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Old 04-29-2014, 08:14 AM   #21
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Do you do two quick compressions and pause a second or just keep compressing two a second continuously? (I think I may have 'Stayin' Alive' stuck in my head all day. And I was just getting over Disco. Shit.)
The CPR class is about a 2 hour class with practice on dummies while being watched by an instructor for advice and help. You can't, under any dream of being responsible, learn how to do it through a couple of forum questions. Don't even think of going down that route.
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Old 04-29-2014, 08:37 AM   #22
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Well, I have learnt a few things here.

Good posts Dan, Pete & AC.

Two months ago I found myself in Canada, catching up with some of my kids who are working in Whistler. One of my older boys works as night security in a hotel, he was on duty when a guest had a massive heart attack in her hotel room.He worked on the lady for about 15-20 minutes till the para medics arrived,administering both mouth to mouth and CPR.

He managed to get her breathing, but unfortunately the lady subsequently died.

When we sat down and he talked about that night, I began to realise what a traumatic situation it must have been. Nothing remotely like the neat, calm CPR training sessions we had in our first aid course. This was a room full of people yelling, crying, convulsions & vomit set against a desperate race against time. I asked him how he coped, he said he just concentrated of what he had been taught, and kept counting aloud.

I have no idea how first aid courses are run now, however I think it would be beneficial, in addition to the technical training, to provide some explanations and descriptions of what you may have to deal with while putting your training into practice.Which I think after talking to my son can be pretty confronting.
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Old 04-29-2014, 09:00 AM   #23
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You don't concentrate on the bad calls. You remember the lives you've saved. But things like this are like boaters getting together, talking cruising. You always end up talking about the worst weather you've been out in!

We live in the town where the Maine Maritime Academy resides. Classes start in late August. We usually leave for cruising in the beginning of September so we still overlap with the students a little. The worst call for me was that first weekend of school starting. Four 18 year olds ran off to the next town, drank, and sped back into town flipping their car at a curve. I wasn't on duty but I was advanced life support for the town and maintained a beeper. At 11 pm the call went out and I went directly to the scene. Two of the kids were hurt. The driver was pinned and unresponsive. I took him as a patient and let the next EMT take the other patient who was screaming (screaming patients are good patients).

The flipped car stopped any of us from getting in and I couldn't do more than assess breathing, pulse, etc. He had a very weak and thready pulse which is bad. I kept talking to him about help being there and to try to hold on, etc. The ambulance showed up and I got the cardiac monitor. As I pulled up his shirt to get the leads on, it was a very uncomfortable feeling like the last heat of his body was escaping out of the shirt - his core was already too cool. I reached in to slap the leads on his chest to find that he was flat lined. And no matter what you see on TV, that's not a rhythm that you can shock back to life. He was gone. The drug protocol happened but there's no way you're coming back from a flat line due to trauma.

It pissed me off that some parent who just wished their freshman son well as they went off to school needed to get a call from the police that night. And it was all due to drunk driving that I didn't need to be a part of or witness.

I had trouble sleeping for 2 weeks after that.
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Old 04-29-2014, 09:42 AM   #24
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[QUOTE=ActiveCaptain;230633]You don't concentrate on the bad calls. You remember the lives you've saved. But things like this are like boaters getting together, talking cruising. You always end up talking about the worst weather you've been out in!

Your are right, but the point I was trying to make is that for 99.5% of us we will never have to put our training into use, and if we are the .5% we probably will only use it once in our life.

We never get a chance to concentrate on the good outcomes( if the survival figures for CPR are correct).

You are a professional, you have training and experience, you have a fair idea what is going to confront you when you are called out.

What I'm saying is perhaps it would be beneficial, as part of the first aid training, for an instructor to sit down with the class and pass on their experience, warts and all. It may shock the class, but no where near as much as the real thing will do if they are ever called on to use CPR in a real life situation. At least you are giving them an idea of what to expect.
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Old 04-29-2014, 11:36 AM   #25
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...

