Fatality at Dartmouth

[[70521]]

Do many people shoot at you while you're sailing? I heard that the owners of Sanda were a bit antisocial, but not that bad, surely?

So the rumors are true. A major trauma injury is a major trauma injury, I was unaware the body could say, "oh I have been shot I must bleed lots" or "it's only a complex fib and tib fracture i'll only bleed a little".

How long does it take the local ambulance to get to a pontoon in Dartmouth?

Getting an ambulance anywhere in Dartmouth takes ages! Especially during the summer months.

 

[AntarcticPilot]

And it's important that on a outdoor first aid course, (rather than one where for situations where the ambulance might be expected within a reasonable time), that the first aiders really understand and feel empowered, about when CPR can be discontinued. To not have a reasonable set of guidelines can lead to first aiders being constrained into actions that might make the whole situation worse. They must also know when enough is enough or otherwise you're setting them up for pretty traumatic post event guilt.

However I can understand how an 'experienced kayak expedition leader' might have a slightly more committed approach to CPR as the recovery from apparent cold water drownings have been quite dramatic even after long unresponsive times.

I was taught on first aid courses that you don't decide when enough is enough. You keep going until help arrives or you physically can't do anymore.

If you're sailing offshore, the chances of a single person being able to maintain CPR until help arrives is practically zero. The realities of the choices that have to be made when sailing, as many do, as a husband and wife team on long term cruises, should be part of any relevant first aid course, just as they are when we're training group leaders for land based expeditions. The simplistic "keep going till help arrives, hasn't been taught on any course I've done since the days when Dr Jones from Bangor Hospital used to do his 'First Aid for Mountaineers' course in the 70s.

The advice given to those going to Antarctica, potentially DAYS away from skilled help, was that you keep going with CPR until you're sure they're dead - and then keep going until you're told to stop by a doctor on the radio. Of course, in any party everyone would be fully trained in first aid (to a much higher level than UK based courses) and parties less than 4 were unusual. Of course there are obvious exceptions - for example, injury clearly incompatible with life - but the general advice was "don't stop until you're told to". Part of this was the obvious psychological need to ensure that people knew they'd done everything possible, but another part was that a deeply cold person can be revived after a surprisingly long period with no discernible life-signs; I forget the record (for non-medical cooling), but its tens of hours.

 

[[70521]]

The advice given to those going to Antarctica, potentially DAYS away from skilled help, was that you keep going with CPR until you're sure they're dead - and then keep going until you're told to stop by a doctor on the radio. Of course, in any party everyone would be fully trained in first aid (to a much higher level than UK based courses) and parties less than 4 were unusual. Of course there are obvious exceptions - for example, injury clearly incompatible with life - but the general advice was "don't stop until you're told to". Part of this was the obvious psychological need to ensure that people knew they'd done everything possible, but another part was that a deeply cold person can be revived after a surprisingly long period with no discernible life-signs; I forget the record (for non-medical cooling), but its tens of hours.

Is this current practice? I am actually interested.

Over the last 10 years there has been a change in what has been taught on first aid courses in the UK. Along with the medical profession actually asking people if they want re-sussed if they stop breathing in hospital.

 

[JumbleDuck]

Getting an ambulance anywhere in Dartmouth takes ages! Especially during the summer months.

Good point. On the other hand, lots of bystanders to take over CPR.

 

[Stemar]

I know the cold keeps you alive bit is true. Casualties in the Falklands survived worse injuries with no more than basic first aid far longer than would have been expected because they were severely hypothermic, and I know of someone who survived overnight in a Canadian winter with fairly severe injuries following an accident coming home on a bike. There were no signs of life when they were finally brought into the hospital, but after careful warming, they came back to make a full recovery. As they say over there, you're not dead until you're warm and dead.

As for when to stop CPR, the advice to keep it up until you can't keep going or help arrives applies to a situation where help in the form of an ambulance isn't going to be long. If you're mid-Atlantic and days from help, or even mid-Channel and a couple of hours from help, the chances of getting anyone back is remote, though worth a try if the cause is drowning, IIRC, but you don't want to make yourself a second casualty.

 

[JumbleDuck]

... another part was that a deeply cold person can be revived after a surprisingly long period with no discernible life-signs; I forget the record (for non-medical cooling), but its tens of hours.

Anna Bågenholm has one of the records. She was trapped under ice for 80 minutes and her heart stopped after 40 minutes. After 9 hours in resuscitation she made almost a full recovery. By the time they pulled her out her core temperature was under 14^oC.

IANTSOD (I Am Not That Sort Of Doctor) but I gather that death is now generally seen by medicine as a process rather than a binary state. When they turned the machines leeping my old man alive in ICU, it took them quite a while to decide that he was, in fact, dead -and that despite most his brain having died several days before. "The best we can hope for is a persistant vegetative state" is not something you want to hear.

But I digress. Here's a telegraph story about a woman who recovered after 17 hours of no detectable brain activity (during which I presume she voted for Donald Trump): https://www.telegraph.co.uk/news/ne...ck-to-life-after-being-dead-for-17-hours.html. As an amateur first aider I am not going to guess when someone is dead.

 

[penberth3]

...But I digress. Here's a telegraph story about a woman who recovered after 17 hours of no detectable brain activity (during which I presume she voted for Donald Trump): https://www.telegraph.co.uk/news/ne...ck-to-life-after-being-dead-for-17-hours.html. As an amateur first aider I am not going to guess when someone is dead.

