AED on Board?

D

Dreamer

New member
Has anyone else thought of carrying an AED aboard while cruising? On our trip in the Broughtons last Summer, we found out how long it takes to get someone to a medical facility (Too Long!)

I'm thinking that for the price of an AIS or so, we might avoid a terminal event for ourselves or someone nearby. I'd be interested in your thoughts. Many of us are retired and in the age bracket where this becomes a bigger threat.

AED according to Wikipedia:

An automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially 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.

AEDs are designed to be simple to use for the layman, and the use of AEDs is taught in many first aid, first responder and basic life support (BLS) level CPR classes.


 
I know a lot of the Yacht Clubs in this area are beginning to purchase these and taking it on club events- just in case.

I suppose if someone has a history of heart issues, then this would be a very good idea.
 
Roger,

You forgot to add the bit about only having medical emergencies on alternate days 'cos THE doctor isn't here today !!! (but we can put you on a bus......) :shock:

Sounds like a great idea and certainly costs less than one finger splint! I suppose for dislocations one person could hold the patient's dislocated member while someone else gives them a shock and maybe that does the trick. Just about as scientific an approach as you can get for 4 hours and $700 CA. :twisted:

We suggest you get one, and we will stay close. I have ideas about using it for fishing.....


Merv & Kathy
 
All of the tools we use in the EMS field that help to extend our "golden hour" (minutes in a heart attack) are great. Today with AED's being placed on many modes of public transportation, public vehicles (of numerous types) and in public buildings, they have become a good tool to buy "more time" to get the patient to the hospital. So, when we are on the water, which means we are almost always going to see an extended time for advanced life support of any kind, IMHO having an AED available, with the appropriate additional training, would be a significant advantage.

Now that I have rambled on, our very best information is going to come from what is probably the most qualified field experienced member, and that is our own (practicing.........like in physician) Firefighter/Paramedic, DaveS on C-Shift. He deals with this virtually every shift he works, so his words of wisdom (and that is a sincere compliment) will be worth considering.

Hope this helps!

Doug
on Lil' Brother
 
Hi,
This is a subject which I think I can speak upon with some experience.
To see a good medical article on the subject of Sudden Cardiac Arrest, written by an MD, see http://emedicine.medscape.com/article/151907-overview <br>
If you have a "heart condition" or family history, one of those automatic jobbies might provide you with some comfort level, at least. Quoting from that article, SCA results in ~ "325,000 deaths per year in the United States;---. This represents an incidence of 0.1-0.2% per year in the adult population." <br>
If SCA occurs outside of a hospital, estimates vary, but only 5-10% of patients survive. I am one of those lucky ones. My "event" happened 11 yrs ago in an airport restaurant at noontime, with no warning symptoms. Fortunately it was a large airport and a nearby nurses' station had a portable defibrillator, and the restaurant staff had some first responder training. Quick response is absolutely necessary for survival. If mine had happened an hour later I would have been on a cross country flight, and I wouldn't be writing this. About a yr later they started carrying the automatic devices on planes.<br>
I am presently on my 3rd ICD, Implantable Internal Defibrillator, so I carry my own. (It's no fun to get zapped.)
Al
 
While an onboard AED is not a bad idea, it should not be thought of as a 'stand alone' device. Let me explain...the AED is part of an intense response to sudden cardiac death (SCD). Approximately half of SCD involves abnormal heart rhythm for which the AED might help. Let's say you have an event like this on your boat...AND you have an AED handy...AND you have someone who can apply it to your lifeless body and activate it. IF it restores an effective heart rhythm, you will likely need further cardiac resuscitation (known as Advanced Cardiac Life Support or ACLS). ACLS is what you would receive from EMTs, paramedics, and/or hospital emergency room physicians. Please note at this point that those who provide ACLS usually carry or have access to at least two LARGE boxes with medications and medical supplies that go WAY beyond the standard first aid kit (yes, even beyond NORM's great first aid kit - look here [http://www.c-brats.com/modules.php?set_albumName=Antibody&id=CIMG0517&op=modload&name=gallery&file=index&include=view_photo.php]). At a minimum you need a means to oxygenate/ventilate the victim with oxygen enriched air -- that means you need a 'bag & mask' to provide artificial breathing and an oxygen cylinder.

A brief look at the article Al Parker cites in his post above yields sobering facts. Although the article was written in 2006, I believe the statistics to be largely unchanged. I'm referring to the stats on survival of out-of-hospital SCD. Under "ideal" circumstances, no more than 20% of out-of-hospital SCD victims can be expected leave the hospital alive. Al's statistic of 5-10% survival is probably more accurate. Don't get me wrong, when I collapse on the floor at Hartsfield Int'l Airport, somebody slap that AED on me, push the red button, and call 911. Note that the AEDs we see now are placed in public (usually busy) areas that have a reasonably good link to emergency medical (911-type) services.