Just thought that point was worth highlighting, as just compressing is far easier, and can be kept up longer, especially if people do it in short shifts, and with as little interruption as possible. The speed needs to be about 2 compressions a second, with downward movement about 6-8cm = 2-3 inches. One CPR instructor I heard caught people's attention by saying "do it in time with a brisk version of the BG's song, 'Stayin' alive"…you remember that stuff…
To really drive this home...

The new techniques being taught in CPR today is why people who have had CPR in the past need to get recertified. The CPR techniques have really changed over the last few years to make things simpler and more likely to help the patient.

I was really impressed with the last recertification class I had this year and I have been certified, hmmm, maybe I should rephrase that , for decades. My first CPR class was more than a few decades ago when I as in 9th grade. There is a great difference in CPR now, compared to then, and today's CPR is much easier to do and provides better odds for the patient.

AED usages was added 4-6 years ago in my area and while using the devices is pretty easy, the AED talks you through its setup and use, training will help speed up deployment. The faster the rescuer starts working on the patient, the better the odds for the patient.

Either the updated CPR techniques, or the AED training, is more than enough reason to take or retake a CPR class, but both together make the training very much worth the time investment.

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Old 04-29-2014, 11:43 AM   #26
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Thanks for all the info. Do you do two quick compressions and pause a second or just keep compressing two a second continuously? (I think I may have 'Stayin' Alive' stuck in my head all day. And I was just getting over Disco. Shit.)
You really have to take a class learn CPR and there is more to CPR than compressions and timing. CPR is not hard to do per say, but proper hand placement and technique is critical. I have never seen CPR "performed" anywhere close to correctly on a TV show or movie.

The Red Cross, hospitals, and I noticed our gym, schedule CPR classes. They gym I go to has an rather aged population and they have built the gym to handle emergencies. Each floor in the gym has an AED and their are emergency alarms that are at FLOOR level. First time I have seen that and it make perfect sense.

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Old 04-29-2014, 11:50 AM   #27
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Yes, most of us will never use those skills or hope we never do. And when we do, we won't always be successful. The entire subject is frightening. In class just the very thought of something bad happening to my wife shook me up, but then I thought of being unprepared and just standing there not even being able to try helping her, not knowing how or being equipped, and it only made me want to learn more. On land, I was always content thinking someone else would be there to help. Now when we're out on the boat maybe we're over protected now with equipment and with several of us trained. But I've always valued knowledge in all areas and certainly in first aid I now value it.

Crossing the Atlantic is in our future, still a few years away. Someone was asking the other day though "But what if" and went on to talk about something that could happen four days from the nearest land. We immediately launched into what we'd do and the equipment we'd use and the steps we'd take and while one of us working on the patient the other contacting Medaire. Is it a perfect plan? No, there are none of those. But we realized the courses had already paid for themselves just in what we now knew, even if we hoped never to have to use it beyond scrapes, sun burn, colds, etc.
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Old 04-29-2014, 12:19 PM   #28
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You don't concentrate on the bad calls. You remember the lives you've saved. But things like this are like boaters getting together, talking cruising. You always end up talking about the worst weather you've been out in!

Your are right, but the point I was trying to make is that for 99.5% of us we will never have to put our training into use, and if we are the .5% we probably will only use it once in our life.

We never get a chance to concentrate on the good outcomes( if the survival figures for CPR are correct).

You are a professional, you have training and experience, you have a fair idea what is going to confront you when you are called out.

What I'm saying is perhaps it would be beneficial, as part of the first aid training, for an instructor to sit down with the class and pass on their experience, warts and all. It may shock the class, but no where near as much as the real thing will do if they are ever called on to use CPR in a real life situation. At least you are giving them an idea of what to expect.
You might be surprised how often you will use first aid and/or CPR training.

I have "used" my training off the job at least six times that I can quickly count. One of those events was when our oldest started to choke and did the classic hands to throat movement. I saw what was happening, jumped over a couch, pulled the kid out of the high chair, put them head down at a 45 degree angle and popped their back. Out popped the food. I looked at our child in the face and the kid looked at me with a "Whats Up?" look so I put said child back in the chair. The kid picked up more food and kept on eating like nothing had happened.

