Defibrillation on the Yacht?

[Kings Gambit]

Getting older, friends are getting older. Thinking more now about emergency medical equipment on the yacht after me episode with vestibular veritus in October. There have been some other things as well. Has any one here had to use a defibrillator on a boat like ours? Do you carry one? Is there actually enough room in a cockpit to use one on a non-responsive crew on a boat underway? Also carry medical oxygen? I’ve noticed them in some yacht clubs.

KG

 

[MikeHoncho]

You can use a defib anywhere. It's what happens after that tends to make a defib not very applicable by itself in this situation. Most requiring its use also need continuing, advanced treatments like meds, advanced airways and an ED. Not always but more likely than not. So having a defib is good but it's one of those things that really need to go along with all the other ALS stuff that you aren't going to have access to on the water compared to land (EMS). You're not going to get medical O2 without a RX but you could go the welding gas route. The items are tools, which work but you really need a toolbox in the situations that they are used in, cardiac arrest.

And I think you might have meant vestibular neuritis? About as far away from cardiac arrest as an emergency can get (although I bet it felt like the world was ending). Benadryl is a good "what's in my cabinet" to help with that one.....

 

[Kings Gambit]

And I think you might have meant vestibular neuritis? About as far away from cardiac arrest as an emergency can get (although I bet it felt like the world was ending). Benadryl is a good "what's in my cabinet" to help with that one.....

Yes, neuritis; thanks. But the only comparison I was attempting was a lack of preparedness to meet either, and maybe other medical emergencies as well.

 

[MikeHoncho]

You can't go wrong with a defib for sure. Most people think it is the answer to cardiac arrest. In most cases, it is not. Especially when they are automatic. They only function under specific cardiac rhythms. I recommend being prepared for other serious medical situations that you have a chance of making a significant impact and that are probably more probably. Situations like strokes, severe allergic/anaphylactic reactions, trauma, hemorrhage stuff like that that requires minimal equipment but knowledge.

 

[BigEasy]

Yes, you could certainly use an AED in the cockpit; however, as Mike mentioned, you really need additional equipment to supplement and a means to evacuate patient to a medical facility quickly. Could an AED make a difference, perhaps. I purchased one for my office a few years ago. They are compact (9"x11"x4") and cost approximately $1500. Another item that will need to be maintained as it has to be serviced by the manufacturer every few years for battery replacement.

 

[MikeHoncho]

Yes, you could certainly use an AED in the cockpit; however, as Mike mentioned, you really need additional equipment to supplement and a means to evacuate patient to a medical facility quickly. Could an AED make a difference, perhaps. I purchased one for my office a few years ago. They are compact (9"x11"x4") and cost approximately $1500. Another item that will need to be maintained as it has to be serviced by the manufacturer every few years for battery replacement.

training would be a nice touch.... lol

 

[Kings Gambit]

You can't go wrong with a defib for sure. Most people think it is the answer to cardiac arrest. In most cases, it is not. Especially when they are automatic. They only function under specific cardiac rhythms. I recommend being prepared for other serious medical situations that you have a chance of making a significant impact and that are probably more probably. Situations like strokes, severe allergic/anaphylactic reactions, trauma, hemorrhage stuff like that that requires minimal equipment but knowledge.

Thanks. It’s a matter of risk analysis. My medical “kit” aboard already can address the conditions you mention, plus some others; but I have really no good way to attend to a cardiac arrest or a sudden heart attack that might cause an arrest. Physical CPR in the cockpit would be tough to administer effectively for anyone heavier or taller than myself (5’6”), especially if the boat is underway. So, I’m thinking get the heart pumping again if possible and administer oxygen as might be needed while awaiting EMS. We’re of course talking only minutes to make a life-saving difference to the victim. I’m wondering here if anyone has had to deal with such a situation?

 

[shemandr]

You have to replace the paddles periodically too. I used to have a service to keep my AED up to date. Thankfully I never had to use it. They are basically portable and I used to carry mine to some events where there would be a lot of people and remote from access to an AED. I took training but it was woefully inadequate. You can't substitute for experience - and that experience is hard to come by.
As far as medical kits on boats they are general pathetic. They should have an epi-pen, Oral Benadryl, an asthma inhaler, nitro-glycerin sub lingual tablets, ammonia inhalants, sutures and butterfly bandages, disinfectant wipes, anti-biotic ointment, and a variety of bandaging materials. Some of the kits have sunblock, dramamine and other palliative treatments (Ibuprofen, etc.).
The only medical emergency I was involved with on board was a women who had an allergic reaction to shrimp which was served. Don't think it can't happen.

 

[jssailem]

Interesting topic.
Finding my self in the age when cardiac arrest can be come a problem, having equipment nearby would be a comforting factor. But as has been stated, having the equipment and not the training is like me running out side and jumping in a Ladder Fire Truck vehicle and taking off down the street. Getting to the fire would be more luck than skill.

Even the equipping, management, and use of a first aid kit requires some skill building.

Planning to untie the lines and sail off for a 2 week holiday should consider medical emergencies and develop a strategy for dealing with them. I will venture to guess that a drama kit and training to use it is low on the priority list of most skippers. We generally do not like to think in those terms. Those problems happen to others.

While acquiring an AED unit for my boat is not on the Priority list. Having resources (books, training, iPad medical data) to understand and address trauma for typical boating injuries is a priority. Having a stocked medical kit with ways to control bleeding, clean wounds, splint or immobilize broken bones and a way to call for help are things I can do to improve the safety of myself and crew.

Have you ever tried to blow up an air splint on your leg? Have you tried to tie a triangular bandage " on your self" in a way to immobilize your shoulder should you break your collar bone or dealt with a fractured wrist? I am sure there are a many scenarios to consider.