And the 911 response is where our boats will usually have the problem. If you boat with those who can mount a sufficiently aggressive response to SCD and then get you to the hospital RAPIDLY, then maybe you do need an AED onboard. In my situation it would normally take 20-60 minutes (or more) to get an SCD victim back to the dock when they could then be put into an ambulance or helicopter for evacuation to a hospital setting. So, IF you have ACLS training and equipment available when you go boating, then certainly consider carrying an AED onboard.

Do people actually die from cardiac causes on boats? Take a look at the US Coast Guard Boating statistics (these are from 2006 which i believe is the most recent data available). You can see the PDF document here (www.uscgboating.org/statistics/Boating_ ... s_2006.pdf.).

There were 710 boating deaths. As observed in previous years, 70% of reported fatalities occurred on boats where the operator had NOT received boating safety instruction. Alcohol was the leading contributing factor in fatal boating accidents. It accounted for nearly 20% of all reported fatalities. Drowning accounted for 474/710 (or 67%) of these deaths; 90% of drowning victims did not wear a lifejacket. Death from trauma occurred in 130/710 (or 18%). Cardiac arrest accounted for 18/710 deaths (or 0.025%). So, while people DO die from cardiac causes on boats, it is a VERY small percentage. The USCG data are not perfect and maybe they missed or mis-categorized a few deaths, but it is still clear that most people who die in boats do so from drowning, drinking, making errors of judgment such that they lose their lives.

My practice is to wear a PFD and be prepared for the common emergencies with a decent first aid kit and a few more 'advanced' items to buy some time for an accident victim on my boat (or someone else's boat). Standard first aid (like controlling blood loss) can prolong some trauma victims lives quite simply and effectively. An AED does not fit into my current response plan but that doesn't mean that's the right decision for everyone. It is an individual decision.

Boat safe,

/david
hospital-based physician
 
David,

Thanks so much for a great response. That's why I ask these questions on this forum. We have such a broad spectrum of experts in most areas. You have given me much to think about. I'll be interested in Sea Shift Dave's take on this.
 
Hello Roger,

A quick online search shows that you can get a beautiful first aid kit and AED. Details below...

If you wanted to go the onboard AED route, here (https://www.critikit.com/store/details. ... ategory=19) is the Banyan 900HD, a nice, water-tight 'advanced' first aid kit for $1287 + S& H; you will need a 'prescription' to get this kit as it contains ACLS medications. The beast weighs 55# and its water-tight Pelican container is approx 32 x 20 x 11 inches. This kit is not for the faint of heart...(oops, no pun intended :))

And here (https://www.statkit.com/store/details.p ... category=6) is a Phillips AED for $1364. No prescription nec'y!

AND, the AED will fit into the Pelican case which houses the Banyan 900HD kit, so it is all relatively compact.

We might be able to do more good by carrying the AED in the trunk of our car rather than our boats. I would think it much more likely we could effectively employ the AED to the ultimate advantage of a SCD victim in that setting where activation of the 911 Emergency system could happen in a timely manner.

The oxygen bottle in the kit is quite small, i.e., it will only provide a few minutes supplemental O2. This leads back to the point I was trying to make above: when you need an AED, Time is of the essence, so unless you boat where sophisticated medical help is CLOSE BY, you might consider investing your $2651 in safety gear that is more likely to prevent an accident or assist you after one occurs.

/david
hospital based physician
 
From another physician (Pediatric Intensive Care):

What David said, great response. Invest in safety gear way more likely to be useful. I would expect a hoist and sling to be way more likely to save a life than an AED
 
The "Chain of Survival" in Cardiac Arrest is illustrated with 4 links in a chain. Early Access (activating the Emergency Response System ie: 911), Early CPR, Early Defibrillation (having an AED readily available), and Early Advanced Care (Paramedic/Physician Intervention) and obviously transport to the hospital for definitive care.

Would it be useful on a boat? If I were in the San Juans (as an example), and someone on my vessel experienced sudden cardiac arrest I would immediately place a call on channel 16 to advise the Coast Guard and any other vessels in the area of the situation and my location. Attach an AED (if I had one), (it is only going to shock if the patient is in Ventricular Fibrillation), the patient MIGHT be successfully converted into a viable cardiac rhythm and might actually "come around", but even then the patient would be in need of more advanced care and short of having one of those LARGE BOXES Dr. David referred to (and the knowledge to use what is inside it) the patient would most likely slip back into V-F with the need for more defibrillation attempts. Obviously, if the AED doesn't produce the results we'd all like to see, CPR will have to be started and continued until advance care arrives or if you are fortunate to have someone else on board your vessel to begin a rapid cruise towards advanced care while you continue with your patient care.
(Disclaimer to the above....if I had an AED, I'd use it before calling for help....or have someone else, if on board, call while I'm performing the medical procedures).

