In his first post to the Dockwalk.com Forum “Defibrillators on Yachts” Capt. PNW Rick asked, “… in renewing my CPR certificate at the local Red Cross today, the nurse teaching the course told me that AEDs cannot be used aboard vessels due to the motion which will interfere with its monitoring ability. Is that right?”
Dockwalk.com sat down with MedAire staffers Ginger Bartos, RN, BSN and Lin Gholson, RN, for a Q&A on Automated External Defibrillators (AEDs). They gave us the answer to the captain’s question and a whole lot more.
Q: Is the motion of the ocean too much for an AED?
A: While motion can affect AEDs, it would take a wild ride to interfere with the AED’s analyses. Direct patient stimulation is often a cause for interference with an AED analysis. There have been no official studies to date on using the AED on board yachts, but it can be done safely.
Q: Does the yacht have to be tied up at a dock?
A: No, the AED can be used at any time, including during rough seas. The yacht can be anywhere in the world – dock side, at anchor or under way. Any time that a person has collapsed and there is no breathing or circulation is the right time to apply an AED.
Q: Does the size of the yacht matter?
A: Any yacht, regardless of size, can have an AED on board. The only safety consideration in a small yacht is for the person pushing the AED button; he/she must step away from the victim when the shock button has been initiated. No one can be touching the victim.
Q: What training is required for crew to be able to use an AED on board?
A: While AEDs are designed for use by a layperson, with easy-to-understand instructions, it is recommended that anyone using an AED receive training.
The Maritime and Coastguard Agency (MCA) stated in August 2003 in Merchant Shipping Notice (MSN) 1768 (M+F) that “there is no statutory requirement under international or national legislation for ships to carry defibrillators.” It goes on to state that the MCA recommends “adequate training for first aiders, including regular refresher training (at least every 6 months).” In the January 2009 Consultation Draft “The Carriage of Defibrillator on Ships,” the MCA clarified its position, stating, “First aiders on board ships should receive suitable familiarisation training in the use of AEDs, including refresher training at least every 6 months.”
The crew will also benefit with CPR and basic first aid training, as an adjunct to AED training. Yearly AED refresher training and biannual CPR recertification is recommended.
Q: What type of medical situation requires the immediate use of an AED?
A: Any time someone is unconscious, not breathing or without a pulse, it is recommended that CPR be initiated and the AED attached as soon as it is available. It is always better to err on the side of caution. The AED will analyze the heart rhythms and only deliver a shock if it is needed.
Q: What role does the telemedicine provider play?
A: Heart attacks are extremely life-threatening, requiring immediate crew action. As a result, CPR and placement of the AED should be initiated immediately, while another crewmember contacts the telemedicine provider.
The telemedicine provider should ensure that the AED pads have been placed properly and will be given regular updates on the results of the AED analysis. The telemedicine provider is to take this information, along with an overall assessment of the situation, and make recommendations for continued care. For example: what types of medications should be administered? Does the yacht need to divert to the closest port? Do we need to activate the Coast Guard?
Q: Any tips for crew about AEDs on yachts?
A: The AED should always be part of the first medical/first-aid equipment brought to the scene by the crew. Since time is of the essence with heart attacks, the crew will have lost no time in retrieving it and can begin administering shocks immediately if necessary.
- Know where the unit is stored on the Yacht.
- Know where the pads are located.
- Understand how to convert the pad from Adult to Pediatric.
- Know how to test your model to ensure that the batteries are sufficiently charged.
- Develop a routine on board the vessel to regularly check the unit to ensure the pads are good and the batteries are charged.
Always follow these safety precautions when using an AED:
- Call for telemedicine support early
- Dry the chest of the victim
- If the victim is wet, don’t kneel in the surrounding water.
- Don’t try to use it on a drowning victim while he/she is still in the water.
- Make sure you no one is touching the victim when you push the “Shock” button.
- Take special care when working in close quarters, such as the engine room.
Q: Has MedAire been involved with many resuscitations where crew have used an AED?
A: MedAire has helped with several resuscitations that have been successful. In one instance, an AED delivered a life-saving shock. MedAire managed the patient’s symptoms, using medications and supplies available in the kit, while the captain diverted the vessel. The patient was treated in the hospital and released several days later.
In another case, the AED was applied, but analysis determined the patient did not need to be shocked. In this case, MedAire managed the patient’s immediate symptoms and arranged for evacuation off the vessel. The patient went on to the hospital where a pacemaker was inserted due to the cardiac issue. The patient experienced a full recovery.
MedAire provides AED/CPR skills training and certification by the American Heart Association in the U.S. and the European Resuscitation Council in the UK.