Defibrillators

[jrudge]

The Defibrillator was acquired through British Heart Foundation with a village project to raise the £400 to purchase it plus cost of suitable cabinet and signage. Our local retired GP carries out regular checks on the equipment.

The key point to note is that use of a defibrillator is only one part of the rescue procedure, with heart massage being the most important. Training is essential.

I guess such equipment would be of limited value on a boat unless there is someone else there to use it when needed. It is obviously not a DIY task!

I think the key this is that they now ARE are DIY job.

The machines are fully automated and THEY decide to shock - NOT the user.

I you look here and follow the Video link

http://heartsine.com/product/p/samaritan-pad-360p/

You will see the instructions.

It then goes on to tell you how to do CPR.

So yes of course knowledge may help, and reduce shock / fear factor but the machines are designed to do their best and tell the user what to do.

Which of course is what they can be deployed in public places.

The stats below seems to vary a bit, but the general message seems to be that with nothing your odds are less than 10% and with a rapid intervention, a shock and CPR this goes put to circa 50%. 70%.

Those seem pretty impressive stats. Almost certain death or an above even chance of coming through.

Henry - I also fully agree with you. I have just dropped 10.5kg and have at least as much to go, so prevention is clearly preferable to cure!

 

[Portofino]

I told you about the stats they are all over the place ,but pretty useless in the boaty context in the sense of they ( stats ) are all within the usual paramedic in what ever time ( 7 mins you choose ) arriving to take over .
There’s a bit more follow up than the AED .
First thing they do is remove the Micky mouse AED pads from the village pub , and put there own on and connect up there EGC / monitor / defibrillator / printer - yup printer .,and start direct admin of drugs ,along with bag and 02

So is it or was it the AED —- or the activity of the paramedics ?

So 1/2 way across the channel or Corsica for the Med guys .

Remember what I said in my 2 nd post about time I,am IN agreement , but the brain will die within 10 mins if you don,t get pressurised 0 2 on the job .Wait a minuate ( scuse the pun ) the paramedics have arrived in the pub scenario - and taken over .

Nigel just reflect a mo 1/2 way across the Atlantic .

Hence in a boat whereby paramedics are NOT ( excluding marinas ) within [ insert your time ] on the scene- AND you are prepare d to lay out £ on an AED then I think it’s prudent you also get an 0 2 bottle , and portable suction .( they are in the ambulance say 10-15 mins in then they puke - )

While you are training you might as well learn how to fit intubators - easy to do on conscious volunteers .
Shame to used the AED and CPR on a shockable rythem in a MI ( myocardial infarction) out at sea a zillion miles away from land and then lose the airway .Theres a bit of skill maintaining an airway .Agian on land in the pub scenario- you don,t see this by the arriving professionals who take over .
Once conscious they will spit it out .

My very last patient before I retired was a gunshot in the mouth ,missed the brain / cranium and exited under the ear .
After rebuilding what was left she went into VF , we after several attempts (plus a load of other stuff going on ) managed to get a stable output , with the defibrillator.
Then about a week later a colleague turned the ventilator off .
Aged 84 attempted suicide .

If you not leaving the marina and professional help is minuates away then an AED in isolation with CPR is good ,iam not saying it’s no good .

I,am thinking of after that the next time phase at sea all by your self + the casualty with a suspect MI .
They will have another an another if the 0 2 saturation is not there .

I Know it feels like advanced stuff , but it will turn into advanced stuff all alone @ sea - no paramedics in 7 mins
Therefore go the whole hog with the kit I suggested and importantly training / updating .

 

[NoviceRod]

I think the key this is that they now ARE are DIY job.

I think you may have misunderstood. What I meant was if you are having an MI, there must be a 2nd person present to administer CPR and the Defib. You can't apply the Defib to yourself!

 

[Portofino]

Really, almost zero chance of saving someone with a public defib?
If you get to someone within a couple of minutes with a public defib their chances are actually pretty good. Actually better than 50/50. Your odds of surviving if there's no defib and you wait for an ambulance are single figures so having one available is definitely worthwhile. The defib talks the operator through how to use it and it only shocks if it needs to.