The wife and I aged a few years and my hair turned gray.

The whole event took less time for me to do than for people to read about.

Now here is the thing. In CPR class, I would bet there is maybe 30 minutes of training covering choking babies and of that maybe 5-10 minutes is working on the baby dummy. Back in the day, I would likely have had the class maybe four times before this incident so not much "practice." I don't remember if the first CPR class I took even covered choking children. Even with the limited amount of training time I had, when it was time to move, I moved, and did the technique... I doubt our oldest would be alive if I had not had the training and used it.

This is the only time I have to ACTIVELY use CPR or first aid training. Notice the word ACTIVELY. There are have been other times were I have been at incidents and evaluated people's health. That too is part of CPR and first aid. Knowing when to NOT use CPR or other first aide is just as important to knowing when to use. You might still need an ambulance but if everyone is breathing and not bleeding much, EMS can run at a safer speed. No need to run lights and siren which is risky for the crew and the public.

Now maybe I am just lucky or unlucky but I have used my training outside of work quite a few times. Even on vacation but that is another story.

A CPR instructor may give you real live examples or maybe not. It really depends on the instructor and how the instructor feels about passing along that information.

I think every class I have had talks about the patient puking on you if you perform breaths. They also mention breaking and cracking ribs when doing CPR. They may or not mention the success rate.

The success rate is not important.

If one is performing CPR, the patient is D E A D. You can't hurt them. They Be D E A D. Cracking their ribs maybe not sound good but the patient is DEAD and they ain't feeling it.

Even if CPR has a poor success rate, and it does, if one does nothing the patient is going to stay DEAD. If one does CPR, the patient has some chance of NOT being dead. Some chance, is much better than no chance.

Often times CPR is continued even though everyone knows the patient is gone. Why? For the patient's families mental health. If the family is watching a loved one die, showing them that everything that could be done, was done, can help them deal with the situation. This might be your most beneficial outcome.

Later,
Dan
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Old 04-29-2014, 12:41 PM   #29
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The postings here have been great. I'd just like to add one thing. The reason that my wife and I created our medical emergency talk for cruisers is that, without question, the number one thing we'd experience when arriving at a scene is multiple family members stopping us saying things like, "I know there is something we should have been doing - what was it?" We'd have to gently ask them to wait until the patient was taken care of before talking to them, often the next day. EMS is taught to "treat the family" so if grandpa stopped breathing and everyone stood around watching him die, we'd have to go back and tell them that there was nothing that could have been done. It's just not the right thing to tell them that there was a good chance they could have kept him alive.

What we wanted to create was a lecture about all the things you should have known to do before EMS arrives and tailor it for being on a boat. Having the lecture happen before there is an emergency makes all the difference. We've received about a dozen emails over the last 4 years from people who were able to use the skills and ideas at home or on their boat. That's really the best complement we can receive.

You can get to all our slides for the talk but the slides don't have all the content - they're really about keeping the talk on track and focused for us. There are many example scenarios for boats given and ways to look at what can/should be done. The slides are at:
https://activecaptain.com/articles/medical/intro.php
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Old 04-29-2014, 02:02 PM   #30
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... On land, I was always content thinking someone else would be there to help. Now when we're out on the boat maybe we're over protected now with equipment and with several of us trained. But I've always valued knowledge in all areas and certainly in first aid I now value it. ...

Crossing the Atlantic is in our future, still a few years away. Someone was asking the other day though "But what if" and went on to talk about something that could happen four days from the nearest land.
...
The reality is that the most dangerous thing we do is get in a car and drive...

What scares me about driving, is not MY driving, it is the idiots that are driving near me. I can control my driving but there is not much I can do about theirs. One of them hit our car once, and if I had not seen it coming, had not had drivers training and experience I don't think I would be typing at the moment...

