Heart attack procedures aboard

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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The LAs report specifically deals with public defibrillators, not hospital ones, and I find their figures pretty convincing. Of course it's all about getting people to the professionals in time.
 
BurnitBlue said:
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.
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I think you are over-simplifying. I believe I was on a heart-lung machine while having my heart surgery in September. This is because the heart is two pumps, one sending blood round the lungs, the other a separate stream round the rest of the body. So you are going to need four connectors, all with anti-clotting problems etc...

Mike.
 
foeu said:
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.
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I was in the emergency dept with chest pains later diagnosed as stress related this was a couple of years after my triple bypass the doctor was on his first rotation in emergency and insisted on giving me a second dose of trinitrate spray just as I was being sat up for an ex ray I have never felt as scared as I was then I felt that I was falling through the bed and dying the nurses took over and all was ok but it scared me and I still can recall the feeling six or so years on so would be pleased to hear professional advise regarding use of spray
 
BurnitBlue said:
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.
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Apart from anything else, the heart is connected to a 40A heater cable and your arms only have 2A lighting circuits in them.
 
I completed a Red Cross "top-up" Ist Aid course yesterday.

The statistics about survival after CPR and after defib are very variable and one good authority can quote quite different numbers from another.

What was made very very plain to us was that it is not necessary to give any breathing assistance (mouth to mouth). Especially if you are on your own, taking time to give breaths will take you away from the over-riding requirement - to keep compressing the heart to circulate blood to the brain.

If you have the casualty's head bent back a little, the tongue will keep moving out of the way, and the chest compressions (which can be by hand, by knee, by foot, or by a stick) will keep air moving in and out of the lungs any way.


The other advice which well noted was that you have no more than three minutes from the onset of a person being unconscious to getting the blood pumping round the brain. Otherwise brain dead.


It was also said that if you don't break one or two ribs while doing the compressions, you aren't trying hard enough.


So many things have changed in the three years since I did my Competent Person At Work course, that I would seriously recommend going on a four hour top-up course.

It really should be the sort of thing that every marina or yacht club runs, anyway. Perhaps YBW might investigate setting up courses ?

Here in Somerset, our county Adult Training will pay for a proper trainer if you can get enough people together, so no costs apart from coffee and biscuits.
 
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st599 said:
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.
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That advice not to start cpr is wrong.CPR in itself is the best way to reverse a cardiac arrest and should always be attempted even if you subsequently become unable to continue due to exhaustion or whatever.If you have a defibrilator clearly that is good, if not dont give up.
In reality a cardiac arrest on a boat at sea is very likely to have a bad outcome,but a heart attack short of an arrest is eminently treatable.It certainly is a Mayday and time is of the essence.As said Aspirin is good if the casualty is not unable to tolerate it.Otherwise keep the casualty as still as possible and dont let them hide in an obscure part of the boat.They will need to be evacuated and getting them out of the forepeak or a quarter berth is a real pain.The GTN spray is sort of good but it lowers blood pressure and can be a problem for those who have low blood pressure or a slow pulse already.Personally Id take it if there is a strong pulse at the wrist and the rate was over 60.Very good recovery from this sort of thing these days if treated in good time.
 
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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To improve the chance of surviving a heart attack while on board:-
1. ensure at least one of your crew has been on a first aid course within the last 3 years. Ideally more than one in case a first aider is the casualty.
2. ensure at least one, or more, of your crew is competent at broadcasting a mayday on VHF and knows how to communicate your position.
3. Buy an AED (Defibrillator ) in case the heart attack becomes a cardiac arrest before help comes.

Then ensure your instructions and written procedure to crew say:-

At the first signs/symptoms of a heart attack (a) broadcast a mayday (only if no response try 999 on mobile and ask for the Coastguard) (b) administer first aid until help arrives. (Hopefully a and b can be done simultaneously by two people)

Www.solocoastalsailing.co.uk
 
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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Aspirin (if not allergic) was certainly a recommendation on the MCA proficiency in medical first aid at sea course I did, although it was a paramedic giving the course.

Asking about medication people have (including GTN spray) and how people would like me to use it in an emergency is part of the safety briefing for new crew. Obviously not much cop if it's someone's first bout of heart trouble and they have no medication...

Where are these budget AEDs which JumbleDuck refers to? I considered acquiring one after getting my AED certificate but they seem to be over a grand and given that I don't think we've had anyone over 50 on the boat when under way I thought it was probably a bit overkill. In extremis isn't the PBO solution a couple of 70mm wires from the alternator?

PS: Good thread. This is something I do worry about should I ever manage to convince my elderly mother to let my Dad come sailing with me.
 
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Stemar said:
........................... 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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Yes we are- my last two Remote First Aid 16hr refreshers for my caving instruction and DofE updated this (we'll leave aside Epipens and inhalers) and not to worry about aspirin allergy.

More whimsically, one FA instructor asserted that our CPR was 100% successful, as when we hand over the casualty death has not yet been certified.......
 
Now that I too am reaching a certain age I tend to feel a mixture of sympathy for the family but pangs of envy for anyone who dies quickly while sailing. A DNR medal round my neck seems a lot preferable to an old folks home.
 
Hopefully the professionals on here will correct me if I am incorrect but "heart attack" is a meaningless term. You have symptoms and you treat those symptoms accordingly. I have had a "heart attack" and yet the heart muscle is perfectly healthy and I never experienced any pain or discomfort as a result. The only time I have ever experienced the classic "heart attack" symptoms has been when I have had trapped wind.

