Onboard Defibrillator

[grumpy_o_g]

Really? If defibrillators are so great why do ambulances take people to hospital? Perhaps if the patient could stroll into the Cardiac clinic in two or three weeks the Consultant Cardiologist will see them then.

A defibrillator is first-aid not remedial. The idea of a defibrillator is to stop someone dying and give them a chance to get to proper care. Contrary to popular opinion that might not be within the next hour but it certainly shouldn't be a few weeks later either.

 

[Elessar]

Serious question, not a dig.

What are you qualifications?

W

Not taken as one.

I regularly do or review risk assessments as a part of my job.

 

[Sandy]

Is called risk mitigation not risk elimination.
People die wearing life jackets. So don’t bother with them. Same logic.

I fully understand risk mitigation, I spent a long time as a Safety Engineer and many moons ago I was a member of a Mountain Rescue Team hence my First Aid skills were a lot higher than my current RYA First Aid at Sea certificate. I was a just a tad surprised at your comment. I am sure we both understand the 'Golden Hour' and that when offshore we are nowhere near medical assistance.

 

[Zing]

Probably because we are living longer. Stable IHD is a relatively benign condition, so even if more of it, it's not so bad. I'd wager an awful lot of the posters here, given the age demographic, will have some atheroma in the coronary arteries. We are living longer with ischaemia, and that's no bad thing.

CVD is a huge health issue, the biggest killer there is and stabilising it, or reversing it is not generally achieved, because there is no consensus on how to do that. I’m sure we we mostly have it to some degree on here, just like we are all to some degree chronically sick from our modern diets.

Also, we are not living longer anymore, in no small part because of the seriousness of atherosclerosis, the precursor to much CVD and other deadly diseases and our terrible advice on its prevention:
National life tables – life expectancy in the UK - Office for National Statistics

 

[lustyd]

when offshore we are nowhere near medical assistance.

That would depend on the crew and facilities on board. Hospitals aren’t the only place people can be cared for.

 

[Sandy]

That would depend on the crew and facilities on board. Hospitals aren’t the only place people can be cared for.

From time to time I sail on a 30 meter yacht with a crew of 24, the skipper and usually the first mate hold a Ship's Captain's Medical Certificate, and we carry extensive trauma kit and sizable range of medication. I strongly suspect with all that kit onboard we would be unable to care for a patient who had suffered a heart attack for any length of time.

Two years ago an ex-colleague of mine, aged 55, died about a week after a heart attack even though he spent all the time between the attack and death in ICU. Another ex-colleague, aged 45, is currently in and out of hospital following a minor heart attack - if we were allowed to visit I would be sat by his bed eating the grapes that I had brought as he was readmitted again last night!

 

[lustyd]

An anecdote about one person dying is not a good reason to not try. Either way you’ll need to take the body back to port, so might as well do your best to stop it stinking up the yacht by dying in the mean time. People have survived all sorts too, anecdotally speaking.

 

[Stemar]

That doctor clearly didn’t complete the module on risk assessment. Stupid statement frankly.

It's not an unreasonable statement, nor an unreasonable risk assessment. I can think of a lot of things to spend £1000 on that would be far more useful in keeping alive and kicking on a transat.

A defib will interrupt ineffective heart rhythms, effectively rebooting the heart. They are unnecessary in any other situation, which includes most heart attacks that are survivable when you're a day or more from effective medical treatment. The chances are that heart attack that leads to ventricular fibrillation or tachycardia has been caused by a blockage in one or more arteries that supply the heart. If they aren't unblocked PDQ - an hour or two, the part of the heart that those arteries supply will die. It's possible a defib would bring me back in that situation, but likely not for long, nor with a reasonable quality of life, even if I make it home. Please don't bother, I'd rather feed the fishes

It makes far more sense to carry one for a trip round Britain, where you're in with a chance of getting those arteries unblocked in time to save the heart.

 

[Sandy]

An anecdote about one person dying is not a good reason to not try. Either way you’ll need to take the body back to port, so might as well do your best to stop it stinking up the yacht by dying in the mean time. People have survived all sorts too, anecdotally speaking.

See post #83. I have more experience than most of the care of patients with heart attacks in remote areas.

I am not saying don't try, I am saying that post use of a debulator the likelihood of getting the right medical attention while offshore is, at best slim at worst not going to happen, and was giving an example of somebody who had all the right care not surviving!

Let us not stray into the field of brain oxygen starvation as that opens another can of worms.

The transportation of a body is another delicate matter. Do you remember the thread several years ago when a crewmember of an ARC yacht did die, I recall he was a GP, and the comments that were made on here. Eventually, his son posted information about what had happened to his dad.

 

[Supine Being]

That doctor clearly didn’t complete the module on risk assessment. Stupid statement frankly.

She didn't strike me as a stupid person, but you're entitled to your opinion based on the slither of information that I shared with you. I do know that she gave their strategy a great deal of thought.

I'm in no position to defend her position as I'm not a medic, but her logic seems sound. Balance the likelihood of them requiring defibrillation, fairly fit as they are, against the eventual effectiveness and outcomes of the treatment in the likely circumstances that they would find themselves. I don't have the data on outcomes in such circumstances and, I suspect, you do not either. From talking to her, I think she probably did.

Not all risks can be 100% mitigated, and the line has to be drawn somewhere. But everyone's appetite for risk differs, as do their individual circumstances (and, therefore, level of risk). People should take this kind of decisions based on what is right for them and their crew, not someone else. As others have said, someone with a higher cardiac risk sailing inshore waters may decide that such measures are warranted.

