Defibrillator on board

Personally, I have a do not resuscitate policy.

Having spent 5 years as a member of a mountain rescue team I have a very black sense of humor and a real understanding of the chances of survival from a cardiac arrest in remote areas.
 
JumbleDuck said:
I looked up the London Ambulance Service figures when I did my AED training for FAW, and as I recall it takes your chance of surviving a heart problem from about 1% to about 12%.
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Thank you for finding that. So it's still 88% you're going to die anyway.
 
JumbleDuck said:
Please don't trust my figures too much but yes, you're probably going to die. That's a big improvement on "almost certainly", though.
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The "big improvement" is about the same as playing Russian Roulette with 5 bullets instead of 6.

I'm still not convinced a de-fib is a good investment.
 
AntarcticPilot said:
I think we're all 100% certain to die. It's merely a question of when and how!
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Indeed, but I'd rather postpone the inevitable for as long as is reasonably possible.

penberth3 said:
The "big improvement" is about the same as playing Russian Roulette with 5 bullets instead of 6.
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I prefer to think of it as a tenfold increase in your chance of surviving. Which revolver would you choose to play with? However ...

I'm still not convinced a de-fib is a good investment.
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... on the whole I agree with you. Having AEDs scattered around the country is extremely sensible, because they save a lot of lives in the sense that they keep a lot of people arrive long enough professional help to arrive. However, if that's not within ten minutes or so, you're brown bread anyway. There are almost certainly more effective ways of spending a grand on a cruising yacht.

However, I think club safety boats would be well advised to carry AEDs, particularly when there are elderly sailors whizzing whatever fleet they prefer. Lots more people covered by the one device, far better chance of a paramedic getting there in time.
 
JumbleDuck said:
... on the whole I agree with you. Having AEDs scattered around the country is extremely sensible, because they save a lot of lives in the sense that they keep a lot of people arrive long enough professional help to arrive. However, if that's not within ten minutes or so, you're brown bread anyway. There are almost certainly more effective ways of spending a grand on a cruising yacht...
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Absolutely. The AED's that we see are in public places, shopping centres etc., with probably thousands of people within reach. That is a "cost effective" way of spending money. For personal use forget it, look at the root causes and spend your money on gym membership, healthy food, and maybe a private medical every so often, then you can stop worrying and enjoy yourself.

Edit to add: if you want to carry more kit, there are some cheaper things which may be useful and are proved to work: glucose for diabetics, epipens for allergies, there's two for a start.
 
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girlofwight said:
Apparently the independent life boats have them afloat, RNLI don’t.
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I would be really surprised if the RNLI boats don't have them. They are standard equipment on the French boats.

Pour sauver des vies, la SNSM a choisi le défibrillateur FRx de PHILIPS. Le kit comprend: 1 défibrillateur FRx PHILIPS 1 pile lithium 1 pochette d'eléctrodes SMART II 1 mode d'emploi 1 carte mémoire 1 mallette étanche 5 ans de garantie kit mallette étanche + défibrillateur FRx PHILIPS
 
Sybarite said:
I would be really surprised if the RNLI boats don't have them. They are standard equipment on the French boats.

Pour sauver des vies, la SNSM a choisi le défibrillateur FRx de PHILIPS. Le kit comprend: 1 défibrillateur FRx PHILIPS 1 pile lithium 1 pochette d'eléctrodes SMART II 1 mode d'emploi 1 carte mémoire 1 mallette étanche 5 ans de garantie kit mallette étanche + défibrillateur FRx PHILIPS
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I was told that by Isle of Wight Ambulance Service, when I did a First Aid training with them. The Ambulance Service have a fairly good grasp on what’s where...
 
Not all aircraft carry a defib. 300+ passengers. Many not as fit as those on a yacht. possibly 2+hrs to divert to a suitable airport. Plane used every single day.

Yacht has typically maybe 4 passengers. Depending on your cruising grounds you can probably be in a chopper on the way to hospital in 2 hours if you are in UK waters. Used relatively few times in the year. Chances of use diminishing all the time.