In some instances cardiac patients have been prescribed AEDs for home use by their families so they are becoming increasingly available to the "private sector". Cardiac patients with a propensity to develop V-F often have implanted cardiac defibrillators.

Dr. David (of the vessel Seadation), appropriately mentioned that there are other medical/trauma emergencies that individuals should become knowledgeable in that are more likely to arise. Additionally, do you have guests/family on board that are diabetics, asthmatics, have allergies etc? Do they have their inhalers, epi-pens, etc? Do you know how to assist them if the need arises?

As you can see there are many emergencies that can occur when we choose to place ourselves in geographic areas that are relatively inaccessible to all of the emergency assistance that we might have readily available at home. The amount of preparedness and the amount of equipment that we as individuals choose to have with us at all times is certainly a personal preference. I certainly don't discourage anyone from being prepared with equipment and knowledge.

In summation Roger, since you asked the question about AEDs, yes they certainly can be life saving in the right conditions, but bear in mind that they are ONE LINK in the "Chain of Survival". All links have to be connected in the chain, for an individual that suffers cardiac arrest to walk out of the hospital with all of his brain cells intact.
 
Roger, since we are discussing medical equipment, I resurrected a thread about First Aid Kits that includes a posting that I made in 2002 about the First Aid Kit that I carry on board "Sea Shift".
 
Like Al, I too had to have a little "jolt" nine years ago. Mine came on while driving I-5. I have thought a couple times about an AED but for sometimes remote boating like the C-Dory allows us to do it would most likely not be a viable solution. I also watched a person who had had an attack out at Blake Island, minutes by air from Seattle. It took probably over 20 minutes before he received any care from the air ambulance.

About 1992 my ex slid down the ramp at the marina on Cortez island at low tide. Her ankle was crushed upon impact at the bottom. The trip to medical care involved two ferries, three ambulances, and a whole lot of hours. When folks like most of us go up into those islands we pretty much take our lives into our own hands and have to hope for the best. But I wouldn't change a thing. The trip is worth it, no matter what the risk. We give up the luxury of sudden service when we boat in the areas we really like to boat in.
 
Excellent discussion.

I have my own home made first aid kit I take on fishing expeditions, either on other boats, or my own (in recent past). I'm a doc so I can use more stuff.

Focuses on trauma: bandages, sutures, lidocaine, pain meds, hemostats. Medical stuff include epinephrine, inhalers, syringes. Splints can be improvised so I have alot of tape. When it was my boat, I always had dry towels off limits except for help with hypothermia.

All of this doesn't take up much space, but I can't emphasize some pain meds enough, I always have a few vicodyn on board. Not sure what I would do with a stethoscope or BP cuff.

The lidocaine is worth it's weight in gold for some hooked fingers, nasty cuts, etc.
 
As a physician (retired) who as Advanced life support certified--and whose wife was also advanced life support certified (both past tense), and who has cardiac disease, we have so far elected not to carry an AED onboard. I do have a precription--which my cardiologist reluctantly gave to me--in case we decide to get an AED.

The AED is most useful where there is likely to be a large group of people--like the yacht club--or even the marina--and there should be people trained to use the AED. But any person who travels by boat should also be first aid at at least basic CPR certified.

Dave has gone into the resons very well about the pros and cons. But consider that there has to be a person available to operate the defibrillator, and give CPR to be successful. What is the percent time that you are on the boat--vs the car, office, home etc--where do you put the AED--or do you have 6 AED's? Percent wise, you are more likely to have the cardiac arrest at home, at work, or in the car than on the boat.

I was offered a prophylactic internal defibrillator because my ejection fraction is at a low level, and I decided last year to wait--my next stress test is next month. So this is a very personal decision for me.
 
How many people here have been trained to use an AED? For that matter, how many have a current Red Cross CPR card? I'm not taking a poll, but hopefully this thread will cause you to consider taking a Red Cross class. After I first took the class as part of getting my captains license years ago, I told Joan that I could give her first aid, but what about me?? She took the Red Cross class the next time it was available. So, if you travel as a couple, it's a good thing for both to know CPR and basic first aid.

When I took the CPR class again early this year, they had training with an AED; I had never seen one before, but now I'm confident that I could use it.

Just something to consider.

Best wishes,
Jim B.
 
