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Old 04-28-2014, 02:08 PM   #1
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First Aid While on the Boat

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Originally Posted by psneeld View Post
  1. First Aid - most first aid along the coastal US is good but with the internet...only a click away. Things like paramedic skills are great but hard to fit into an already busy schedule and hopefully with the click of an EPIRB....the USCG will be there within the hour. From 35 years as a first responder on the water...buy an AED and learn how to use it...CPR is overrated to the max on the water (read wilderness)

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...

I've had the unpleasant opportunity to perform CPR multiple times. It is never like it looks on TV and patients never cough and wake up after it. But CPR does something critically important - it keeps the patient alive until more definitive care is available. The main issue with cruising is that the medical response time increases from under 10 minutes on land to 30-45 minutes on water (and even longer). 50 miles out to sea, yeah, CPR won't matter - the patient is going to die. But that's quite a rare mode of cruising for most of us. For a significant amount of our time on the water, we're within VHF response to some fire department. You'd be amazed.

This is one of the reasons why it is so important for a significant other to be able to operate the boat and keep it moving and in safe water. It's got to be near second nature because they might be having to render emergency care at the same time during a very, very stressful situation.

Bottom line - learn CPR now unless you've had a course in the last 2 years. It is not a waste of time at all and it's not something to ignore. It's simple and it will save the life, probably of someone you love.
When I posted my list, I kept it very broad and First Aid can mean many things.

I have had First Responder training in two states and my CPR certification is kept up to date. The wife will need to take some classes before we go.

I don't think I have ever had more than two, maybe three, CPR classes that were the same. Seem like every couple of years the training changes slightly. The course changes are usually by being simplified but also there are new techniques to use or NOT use. Having CPR training is good but it is better to maintain CPR certification. The last few cycles have incorporated AED usages which is very important and CPR itself was simplified again.

When people say CPR, they always are thinking of breathing and chest compressions, though with the latest training, it is all about compressions, compression and compressions. Frankly, in the past, the more important part of CPR class is the choking training. CPR does not have a high success rate but some chance of success is better than no chance. I would think the odds of being brought back from a heart stoppage on a boat on the water would be even smaller than someone in a house with EMS service a few minutes away.

Today, the other important part of CPR training is in the use of AEDs. These things are pretty full proof, they are designed for anyone to use them, and they have a higher success rate than CPR alone. I looked up the cost of an AED on Amazon and they started at $1,100. I would think that an AED on a boat would have a better chance of bringing someone back to life than plain old chest compressions. I don't think most people are going to be able to do chest compressions for the time it takes for rescue services to get to the boat on the water, at least in the places we intended to go.

Thinking about places we were cruising in FLA, I would think most of the time the boat could get to shore quickly but if there were only two people on the boat, getting the boat to land means no CPR.... One of the various LE agencies MIGHT be able to get a boat on scene but that could take some time. Flip side, is that other boaters could board and lend a hand....

Chest compressions just move blood to supply O2 to the dead person's organs to buy them time. The person is dead. Breaking their ribs ain't gonna hurt them. They are dead. You buy the person time until better equipment arrives to revive, but it is doubtful CPR will revive a dead person, however, some chance is better than no chance. I doubt my wife could perform CPR for more than 20-30 minutes and she works out...

I just had a class on about tourniquet usage which has greatly changed that what was taught in the past. In the past, I was taught to never completely tighten a tourniquet to stop blood flow. The latest training is to stop the blood flow and there are tourniquets out there that can easily be used on handed. Of course, you can get these on Amazon. It seems that it is far more likely to have to use a tourniquet or other first aid techniques on a boat than CPR compressions or AED usage. Choking would be at the top of my list of most likely to used rescue skills.

Having said all of this, I feel like a dunce. I have a list of emergency equipment we should have on a boat and I DID NOT have an AED listed! I do now.

Later,
Dan
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Old 04-28-2014, 02:42 PM   #2
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We have an AED onboard along with a small ambulance of medical supplies. To add to what Dan wrote (which was great), even if you don't have an AED, CPR is nearly free to learn. Learn it. Here's a perfect example why...

We were anchored last night behind Butler Island off the Waccamaw River in South Carolina. There were two other boats anchored with us. Chances are, neither of them had an AED. But if horns started going off in the middle of the night, we would have gotten in our dinghy along with the medical jump kit we have prepped and ready to go, and would have been at their boat within 5 minutes. Even with that quick response, closer than any on-land emergency response could be expected, brain tissue starts to die at 4 minutes. CPR is the one thing that will stretch out those 4 minutes to 45+ minutes, certainly enough time for me to jump onboard and defibrillate the patient.

