Heart attack procedures aboard

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ianat182

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As a regular sailor approaching old age, even reached that area of life,I wonder what procedures could be written down for guests or crews in the event of a crew member suffering a heart attack or symptoms.
I' m thinking primarily of immediate actions to take, followed by a PanPanMedico radio message on Channel 16.
I' d like to makeup a printed notice near to the radio with step by step instructions regarding care of the sufferer immediately which will not cause further trauma whilst awaiting full medical assistance by para medic or other qualified medical professional.
I envision a sequential flowchart type of instruction as the notice.
Has anybody here done a similar for their boat.
Maybe something for PBO to think about and publish

ianat182
 
ianat182 said:
As a regular sailor approaching old age, even reached that area of life,I wonder what procedures could be written down for guests or crews in the event of a crew member suffering a heart attack or symptoms.
I' m thinking primarily of immediate actions to take, followed by a PanPanMedico radio message on Channel 16.
I' d like to makeup a printed notice near to the radio with step by step instructions regarding care of the sufferer immediately which will not cause further trauma whilst awaiting full medical assistance by para medic or other qualified medical professional.
I envision a sequential flowchart type of instruction as the notice.
Has anybody here done a similar for their boat.
Maybe something for PBO to think about and publish

ianat182
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Keep comfortable, pan pan medico and follow advice.
 
Follow the current First Aid advise and then shout for help. Personally, I'd go straight to Mayday as there is "grave and imminent danger to life or the vessel".
 
Camelia said:
Follow the current First Aid advise and then shout for help. Personally, I'd go straight to Mayday as there is "grave and imminent danger to life or the vessel".
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Agreed. Any suspected heart attack or unexplained chest pain that goes on for 15 minutes is an immediate mayday.

A Disprin Direct (soluble in the mouth aspirin) isn't an approved first aid treatment because first aiders aren't supposed to "prescribe" anything, but it's a standard paramedic treatment and I'd only hesitate long enough to ask if the victim is allergic to aspirin.

If they're unconscious, check for breathing - chest movements, air from mouth/nose. If they are, put 'em in the recovery position and keep a close eye. If not start CPR. If you don't know how, it's time to do a course. Good CPR is a life-saver, but you won't make things worse with bad CPR

If they're conscious, sit 'em down with legs raised.
 
Pan-Pan Medico was abolished many years ago.

If you think you or yoru crew is at significant risk of heart attack, I'd suggest an Automatic External Defibrillator (AED). They are not expensive, and raise your chance of surviving a heart attack from "negligible" (4% or so) to "low" (40% ish).
 
People don't always have "Hollywood Heart Attacks". The person may have no idea what has happened, and the onlookers may not know either.
Two years ago I had a heart attack while alone asleep on my boat. Fortunately I was in my winter berth in a marina and not out on the mooring nor anchored up some creek.
I awoke feeling very unwell but had no idea what was wrong. I had no initial pain just hard work breathing. I was conscious the whole time and didn't know what had happened until I was in hospital. In the ambulance they gave me aspirin and under the tongue Trinitrate spray. Could be worth keeping those in your first aid kit but the spray will time expire. Even so you may have no idea that your crew member is having a heart attack, but the aspirin and spray won't do any harm and may well save a life.
I had a blocked LAD artery and they put a stent in and I was feeling better almost immediately.
Getting medics on board is the obvious priority and they will soon know what is wrong.
 
JumbleDuck said:
Pan-Pan Medico was abolished many years ago.

If you think you or yoru crew is at significant risk of heart attack, I'd suggest an Automatic External Defibrillator (AED). They are not expensive, and raise your chance of surviving a heart attack from "negligible" (4% or so) to "low" (40% ish).
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Those statistics sounds very strange to me - 4% survival rate for heart attacks seems far to low, and 40% survival from an actually stopped heart seems too high.
 
Stemar said:
A Disprin Direct (soluble in the mouth aspirin) isn't an approved first aid treatment because first aiders aren't supposed to "prescribe" anything, but it's a standard paramedic treatment and I'd only hesitate long enough to ask if the victim is allergic to aspirin.
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Or perhaps already taking aspirin. (As I am, following a heart operation a few months ago.)

Mike.
 
RupertW said:
Those statistics sounds very strange to me - 4% survival rate for heart attacks seems far to low, and 40% survival from an actually stopped heart seems too high.
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The London Ambulance Service produces an interesting annual report on cardiac arrest statistics. From the 2013-4 one, survival rates to discharge are 10.3% when resuscitation was attempted, 58.8% when an AED was used. I can't find the figure for no resuscitation attempted.

I looked into this in more detail when I did FAW training three years ago, and then I think the survival rates were significantly lower. The LAS report notes that a lot more people try CPR now and a lot more AEDs are available.
 
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Silly question; but why is there not an external pump invented yet. Something like an external hard disc on a PC that plugs into a pre-installed connector. Perhaps two connectors would be needed, one in each arm.
 
Well, I was in the lucky position of having a nice big heart attack in September in Palma Bay, Majorca, two hours out of Palma Harbour. Left Anterior Descending artery blocked, and I was in NO doubt what the problem was. One of my crew had previously had a heart attack, so I asked for one of his Aspirin tablets. My brain was not working properly, because the dose was too small (75mg instead of the recommended 300mg - I should have asked for four of his pills). My crew called the Spanish coastguard, but did not declare Mayday. (in retrospect, they probably should have, but again my brain was a bit befuddled with pain at the time). They promised to send out a rescue boat, but in the event it did not arrive till we got to the harbour entrance. Bizarrely, the yacht's mate tells me that in-between groans I was busy criticising his radio procedure - I don't remember that.