If I was buying one I'd be looking at a Heartsine 360, purely based on purchase price £700+VAT) But is also IP65 rated, smaller than most, lighter than most, 10* year warranty. Only possible downsides I'm seeing: it probably isn't the model you trained on (but they all tell you what to do) and the battery and electrodes are combined which means replacement is the whole lot. But should come with ~4 year life and cost £100 + VAT. So total cost over lets say 10 years is 700+ 2 x 100 = £900 + VAT = £1080.

The Phillips unit seems (HeartStart 1) to be the one most places train (I suspect they do good bulk purchase discounts) - 8 year warranty, 4-5 year battery life, but 18month pad life. £100+VAT more expensive. Battery £150, Pads £60. Cost of ownership over 10 year is 800 +vat + 2 x 150 + 6 x 60 = £1620 (the costs change when you move into an environment where pads are more often used before expiry)

*check that - it could be only on the 350, 360 could be 8 years.


Carrying one in your car - almost certainly not for your own use - unless you have a big flashing sign on your car that says Defib in the boot - use it even if not trained - when you arrest no-one will look for it. You are carrying it in case you come across someone else.

Which brings me to my next thought - chances of your arrest being shockable. Driving down a city centre street you see someone collapsed at the road side. Possible. Driving through rural roads you come across a RTC - rarely are traumatic arrests shockable. Sailing along - acute cardiac event - possible. Drowning, head injury etc... less likely shockable. And technically for a hypothermia you aren't dead till you are warm and dead...

My sailing club bought one a few years ago with donations and some public access grant money. It is a rural club. A neighbouring club had a recent scare at the time with someone ashore evacuated by air ambulance with cardiac event, and a few years before another club had an incident where having a defib probably would have made no difference... but sometimes being able to tell everyone you tried absolutely everything is important...
 
Sybarite said:
I would be really surprised if the RNLI boats don't have them. They are standard equipment on the French boats.
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Then be surprised.

They wouldn't be much value on a ILB and making them robust enough would be a challenge. *Some* ILB stations have PAD (Public Access Devices) on the station wall, but not all.

The Lifeguards have them. They also have a big crowd of people.

The ALBs don't have them - I think the argument is the response time. 5% loss of chance of ROSC for every minute without defib. Chance is considered pretty much zero at 20minutes. By the time a Mayday is sent, handled, DLA contacted, Paged, Team arrives, Launched and proceeded to scene... >20mins elapsed. There may be an arguement that that only applies if in arrest when the mayday call is made rather than after. I suspect they have access to enough expertise to know how commonly that happens and the deterioration is to a shockable rhythm...

The E Classes on the Thames DO have a defib on board. They launch in < 90seconds normally. They are occasionally tasked to "shore incidents" usually on pontoons etc - for medical emergencies exactly because they have the kit. LAS know where they are. I expect an e-class is a bit easier to keep parts of dry than a D class...
 
ShinyShoe said:
Full research paper is here: https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.20790
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Makes for interesting reading. Maybe having a heart attack on a place is not so disimilar to being on a boat, as planes prefer not to divert!
This paragraph might help decide on cost benefit
In 1997, American Airlines equipped planes with AEDs and trained flight attendants in their use. On 627 956 flights from June 1, 1997, to July 15, 1999, involving 71 000 000 passengers, 12 the AED was used every 3228 flights, and death or resuscitation from cardiac arrest occurred every 21654 flights. The AEDs were used 200 times (9 at the gate and 191 on the aircraft). AEDs were used 101 times to monitor an ill passenger and 99 times for loss of consciousness. Fifteen patients had VF, and a shock was given by the AED. Six of the 11 patients with VF on the plane (55%) and none of the 4 at the gate were discharged home. An additional 20 patients died, 14 with agonal rhythms and 6 with an initially stable rhythm;none received an AED shock. Overall, 17% of cardiac-arrest victims were discharged alive from the hospital.
So 15 of 200 patients had a shockable rhythm. Of these 6 lived to be discharged from hospital. Not great odds, but if you were one of the 6 I bet you'd be pleased the plane carried an AED!
TudorSailor
 
ShinyShoe said:
Then be surprised.