The key to all of it is knowing CPR yourself and understanding the communications and alert mechanisms available to get help at anchor or at a marina (or even at home). You might not be an EMT but we might be anchored right next to you with 40 years of combined ambulance experience.

And for what it's worth, in our 11+ years of cruising, I've run off to 2 emergencies by dinghy and 2 at marinas.
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Old 04-28-2014, 04:44 PM   #3
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I never even learned CPR before, had no first aid training. My wife did have some as most teachers have. But when we knew we were going to spend time on the water, some not so close to medical help, we got serious about training and supplies. As we looked down the courses offered at the Maritime School we have gone to, they jumped out as us. We might have to one day be the first responder, be the medical officer on board, be the only one there to help. So we've taken that seriously and gotten training, plus kits plus subscribed to a medical service. Have we gone overboard? Sure hope we've done far more than we'll ever need. But ActiveCaptain speaks of four times. Our only time ever was a wreck we saw on the lake and we just went and fished people out of the water. Fortunately none hurt badly. It was also within a quarter of mile of shore.

One we intend to take sometime along the way is Fire Fighting. Sure hope we never need it either. We look at these sort of like insurance. You hope you don't ever need them.
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Old 04-28-2014, 05:41 PM   #4
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We have an AED onboard along with a small ambulance of medical supplies. To add to what Dan wrote (which was great), even if you don't have an AED, CPR is nearly free to learn. Learn it. Here's a perfect example why...

We were anchored last night behind Butler Island off the Waccamaw River in South Carolina. There were two other boats anchored with us. Chances are, neither of them had an AED. But if horns started going off in the middle of the night, we would have gotten in our dinghy along with the medical jump kit we have prepped and ready to go, and would have been at their boat within 5 minutes. Even with that quick response, closer than any on-land emergency response could be expected, brain tissue starts to die at 4 minutes. CPR is the one thing that will stretch out those 4 minutes to 45+ minutes, certainly enough time for me to jump onboard and defibrillate the patient.

The key to all of it is knowing CPR yourself and understanding the communications and alert mechanisms available to get help at anchor or at a marina (or even at home). You might not be an EMT but we might be anchored right next to you with 40 years of combined ambulance experience.

And for what it's worth, in our 11+ years of cruising, I've run off to 2 emergencies by dinghy and 2 at marinas.

What would be the best, or proper, or preferred, method of alerting others in an anchorage that help is needed (assuming no cell coverage)?

If during the day, my thoughts would be VHF first, then just yelling if close enough to others, and finally in a dinghy looking for help.

At night, I think most VHF's are off (mine normally is). The horn does seem like it would get attention. If I heard one in the middle of the night, the first thing I would do is look around and then turn on the VHF.

Any guidance or experience would be appreciated.
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Old 04-28-2014, 05:47 PM   #5
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What would be the best, or proper, or preferred, method of alerting others in an anchorage that help is needed (assuming no cell coverage)?

If during the day, my thoughts would be VHF first, then just yelling if close enough to others, and finally in a dinghy looking for help.

At night, I think most VHF's are off (mine normally is). The horn does seem like it would get attention. If I heard one in the middle of the night, the first thing I would do is look around and then turn on the VHF.

Any guidance or experience would be appreciated.
I would think first you want to wake them so horn, then VHF and scream....whistle too if you have one handy. Enough noise and you'll get attention.
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Old 04-28-2014, 06:05 PM   #6
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What would be the best, or proper, or preferred, method of alerting others in an anchorage that help is needed (assuming no cell coverage)?
Here's the rules we give in our seminar about medical emergencies.

If you're tied up at a marina:
1. Dial 911

2. Blast your horn 5 times or make a lot of noise, scream, etc.

If you're underway or anchored:
1. Issue a Mayday on channel 16 or using DSC - it is a completely valid reason for issuing a Mayday. Of course, it needs to be a real medical emergency which includes not knowing or understanding what's happening to someone else.

2. Blast your horn 5 times or make a lot of noise, scream, etc.

All of this assumes the incident is happening in the US.

It's also OK to issue a Mayday while tied up at a marina if you really just don't know what to do. The CG will arrange for 911, Fire, Ambulance, etc based on the need. I've been on multiple ambulance calls that were arranged through the CG with no patient/family/bystander interaction.
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Old 04-28-2014, 06:23 PM   #7
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Here's the rules we give in our seminar about medical emergencies.

If you're tied up at a marina:
1. Dial 911

2. Blast your horn 5 times or make a lot of noise, scream, etc.

If you're underway or anchored:
1. Issue a Mayday on channel 16 or using DSC - it is a completely valid reason for issuing a Mayday. Of course, it needs to be a real medical emergency which includes not knowing or understanding what's happening to someone else.