The two hours or so returning to Palma felt like an eternity, and the feeling of relief when we got alongside and the paramedics came aboard was immense. If possible, have a crew member stay with the casualty, it is very reassuring to have someone nearby in case CPR is needed. The intravenous morphine* was wonderful. TIP: if possible get into the cockpit before the paramedics arrive. I was in the saloon, and they insisted on removing me on a rigid stretcher / backboard. It is very hard to maneuvre these things through a hatch, and very uncomfortable for the occupant of said stretcher. Another tip: if you must have a heart attack on board a yacht, make sure you are within easy reach of a good hospital with excellent cardiology facilities.

Within an hour or so of reaching the hospital in Palma, I had angiography and four stents put in various coronary arteries. I am sure the prompt treatment from the paramedics and the hospital made a big difference to my recovery. The Spanish nurses were lovely as well - I fell deeply in lust!

*If you have a doctor in your crew he could consider taking some morphine in his medical kit. I did when we did a Transatlantic a few years ago, as one of the crew had a possible heart history. In the event it wasn't needed and I had to ditch it overboard before reaching Caribbean territorial waters in case I was accused of drug smuggling.
 
JumbleDuck said:
The London Ambulance Service produces an interesting annual report on heart attack statistics. From the 2013-4 one, survival rates to discharge are 10.3% when resuscitation was attempted, 58.8% when an AED was used. I can't find the figure for no resuscitation attempted.

I looked into this in more detail when I did FAW training three years ago, and then I think the survival rates were significantly lower. The LAS report notes that a lot more people try CPR now and a lot more AEDs are available.
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I think you are referring to survival following cardiac arrest rather than merely heart attack.
 
foeu said:
In the ambulance they gave me aspirin and under the tongue Trinitrate spray. Could be worth keeping those in your first aid kit
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I have a bottle of the trinitrate spray, it comes in the MCA Cat C first aid kit which I used as the basis for a larger set of stuff. Always struck me as a bit oddly specific - why a drug for this particular complaint and not any other, did someone at the MCA have a heart problem themselves? - but since it's there I might as well have it on board.

Pete
 
JumbleDuck said:
Pan-Pan Medico was abolished many years ago.

If you think you or yoru crew is at significant risk of heart attack, I'd suggest an Automatic External Defibrillator (AED). They are not expensive, and raise your chance of surviving a heart attack from "negligible" (4% or so) to "low" (40% ish).
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As stated by others, one has to be clear about differentiating between a heart attack where the heart does not stop or does not fibrillate, and a cardiac arrest where the heart stops or stops pumping due to fibrillation.

In a hospital, defibrillation is accompanied by the administration of drugs such as bicarbonate and adrenaline. Not something that one can do if your are not a doctor!

The question is how long can you survive having been defibrillated without being in a coronary care unit? I think that if you are coastal cruising then an AED may be of value since you should be taken off the yacht soon after the AED has been used. If you are off-shore and help is hours away, I suspect that AED may only delay the inevitable.

In my past as a young doctor, I recall using a defibrillator and it was like a miracle when the regular rhythm returned. Now I am older and thinking of doing the ARC, I see no point in getting an AED. Probably a supply of aspirin is all that will help once out of range of a helicopter

TudorSailor
 
I was up in the far NW, somewhere near Lochinver/Old Man of Stoer area when the VHF buzzed into life on 16, obviously not a familiar user (as far as I can remember the conservation went):

Man: Coastguard, I have a problem, I think the skipper has had a heart attack.
CG: Understood, is he conscious, where are you?
Man: Sort off. Dunno where, never been on this boat before. I need help.
CG: What is the boat, where did you start from?
Man: Fishing boat, left Lochinver early this morning. I can't operate the hydraulics.
CG: What is the boat colour, when you left Lochinver did you go north ot south?
Man: Red, dunno which way we went. I must have help
CG: We are getting help to you - lifeboat and helicopter.

So it went on, the CG coaxing information from the man, and the other local boats chipping in. Within an hour they had airlifited the guy off to Inverness hospital and the locals had put a scratch crew on the fishing boat. I gather he made a good recovery.

Moral: A suspected heart attack IS a 'Mayday'. Make sure that there is a crew member who can operate the VHF, read the GPS display, and knows how to use the DSC. I suspect that is as important as first aid measures.
 
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RupertW said:
Those statistics sounds very strange to me - 4% survival rate for heart attacks seems far to low, and 40% survival from an actually stopped heart seems too high.
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I was told 6% if you had one outside a hospital and had CPR but no defibrillator, 70% if defibrillated within 5 mins and in hospital within an hour.

On the offshore medical course, we were told to check how long a chopper was away - if more than an hour don't start CPR as you'll end up taking a badly battered body home.
 
tudorsailor said:
In a hospital, defibrillation is accompanied by the administration of drugs such as bicarbonate and adrenaline. Not something that one can do if your are not a doctor!
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A full MCA medical kit, as carried on ships, includes quite a few prescription drugs, to be administered on the advice of a doctor by radio or sat-phone. Some long-distance yachts are equipped to a similar standard. Any idea if it would, or could, include these?

Perhaps even that might just be delaying the inevitable if you're many days from a hospital?

The bosun of a square-rigger once told me that a very valuable use for a radio doctor service, when in mid-ocean beyond reach of rescue, was that they could be a dispassionate and authoritative voice to say that someone was beyond help and their shipmates should stop trying.

Pete
 
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