Confusion / x purposes - I think - permit me to elaborate

I,am working on nil paramedics turning up like say - hmm let’s think — I know how about on a boat mid channel .


You are figuring that by the time the revellers in the pub have used the AED the paramedics arrive and take over ., administering the next level of life support ? Happy to be corrected .

Don,t worry I’ve STILL got the patiances of a NHS consultant teaching surgery to newly qualified
There will be no swearing from me

 

[Mr Googler]

I’ve been deciding whether to reply to this thread or not but here goes.

This is my area of profession.

It’s important to note, heart attack (MI) is a blockage in blood supply to the heart (chest pains, pale clammy etc...)

Defibrillators are used to treat Cardiac Arrest. The muscle of the heart is not contracting therefore not pumping blood. A heart attack can lead to cardiac arrest if the blockage is effecting a large enough area of heart muscle.

To work properly, the heart needs organised electrical activity and muscle responding. Both of these need blood flow around the muscle and nerves to operate.

A defibrillator only works on the electrical side of the heart.

There are 4 possible electrical rythyms an arrested heart will normally be in. VF/VT/PEA/Asystole. Happy to explain what’s going with all of those but it won’t be a short post

A public automated defib will only shock VF. It will not shock VT as this can be pulsed or pulseless. (Edit...internet says they will shock a VT....make sure they are not talking to you then )

So....what’s the priority when dealing with someone in cardiac arrest? Getting help. The reality is, if you don’t get help on the way, your fighting uphill.

Ideally this should be done in conjunction with CPR. The pump (heart) has stopped so you need to take over. Compressing the chest moves a small amount of blood with each push. Air is also drawn in and out of the lungs by this action so you get a small amount of oxygen exchange within the bloodstream.

When help arrives, they will not stop everything, take your defib off and start again. The priority is “staying on the chest”. It takes the first 5 or so compressions to build up any meaningful blood flow so any interruptions in compressions need to be minimised.

The aim of resuscitation short term, is to keep oxygenated blood moving around the organs. A heart will not stay or go into VF unless there is a degree of oxygenation. That is why early defibrillator is so effective as the heart is still oxygenated at that early stage and hopefully in VF.

Medical oxygen is a prescription only medicine so you can’t just buy it. Oxygen guidelines changed some years back and is no longer indicated just because you’re having an MI (heart attack) unless oxygen SATs are below certain levels.

Intubation is an advanced airway technique....don’t consider that.

There are other airway adjuncts such as Igel, OP, NP which you can think about if you want but all require training as you can cause damage. First aid course will teach you how to open an airway effectively without any of that....in the short term.

All the efforts you see during advanced life support are about trying to maintain conditions within the body that are compatible with life and getting the heart to VF so it can be shocked. Without an active circulation, that gets harder in a very short time frame.

It is not like the TV. In 20+ years, never seen anyone sit up and say thanks after being shocked into an organised rhythm.

Can early defibrillation save a life.....absolutely.

Is it worth having one on a boat.......you never know!

Will a defib help if I don’t do or know how to do CPR.........unlikely.

Survival of a cardiac arrest comes down to a huge range of factors. Where you are, how far away help is, how far away definitive care is, the reason for the arrest in the first place, exsisting medical conditions etc.....

The one factor that is always the same.....if no one moves blood when the pump stops.....survival is zero.

I’m so very mindful of the reason this post started and have to say, even when absolutely everything falls into place....help close by, defib on the wall behind you, RYA first aid Course going on next door etc.... the outcome can still be poor. You can only do what you can do and more often than not, the outcome is not within your control.

I would urge everyone to do a first aid course and refresh as things change (for good reason as our clinical understanding improves)

In regards of boating, being aware of any medical conditions people on board have and understand what medications they might need and where they are is a good idea I.e. angina = GTN spray etc...

Enjoy the time we have with the ones we love.



p.s. we all have stories Porto. No idea what bearing or place that has here.

 

[ballyabroad]

I’ve been deciding whether to reply to this thread or not but here goes.

This is my area of profession.

It’s important to note, heart attack (MI) is a blockage in blood supply to the heart (chest pains, pale clammy etc...)