2. Blast your horn 5 times or make a lot of noise, scream, etc.

All of this assumes the incident is happening in the US.

It's also OK to issue a Mayday while tied up at a marina if you really just don't know what to do. The CG will arrange for 911, Fire, Ambulance, etc based on the need. I've been on multiple ambulance calls that were arranged through the CG with no patient/family/bystander interaction.

Great information. Thank you!
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Old 04-28-2014, 06:59 PM   #8
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At anchor, don't forget your flares. And the loud hailer. Most people in the anchorage will have radios off. As Jeff is trying to tell us, in a true emergency, anything and everything goes. He puts it in order, Mayday first, which will occupy some time with the CG, just let them know you need to send some signals to the surrounding area, then the kitchen sink.
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Old 04-28-2014, 07:07 PM   #9
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What would be the best, or proper, or preferred, method of alerting others in an anchorage that help is needed (assuming no cell coverage)?

If during the day, my thoughts would be VHF first, then just yelling if close enough to others, and finally in a dinghy looking for help.

At night, I think most VHF's are off (mine normally is). The horn does seem like it would get attention. If I heard one in the middle of the night, the first thing I would do is look around and then turn on the VHF.

Any guidance or experience would be appreciated.
Radio...Mayday
DSC Emergency Button
EPIRB/PLB
911 cell phone..but don't waste a lot of time holding or explaining
Horn...5 or more short blasts and scream help...

Again your time has to be split between sounding alarm and attending to emergency.

That's what is funny about Captain's licenses...you have to have First Aid/CPR for initial...then it's not required in all cases to keep renewing it...the USCG's philosophy is that the captian is responsible for the vessel...and only indirectly to it's passengers.
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Old 04-28-2014, 07:20 PM   #10
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*16 in Canada on a cell phone will connect you directly to the Canadian Coast Guard Officer on Duty at a MCTS for an emergency.

I didn't realize the USCG did not offer the same service until a Google search a few minutes ago.
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Old 04-28-2014, 07:26 PM   #11
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Some places used to have *CG but I think it was so underutilized...the USCG gave it up...but I'm not positive what happened to it or what it evolved into.
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Old 04-28-2014, 08:35 PM   #12
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Originally Posted by psneeld View Post
First Aid - most first aid along the coastal US is good but with the internet...only a click away. Things like paramedic skills are great but hard to fit into an already busy schedule and hopefully with the click of an EPIRB....the USCG will be there within the hour. From 35 years as a first responder on the water...buy an AED and learn how to use it...CPR is overrated to the max on the water (read wilderness).
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That's what is funny about Captain's licenses...you have to have First Aid/CPR for initial...then it's not required in all cases to keep renewing it...the USCG's philosophy is that the captian is responsible for the vessel...and only indirectly to it's passengers.


Unlike the commercial world of for-hire boating, most TFers consider their 'passengers' health and safety to be of paramount importance. We're not commercial skippers going for some license renewal here. Most of us are travelling with our loved ones and their comfort, health and welfare is first and foremost in our minds.

I don't understand why anyone would argue against CPR training for recreational boaters. That's either a bad joke or just poor advice and I hope no one takes your seriously. It just doesn't make sense unless one is just trying to be argumentative. And thanks for another reminder of your 35 years of walking on the water! I almost forgot.
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Old 04-28-2014, 08:48 PM   #13
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Unlike the commercial world of for-hire boating, most TFers consider their 'passengers' health and safety to be of paramount importance. We're not commercial skippers going for some license renewal here. Most of us are travelling with our loved ones and their comfort, health and welfare is first and foremost in our minds.

I don't understand why anyone would argue against CPR training for recreational boaters. That's either a bad joke or just poor advice and I hope no one takes your seriously. It just doesn't make sense unless one is just trying to be argumentative. And thanks for another reminder of your 35 years of walking on the water! I almost forgot.
If I explained it...you would just call me argumentative...

And I can understand why you wouldn't understand...

Anyone interested feel free to PM me.
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Old 04-28-2014, 09:25 PM   #14
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And I can understand why you wouldn't understand...

Anyone interested feel free to PM me.
No, come on. It's a discussion - we're all friends.

My wife was a CPR instructor. I've read books on the efficacy of CPR - there's a great one called Sudden Death and the Myth of CPR:
Sudden Death and the Myth of CPR 1st (first) Edition by Timmermans, Stefan published by Temple University Press (1999): Amazon.com: Books

I actually show that in one of our lectures. There are misconceptions about CPR and what it does. Let's get them all out and judge the valid ones from the rumor ones.
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Old 04-29-2014, 12:14 AM   #15
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Unlike the commercial world of for-hire boating, most TFers consider their 'passengers' health and safety to be of paramount importance.
Unless you are just being sarcastic, as a full time captain for the last 30 years I take exception to that. The captains and crews I know take their boat owners, guests and passengers safety very. very seriously. We have to take basic STCW training and as we move up in license size we take more and more advanced safety training. Along with performing on board drills to keep the skills we learn fresh.

