that hard choices need to be made on safety gear, or one fears a less than eupeptic outcome from use of the AED, I certainly see your point. It's an individual choice, not like the requirement to have life jackets.

I'm not inclined to try to talk anyone into having or not having an AED; in my case, with myself, my wife, and close friends having irregular heart rhythms, it seems like a prudent choice.

Thank you for your concern.

Fair winds,
Leo

[caradow]

Gentleman the bottom line here is PERSONAL CHOICE......there is no right or wrong answer.
There have been compiling arguments on both sides.
Some of you quoted medical statistics and others spoke about the weakness of anecdotes while others spoke of their feeling of responsibility to their crew.
As I read these posts some of you may be physicians and basically quoted the new ACLS (advanced cardiac life support) Guidelines.
What I do disagree with is those who try and talk others out of following their gut feelings.
If you spend enough time in medicine you will see amazing outcomes, some tragic, but others miraculous. Statistics don't mean much when you are the one in the minority of clinical responders.
Again I commend Kenomac and others who carry AED's.
Just maybe they will save someones life

[hellosailor]

Invisible AEDs in airports?


It is called "situational awareness". Most of the herd do not look around. Do not stop to look at fire extinguishers in the hotel hallway (often discharged by frolicking guests), do not stop to look for the emergency exits when they are in airports, or theatres, or anyplace else. It is an acquired habit, not a natural one in our society.


But if you LOOK at the walls around you, you will find red and white "AED" signs, the same way there are "FIRE" signs and exit signs.


As to fire extinguishers being compared to AEDs...considering how many times I have grabbed an extinguisher, and how many times I have used one (or something else when there was none) I would say any comparison makes it extremely likely that I'll be grabbing AEDs in the near future.