boating with elderly folks in remote areas

psneeld said:

The success rates of AEDS and CPR in and out of hospitals/minutes from higher medical care (paramedic and above with medicines) and out in the wilderness/on boats is pretty drastic from my experience.

We discussed putting AEDS on USCG helos at great length back around 1999 when they first came out. Because of metal and lots of salt water involved....they were not adopted at the time. Too much risk for low outcome of success.

I thint they are carrived now..but I believe the guiding principle still stands...unless a pretty high level of care is rapidly available, or the AED does a simple correction in a short amount of time, or CPR is only needed for a few minutes...survival rates are still pretty low.

So absolutely general health is a factor in survival and recovery and how the body handles recovery.

Again AEDS and CPR are great tools....but not miracles all the time...and seemingly in the boating world less than preferred.

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Survival of certain medical events without hospitalization fairly quickly isn't going to be good, as he says. Heart attack, stroke, being the two that come quickest to mind. That's also when we would want an ER type doctor online to advise us of the next steps to be taken. As to AEDS and CPR they improve survival rates but they're still not to a good level by themselves.

We do keep a large medicine kit as well to follow up on treatment. Well equipped to this point but never tested at sea and hope not to be.

A larger crew, well stocked sea medical chest with IV drugs, and capability to administer is not a luxury most of us have.

NOTE to any skipper..unless changed, we used to be able to phone patch flight surgeons to the radio communications with vessels with medical emergencies....if you have a medical kit with advanced medicines onboard or are unfamiliar with basic first aid techniques...there may still be that capability.

psneeld said:

A larger crew, well stocked sea medical chest with IV drugs, and capability to administer is not a luxury most of us have.

NOTE to any skipper..unless changed, we used to be able to phone patch flight surgeons to the radio communications with vessels with medical emergencies....if you have a medical kit with advanced medicines onboard or are unfamiliar with basic first aid techniques...there may still be that capability.

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Very true on many not having the luxury although the kit is less costly than one might imagine. The training however didn't come cheap. While we have a service for the radio communications what you describe is also possible. Let the Coast Guard know of the medical emergency and they will get you in communications with someone. Worst case get patched through to an ER somewhere. Hopefully one can find someone out there to guide them through it.

It's certainly not a perfect solution, there isn't one. And again you need to evaluate the risk before leaving shore and determine if it's one you're willing to take. I knew an 83 year old who after a long cruise got home and had a heart attack. He had emergency care in less than 5 minutes and was to the hospital quickly. He realized had it happened a week earlier with him hundreds of miles from anywhere he probably would have died. On the other hand I know an 83 year old about to start what may end up being a circumnavigation. But he's in extraordinarily good health.

Donsan said:

Been waiting for someone with a medical background (which I do not have) to chime in on this but from my experience with folks about 90, I would have some concern about using an AED on them. I looked on the web for something on age use of AEDs without much success. Even in good health, someone 90 years old is going to be significant weaker than they would be at 60. Not saying having an AED on a boat isn't a good thing but the older the patient, I would guess the less likelihood of a successful outcome from its use.

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The chest compression part of CPR is when someone's heart has stopped. They are DEAD. Chest compressions are almost certainly going to break ribs even in a strong, young person. In an elderly person, with weakened bones, it is going to get ugly. An AED would be much easier on the body, and I think, the rescuer. With CPR/AED you are trying to bring a person back from death. Broken ribs are better than dead.

A big advantage of the AED is that it is pretty automatic. The AED tells you what to do, when to do it, and if there is a problem with the pads, it will tell you so. The AED is pretty danged easy to use and requires very little physical effort. Chest compressions is very tiring and one can easily do it wrong but there won't be a computer monitoring if the compressions are correct. If one does not panic, anyone can use an AED.

For a couple on a boat, if the boat is moving when one of the couple goes down, the other person is going to have to handle the boat, call a May Day, and deal with the casualty. Doing this with CPR is going to be problematic to say the least. With an AED, after the May Day call, one would have a chance to hook up the AED while at the same time handling the boat. It is not optimum but it would be possible. One could not really do this with CPR.

If one is hours from help, CPR and an AED is likely not going to be successful. One needs to be close in time to EMS and an ER. It seems most of the members of this website are close to EMS and and an ER most of the time.

Later,
Dan

This is a great discussion and has certainly got me thinking but is there a medical doctor in our midst whom might give us an opinion? Certainly being trained in first aid and CPR is a huge advantage but what about the real efficacy of the gadgets? All of the business jets we built had AEDs on them and most had radio connections to a central medical service with docs on standby but now that I think of it, I can't remember the service being used and I never heard of an AED being used either.

dannc said:

The chest compression part of CPR is when someone's heart has stopped. They are DEAD. Chest compressions are almost certainly going to break ribs even in a strong, young person. In an elderly person, with weakened bones, it is going to get ugly. An AED would be much easier on the body, and I think, the rescuer. With CPR/AED you are trying to bring a person back from death. Broken ribs are better than dead.

