AEDs

[Foswick]

I am preparing a presentation on managing medical emergencies onboard for coastal cruisers and other recreational boaters. The scope of the presentation means that I need to address the topic of AEDs. This is always sticky because, on one hand, I would never discourage anyone from carrying an AED. But, on the other hand, they have really limited use and some dangers that make them not something I would recommend for most people. (That is, I would not recommend against them, but not for them either.)

I don't want to debate that here because a) you shouldn't take medical advice from a stranger, and b) you shouldn't take medical advice from a stranger.

But, I am interested in an informal survey. Does anyone here carry one?

 

[dLj]

I do not carry an AED.

I'm not sure what you don't want to debate? I can tell you why I don't carry one if you'd like or I can just leave it as is - nope.

dj

 

[Foswick]

I do not carry an AED.

I'm not sure what you don't want to debate? I can tell you why I don't carry one if you'd like or I can just leave it as is - nope.

Thanks. I am actually interested in knowing the reasons for people who do carry them.

I suppose I can't bring up the topic without getting into some discussion about the pros and cons. I just don't want to get into a thread that discourages people from carrying them and knowing how/when to use them.

 

[dLj]

Thanks. I am actually interested in knowing the reasons for people who do carry them.

I suppose I can't bring up the topic without getting into some discussion about the pros and cons. I just don't want to get into a thread that discourages people from carrying them and knowing how/when to use them.

I don't think there are really any cons - as long as you know when and how to use them. If you need to use an AED, the patient needs to be taken to a hospital as soon as possible. You need emergency personnel to get there ASAP. I don't know the time frame from using an AED to getting the patient into hospital is, but it's not days. It's minutes or hours at best. Sailing off-shore where I'm likely more than 48 hours away from any sort of rescue, it simply doesn't provide me enough security for the cost of carrying one. If you are primarily sailing close to shore, hey, they are a great addition to your first aid kit. Expensive little guys...

dj

 

[BigEasy]

I have one at home that I previously had in my office. Be aware that if someone experiences cardiac arrest, if they aren't provided access to an AED within 10 minutes or so, the victim probably won't survive. CPR alone without defibrillation doesn't have a high success rate for cardiac arrest victims. On a boat, you're 60 to 90 minutes (at best) from an ER; therefore, with a cardiac arrest patient, the odds are not favorable even with an AED on board, because you're not going to have 100% oxygen on board nor advanced cardiac life support (ACLS) drugs and the training to use them.
Initial cost is $1500-2000. Battery requires replacement every 5 years at cost of approximately $300.
I believe you are spot on, I wouldn't discourage having an AED onboard if the captain or mate is trained to use it; however, I wouldn't necessarily recommend it either. Would definitely cover basics of rescue breathing & basic CPR or advise them to attend an American Red Cross basic CPR course. Going to have to research topic of outcomes of cardiac arrest survival with & without access to defibrillation and time factors involved.

 

[dlochner]

I'm curious, beyond any concern I might have about handling on board emergencies, what do skills, experience, or training do you have that would entice me to attend your presentation? Is this for a local sailing club or is it open to the public?

 

[Foswick]

I'm curious, beyond any concern I might have about handling on board emergencies, what do skills, experience, or training do you have that would entice me to attend your presentation? Is this for a local sailing club or is it open to the public?

It isn't in your area. Probably not worth the trip cross country.

 

[chuckwayne]

A bit of history.... I was formally trained in AED use, and had to employ one once at work; the employee survived, may not have with just CPR. Escape carries an AED - the modern units are pretty self explanatory, won't activate if the patient has a pulse, etc. I also carry oxygen on board (some of us are SCUBA divers). My rationale is simple; I sail with older people, not only on Escape but also in our club. As good as the CG is, as was said previously, a heart attack victim needs help within the first 10 minutes or less or the chance of survival plummets. Even if you're next to a patrol boat, the time to recognize the problem, get on the radio to hail for help, get a boat in the water and have a team come over and start rescue is probably not going to make the 10 minutes.....
We are mostly coastal cruisers, perhaps within maybe 30 miles of shore, too far. Getting a jayhawk in the air takes about 40 minutes from the alert, then flight time.
I'd rather have the AED available and never use it than the opposite.

 

[Foswick]

Thanks Chuck. I'm glad to hear you carry O2, provided you also carry a pulse oximeter and know when 02 is contraindicated. When I became an EMT, the culture was that pretty much everybody gets O2, even if just as a placebo. But, when I moved into the ER setting, I learned that there are a lot of really common conditions (like COPD) that seem like obvious candidates for O2 therapy, but which can really be harmed by it. In 2010, or so, the AHA finally changed their recommendations, but the culture is slow to change on that.

Also, congratulations on the AED success.

