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

[Wookie]

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

You're not reading the whole statistic. A person who receives some sort of emergency medical attention is indeed 4 times as likely to survive as a person who doesn't. However, the short term survival rate for MI victims who receive CPR from bystanders is 22%, versus 14% for those who do not receive CPR, and adding an AED to that boosts the survival rate to as much as 74%. All numbers assume that the MI occurred at O'Hare airport in Chicago where access to EMS is next to immediate and the ER is only 15 minutes away.

Anecdotal evidence suggests that if you suffer an MI underwater, your chances of dying are 100%, regardless of medical care provided.

 

[Doc Harry]

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

And not mentioned in the article is that defibrillation from an AED must occur within minutes of collapse, otherwise the survival rate is, again, abysmally low.

CPR is useful only in that it buys you time to get a AED (defibrillator) and administer shocks. For more advanced personnel, CPR also buys some time to figure out if there is any other immediately-correctable problem (like tension pneumothorax, etc.).

If there is no shockable rhythm and the person is in cardiac arrest, then, statistically, survival rate is absymally low.

It's a completely different ball game for infants and children.

Bottom line is to summon emergency services and continue CPR as perfectly as possible until someone with more advanced training relieves you of responsibility, or you become exhausted and are unable to continue.

At least you can say that you tried to save them.

 

[scubadada]

Is there information about how well AEDs hold up in the marine environment? Do special precautions need be taken or special maintenance performed? Are there specific units designed for this setting?

 

[Tigerman]

And not mentioned in the article is that defibrillation from an AED must occur within minutes of collapse, otherwise the survival rate is, again, abysmally low.

CPR is useful only in that it buys you time to get a AED (defibrillator) and administer shocks. For more advanced personnel, CPR also buys some time to figure out if there is any other immediately-correctable problem (like tension pneumothorax, etc.).

If there is no shockable rhythm and the person is in cardiac arrest, then, statistically, survival rate is absymally low.

It's a completely different ball game for infants and children.

Bottom line is to summon emergency services and continue CPR as perfectly as possible until someone with more advanced training relieves you of responsibility, or you become exhausted and are unable to continue.

At least you can say that you tried to save them.

Working at a hotel we have had our share of people collapsing with heart issues and its no fun regardless.
We have been able to save some, and lose some despite a 20+ minute response time. Fortunately the majority has not been full cardiac arrests.
I had three cardiac events within two weeks last summer. One was a sudden, total cardiac arrest, one actually had a "built in defibrilator" that shocked him automatically (several times) so what we had to do was pretty much nothing but make sure he was ok till the ambulance arrived.
The third was a person who had experienced cardiac issues before so he recognized the symptoms, had us call the emergency services and was airlifted to the nearest hospital.
I NEVER do ANYTHING with guests who have cardiac issues before I make sure we have someone summoning the emergency services. I am not a doctor, I do not have either expertise or advanced equipment so if I doing CPR waiting for an ambulance that has not even been called yet, Ive already lost..

Is there information about how well AEDs hold up in the marine environment? Do special precautions need be taken or special maintenance performed? Are there specific units designed for this setting?

Good question..

 

[Wookie]

Is there information about how well AEDs hold up in the marine environment? Do special precautions need be taken or special maintenance performed? Are there specific units designed for this setting?

I bought mine from DAN. They now have a grant program you might look into. Since I bought directly from them, I got a discount from retail. Their AED came in a nice pelican case (waterproof, or relatively so). It is still in service 5 years later with nothing more than routine maintenance. It lives on the boat. I have the rechargable battery instead of the one that has to be replaced every 4 years, and also a training battery and pads... The DAN store is off-line right now, but I found the ones on the DAN Europe site to be not available. Maybe DAN is getting out of the AED business?

 

[flots am]

Unbelievably, in my last recert HCP CPR course I was told the new standard is not to even check for a pulse because it's "too hard to do". We were shown an AED, the instructions for it, and told it would do the diagnosing for us - just follow the prompts. Uggh.

I can actually see a reason behind that.

Supposedly an AED will only shock an abnormal rythym. I'd much rather trust a box that can actually take electrical measurements than a bystander who mistakenly thinks he feels a pulse and does nothing.

flots.

 

[Duke Dive Medicine]

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.

Frank,
There are a lot of caveats to this. This part of the protocol is for Coast Guard EMS personnel on a SAR or MEDEVAC mission and does not apply to civilian lay rescuers. The whole flowchart can be found here: http://www.uscg.mil/health/docs/pdf/SAR_CPR_protocols.pdf

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.

True and usually applies to first responders, e.g. firefighters/EMTs who do a welfare check and find a victim who's been down for an unknown amount of time. Could also be applied to lost divers who are later found pulseless and apneic.

One thing to consider is that if you do carry an AED, the public has a reasonable expectation that you'll use it according to applicable standards. The Coast Guard standards you cited don't apply to lay rescuers and if you're using them as go/no-go criteria for resuscitation it could put you on shaky legal ground. Not trying to dictate what you do, but it's something to think about.

Best,
DDM

 

[DaleC]

Whether the statistics are abysmal or not, every non professional first responder needs to know one thing "We don't determine who lives or dies". Our job is to provide the best care, within our scope of training, for as long as we safely can. Hopefully that's longer than 6 minutes. That's been my message, not that CPR is a panacea.

Also, statistics break down at the individual level and are not relevant in the field. We do not look at a particular case and take action based on outcomes that are statistically probable. We take action based on the protocol our training dictates for that condition.

CPR is a tool in our tool box, just like an AED, but it costs a lot less, is always with us, and doesn't need batteries. It is also the basic building block that all other advanced life saving measures are built around so for my money, it is the tool one should focus on. Losing focus on CPR, in favor of an AED is wrong minded IMO.

I suppose in a fear based culture though, many might favor placing responsibility onto a machine rather than the application of their own skill (which is one of the unintended consequences I see arising from AED popularity). It is a real barrier that instructors should try to break down = That it is ok to provide reasonable care and that doing your best is good enough. You don't need to be afraid or perfect. If you want your best to be better; practice.

Like many skills, CPR needs to be practiced. While I sympathize with your unique position Wookie and am not being negative, classroom training is needed to develop a degree of competency so that CPR on a heaving boat has a chance to be successful. We can't look at a circumstance and, seeing it's difficult, determine that practice is not worthwhile (not saying you said that necessarily). Just like many diving skills, practice in a controlled setting produces muscle memory so that, in the event of an emergency, the reactions will be (hopefully) reflexive. It's the same thing. Ever watch people in a CPR course. Thinking thinking thinking... it needs to become acting acting acting.

How about a flail chest (detached sternum) annie - that's a weird one to see

Flotsam, that was the explanation given to me as well as that people weren't so good at detecting pulses anyways. I didn't argue (as it seems they change something every year or two no matter what) but I did wonder why they didn't just teach people to check pulses better. Then again, I am reminded of diving and how many skills have been minimized in favor of reliance upon equipment.

 

[Wookie]

Remember, we have also had success with CPR and rescue breathing, so I don't lightly choose not to attempt a resuscitation. Warm water drowning/MI victims where the victim was found lifeless on the bottom after an undetermined amount of time need someone to step up and make a decision, especially from a remote location, hours from EMS. It's what I'm paid to do.

 

[Duke Dive Medicine]

Warm water drowning/MI victims where the victim was found lifeless on the bottom after an undetermined amount of time need someone to step up and make a decision, especially from a remote location, hours from EMS. It's what I'm paid to do.

Completely agree... that's where the AHA ethical guidelines you cited earlier would apply.