Calling for help

[Biggles Wader]

The guidelines do change from time to time (the "current" guidance is 2021, but a new draft had been out for consultation and should be finalised later this year) - and because clinical trials are a bit hard to do in this setting are based on basic principles and experience from thousands of cases across multiple countries by internationally recognised experts in emergency medicine. I believe the current draft doesn't change the get help guidance. Your own personal resuscitation guidelines are likely never going to be critiqued in an amatuer setting but I'm not sure you can justify arguing your advice is better than the european expert body. Especially if you are basing it on this:

If that doesn't work then yes other more specialist methods will be required, but their success rate is low, so summoning help is secondary to giving initial help.

About 1/4 of out of hospital cardiac arrests are believed to have initially shockable rythyms, for cardiac causes with a bystander around and an initially shockable rythym over 50% will have a return of spontaneous circulation. After the first few minutes the probability of success falls roughly exponentially the longer CPR continues. The last time I saw stats on success of CPR alone it was a heavily caveated "<5%" with the caveat that in most cases there is uncertainty over whether the patient was actually in cardiac arrest to start with. This:

The initial and rapid application of chest compressions is the thing that is most likely to restart the heart.

seems to have been largely shown to be wrong - its a chain of survival without that your odd for the next steps fall but CPR alone is very unlikely to be the answer. Maintaining effective CPR as a solo bystander (otherwise there is no need to debate the help or cpr first point) is very unlikely to be possible on a yacht - you need professional help and equipment ASAP but you also need other help to share the workload until that arrives.

I think we are talking about rather different scenarios here. In an urban area where EMS help or even a defibrillator should in theory be available very quickly that advice makes sense but as a lone person confronted with a cardiac arrest away from access to assistance some more thought is needed. As you say decent clinical evidence is hard to come by so we have to go with what we have. It's interesting to me that the official guidelines abandoned the pre cordial thump many years ago for witnessed arrests. I have seen that trick work twice in my lifetime. On a yacht at sea for example I would use that and do a minute of cpr before anything else given that professional help with drugs/defib and all the rest would be some considerable time away and that short delay would be very unlikely to make any difference.

 

[penberth3]

Given that the guidelines change frequently(every couple of years from my memories in the "business")it's sometimes useful to keep to basic principles. My first principle has always been that immediate cpr gives the best chance.

My principle is call for help first, or delegate that task, before you get distracted with other things.

 

[ylop]

I think we are talking about rather different scenarios here. In an urban area where EMS help or even a defibrillator should in theory be available very quickly that advice makes sense but as a lone person confronted with a cardiac arrest away from access to assistance some more thought is needed.

Ignoring for a second that any cardiac arrest on a boat is very unlikely to have a happy outcome, even more so if you are now "singlehanded". If the person is on board "in your cockpit" then to get from cockpit to radio, lift flap, hold button and get back to the casualty is <15s. If your phone is in your pocket 999 and speaker phone is maybe less (although a DSC distress might still have other advantages, and my phone is usually so awkward to get out that it might not be quicker).

Frankly though, coming back to my opening point - the sooner help is there, whether its another yachtsman to take over control of the boat, an extra hand with CPR or a lifeboat/helo then the sooner the trauma can end for you. The likelihood is the odds are the same either way (grim) for the patient.

As you say decent clinical evidence is hard to come by so we have to go with what we have. It's interesting to me that the official guidelines abandoned the pre cordial thump many years ago for witnessed arrests. I have seen that trick work twice in my lifetime. On a yacht at sea for example I would use that and do a minute of cpr before anything else given that professional help with drugs/defib and all the rest would be some considerable time away and that short delay would be very unlikely to make any difference.

Interestingly what evidence there is says precordial thump statisitcally is not useful and might actually be worse: TV and film ‘thump’ is not effective alternative to CPR, researchers at University of Warwick demonstrate.

Like I said I'm not going to argue with you about what you want to do if you find yourself in this boat. But you seem to be encouraging others to ignore the resus guidelines.

 

[Biggles Wader]

I must defer to the University of Warwick if they have done clinical research which shows the precordial thump to be not effective and possibly harmful. I wonder how they did their trials. My personal experience is different.

 

[ylop]

I must defer to the University of Warwick if they have done clinical research which shows the precordial thump to be not effective and possibly harmful. I wonder how they did their trials. My personal experience is different.

The paper was pay to view so I didn’t follow the detail only the headlines. From what I could glean from other studies if you are in VT it may help, but not necessarily any more than CPR alone, but if you are in VF it can have an adverse effect and since you don’t have a monitor already wired up in a typical out of hospital setting you don’t know which rhythm so it’s pot luck. Seems it’s still used in some US in hospital settings (presumably with monitoring).

 

[Stemar]

Where I grew up it was 111 (old rotary phone dials were the other way around). 60 years on it's still my default thought. Wonder if that one works here.

