Emergency Life-Support Equipment - Oxygen and AED? - Who Carries on Dive Trips?

[FF-EMT Diver]

I'd like to piggy back with DaleC and add that I agree with him, IMO your $5000+ would be much better spent in other areas. Unless you are running a very large operation with a lot of people every year then the likeliness of you ever using it is slim to none. IMO your money would be much better spent sending yourself/staff to a GOOD CPR instructor. If you're running a shop I might even suggest that you take an instructor class as well and buy the teaching material and go over it once a month with yourself/staff.

CPR has gotten pretty basic over the years and is now down to chest compressions only for Layperson. Emphasis on pulse checks has gone away and the main thing the AHA wants you to do is good high quality CPR, I'm not saying you shouldn't be as prepared as possible I'm simply saying there are a lot of steps before getting there. Good luck with whatever you choose!

 

[Wookie]

So, I keep seeing this number $5,000 bantied about. The DAN unit (when I bought it) was a HeartStart FR2+ by Phillips which is still about $2k for a factory refurbished unit (they don't make them anymore). The HeartStart FR3 is $2500 bucks, and the cheapest unit (HeartStart Onsite) is $1195. Annual maintenance is a new set of pads for $61, and a battery every 4 years is $153. I'm getting these prices from the AED Superstore which is where I get all of my supplies online. Maybe Taiwan taxes you for imports very heavily, but I think that they are cheap insurance against lawsuits.

 

[Hawkwood]

We bought one for the office for just under $1,500 CDN.

 

[DaleC]

Wookie, I'm not against having a tool in the toolbox - just saying that an AED would not be my first pick and that it is somewhat limited in scope.

I notice you said that, because the unit advised no shock, you were free to stop life saving measures. I'm not sure what the protocol is in your neck of the woods or what the machine said but that doesn't sound right to me.

The indicator may be suggesting that the rhythm detected will not respond to cardioversion. It does not also mean the patient cannot be resuscitated by traditional means. Someone can correct me (I may not know the legalities regarding AED's and will stand to be corrected) but I'm pretty sure a machine cannot pronounce someone dead so, once life saving measures have begun, they cannot be stopped unless someone qualified calls it or one is exhausted or in danger.

Not challenging your actions in that case, as there may be circumstances not related, but I still believe the standard of care would indicate CPR until a medical authority states otherwise. Though I agree that someone 13 minutes into an event without intervention probably won't make it I have also seen some strange recoveries. Irregardless, as trained responders we have certain rules we have to abide by and claiming life saving measures were abandoned or not even started because of an AED reading may cause more legal problems than it solves.

Or maybe I'm behind current trends in this regard.

On another tangent - Perhaps a large company or dive op that had money to invest on life saving equipment might consider purchasing a CPR training doll, particularly one that records the effectiveness of CPR on a tape (probably downloadable software now). Make it available to staff to practice on whenever they want and even make it a requirement that all staff has to submit an acceptable readout each month or two. This was one tool we had during EMT-A training and it helped me to refine my skills a lot. Having an ongoing training opportunity like that would be a huge boost to safety and would make CPR a routine procedure instead of a crisis response.

 

[Hawkwood]

The unit may determine "no shock advised", but it will not tell you to discontinue CPR.

 

[Wookie]

The USCG has actually developed a protocol for this.

For a non-hypothermic victim that is not obviously dead (decapitated, incinerated, major organs unattached, rigor) and has been apneic, unresponsive, and pulse less for 10 or more minutes, and EMS or a physician are 30 or more minutes away, and the victim is 18 or older, you do not need to start CPR.

If you start CPR and the above criteria become met, you may quit CPR.

New AHA guidelines state that if the arrest was unwitnessed, (you don't know how long the victim has been down), you do 3 rounds of CPR of 2 minutes each and there is no return of pulse, and no shock is advised, you may discontinue CPR.

 

[DaleC]

The USCG has actually developed a protocol for this.

For a non-hypothermic victim that is not obviously dead (decapitated, incinerated, major organs unattached, rigor) and has been apneic, unresponsive, and pulse less for 10 or more minutes, and EMS or a physician are 30 or more minutes away, and the victim is 18 or older, you do not need to start CPR.

If you start CPR and the above criteria become met, you may quit CPR.

I understand the first part of this if one is far offshore but does the last line mean that, once begun, you only have to do CPR for 10 minutes and then you may call it? My experience is mainly land based and I suppose there may be different rules for marine based activities. I think I could go along with that as, without advanced intervention, resuscitation is unlikely to occur.

New AHA guidelines state that if the arrest was unwitnessed, (you don't know how long the victim has been down), you do 3 rounds of CPR of 2 minutes each and there is no return of pulse, and no shock is advised, you may discontinue CPR.

That IMO is crazy (but then again a lot of things these days are). I would hate to think that a layman could do 6 minutes of CPR and pronounce someone dead without recourse to advanced intervention. Unless one is in a remote setting there is really no reason not to continue CPR until one can hand off the patient to EMS. I've personally seen a patient revived that had CPR done in the field for 45 minutes and a further 45 minutes of CPR, drug therapy and cardioversion in the ER.

To me, at the field level, CPR is more of a continuation of cellular perfusion by mechanical means (chest compression and ventilation) than a means of reversing the patients condition. I wouldn't particularly worry about bringing someone "around" as much as keeping the brain and other organs viable via oxygenation. It's the EMS/ER's job to treat the patient (if you follow my meaning). In that way, CPR can be seen as a mechanical skill rather than a medical intervention; the success of which depends on the first responders ability to perform it adequately.

 

[Doc Harry]

..To me, at the field level, CPR is more of a continuation of cellular perfusion by mechanical means (chest compression and ventilation) than a means of reversing the patients condition...

Statistically speaking, the outcomes are abysmally poor. And those who you may save are brain dead.

Even when done by personnel trained in CPR, it is usually done poorly and inefficiently.

Even when CPR is performed perfectly, you can still generate only a fraction of normal cardiac output.

CPR is not the panacea that you make it out to be.

 

[Wookie]

I am way smarter than to argue with professionals outside of my field, in a field where I am merely a layman. My only defense (or justification, perhaps) is when 8 hours from EMS, and the Coast Guard refuses to transfer the victim by basket (knowing that the transfer time will absolutely kill the victim) I don't have to shag out the crew and willing passengers and distress the family further on what is essentially a hopeless task. I have the resources and knowledge and procedures that allow me to stop. I only know this because in the old days (pre 2010) we performed CPR for 8 hours unless we had a physician on the boat as a passenger. The passengers and family were fully freaked out witnessing that, and if you were EMS, you know all of the reasons why.

Performing CPR on an Annie in the classroom at the dive shop with beer and pizza is a whole different animal than doing it for real on the deck of a heaving boat in the middle of the Gulf all night long. Maybe Laerdal needs to invent a "Leaking Annie"?

 

[Tigerman]

Statistically speaking, the outcomes are abysmally poor. And those who you may save are brain dead.

Even when done by personnel trained in CPR, it is usually done poorly and inefficiently.

Even when CPR is performed perfectly, you can still generate only a fraction of normal cardiac output.

CPR is not the panacea that you make it out to be.

Im not a doctor, but research says if you get CPR OR AED youre only 4 times more likely to be survive.. (for atleast a month)

Widespread CPR Training Could Boost Heart Attack Survival Rates