And since the USCG is the organization mandating these increases in training, I'd say this statement is a load: "the USCG's philosophy is that the captian is responsible for the vessel...and only indirectly to it's passengers.".
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Old 04-29-2014, 01:15 AM   #16
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Unless you are just being sarcastic, as a full time captain for the last 30 years I take exception to that. The captains and crews I know take their boat owners, guests and passengers safety very. very seriously. We have to take basic STCW training and as we move up in license size we take more and more advanced safety training. Along with performing on board drills to keep the skills we learn fresh.

And since the USCG is the organization mandating these increases in training, I'd say this statement is a load: "the USCG's philosophy is that the captian is responsible for the vessel...and only indirectly to it's passengers.".
I totally agree with Bill. The Captains I've met and known are very serious about safety. In fact, it's often owners who try to push them into unsafe actions. Now I do not doubt there are Captains out there who aren't as responsible. In fact, I know on some of the larger charters alcohol use has become an issue with some Captains. But I do believe the bad Captains are the exception. I have many Captain friends and they are all very safety conscious and very protective of passengers and crew. Broad labeling and generalizations based on a few bad people in any profession is always unfair.
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Old 04-29-2014, 02:24 AM   #17
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Carrying a Defibrillator.
We had a member, also an Ambulance paramedic, now an instructor, talk at one of our Club meetings about first aid on the water. He has a sideline selling defibrillators, and was very persuasive that survival prospects were far better with one, than CPR. I guess he would say that, but I think he`s right.
We considered one for the Club but figured it would never be in the right place at the right time. Cost was above 2K AUD, the machine talks you through using it on a patient as you go. Obviously if you actually need one the 2K is nothing, if you never need it,(you never want to), the value is uncertain. Fortunately the "Admiral" is First Aid qualified.
We had a friend take ill at night on the Hawkesbury River, 20 miles north of Sydney. He had a throat hemorrhage, got himself wedged in the head, door closed, collapsed. I think his wife called for help on the VHF(cell is lousy up there), Water Police came, got him out, were met by a waiting ambulance on land, transferred him to hospital, all ended well. But if we call 000(=911) for help on a boat, emergency services have been known to demand you supply a cross street! You tell them you`re on a boat, but....The Water Police however, can be a godsend.
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Old 04-29-2014, 06:25 AM   #18
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As a medic, if I can just clarify a comment made quite correctly by Dannc, re the CPR being more about compressions and less re the breathing, when he said…
When people say CPR, they always are thinking of breathing and chest compressions, though with the latest training, it is all about compressions, compression and compressions. Frankly, in the past, the more important part of CPR class is the choking training..

This is relatively new in CPR, and has been a major advance in terms of members of the public being more ready to step in and do it. It has been shown that effective cardiac compression also compresses the rib cage (which is springy, after all), sufficiently that there is sufficient airflow, as long as the airway is clear - I emphasise that - without trying to also actively ventilate the patient - (not until oxygen via mask or tube is available anyway), so THE GOOD NEWS IS it is no longer expected one must try to perform mouth to mouth breathing, which of course was naturally the big turn-off. I wouldn't do it to a stranger either.

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…
Great post Dan.
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Old 04-29-2014, 07:20 AM   #19
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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.)
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Old 04-29-2014, 07:23 AM   #20
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and was very persuasive that survival prospects were far better with one, than CPR. I guess he would say that, but I think he`s right.
There are consistent studies showing the same outcomes. For a patient in cardiac arrest (which is what the topic of AED's is really about), if you arrest in a hospital and only receive CPR only, you have a 2.4% chance of survival. If you're outside a hospital, the survival rate drops to 1.6%. Within the reasons for going into cardiac arrest, CPR is quite effective for drowning. But that's not what the typical trawler owner with known or unknown heart disease is worried about.

Add an AED and the numbers change dramatically. Apply an AED within 4 minutes and the survival rate jumps to 75%. This is why there are so many AED's in malls, airports, schools, and boats.

So looking at that data, CPR is a waste of time, right? Except CPR's goal isn't survival. CPR's goal is to stop the clock before 4 minutes. When done properly, you are giving extra time to allow an AED (onboard, from the boat next door, or from a racing ambulance) to be applied. In that role, CPR is critical and will save someone.

It's interesting that in the show ER, 80% of patients receiving CPR coughed and woke up. It just doesn't happen that way.
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