 

[capta]

I think the amount of medical equipment aboard should be proportional to the amount of time to a medical facility. If you're 800 miles from medical help on a 6 knot boat, there is little hope for the survival of a cardiac patient unless there was a well stocked medical facility aboard.
On the other hand, I drove a 65' boat for around 5 hours to the nearest dock while having a myocardial infarction. I secured the yacht to the dock, put out 2, 50 amp cords, took a shower, then a taxi to a small local clinic.
Walking up to the window, I mentioned that I thought I was having a heart attack, and within seconds I was on a gurney and the next morning I woke up in an ambulance taking me to a Charleston hospital.
In the end, I had survived with nothing more than a few aspirin. Not undamaged, but alive.

 

[Foswick]

Walking up to the window, I mentioned that I thought I was having a heart attack, and within seconds I was on a gurney and the next morning I woke up in an ambulance taking me to a Charleston hospital.
In the end, I had survived with nothing more than a few aspirin. Not undamaged, but alive.

Good thing you showered.

You might know that an ECG can actually show that a person has had a MI at some point in the past. You might be surprised at the number of ECGs I have done where the person had an MI at some point in the past and never realized it - probably 2-3 per month. (The reality is that those were false positives about about 25% of the time ... but still.) Keep in mind, I am talking about past MIs, when I talk about false positives. If you have an ECG done and they tell you that you are currently having an MI, then you are. It's pretty distinct.

I think the amount of medical equipment aboard should be proportional to the amount of time to a medical facility.

Most of us can plan on EMS being an hour away, when on the water. Could be less, in certain places, but there aren't many places where that is a safe bet. The rub, here, is that for most medical emergencies (actual emergencies) there is rarely anything I could carry that would be useful after 1 hour that would not have already been useful in the first hour - at least nothing that actually affects the outcome. And, I can't think of anything in my kit (which is pretty comprehensive) that I would pull out in that hour that I wouldn't want in the first 15 minutes.

If EMS is several hours or days away, that changes the kit a bit, but not really as it pertains to most emergencies. I would carry some additional medicines, sterile dressings, maybe some better splinting options, because these are all consumable or help crew function with an injury or illness. And, I don't carry sutures in my coastal med kit because I will never close a wound on a boat when we are less than a day from a clinic - so I would also add some sutures and better wound care options than my normal kit. But honestly, 90% of what I would ever want in my kit, I would want in the first hour.

 

[Tally Ho]

I am preparing a presentation on managing medical emergencies onboard for coastal cruisers and other recreational boaters. The scope of the presentation means that I need to address the topic of AEDs. This is always sticky because, on one hand, I would never discourage anyone from carrying an AED. But, on the other hand, they have really limited use and some dangers that make them not something I would recommend for most people. (That is, I would not recommend against them, but not for them either.)

I don't want to debate that here because a) you shouldn't take medical advice from a stranger, and b) you shouldn't take medical advice from a stranger.

But, I am interested in an informal survey. Does anyone here carry one?

Nope

 

[jssailem]

No to the AED on board. I am solo sailing for the greater part of the time. Back in the 70s, before AEDs, with EMT training, I helped our community volunteer ambulance crew. The Chief of Police cornered me in the coffee shop and made me an offer I couldn't refuse.

Distance and time from critical care are issues for coastal cruisers. For me, the best option is to stay healthy and regularly visit my MD. I have aspirin available to help. I can recognize the symptoms and do my best to manage the situation. I would call the CG and tell them about that boat floating in the Vessel Traffic Lane; that way, when they find me, the mystery will be solvable. Or I could find my way to port (as @capta did) and pray.

 

[capta]

Or I could find my way to port (as @capta did) and pray.

Don't get me wrong. Had I known how serious what was going on in my chest was, I would have driven the boat into the mud (we were in the ICW) and called for a chopper! I had some pain in my chest, but it wasn't incapacitating. I'd had worse, but not in the chest. I only began wondering if this was really serious when my Topsiders literally filled with my sweat a couple of times. I was healthy, active, eating well and only 43; how could I be having an MI?
The owner and his wife were aboard because he was recovering from a triple by-pass, but for some reason they did not discuss the possibility that I was having a serious cardiac event with me. They just gave me a couple of aspirin and said that they'd make me feel better.

 

[Foswick]

Good to hear folks are carrying aspirin. There has been a little backpeddling on aspirin, in recent years, and some people have been been more concerned about taking it. The concern is over the increased risk of bleeding. I think the shift in attitude followed a period of increased use of blood thinners, so people became more aware of the dangers of blood thinners. And, it is true that aspirin does have risks.

But, there was a JAHA (Journal of the American Heart Association) that came out about this time last year that I felt closed that controversy. I don't recall the details, but broadly, it showed that aspirin self-administered following the onset of chest pain resulted in a 25% reduction from MI mortality and something like a 1% increase in bleeding risk.

And there have been a few studies that show that 162mg (two baby aspirin) are at least as effective at reducing MI mortality as 325mg, but with lower bleeding risk. (That isn't new.)

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As for carrying AEDs, I think I got my answer. Very few people carry them. And, I think that is probably an appropriate decision for most.