 

[penberth3]

That doctor clearly didn’t complete the module on risk assessment. Stupid statement frankly.

Read it again. It's a realistic assessment of a serious medical emergency in mid-ocean.

 

[lustyd]

while offshore

Just a reminder though, OP never mentioned offshore so help could well be close at hand.

 

[Irish Rover]

I've posted another thread on a piece of kit that may be of interest to those with cardiac issues or risks
6 lead ECG monitor in your pocket

 

[PilotWolf]

Do the RNLI carry them (routinely) now?

W

 

[Sandy]

Do the RNLI carry them (routinely) now?

W

Lifesaving automated external defibrillator (AED) now in place at Conwy RNLI | RNLI

 

[SaltIre]

That would depend on the crew and facilities on board. Hospitals aren’t the only place people can be cared for.

Indeed - but not many places other than hospitals have staffed Critical Care Units.

 

[lustyd]

Indeed - but not many places other than hospitals have staffed Critical Care Units.

And that's fine, I'm sure the CG helicopter will drop OP off at A&E

 

[Sandy]

Just a reminder though, OP never mentioned offshore so help could well be close at hand.

If you follow the thread my first comment was in reply to @Elessar's comment about the doctor not taking a defibrillator on the ARC, I understand this is an ocean passage with parties at departure and arrival points, in my opinion that qualifies as offshore. As ever threads go off topic within 10 posts.

If consider my own passages, let's say I'm at the Eddystone Light off Plymouth, my home port. It's a pleasant 12 miles out then back and a nice day out. My friend John collapses and I don't feel a pulse, I hit the wee red switch and broadcast a Mayday. It will be about 45 mins before the Plymouth Lifeboat reaches me. If I am lucky there might be a passing RN Frigate with a helicopter that can CASIVAC John. The local CG Air Station is at Newquay, Cornwall about 30 mins flying time. With the use of helicopters and a bit of luck John might be in Derriford, the local General Hospital, in about an hour. Halfway across Lyme Bay or to Roscoff, it would be more of a challenge. A question that I ask anybody coming onboard is, 'Is there any health condition I need to know about?'

It really depends on the type of sailing you do. A potter round the bay, Torbay for example, with a hospital and a local RNLI station, and the skills (and space to use a defib) might work. As @Elessar it is all about the mitigation of risk to as low as reasonably practicable. If we eliminate risk from sailing we may as well sell the boat and take up tiddlywinks or bridge (although there is risk of choking on the finger rolls).

From practical experience it takes a bit of time to mount a rescue - I needed to get into my mountaineering kit while Mrs Sandy sorted out a flask and something to eat, jump in the car and get myself to the Mountain Rescue Centre, get briefed, and on the hill. That could be an two hours before we were ready to start a search . An incident I was on the fringe of near Stonehaven in August was only reported by a passing RIB where a chap was found on the keel and had been there for two hours, his two friends had been in the water all that time. Thankfully, the RNLI and CG helicopter found the two chaps in the water within the hour. Sadly, I heard one of the chaps did not survive the night. RIP.

Out of interest who does the RYA First Aid at Sea 'add on' to dispense that heart drug, the name escapes me, and carries it onboard?

 

[PilotWolf]

If you follow the thread my first comment was in reply to @Elessar's comment about the doctor not taking a defibrillator on the ARC, I understand this is an ocean passage with parties at departure and arrival points, in my opinion that qualifies as offshore. As ever threads go off topic within 10 posts.

If consider my own passages, let's say I'm at the Eddystone Light off Plymouth, my home port. It's a pleasant 12 miles out then back and a nice day out. My friend John collapses and I don't feel a pulse, I hit the wee red switch and broadcast a Mayday. It will be about 45 mins before the Plymouth Lifeboat reaches me. If I am lucky there might be a passing RN Frigate with a helicopter that can CASIVAC John. The local CG Air Station is at Newquay, Cornwall about 30 mins flying time. With the use of helicopters and a bit of luck John might be in Derriford, the local General Hospital, in about an hour. Halfway across Lyme Bay or to Roscoff, it would be more of a challenge. A question that I ask anybody coming onboard is, 'Is there any health condition I need to know about?'

It really depends on the type of sailing you do. A potter round the bay, Torbay for example, with a hospital and a local RNLI station, and the skills (and space to use a defib) might work. As @Elessar it is all about the mitigation of risk to as low as reasonably practicable. If we eliminate risk from sailing we may as well sell the boat and take up tiddlywinks or bridge (although there is risk of choking on the finger rolls).

From practical experience it takes a bit of time to mount a rescue - I needed to get into my mountaineering kit while Mrs Sandy sorted out a flask and something to eat, jump in the car and get myself to the Mountain Rescue Centre, get briefed, and on the hill. That could be an two hours before we were ready to start a search . An incident I was on the fringe of near Stonehaven in August was only reported by a passing RIB where a chap was found on the keel and had been there for two hours, his two friends had been in the water all that time. Thankfully, the RNLI and CG helicopter found the two chaps in the water within the hour. Sadly, I heard one of the chaps did not survive the night. RIP.

Out of interest who does the RYA First Aid at Sea 'add on' to dispense that heart drug, the name escapes me, and carries it onboard?

Probably GTN for angina. I can’t spell the name without looking it up.

W

 

[PilotWolf]

Lifesaving automated external defibrillator (AED) now in place at Conwy RNLI | RNLI

I was thinking more on the boats. But I guess they could take it with them.

W.