While you can never be cautious enough, I think that if it is your time to go god wouldn't be cruel enough to completely wreck a great weekend of boating with something like a heart attack. Don't get me wrong - he'd try to sink you, make you miserable with ground swell, and give you every bit of the murphy factor he can throw at you. But, like it has been pointed out, statistically it probably is not going to happen in a low stress situation like on the boat. And, if it did where I go, it wouldn't matter anyway. There would be no helping me three or four hours out. Even Kodiak's J-Hawk could not run out fast enough to really do anything. But, if you are worried about it, bring it along for the piece of mind. At least if you have it on your boat it certainly then won't happen on your boat.......
 
JamesTXSD":22bhnf8x said:
I told Joan that I could give her first aid, but what about me?? She took the Red Cross class the next time it was available. So, if you travel as a couple, it's a good thing for both to know CPR and basic first aid.
Jim B.
Click to expand...

Well said Jim. That perhaps is why folks involved in the medical field (like Bob and I) chose to marry a woman that is likewise involved in the medical field. :lol: And here all along, you folks thought the old soap operas involving hospital romance was just a shallow pastime.... :wink
 
Roger (Dreamer) great topic! Ahh, the chain of care. What if you had and AED on board, and had to use it on someone, a Guest say, out here around the islands, or in the Strait. Would a call on 16 to the Coast Guard bring a Helo response and maybe a basket ride to a local hospital? That and some lucky (or Providential timing) would probably be the only chance for survival in that situation.

Harvey
SleepyC :moon
 
A few more points--and sorry for not having been more responsive at first, but I had just finished a rather long day, flying across the US and recustiting my RoadTrek van in Calif.

At one time I directed a large medical group, with several different units. We required all employees to have yearly CPR certification. That is really necessary, no matter now well trained you are. At that time we had protable defibrillators, but only a few of the physicians were certified to use them--the AED makes this a much easier situation to respond to. But again--units placed where there is access to many people makes more sense.

I have also had to perform CPR several (successfully) on small boats. It is not at all easy. Consider how you will do this on the C Dory. In other posts I have referenced to written plans for emergencies--and this is certainly one I would write up and include practice. Even with our great cabin boats, performing CPR in the cabin, on the V berth or in the cockpit would be difficult at the very best! What about in heavy sea conditions? Who will drive the boat, when you perform CPR?

Lets say you get a helo--what are the conditions of rescue?--does the person have to go into the water, so a rescue swimmer can pick up a person? Helo transfer is not at all easy from the deck of a vesesel the size of a C Dory. Again, think out plans and where you want to take the boat for transfer of the patient. Also, various boating areas should have protocols as to where the boat should be driven for rescue and transport via lifeflight. It may not be an obvious place. First contact Coast Guard--and also call the 911 dispatcher--be sure and give exact lattitude and longitude as well as an accurate description of what the emergency is.

Even what is fairly easy and routine in a clinic or emergency room (like suituring) is much more difficult in cramped space, poor light and an unstable boat.

I'll add more on medical emergencies at sea and first aid etc later, when I am back home and have access to my lists, photographs etc. Tlhis subject might make a nice "Sticky".
 
One other point--when you call the CG make it a "Mayday" call. Describe the situation and the urgency--remember that the CG boat may be otherwise deployed or take along time to get to your location.

My experience in situations where the AED might be life saving outside of a hospital setting: I was director of Athletic medicine at a major university for 6 years, and traveled with a portable defibrillator. We never used it--this included hundreds of airplane flights and various stadiums with capacities from a few hundred to over 100,000 people. Of course there were often paramedics in attendance, but I cannot remember any instances where a defbrillator was used on the audience. Same for being at the university (35,000 students, plus facaulity and support) for 6 years, and having a rapid response team, which had a defbrillator--again, I cannot recall once where we had an arrythmia where the AED would have saved a life. This does not indicate that an AED should not be used or carried. I have been watching airports, recently and all most all of them have AED located in many places. This is a place where they are probably best deployed.

I do know of one instance where a relitatively young friend had Ventricular fibrillation, and was kept alive with CPR until a paramedic unit arrived and defibrilated him on a dock. The response time was less than 5 minutes...and this is critical.

A paramedic first responder will have a greater experience--and maybe can give better statastics..
http://emedicine.medscape.com/article/158712-overview Is a good article on the incidence. Although 225,000 people have V fibrillation, about 40% of these are not in a place where there is another person who can admisister CPR or and AED. So the number comes down into the mid hundred thousand deaths which could be treated. Patients with a history of myocardial disease, a low ejection fraction and congestive heart failure are more likely to have sudden cardiac deather due to v fibrillation.
 
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