Defibrillators are used to treat Cardiac Arrest. The muscle of the heart is not contracting therefore not pumping blood. A heart attack can lead to cardiac arrest if the blockage is effecting a large enough area of heart muscle.

To work properly, the heart needs organised electrical activity and muscle responding. Both of these need blood flow around the muscle and nerves to operate.

A defibrillator only works on the electrical side of the heart.

There are 4 possible electrical rythyms an arrested heart will normally be in. VF/VT/PEA/Asystole. Happy to explain what’s going with all of those but it won’t be a short post

A public automated defib will only shock VF. It will not shock VT as this can be pulsed or pulseless.

So....what’s the priority when dealing with someone in cardiac arrest? Getting help. The reality is, if you don’t get help on the way, your fighting uphill.

Ideally this should be done in conjunction with CPR. The pump (heart) has stopped so you need to take over. Compressing the chest moves a small amount of blood with each push. Air is also drawn in and out of the lungs by this action so you get a small amount of oxygen exchange within the bloodstream.

When help arrives, they will not stop everything, take your defib off and start again. The priority is “staying on the chest”. It takes the first 5 or so compressions to build up any meaningful blood flow so any interruptions in compressions need to be minimised.

The aim of resuscitation short term, is to keep oxygenated blood moving around the organs. A heart will not stay or go into VF unless there is a degree of oxygenation. That is why early defibrillator is so effective as the heart is still oxygenated at that early stage and hopefully in VF.

Medical oxygen is a prescription only medicine so you can’t just buy it. Oxygen guidelines changed some years back and is no longer indicated just because you’re having an MI (heart attack) unless oxygen SATs are below certain levels.

Intubation is an advanced airway technique....don’t consider that.

There are other airway adjuncts such as Igel, OP, NP which you can think about if you want but all require training as you can cause damage. First aid course will teach you how to open an airway effectively without any of that....in the short term.

All the efforts you see during advanced life support are about trying to maintain conditions within the body that are compatible with life and getting the heart to VF so it can be shocked. Without an active circulation, that gets harder in a very short time frame.

It is not like the TV. In 20+ years, never seen anyone sit up and say thanks after being shocked into an organised rhythm.

Can early defibrillation save a life.....absolutely.

Is it worth having one on a boat.......you never know!

Will a defib help if I don’t do or know how to do CPR.........unlikely.

Survival of a cardiac arrest comes down to a huge range of factors. Where you are, how far away help is, how far away definitive care is, the reason for the arrest in the first place, exsisting medical conditions etc.....

The one factor that is always the same.....if no one moves blood when the pump stops.....survival is zero.

I’m so very mindful of the reason this post started and have to say, even when absolutely everything falls into place....help close by, defib on the wall behind you, RYA first aid Course going on next door etc.... the outcome can still be poor. You can only do what you can do and more often than not, the outcome is not within your control.

I would urge everyone to do a first aid course and refresh as things change (for good reason as our clinical understanding improves)

In regards of boating, being aware of any medical conditions people on board have and understand what medications they might need and where they are is a good idea I.e. angina = GTN spray etc...

Enjoy the time we have with the ones we love.



p.s. we all have stories Porto. No idea what bearing or place that has here.

Nice sensible post!

 

[jrudge]

Very interesting thank you.

So worth a punt but still if you don't get urgent medical care the outlook is not very good.

So if you are anchored outside the marina and can be there in 10 mins ( i am sure this is more than ideal but lets be realistic by the time someone has had the presence of mind to haul the anchor, get on the radio and scoot to the marina and park you are not going to do it much faster) you might (might) be ok, but time away from care and the odds keep diminishing.

Logically i suppose the heart was not healthy in the first place so a quick shock Al La James Bond is not going to suddenly cure the underlying problem.


A friend of mine in Mallorca is ex special forces and now runs a private army. The forces people specialise in not getting into grief, and having the kit to deal with it if they do. They have defibrillator, oxygen and so on, and the skipper once commented to me after someone get a jelly fish sting that if you were going to be sick on a boat in the med their boat was probably the best place to be. You still have to be able to use the stuff of course.