I use a chainsaw quite a bit. We have forested land and Momma Nature likes to drop trees for us to use to heat the house. Sometimes, Momma Nature just kills the trees and does not bring them down for me which provides me with more dangerous work to do. Now, running a chainsaw is rather risky but I minimize my risk by having certain rules I follow and wearing safety equipment. However, one rule that OTHERS state, is to never run a saw by yourself which is a good rule but if I followed that rule, we would still be living in the city. I evaluate risk, think about the Oh S...t, and go from there...

Now, there are a bunch of people hurt with a chainsaw each year, I think the number is over 30,000 people in the US that go to a hospital, but some people do die, usually with a kickback of the saw into the neck. My attitude is that the saw will kill me if it touches me so I do everything I can to minimize that possibility.

I mention chainsaws because I was once taking the wife, should I call her Admiral? , to the hospital and saw a guy trimming Crepe Myrtles. Well, he did not have the right safety gear and he was cutting over his head. Perfect setup of a kickback into his neck which would almost certainly been fatal even though he was just around the corner from the ER at one of the best Trauma Centers in the US...

When I mention our desire to cruise overseas or my Duckitis, to coworkers, they think we are nuts. They bring up storms, pirates, etc. They worry about these unfamiliar risks, which in many cases can be avoided or handled, while everyday they do what is far riskier, get in a car and drive.

There was a full and half marathons in Raleigh a few weeks back and not one but TWO men dropped dead in the race. Both were in their 30s. These guys went down, and even with EMS at the event, it did not change the outcome. A few years ago, a coworker's wife went for a walk and dropped dead. Just before this happened, a coworker who was in great health, ate well, and exercised, had a heart attack when he went for a run one day! This kinda tells me I should NOT go to the gym tonight and just go home and be a Lounge Lizard in the Lazy Boy!

I think many people over rate unfamiliar risk and under rate familiar risk...

What one needs to do is to try to correctly rate risk and plan and prepare for worst case. Which for this thread, is to get some easily learned first aid and CPR classes, and carry appropriate equipment and medicines on the boat.

Later,
Dan
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Old 04-29-2014, 02:12 PM   #31
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While cars and marathons and getting into your bathtub all have their dangers, they never pushed us to learn anything. I guess our underlying assumption was that help was always close. It's when we started talking about long trips on the water. In fact, right now would be a good example as I imagine we're at least 4 hours from any hospital or medical attention as we're off the coast of Washington. Coast Guard could get to us but that would take a while. So that was our impetus to learn. I'm just glad we didn't wait until there was a problem or tragedy before realizing we needed to. In fact at the moment there are 8 of us on board and 7 of us have had training.
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Old 04-29-2014, 05:21 PM   #32
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I think many people over rate unfamiliar risk and under rate familiar risk...
Heart disease is the number one cause of death in the US - higher than any of the trauma events you mentioned. The rate is equivalent to about 5 jumbo jets crashing every day. It's not unreasonable to prepare yourself for that especially given the age and demographics of the typical trawler cruising couple.
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Old 04-29-2014, 07:25 PM   #33
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Started looking around on the internet for AED, found several outfits that sell re-certified AED's, will send the link late as computer having issues. Any problem w/ re-certified AED's? The price for a Phillips was $795 or so, $1195 for new on Amazon.
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Old 04-29-2014, 07:29 PM   #34
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Re-certified AED link:
Recertified AEDs - Refurbished Automated External Defibrillators - AED.com
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Old 04-29-2014, 09:39 PM   #35
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Philips is a quality company and their AED is pretty good. The thing you want to make sure about is the availability of batteries. Because of the technology, they are not rechargeable and typically have to be replaced every 4 years (at about $200 per change). Make sure the pads are available too (usually about $45 each). They are disposable and expire after about 2 years typically. And when they expire, you need to throw them out - it's not a fake expiration - they dry up and are much less effective.

If you're buying an AED today, you want it to be a biphasic type. The Philips is biphasic.

I personally like the Defibtech models. I don't think the screen is needed either - just a good voice alert and a trivially simple user-interface is all that's needed. Our town bought 5 Defibtech's + an additional one for the ambulance (which also had a cardiac monitor + manual defibrillator). I was the one who put together a maintenance program for them and checked them whenever I was in town. They're quite nice. I've used them in bad weather outdoors too and they are weather-resistant.