One part of being safe is considering in advance the way you would deal with unexpected events.

Thanks KG for triggering this concept.

 

[MikeHoncho]

Nitro really isn’t a good idea unless the pt has a history of using. You can really cause a worse problem if not given appropriately.

 

[MikeHoncho]

Thanks. It’s a matter of risk analysis. My medical “kit” aboard already can address the conditions you mention, plus some others; but I have really no good way to attend to a cardiac arrest or a sudden heart attack that might cause an arrest. Physical CPR in the cockpit would be tough to administer effectively for anyone heavier or taller than myself (5’6”), especially if the boat is underway. So, I’m thinking get the heart pumping again if possible and administer oxygen as might be needed while awaiting EMS. We’re of course talking only minutes to make a life-saving difference to the victim. I’m wondering here if anyone has had to deal with such a situation?

An AED does not get the heart pumping . It stops it allowing the heart’s electrical system to hopefully take over. If the original problem isn’t fixed then things stay the way they are. This is why the toolbox is critical. If cpr fixed the problem and the pt wakes up then cpr wasn’t needed to begin with in general.

 

[MikeHoncho]

There is a lot of myths and misconceptions regarding emergency medicine. Having “stuff” just in case is good but not knowing how and when to use it can be easily worse than not using it at all. Don’t get me started on epi pens and how people jamb them into there, or even worse someone else’s, leg at the first sign of a allergic reaction and then bitch about how much they cost.
On the opposite side of the spectrum. Having the knowledge, skills and abilities only gets you so far without the tools also. Been there, done that.

 

[jssailem]

Having the knowledge, skills and abilities only gets you so far without the tools also. Been there, done that.

That is when you need to channel your inner MacGyver... with his Swiss army pocket knife.

 

[Kings Gambit]

Of course one would need to know how to use the devices; i.e., need training. I’ve already completed more than one set of CPR courses, for example. Something recommended for ASA instructors. I don’t get the comment that a defibrillator does not, or can not, restart a heart that has arrested. So it can reset an arrhythmic heart to regular heart beat, but cannot restart one that is not creating a pulse? Then what can or does? Is there any portable unit that does?

 

[MikeHoncho]

Of course one would need to know how to use the devices; i.e., need training. I’ve already completed more than one set of CPR courses, for example. Something recommended for ASA instructors. I don’t get the comment that a defibrillator does not, or can not, restart a heart that has arrested. So it can reset an arrhythmic heart to regular heart beat, but cannot restart one that is not creating a pulse? Then what can or does? Is there any portable unit that does?

Let’s agree that a AED is only applied to someone showing no signs of life......A AED will only fire with viable cardiac electrical activity (VFib, SVT, Vtach etc) and if applied properly (above) will fire, stop the electrical activity (asystole) allowing the natural, inherited electrical impulses of the heart muscle to take over. The hearts electrical rythm is generated by the heart muscle itself and is manipulated by outside factors like hormones and nerve stimulation (vagus nerve). If they don’t then the pt stays in asystole or tends to go back into the previous non viable electrical activity and you start over. If the original problem bringing on the non viable electrical activity isn’t fixed then the situation isn’t conducive to survival.
“Arrested “ is a generalized term for physical activity, or lack of it. The AED manipulated the electrical activity in a hope for the physical activity to take over. Non automatic defibs have a ton more capabil but at the end of the day they physically do the same thing when activated and cost around $30k. Movies are movies, real life is real life.

ok my TED talk on AEDs has concluded lol. Hope that helps

 

[Kings Gambit]

So, I learned how they are supposed to work under somewhat limited circumstances. There are of lot of folks out there buying these things for that very specialized type of “heart failure?” I doubt it. They probably expect a more generally remedy. It’s not clear that having no such capability aboard impacts preparedness. Looks like effective CPR is would still be required with or without one. Thanks.

 

[MikeHoncho]

Well it’s a matter of progression . The heart does not normally go straight to asystole it tends to be the end game. I wouldn’t call it specialized, more like a limited time of opportunity. How fast it gets there is the million dollar question. Survivability percentages is measured in minutes when discussing application of what we are talking about with the addition of the continued care. CPR is critical to slow down the progression and increase survivability with proper treatment. Make no mistake, cardiology is a little more complicated than what we are discussing. Lol

It’s like being late for a job interview......you drive really fast (use a AED) and get back on time but you get a flat tire ( no advanced life support) and miss the interview (person dies).....so don’t be late!

 

[Kings Gambit]

“Advanced life support” comes with the EMTs. Not trying to be a doctor here. Just wish to keep my friend/crew in “serviceable” condition until the professionals can take over. Not talking about a long sea voyage scenario or situation, far from help. He/she “goes down”, I get off a MayDay then start CPR. Of course, I wouldn’t be able to answer the CG’s multiple questions (e.g., how many persons aboard?, are people wearing life jackets?, what is the nature of the emergency?) requiring one hand on the VHF key while attempting CPR. If an AED cannot help relieve the victim to the point of a resumed cardiac rhythm in short time, then it would not look like a good outcome.

 

[MikeHoncho]

ALS is more applicable to paramedics. Yea if you are in the realm of minutes then go for it. You are trying to make yourself feel better about a potential situation. I’m adding factual information that contradicts your comfort. In the situation above and if the person is in true cardiac arrest......the survivability is extremely low and almost non existent with any quality. CG are at best EMTs not paramedics.

 

[Calif. Ted]

Over 20 years ago we put AED's on every fire engine in a battalion (5) to study effectiveness and results were disappointing, I spent a lot of time doing CPR on people and don't remember any success prior to getting some cardiac drugs administered. We decided more ACLS Paramedics was the best answer so we made Paramedic Engine Companies.