Mallorca is blessed with a lot of Marinas ( unless you are on the West / Soller coast in which case there is just one in the middle!) and I guess most of the time you are within probably say 20 mins of a marina. So this probably comes under the give it a go, but luck is going to need to be on your side category?

 

[vas]

A very worthwhile post and one that might genuinely save someone's life.

It's one of those things where you could argue until the cows come home but ultimately if the time ever came to get involved surely something is better than nothing if you feel you can afford it. I do agree with Pete that from our own perspective the first thing to do is strip off, stand in front of the mirror and ask if like looks like a heart attack waiting to happen. I suspect we are all smack bang in the middle of the target zone so shedding weight and getting your heart working again in a controlled manner will pay dividends.

The recent news was horrible and most tragic. If anything good can come out of it, whether through investment in hardware or ourselves it would go some small way to redressing the balance.

Henry.

+1

reaching 54 in April and having postponed the annual (or biannual...) check, went yesterday for blood tests and this morning to the GP for a full check with ultrasound, heart next week...
If one do that regularly, s/he is one step (at least!) further from a disaster...

Now need to remember to do it again next spring and not when some shocking news come up

V.

 

[Nigelpickin]

I’ve been deciding whether to reply to this thread or not but here goes.

This is my area of profession.

It’s important to note, heart attack (MI) is a blockage in blood supply to the heart (chest pains, pale clammy etc...)

Defibrillators are used to treat Cardiac Arrest. The muscle of the heart is not contracting therefore not pumping blood. A heart attack can lead to cardiac arrest if the blockage is effecting a large enough area of heart muscle.

To work properly, the heart needs organised electrical activity and muscle responding. Both of these need blood flow around the muscle and nerves to operate.

A defibrillator only works on the electrical side of the heart.

There are 4 possible electrical rythyms an arrested heart will normally be in. VF/VT/PEA/Asystole. Happy to explain what’s going with all of those but it won’t be a short post

A public automated defib will only shock VF. It will not shock VT as this can be pulsed or pulseless.

So....what’s the priority when dealing with someone in cardiac arrest? Getting help. The reality is, if you don’t get help on the way, your fighting uphill.

Ideally this should be done in conjunction with CPR. The pump (heart) has stopped so you need to take over. Compressing the chest moves a small amount of blood with each push. Air is also drawn in and out of the lungs by this action so you get a small amount of oxygen exchange within the bloodstream.

When help arrives, they will not stop everything, take your defib off and start again. The priority is “staying on the chest”. It takes the first 5 or so compressions to build up any meaningful blood flow so any interruptions in compressions need to be minimised.

The aim of resuscitation short term, is to keep oxygenated blood moving around the organs. A heart will not stay or go into VF unless there is a degree of oxygenation. That is why early defibrillator is so effective as the heart is still oxygenated at that early stage and hopefully in VF.

Medical oxygen is a prescription only medicine so you can’t just buy it. Oxygen guidelines changed some years back and is no longer indicated just because you’re having an MI (heart attack) unless oxygen SATs are below certain levels.

Intubation is an advanced airway technique....don’t consider that.

There are other airway adjuncts such as Igel, OP, NP which you can think about if you want but all require training as you can cause damage. First aid course will teach you how to open an airway effectively without any of that....in the short term.

All the efforts you see during advanced life support are about trying to maintain conditions within the body that are compatible with life and getting the heart to VF so it can be shocked. Without an active circulation, that gets harder in a very short time frame.

It is not like the TV. In 20+ years, never seen anyone sit up and say thanks after being shocked into an organised rhythm.

Can early defibrillation save a life.....absolutely.

Is it worth having one on a boat.......you never know!

Will a defib help if I don’t do or know how to do CPR.........unlikely.

Survival of a cardiac arrest comes down to a huge range of factors. Where you are, how far away help is, how far away definitive care is, the reason for the arrest in the first place, exsisting medical conditions etc.....

The one factor that is always the same.....if no one moves blood when the pump stops.....survival is zero.

I’m so very mindful of the reason this post started and have to say, even when absolutely everything falls into place....help close by, defib on the wall behind you, RYA first aid Course going on next door etc.... the outcome can still be poor. You can only do what you can do and more often than not, the outcome is not within your control.