It's very wise to be concerned about cardiac health but I would have thought that a day spent getting oneself checked out and then mitigating or reducing any potential issues before ever going offshore would be far more valuable than carrying an AED or whatever.
 
grumpy_o_g said:
Hopefully the professionals on here will correct me if I am incorrect but "heart attack" is a meaningless term. You have symptoms and you treat those symptoms accordingly. I have had a "heart attack" and yet the heart muscle is perfectly healthy and I never experienced any pain or discomfort as a result. The only time I have ever experienced the classic "heart attack" symptoms has been when I have had trapped wind.

It's very wise to be concerned about cardiac health but I would have thought that a day spent getting oneself checked out and then mitigating or reducing any potential issues before ever going offshore would be far more valuable than carrying an AED or whatever.
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I am not sure what you mean but a 'heart attack' is a real thing. It is the lay terminology for a myocardial infarction which is damaged heart tissue as a result of blocked blood supply. Of course there are various severities related to the extent of the blockage and the blood vessels involved.
 
Biggles Wader said:
That advice not to start cpr is wrong.CPR in itself is the best way to reverse a cardiac arrest and should always be attempted even if you subsequently become unable to continue due to exhaustion or whatever
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I agree that there should be no reason to delay CPR, regardless of the time for assistance to arrive, but CPR will never restart or defib a heart. Its purpose is to circulate blood until defibrillation can be achieved. Instances where casualties revive after chest compressions arise because their heart had not stopped in the first place.
 
There are many causes of chest pain and a heart attack is relatively rare. It can't really be confirmed without an ECG and a bllod test but some of the symptoms will give you a clue as to whether it's cardiac related or, more commonly, muscular skeletal (costochondritis). Some clues are a gradual onset of central crushing pain, sometimes, but not always, radiating to one or both arms an/or the jaw, pale, clammy skin, the pain doesn't change when taking a deep breath or with movement and isn't tender to pressure. A pain described as "sharp" is unlikely to be cardiac, especially if the patient, when asked, points to the pain with one finger.

These are all just clues and not definitive but, assuming that there are no contra-indications, and aspirin won't hurt and a single spray (400 mcg) of GTN may help with cardiac pain as long as the patient doesn't have low blood pressure. As previously mentioned, a good pulse at the wrist indicates sufficient pressure.

I'm afraid that a cardiac arrest at sea is unlikely to have a good outcome unless it's caused by one of the reversible causes that can be treated at sea like hypoxia or hypothermia (and others)
 
grumpy_o_g said:
It's very wise to be concerned about cardiac health but I would have thought that a day spent getting oneself checked out and then mitigating or reducing any potential issues before ever going offshore would be far more valuable than carrying an AED or whatever.
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I'm not sure that the OP mentioned going far offshore. I'm guessing that for the vast majority of senior forumites the concern is a more cardiac issues crossing christchurch bay rather than the atlantic. All crew getting a thorough checkup before every sail might not be practical and if a skipper were to demand it as condition of going for every weekend sail, he or she might be left with few mates (as well as it not guaranteeing crew cardiac health).

My understanding is that where you don't have all that long to wait for the helicopter or lifeboat is the optimal situation for an amateur to be using an AED.

Although if I ever needed to use one on a crewmate £1000 would, as JumbleDuck says, be "jolly cheap", for those of us on a limited budget, particularly in my case where I don't think we've been under way on this boat with anyone over 50 there's a strong argument that that £1000 would be better spent on other safety measures.

Whilst I like the couple-of-wires-from-the-alternator solution, I'm not entirely sure that I could diagnose when defibrillation is actually needed quite as well as an AED. However in my elderly father's case, I do still owe him payback from his dodgy DIY 30 years ago but that's another story....
 
Always interesting to consider how much to spend on safety equipment and on what, and much debated on these forums.

So for a couple, both aged over 60, and only coastal sailing, is £1000 better spent on a liferaft or an AED? Statistically, which is more likely to be needed to save a life?
 
Probably the AED but both are not that likely to be required. It is more likely the AED would be required while in the marina when someone else has an arrest. I think the availablity of AEDs in crowded public places may be a statistically significant benefit but the bottom line is that most people hearts only stop for a good reason. Unless you can reverse that reason the outcome is poor. Also, the person you bring back may not be the person they were before so some people make a decision at a certain age that if their time is up it is up. AEDs require regular servicing and checks and are probably not particularly suited to the marine environment. We have one at the surgery and have never had to use it in 30 years. In the hospital, when on the crash team, it was maybe once or twice a week that you would be called and in many instances it was futile.
 
Six years ago while in Finnike Turky I woke up one morning with a tingling feellng in my left hand . I was already on a pill for high blood pressure . Suspecting something wrong we got one of the local marineros to take me to the local hospital where they found my blood pressure exceeding high . Gave me the stuff under the tongue and an injection to reduce the pressure . Caught the plane two days later to Glasgow and on arrival in my home town got sent to Perth infirmary and the next morning was advised that after blood tests I had had a heart attack . later on diagnosed with three blocked arteries unable to have stents fitted and ended up in Edinburgh royal with a triple bypass

The trouble is you dont know what you have got until something happens and when it does there is not much you can do until you get blood tests and medical help other than carry a blood pressure monitor and if anything happens feet up and recovery position in the short term
I am in my late 70's and while SWIMBO is younger than me we are both now on a cocktail of pills with annoying side effects
So while we both now gang warily we don't intend to stop sailing this year if we can help it
 
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