A big advantage of the AED is that it is pretty automatic. The AED tells you what to do, when to do it, and if there is a problem with the pads, it will tell you so. The AED is pretty danged easy to use and requires very little physical effort. Chest compressions is very tiring and one can easily do it wrong but there won't be a computer monitoring if the compressions are correct. If one does not panic, anyone can use an AED.

For a couple on a boat, if the boat is moving when one of the couple goes down, the other person is going to have to handle the boat, call a May Day, and deal with the casualty. Doing this with CPR is going to be problematic to say the least. With an AED, after the May Day call, one would have a chance to hook up the AED while at the same time handling the boat. It is not optimum but it would be possible. One could not really do this with CPR.

If one is hours from help, CPR and an AED is likely not going to be successful. One needs to be close in time to EMS and an ER. It seems most of the members of this website are close to EMS and and an ER most of the time.

Later,
Dan

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This is my point all along..one of the last MEDEVACS I was primary in was I assisted a jet skier (a few years ago) who went over the handle bars after grounding. He was only 100 feet from a road that was accessible to an EMS squad only a 2 minute drive away.


By the time he was in the ambulance was nearly an hour.

Many times injuries and medical conditions happen in less than ideal situations or weather....even coastal cruisers are "in the wilderness" in many cases.

Xsbank said:

This is a great discussion and has certainly got me thinking but is there a medical doctor in our midst whom might give us an opinion? Certainly being trained in first aid and CPR is a huge advantage but what about the real efficacy of the gadgets? All of the business jets we built had AEDs on them and most had radio connections to a central medical service with docs on standby but now that I think of it, I can't remember the service being used and I never heard of an AED being used either.

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Not all doctors are involved with emergency medicine and can be completely unfamiliar with the whole rescue situation much of the time.

A really good EMT with lots of operational experience or an ER Nurse...and of course most ER Docs can certainly chime in...but only the paramedics and rescue crews can really tell you the likelihood of any of these neat ideas or equipment actually working.

While we've been talking about things like heart attacks, there are so many other potential problems that with training and a good medical kit we might address effectively. Those are things that sound simple like proper wound care, infectious diseases, flu, stomach viruses, broken bones, eye, ear, nose, and throat issues. Especially with older women looking out for UTI's. A lot of things that might be routine with younger people can be very serious with older people. Having medications and knowing what to use might prevent pneumonia or a serious leg infection from what was a minor cut. While we might fail to save a life with an AED, treating other conditions might do so. Often at the ages we're discussing a heart attack or stroke will be fatal and our ability to prevent that is limited. To me the bigger key is what I would label "preventable death". Thousands of people die from the flu each year, many because of failure to treat and it turning into pneumonia. Most people don't grasp the full impact of a Urinary Tract Infection. It often leads to an altered mental state and it also spreads so that you get symptoms throughout the body. You may think the person is having a heart issue. You may have to take a stab at the most probable bacteria and choose an antibiotic without knowing for certain if it's the right one.

We got to observe a lot during our course time in ER. Some genius. A little that we thought was far too dismissive. We saw the difference in how various doctors and nurses handled situations. The best doctor we observed was on target on nearly all his initial evaluations and guesses before labs or x-rays confirmed. Had he been at sea or without facilities he still would have done an incredible job. He also represented the type of ER doctor we would hope to be able to communicate with from sea.

We also formed another opinion. When you're 80 and above (and maybe the right number is 70 and above), and you come to ER, it's always serious. There's no minor issue at a certain point simply due to the risk of complications. The way you avoid bigger problems is to treat everything as major or serious.

psneeld said:

A really good EMT with lots of operational experience or an ER Nurse...and of course most ER Docs can certainly chime in...but only the paramedics and rescue crews can really tell you the likelihood of any of these neat ideas or equipment actually working.

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That's a major point I realized I failed to point out. On a boat we need to be far more like an EMT and ER Nurse than the doctor. They are the ones who make major life and death decisions before the patient reaches the doctor. We observed some who were so impressive. We are absolutely certain we observed a couple of situations where the EMT's saved lives.

We know we can't approach the level of some we observed as among other things we do not have their experience, but we'll do the best we can.

(Sadly, that's not an option, as of two weeks ago.)

Sorry for your loss - I posted this a while back, but hope it helps. Found this when our precious English Spaniel died:

[FONT=&quot]Where Shall I Bury My Dog[/FONT]
[FONT=&quot]
There is one place to bury a dog. If you bury him in this spot he will come to you when you call – come to you over the grim dim frontiers of death and down the well remembered path to your side again. And though you call a dozen living dogs they shall not growl at him nor resent his coming for he belongs there.
People may scoff at you who see no slightest blade of grass bent by his foot fall,who hear no whimper, people who never really had a dog. Smile at them for you know something that is hidden from them and which is well worth knowing.
The one place to bury a good dog is in the heart of his master.