I would urge everyone to do a first aid course and refresh as things change (for good reason as our clinical understanding improves)

In regards of boating, being aware of any medical conditions people on board have and understand what medications they might need and where they are is a good idea I.e. angina = GTN spray etc...

Enjoy the time we have with the ones we love.



p.s. we all have stories Porto. No idea what bearing or place that has here.

Very informative, now I feel as though I do not need the course!

Seriously - I think the first aid course for Ann and I is an absolute must and first priority. I haven’t done one since 1988 so I expect to be a little out of date, my trepanning skills are likely out of date....



Thanks for posting

 

[Hurricane]

I think the key this is that they now ARE are DIY job.

The machines are fully automated and THEY decide to shock - NOT the user.

I you look here and follow the Video link

http://heartsine.com/product/p/samaritan-pad-360p/

You will see the instructions.

It then goes on to tell you how to do CPR.

So yes of course knowledge may help, and reduce shock / fear factor but the machines are designed to do their best and tell the user what to do.

Which of course is what they can be deployed in public places.

The stats below seems to vary a bit, but the general message seems to be that with nothing your odds are less than 10% and with a rapid intervention, a shock and CPR this goes put to circa 50%. 70%.

Those seem pretty impressive stats. Almost certain death or an above even chance of coming through.

Henry - I also fully agree with you. I have just dropped 10.5kg and have at least as much to go, so prevention is clearly preferable to cure!

Essentially, I think you have the wrong concept here.
And FARSCO's post kind of confirms this.

I live in the same village as NoviceRod.
We all supported the installation of a defibrillator but our retired local GP who administers it, insisted on additional training for everyone in the village.
SWMBO and I went along one evening - the introduction was held in the local pub!!! - I think NoviceRod did his on a different day.
Most of the time was spent doing the CPR training with the usual dummy (the kind of thing we usually do on a First Aid Course).
The actual training of the defibrillator was the lesser part of our evening.

As you say, it does do it all for you BUT.......
The lesson we learned was that CPR and getting proper help is more important.
Just relying on a defibrillator is NOT the thing to do.
IMO, it might actually lead to a "lulled false sense of security".
Where people believe that the defibrillator will do it all for you.
Which is "kind of" what you said.

FARSCOs post that followed your comment makes real sense.

 

[Mr Googler]

Very interesting thank you.

So worth a punt but still if you don't get urgent medical care the outlook is not very good.

So if you are anchored outside the marina and can be there in 10 mins ( i am sure this is more than ideal but lets be realistic by the time someone has had the presence of mind to haul the anchor, get on the radio and scoot to the marina and park you are not going to do it much faster) you might (might) be ok, but time away from care and the odds keep diminishing.

Logically i suppose the heart was not healthy in the first place so a quick shock Al La James Bond is not going to suddenly cure the underlying problem.


A friend of mine in Mallorca is ex special forces and now runs a private army. The forces people specialise in not getting into grief, and having the kit to deal with it if they do. They have defibrillator, oxygen and so on, and the skipper once commented to me after someone get a jelly fish sting that if you were going to be sick on a boat in the med their boat was probably the best place to be. You still have to be able to use the stuff of course.

Mallorca is blessed with a lot of Marinas ( unless you are on the West / Soller coast in which case there is just one in the middle!) and I guess most of the time you are within probably say 20 mins of a marina. So this probably comes under the give it a go, but luck is going to need to be on your side category?

You’ve hit the nail there to be honest on 2 points.

The reason for the arrest......are we trying to restart a pump that was already badly damaged

Luck.....right place, right time, right people.

I would add that sudden cardiac arrest is not that common in my experience. People rarely arrest with no build up or prior event. Be aware of what your body tells you. Bit of tightness in the chest and shortness of breath after walking but goes when sitting for a bit?.....worth going to the doc’s. Carrying extra timber.....try and avoid 2 puddings Stuff like that.

What would be worth thinking about is how you or people with you would “close the gap” to help especially at sea. Everyone know how to dock the boat? That’s tricky though I guess as there is a case for staying still so you can be found but depends on lots I suppose. We are always thinking of closing the gap to definitive care.....especially with trauma. Lives are rarely saved at the road side, they are saved in theatres. We’re good at buying time and packaging though

 

[Mr Googler]

Very informative, now I feel as though I do not need the course!