For a few years now I've noticed news reports implying paramedics have decided someone is dead "at the scene". AIUI only a doctor could make that decision. Has this changed?

 

[AntarcticPilot]

Is this current practice? I am actually interested.

Over the last 10 years there has been a change in what has been taught on first aid courses in the UK. Along with the medical profession actually asking people if they want re-sussed if they stop breathing in hospital.

I can't speak for current practice; I have been retired for 7 years. But it was certainly the advice given to people going to Antarctica. however, there are several factors to take into account:

1) Everyone going to Antarctica professionally has passed a thorough medical.
2) Most people going to Antarctica professionally are relatively young.
3) Everyone going into the field in Antarctica has had very intensive first aid training, sufficient to allow them to act as assistants to doctors if required.
4) The most likely cause of first aid being required is an accident; things like stroke or heart failures are less likely because of 1 and 2.
5) Although help may be days away, there is always access to a doctor by HF radio.

I forgot to say that there is also: 6) BAS has a high proportion of fitness freaks!

The only group with much risk of heart problems are ships' crews - and there's a doctor on each of the ships.

 

[[70521]]

I can't speak for current practice; I have been retired for 7 years. But it was certainly the advice given to people going to Antarctica. however, there are several factors to take into account:

1) Everyone going to Antarctica professionally has passed a thorough medical.
2) Most people going to Antarctica professionally are relatively young.
3) Everyone going into the field in Antarctica has had very intensive first aid training, sufficient to allow them to act as assistants to doctors if required.
4) The most likely cause of first aid being required is an accident; things like stroke or heart failures are less likely because of 1 and 2.
5) Although help may be days away, there is always access to a doctor by HF radio.

I forgot to say that there is also: 6) BAS has a high proportion of fitness freaks!

The only group with much risk of heart problems are ships' crews - and there's a doctor on each of the ships.

Thanks AntarcticPilot

We have a member of staff here who is ex BAS and can chat it over with him.

I am not going to comment on the frequency of young heart attack/death in sleep people I have known.

 

[ghostlymoron]

And the cottage hospital has been closed.

So the rumors are true. A major trauma injury is a major trauma injury, I was unaware the body could say, "oh I have been shot I must bleed lots" or "it's only a complex fib and tib fracture i'll only bleed a little".

Getting an ambulance anywhere in Dartmouth takes ages! Especially during the summer months.

 

[Spyro]

Is this current practice? I am actually interested.

Over the last 10 years there has been a change in what has been taught on first aid courses in the UK. Along with the medical profession actually asking people if they want re-sussed if they stop breathing in hospital.

The way cpr is done has changed, compressions to blows but I think the advice is still the same regarding how long to do it for

 

[JumbleDuck]

The way cpr is done has changed, compressions to blows but I think the advice is still the same regarding how long to do it for

Here's a couple of screenshots from the current (2015) Resuscitation Council guidelines (https://www.resus.org.uk/resuscitat...port-and-automated-external-defibrillation/):

Note: absolutely no mention of "or when you decide the victim is dead".

 

[ghostlymoron]

It would be helpful if they said how many compressions/breaths. I think it was 5/2 when I last did a refresher but it often changes.

Here's a couple of screenshots from the current (2015) Resuscitation Council guidelines (https://www.resus.org.uk/resuscitat...port-and-automated-external-defibrillation/):

Note: absolutely no mention of "or when you decide the victim is dead".

 

[Stemar]

If you've got a helper to give the breaths, it's 15:2, if you're on your own, it's 30:2. The compressions are far and away the most important thing and have some effect of moving air in and out of the lungs anyway.

If you don't fancy snogging them or can't for any reason, it's OK just to give compressions.

 

[Blue Sunray]

 

[JumbleDuck]

It would be helpful if they said how many compressions/breaths. I think it was 5/2 when I last did a refresher but it often changes.

They do, but I was only copying the bits about going on until you can't or someone qualified tells you to stop. Current guideline is 30:2, do the compressions even if you can't do the breaths.

 

[JumbleDuck]

Good find. I still prefer "Nellie the Elephant", but it wouldn't really go with Vinnie Jones' image.

 

[[70521]]

The way cpr is done has changed, compressions to blows but I think the advice is still the same regarding how long to do it for

Don't I know it! I did my first, first aid course at the age of 12, over 40 years ago, and it was lead by one of the doctors at the Belford Hospital in Fort William, mum was a nurse there, we started with a punch to the heart. Since then the compressions to blows ratios have been a movable feast. We now have the Vinnie Jones and Pretenders soundtracks to work with.

 

[JumbleDuck]

Don't I know it! I did my first, first aid course at the age of 12, over 40 years ago, and it was lead by one of the doctors at the Belford Hospital in Fort William, mum was a nurse there, we started with a punch to the heart.

Oh yes, I remember learning something like that in the Sea Scouts from a leader who was a doctor in the RNVR. Two handed blow to the chest, as hard as you could, to break a few ribs and make the rest easier.

 

[[70521]]

Here's a couple of screenshots from the current (2015) Resuscitation Council guidelines (https://www.resus.org.uk/resuscitat...port-and-automated-external-defibrillation/):

Note: absolutely no mention of "or when you decide the victim is dead".

https://www.resus.org.uk/resuscitation-guidelines/adult-advanced-life-support/#duration suggests 20 mins. Two people on a boat heading to a lee shore, your call.

The only reason I consider AIS useful on a boat. Somebody should see where you are heading.