If you mostly solo sail, then there isn't much point in carrying one. However, I did have a conversation with a person who did just that. He solo-sailed across the Pacific and his plan was that, at the first sign of trouble, he would put the pads on. So, if he did suffer cardiac arrest, he would be all set.

As funny as that sounds, he wasn't entirely wrong that it could work. And, if it ever did, think about what a great story that would be.

But, I told him that I just have a free AED app on my phone that does the same thing and would administer shocks through my pocket and he got excited and wanted to know what the app was called. So, I think that maybe he hadn't researched his plan very thoroughly.

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Honestly, if you have just two people on board (and one is the patient), having an AED isn't much more useful. Someone still needs to start CPR and someone still needs to call the Coast Guard. This means that, whatever that crew member chooses to do, they will be delaying something that should not be delayed.

The reason I wanted to get a sense of how many people carry them, and why, is that if you have one, it changes how you should respond to cardiac arrest.

---

Unfortunately, there are not clear guidelines on any of this. The guidelines are written with certain land-based assumptions about how long EMS will take to arrive.

Most of those recommendations hold up well, but the one sticking point is what to do first, assuming there are just two people on board and one is the patient.

The AHA recommendation (for cardiac arrest) is to call immediately, then start CPR ... except in certain cases, then the recommendation is to "call early" with no clear guideline for what "early" means". It is just a recognition that there are some situations when starting CPR immediately is your best option because it might actually revive the patient. Those conditions are too nuanced to probably be good advice for the average person - contributing to decision paralysis.

My attitude (and this is just me personally) is that we know that people are hesitant to start CPR ... for all sorts of reasons. I have been to a lot of calls where the spouse was present, witnessed the arrest, had received CPR training, but said they were afraid to do it, so they just called 911 and never started CPR. So, I think that anything that confuses the message, "Start CPR immediately" is probably going to worsen some outcomes.

The other side of this is that I have responded to calls where bystander CPR was already underway and the patient was revived by EMS in the field or later revived in the ER. CPR gives the patient time. (Full disclosure: I do not know how many of these people even survived to discharge, nor how neurologically intact they were. The prognosis would not have been good except in maybe one or two cases, out of those I have personally seen.)

So, lacking a clear guideline on cases when the expected EMS delay is one hour, I am telling folks to start CPR and perform for 2 minutes, then call. (Assuming they do not have crew to do both simulateously.) This is inline with a reasonable interpretation of the AHA "call early" guideline (in cases where that is recommended). Also, my reasoning is this:

If I delay CPR for two minutes while I talk on the VHF, the patient's odds drop about 20%. However, if the Coast Guard arrives in 47 minutes, rather than 45 minutes, the difference won't matter much.

 

[Calif. Ted]

When my brother had an MI he thought he could "just walk it off" so he walked to work and didn't go to the ER until the next day. I was on a fire department engine company that carried an AED as part of a study. I used the AED on half a dozen patients and none had a shockable rhythm until after the medics arrived and administered cardiac meds appropriate to the condition. We arrived within 5 minutes of being called but always after the fact, perhaps more successful in a witnessed arrest.
BTW in EMT classes we used to joke that "O2 and rapid transport" was the last sentence of the correct answer to every test question.

 

[Foswick]

I used the AED on half a dozen patients and none had a shockable rhythm until after the medics arrived and administered cardiac meds appropriate to the condition. We arrived within 5 minutes of being called but always after the fact, perhaps more successful in a witnessed arrest.

That is one of the few advantages that we have with cardiac arrest, on a boat - they are virtually always witnessed.

For those who don't know: There is a big survivabililty gap betwen witnessed and unwitnessed cardiac arrest. It is just about rapid intervention. Unwitnessed cardiac arrest happened "some time" before being discovered. There is no way to know the median time because those times are nearly always estimates. For statistics, there is just "witnessed" and "unwitnessed" for OHCA (out-of-hospital cardiac arrest).

As most folks know, survivability goes down about 10% for every minute CPR is delayed. So, on a boat, we have that going for us.

 

[TimFromLI]

I have a some heart issues, I don't plan on getting an AED. I did invest in AIS and DSC after hearing a story about how it most likely saved a sailor's life. He had a heart attack while off the Connecticut coast. He was able to call for help and emergency personnel were able to quickly find him and get him medical aid.

 

[BigEasy]

Big difference in a myocardial infarction "heart attack "(MI) vs cardiac arrest and resultant outcomes.
In many states, AED is not a piece of equipment that is legally required in medical & dental offices, UNLESS you are providing sedation rendering a patient semi-conscious or unconscious. Also dependent on level of drugs administered. Many purchase an AED, when not mandated; however, many private practitioners don't. I am certain that large clinics & group practices have AED's. Health care providers & clinical staff are required to renew CPR recertification every two years, including victim assessment, rescue breathing, drowning victims, choking victims, one & two person CPR, & use of AED for adults, children, & infants, State boards require proof of renewal for relicensing.

 

[Foswick]

I did invest in AIS and DSC [...]

Really solid point. DSC is probably the single most useful piece of equipment. Only takes a few seconds to activate.