Seriously - I think the first aid course for Ann and I is an absolute must and first priority. I haven’t done one since 1988 so I expect to be a little out of date, my trepanning skills are likely out of date....



Thanks for posting

I would. To be honest, it will be less complicated now than 1988.

The message and protocol has been simplified greatly.

If you covered trepanning...you might have been on the wrong course

 

[Whippersnapper]

Excellent post. Many people confuse cardiac arrest with AMI or heart attack although of course the latter can lead to the former. Whenever I read about a “massive” heart attack I assume it is a large Q wave MI which would lead be hard to survive outside of a hospital setting anyway regardless of what interventions were at hand?

 

[Mr Googler]

Q or non Q... that is the question

Severity is more about area effected.

pathological Q’s take hours if not days to develop so you have to survive it to know!

Interestingly, the older you are, you could take a view you are more likely to survive or at least have smaller MI’s due to more collateral circulation having formed over the years. That’s a good news story!

MI care is first class now. Some services still give clot buster pre hospital but the gold standard is straight into the cath lab.

Bad news.....other stuff more likely to effect us as we get older.....damn it.

As with most things medical, nothings black and white really

 

[MrB]

Thanks for your clear explanations FARSCO, great addition to this thread and some very enlightening reading. :encouragement:

 

[Momac]

If defibrillators were, say, £20 each I guess they would be on many boats and fitted in many vehicles and in every place of work.
I accept a defibrillator may not save the patients life......but it may buy some time ...... nor will it kill.

 

[girlofwight]

This has been covered recently:

http://www.ybw.com/forums/showthread.php?497155-Defibrillator-on-board

Yes, interesting. That thread, I think, was more yachties than MOBOers and definitely had a more negative reaction than this one is getting so far.

I wonder if recent tragic events in our own online community is bringing home the reality to us. They may be expensive, it may never get used, but I think, like a liferaft or EPIRB, you might one day be glad you had it onboard, and equally you would be very happy never to have to use it, or have it used on you. Most of us are either at, or fast approaching, a higher risk age.

Yes, I started that thread. I had my mobo mind set on, but as a former yachtie thought it was of wider interest.

I’m still erring towards having one. What price a life? I’m thinking about a couple for work as well; one business location is the middle of nowhere, and probably 10 minutes round trip in a car from nearest defib, the other business location had a defib a couple of minutes away, but I feel one onsite may buy minutes if anything happened.

On the boat, for the most part we are in the Solent, and not that far from help, but I understand the RNLI don’t carry them. If something did happen, and a defib may help, then it may just make the difference.

This is worth a view - if you are going to Arrest, be Air Ambulance controller, and do it at work.... what comes across is how cool the team are

https://youtu.be/w32PUDL2lb8

 

[Fishtigua]

After my late stepfather had a quadruple bypass, a bloody good scar proved it, he was back sailing in Antigua. Heart problems are going to get most of us in the end (not me, have always had big, silly motorbikes for that ending).

Thankfully we have a chain of de-fibs throughout the Channel Islands and plenty of trained users. They are in all the right places, in Town, at the beach and the marina. Get training, it's only half a day to save someone's life.

http://www.defibtracker.co.uk/

 

[rubberduck]

Lots on Isle of Wight, but Southampton are not so good. I will have one on boat, I will lose the cost in that of refit, man maths at its best :encouragement:
If anyone wants to club together in order the achieve a better deal then I'm up for it.

 

[Nigelpickin]

I would. To be honest, it will be less complicated now than 1988.

The message and protocol has been simplified greatly.

If you covered trepanning...you might have been on the wrong course

Update:
We took the course last week, in Lagos; you’re correct in that the course is far more simple than the ones we did in the RN in the 80’s

Plenty of focus on CPR and use of an AED, tellingly a fair bit of focus on mitigating litigation for First Responders....

Anyway, the AED is now ordered and we will keep it nearby when ever possible, it’s a Zoll Plus with CPR metronome. Just uses 123 batteries so should last for as long as it’s needed.