They wouldn't be much value on a ILB and making them robust enough would be a challenge. *Some* ILB stations have PAD (Public Access Devices) on the station wall, but not all.

The Lifeguards have them. They also have a big crowd of people.

The ALBs don't have them - I think the argument is the response time. 5% loss of chance of ROSC for every minute without defib. Chance is considered pretty much zero at 20minutes. By the time a Mayday is sent, handled, DLA contacted, Paged, Team arrives, Launched and proceeded to scene... >20mins elapsed. There may be an arguement that that only applies if in arrest when the mayday call is made rather than after. I suspect they have access to enough expertise to know how commonly that happens and the deterioration is to a shockable rhythm...

The E Classes on the Thames DO have a defib on board. They launch in < 90seconds normally. They are occasionally tasked to "shore incidents" usually on pontoons etc - for medical emergencies exactly because they have the kit. LAS know where they are. I expect an e-class is a bit easier to keep parts of dry than a D class...
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This is what is indicated in the Tamar's description (same for the other AWB models) " The Tamar lifeboat carries comprehensive medical equipment including oxygen and full resuscitation kit, Entonox for pain relief, large responder bag and three different stretchers.

Does "full resuscitation kit" mean defribrillator?
 
Sybarite said:
This is what is indicated in the Tamar's description (same for the other AWB models) " The Tamar lifeboat carries comprehensive medical equipment including oxygen and full resuscitation kit, Entonox for pain relief, large responder bag and three different stretchers.

Does "full resuscitation kit" mean defribrillator?
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Nope. Can't do - coz they don't carry one!

It means things like a bag and mask for the O2, suction kit. There is NO defib.
 
ShinyShoe said:
Which brings me to my next thought - chances of your arrest being shockable. Driving down a city centre street you see someone collapsed at the road side. Possible. Driving through rural roads you come across a RTC - rarely are traumatic arrests shockable. Sailing along - acute cardiac event - possible. Drowning, head injury etc... less likely shockable. And technically for a hypothermia you aren't dead till you are warm and dead...
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In an audit of out of hospital cardiac arrests in Scotland:
http://www.gov.scot/Resource/0052/00523287.pdf
25.1% of 91.1% of those in whom the rhythm was known had a shockable rhythm - VF or VT. I think this was rhythm on arrival of a paramedic with a defibrillator - so the likelihood of a shockable rhythm being present in a cardiac arrest witnessed by a person with a defibrillator immediately available might be higher.
The aim of basic life support (CPR) is to keep the heart muscle and the brain oxygenated (and heart hopefully in a shockable rhythm) until a defibrillator can be used. In the audit, only around 40% of casualties got bystander CPR.
 
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Over the last 40 years I've always kept my First Aid certificate up to date. It is ironic how things have changed over that time. From punching the chest and then starting compressions all the way through to grabbing a defibrillator and using technology decide if it needs to apply an electronic punch or not.

The variety of trainers and their view on the topic has been "interesting", from do CPR as long as you are able to after 10 mins the patient will be brain dead. I've never had to do CPR and don't know how I would react if I had to, either the casualty has died from other injuries or the four hours we took to find them was too long.

The last refresher I did had a Parachute Regiment battlefield paramedic as the instructor, by far the most practical training I've ever had! I'm replacing all of the dressings in the first aid kit with big military field dressings; they are brilliant.

I don't see the us of a Defibrillator onboard vessels that are short crewed, but if there was one I'd give it a go. At least you can say you have done all you could.
 
A1Sailor said:
In an audit of out of hospital cardiac arrests in Scotland:
http://www.gov.scot/Resource/0052/00523287.pdf
25.1% of 91.1% of those in whom the rhythm was known had a shockable rhythm - VF or VT.
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Sorry I meant - mechanism of injury is important to the rhythm...

Clearly you will get cardiac arrests on a boat due to conventional MIs.

BUT - you will get traumatic injury arrests. Head injuries, hypothermia, drowning etc... I'm not sure they result if VF arrests - or maybe they do but because you need to deal with the other stuff they have already become non-shockable by the time you've got them back on board etc.
 
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