That'll get you the NHS help line in the UK. IIRC, 911 will work around London, but I don't think it will everywhere in the UK

 

[Dutch01527]

what3words is a terrible idea. Far too much potential for confusion

I had to call 999 recently when an elderly man fell and hit his head on a kerb. The location was down a small street in Dartmouth and I did not know the address and I did not want to leave the semi conscious casualty to find it out. I offered the ambulance call handler the what three words location and they were not familiar with that service/app and wanted a conventional address.

 

[[70521]]

I had to call 999 recently when an elderly man fell and hit his head on a kerb. The location was down a small street in Dartmouth and I did not know the address and I did not want to leave the semi conscious casualty to find it out. I offered the ambulance call handler the what three words location and they were not familiar with that service/app and wanted a conventional address.

There are several apps that will give an OS Grid Reference.

 

[ylop]

I offered the ambulance call handler the what three words location and they were not familiar with that service/app and wanted a conventional address.

There are several apps that will give an OS Grid Reference.

It’s surprising that anyone call handling for an ambulance service hasn’t heard of W3W, and many of the UK ambulance services do use it - but it costs the ambulance service to do so (they need to modify their call handling software to integrate with in) which is odd when there is a robust well established system that does the same job free of charge without the marketing hype.

I’m not 100% against W3W I have used it for things where someone might need to remember a location or type it from a piece of paper, but it’s a commercial product with better marketing than technical solution and that makes me uneasy.

 

[finestgreen]

There are several apps that will give an OS Grid Reference.

My favourite was OS Locate but annoyingly they've discontinued it

 

[Plum]

I had to call 999 recently when an elderly man fell and hit his head on a kerb. The location was down a small street in Dartmouth and I did not know the address and I did not want to leave the semi conscious casualty to find it out. I offered the ambulance call handler the what three words location and they were not familiar with that service/app and wanted a conventional address.

Then it must depend on which ambulance trust. The ones on the East Coast are all familiar with w3w

 

[[70521]]

Then it must depend on which ambulance trust. The ones on the East Coast are all familiar with w3w

Many years ago South West Ambulance Trust asked every householder to put the OS location near their landline.

Why anybody would use any other system, apart from the route by pub way, is beyond me.

 

[ylop]

Many years ago South West Ambulance Trust asked every householder to put the OS location near their landline.

Why anybody would use any other system, apart from the route by pub way, is beyond me.

Says a sailor who probably uses deg min and second or perhaps deg min.decimal? Deg NS/EW or +/-.

And if you want to quote your OS GB location to what precision? 6 fig is fairly routine but is actually a 10000 m2 area. More figures are possible but not every solution that lets you translate that into location on the ground will accept it. Don’t get me wrong I think W3W is mostly a triumph of marketing, but existing systems are not perfect either.

 

[dunedin]

There are several apps that will give an OS Grid Reference.

But this isn't necessarily easy to then use with modern map apps.
Lat Long works (provided understand the different conventions used DD MM SS, vs DD MM.MM vs DD.DDD, as phones often are different from boat plotters).
I had to recover a bike after an accident today. What3Words worked perfectly - link sent by WhasApp and automatically linked into Google to take me to the exact location. It was perfect.

 

[Plum]

Many years ago South West Ambulance Trust asked every householder to put the OS location near their landline.

Why anybody would use any other system, apart from the route by pub way, is beyond me.

W3W is used by most rescue services as an alternative to (certainly not a replacement for) LAT/long, OS Grid, Postcode. Has proven to be very useful.

 

[Plum]

But this isn't necessarily easy to then use with modern map apps.
Lat Long works (provided understand the different conventions used DD MM SS, vs DD MM.MM vs DD.DDD, as phones often are different from boat plotters).
I had to recover a bike after an accident today. What3Words worked perfectly - link sent by WhasApp and automatically linked into Google to take me to the exact location. It was perfect.

Quite right. Lat/long, for a non-nautical location/boater, is not very good for the reason you give.

 

[penberth3]

...And if you want to quote your OS GB location to what precision? 6 fig is fairly routine but is actually a 10000 m2 area....

The large number is deceiving. Call it a 'football pitch' and it sounds much more reasonable.

 

[ylop]

The large number is deceiving. Call it a 'football pitch' and it sounds much more reasonable.

But a W3W location is 9 m2 so that means your front door and next door’s front door are different locations - if you are trying to direct an ambulance that level of precision may save lives.

 

[PWLS08]

But a W3W location is 9 m2 so that means your front door and next door’s front door are different locations - if you are trying to direct an ambulance that level of precision may save lives.

But the house name/number rather more accessible without IT. Just because IT can be a solution doesn't mean that it has to be.

 

[ylop]

But the house name/number rather more accessible without IT. Just because IT can be a solution doesn't mean that it has to be.

I live in a small town - half the Sat nav systems take you to the wrong place if I give you my house number/street/postcode - you could easily waste 10 minutes trying to find where the house actually is. And I’m not in some weird rural location.

Even if you were local enough to know the area / use an A-Z and find the street most of the house numbers are not visible from the roadside in the dark.

The suggestion I was replying to was an OSGB grid reference. It’s not even obvious for my house which street that would be!