Answer to the question “Where Shall I Bury My Dog” Editorial, Ontario Newspaper circa 1900[/FONT]

I hope people aren't getting me wrong....


There's a big difference in critical care and urgent care while afloat.


Many things are life threatening even in the middle of nowhere if you do nothing or don't call for help....other things it wont matter...you are now in the statistic column.


For the vast majority of medical issues...basic first aid and a tmely call will save your life.


One of my favorite rescue stories was of a guy sailing the pacific that got a fish hook or fin in him and got blood poisoning.


In urgent need of care...he contacted the USCH who organized a SEAL parachute to his boat from a USCG C130.


The SEAL team administered IV antibiotics, stabilized him and sailed the boat something like a 1000 miles to the nearest hospital (I guess some SEAL duty is better than others...)

So if you can hold out 3 days or so....it is possible the US rescue system will preform miracles as they often do....if it is something that requires an AED or CPR...you are on the wrong side of the medical see saw but you never know.

So good medical training is great...but you better be better than you think you are if you go past the basics.

In all professions...proficiency is key....not training.

FoxtrotCharlie said:

(Sadly, that's not an option, as of two weeks ago.)

Sorry for your loss - I posted this a while back, but hope it helps. Found this when our precious English Spaniel died:

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Thank you for that and thanks to those who PM'd me. I don't want to further hijack this thread but want to say I appreciate the condolences.

I am an older retired MD and I worry as much if not more about the young who have ways of breaking things and getting infection and allergic reactions in remote places. I am 75+ and figure when my time comes be it driving a car alone or out on a boat often alone so be it. I figure I might as well die doing what I like. I have seen too many waste away from CA and chronic diseases and would rather go with my boots on. Even in the middle of a city with major emergency response it is easy to go over the deep end when nobody notices since it only takes a few minutes to die. I think it is reasonable to carry a first aid kit and some meds and be CPR capable. I have a defib. unit but realize much of CPR is a temporary life support maneuver meant to allow the rescue squad to get the victim to a hospital often not going to happen in the remote on a reasonable time schedule. While boating in the remote has risk it is not unreasonable for those with knowledge and good equipment relative to many other human travel and sport adventures. Why I had a mid aged neighbor in excellent health who went to India on vacation and died soon after arriving back in the US from a spider bite he got in India. How do you plan for that(insurance and a good will).

psneeld said:

...In all professions...proficiency is key....not training.

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And where redundant practical application isn't possible, your proficiency will come from redundant training.

The more you do something, the more it becomes 2nd nature.
As in, if you train like you'll fight, you'll fight like you train.


OD

psneeld said:

Adrenaline is a powerful drug......once adicted, hard to kick.....

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...ain't that a fact!

A lot of excellent comments so far.

Prepared is always the key to survival. The further offshore/away from civilization you are, the better prepared you need to be. As we say – “Hope is not a plan”. It is amazing how many times the word “Hopefully” is used when discussing disaster or personal preparedness!

Many have asked about or discussed the value of AED’s. In this light, many I believe are concerned about a catastrophic cardiac event (AKA Full Arrest). Bottom line folks, the further you are from the dock and rapid transport, the lower your odds become. That’s a classic understatement if I’ve ever made one. AED’s are marvelous inventions that have saved many lives. However, I would argue that most “saves” are when they are a part of what they refer to as the “Chain of survival”. psneeld articulated it quite well in Post 30. If you don’t have follow up to CPR/AED with rapid Advanced Life Support (ALS) “Paramedic” care, near-immediate transport to an acute care facility, and rapid (often invasive) intervention – the overall odds are often bleak.

So, what am I saying? Bottom line – you can buy an AED from Costco for under $1,200.00. (maybe elsewhere for less!) If you have the money and want to add it to your arsenal – go for it! Be prepared! I like BandB’s approach to life. Give yourself every bit of opportunity to make a difference. However, I wouldn’t beat myself up if I was spending my money on other critical stuff like radio’s, EPIRB’s or life rafts. The chances of needing, using and actually saving a life offshore solely based on having an AED are pretty small. That may make me a heretic to some. But that’s the "away from dock" reality IMHO.

Yes – learn CPR. But more importantly, learn advanced First Aid and take classes like wilderness medicine. There are a lot of emergencies - in addition to cardiac arrest - that you can make a difference on. Carry a good medical kit. Here’s a cheap life saver: Aspirin. Its efficacy is so well documented for chest pain/cardiac issue callers that dispatchers are having certain/appropriate patients take it as part of pre-arrival instructions. (This is not medical advice. Learn when and why to administer prior to use).

And I always advise - don’t wait to initiate the call for EMS/Rescue. You can ALWAYS cancel them. But wasted minutes are never regained.