But of course, having an AED isn't nearly as important as having the training about how to use one. If it were me, I'd take the class first and see which simulator they trained me with. Then I'd look to get the real model for that simulator. The prices of all these things are going to be about the same unless you get into the professional models.
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Old 04-29-2014, 11:28 PM   #36
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My wife is an RN. I just asked her the question how many people saved using CPR? She said maybe 5. Not great odds but at least a shot. I was a CPR instructor and a lot has changed. I did save a lady choking in the supermarket one day. Just good knowledge to have. Kinda like knowing how to bleed your fuel system, when you need to do it it's nice to know how.
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Old 04-30-2014, 12:08 AM   #37
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Thanks for all the info. Do you do two quick compressions and pause a second or just keep compressing two a second continuously? (I think I may have 'Stayin' Alive' stuck in my head all day. And I was just getting over Disco. Shit.)
Jobe…
You keep going continuously, with the minimal pauses possible, even when you change places to have a rest.

Reason being exactly as Active Captain pointed out - apart from in drowning, spontaneous cardiac activity hardly ever returns without a 'shock'. So as he rather neatly put it, you are attempting to stop the clock before those 4 mins of no brain circulation are exceeded, until (hopefully), someone with a defibrillator turns up. The problem with defibs is the cost. They are not cheap, and heck, even when we are talking the local GP's surgery, the number of time one would use it in anger is usually so infrequent it is hard to justify the cost, but accreditation requirements usually come into play there. For the average Jo Blow boater, unless you are made of money, I can't see many having one on board. However, as pointed out, all other rescue services now do. They are 'who you're gonna call' - and damn quick..
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Old 04-30-2014, 12:22 AM   #38
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Jobe…
You keep going continuously, with the minimal pauses possible, even when you change places to have a rest.

Reason being exactly as Active Captain pointed out - apart from in drowning, spontaneous cardiac activity hardly ever returns without a 'shock'. So as he rather neatly put it, you are attempting to stop the clock before those 4 mins of no brain circulation are exceeded, until (hopefully), someone with a defibrillator turns up. The problem with defibs is the cost. They are not cheap, and heck, even when we are talking the local GP's surgery, the number of time one would use it in anger is usually so infrequent it is hard to justify the cost, but accreditation requirements usually come into play there. For the average Jo Blow boater, unless you are made of money, I can't see many having one on board. However, as pointed out, all other rescue services now do. They are 'who you're gonna call' - and damn quick..
We do carry an AED and the made of money thing doesn't fit in my mind when you're talking about all the things boaters buy or spend money on that are as much or more than the cost of one. A refurbished unit is a reasonable choice for a boat. Really you're buying it for a single use at most (might get more but you're just thinking that one time) so not subject to the work a paramedic unit would get.
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Old 04-30-2014, 05:19 AM   #39
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Jobe…
unless you are made of money, I can't see many having one on board. However, as pointed out, all other rescue services now do. They are 'who you're gonna call' - and damn quick..
Gee, I don't know Pete, a $1,000.

I pay that on my car insurance every year, haven't had a crash in 30 years.

I have a EPIRB that cost me $500, really doubt that I will ever use it.

It sounds like these defibrillators may be life savers, and with all these old people hanging around me these days, maybe I should be looking after them.

PS, I think this has been a very informative thread. Occasionally TF does throw them up.
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Old 04-30-2014, 05:53 AM   #40
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Gee, I don't know Pete, a $1,000.

I pay that on my car insurance every year, haven't had a crash in 30 years.

I have a EPIRB that cost me $500, really doubt that I will ever use it.

It sounds like these defibrillators may be life savers, and with all these old people hanging around me these days, maybe I should be looking after them.

PS, I think this has been a very informative thread. Occasionally TF does throw them up.
Put like that Andy, and BandB, you have a point. However, I seriously doubt, (but would be happy to be proved wrong), that you could get an auto defib here in Oz for as little as $1000. If so, then yes, it is certainly worth looking into.
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