Accidents. Resuscitation. AED. Should AED be mandatory on diving boats?

[BlueTrin]

Wouldn’t have believed him at that point. He lied at the beginning before he did the first dive. The news broke in between the first and second dive when there was no way to access the situation and he never mentioned any okay when they spoke to him about the second dive. He was too busy saying how he wasn’t paying for anything and was going to blow us out of the water with a nasty review. We charged him for 2T and gave the other 2 couples a break because it was not fair to them so it was a loss for us but thankfully not a tragic one. We also let our fellow ops know in case he tried them without the necessary clearance as we all do. So I totally disagree with statements saying ops only care about the money. I think most of our colleagues have integrity.

It sounds like you did the right thing.

 

[Edward3c]

Wouldn’t have believed him at that point. He lied at the beginning before he did the first dive. The news broke in between the first and second dive when there was no way to access the situation and he never mentioned any okay when they spoke to him about the second dive. He was too busy saying how he wasn’t paying for anything and was going to blow us out of the water with a nasty review. We charged him for 2T and gave the other 2 couples a break because it was not fair to them so it was a loss for us but thankfully not a tragic one. We also let our fellow ops know in case he tried them without the necessary clearance as we all do. So I totally disagree with statements saying ops only care about the money. I think most of our colleagues have integrity.

I stopped our Regional Coach from diving with us during a training session because he didn't provide evidence of fitness-to-dive. How would it have looked "Your Honour I assumed ...".

 

[ChuckP]

I think I've filled that medical out everywhere I've dove plus I carry a doctors note. Now being more involved, I know what'd more than likely happen to a dive shop when a tragedy happens - invasion of privacy it's not, make them sign off on that paper.

 

[SapphireMind]

I don't believe the evidence bears this out.
There have been many studies looking at OHCA (out of hospital cardiac arrests) and changes in outcomes with epi, nothing points strongly one way or another. Epi may lead to higher ROSC (return of spontaneous circulation) but poorer neurologically intact outcomes and an increased 30 day mortality.
There is most likely a role for epi in OHCA for non-shockable rhythms, where early defib (by definition) is not an option (see ILCOR and ECC guidelines for full reference, beyond the scope of this conversation).

I have seen no data to support that epi does more than good CPR and defib (infact, the trend is very much opposite this, with effective CPR and early defib increasing survival, and epi not changing much if anything).

To avoid re-inventing the wheel, I will simply link to https://first10em.com/epinephrine/ which provides a good overview of the current data. (and one can follow a link to the recent PARAMEDIC2 trial)

I agree that AEDs are not a cure all, but to say that epi has more impact on outcomes than AEDs is misleading given the current literature. The Feb article in Circulation (Impact of Bystander Automated External Defibrillator Use on Survival and Functional Outcomes in Shockable Observed Public Cardiac Arrests. - PubMed - NCBI) showed that the benefits of AEDs are quite robust. There is no data that i have found which demonstrates the same for epi.

If you have resources that support your point, please point me in their direction.

Getting back on topic, the presence of AEDs on dive boats will most likely lead to increased survival of those experiencing arrests onboard (the degree of this would depend on a great many factors). Epi is not appropriate at this level of rescuer and would probably not provide a measurable change in outcomes. O2 probably has negligible effect on the outcome of non-DCI caused arrests. O2 is obviously needed for DCI events. I don't have the experience or knowledge of the literature to intelligently assess the benefits of AED and/or O2 for DCI related arrests, although my gut would say good BLS and early defib (if appropriate) is the most important, and get high-flow O2 on to the best of your ability, as long as it doesn't interfere with the good BLS/AED use.

And as for making it mandatory, there are enough rules out there already....

I am referring to non-shockable rhythms, which again, if you go by the theory that the cardiac arrest is due to lack of oxygenation/ventilation, that typically will not give you a shockable rhythm. No, epi isn't able to be used by bystanders and it is not a cure all, but we're looking at two different patient populations: I'm looking at diving deaths that occur because of the diving/water/drowning/stop of circulation due to hypoxia. You're looking at people who are having cardiac events that happen to be in the water. That was my only point - AEDs are not going to fix hypoxia induced death. Epi sometimes can, along with resumption of oxygenation. Now, that also doesn't mean they are going to have a good outcome necessarily.

 

[Rred]

A side note on the mention of "breathing" and oxygen versus cardiac issues.
For about six or seven years now in the US, the standards for teaching and certifying CPR have changed. For professional responders, they are still taught to pump the chest AND do rescue breathing, the same as ever.
But for non-professionals, for the general public, RESCUE BREATHING IS NO LONGER TAUGHT OR REQUIRED. Apparently some folks did a little experimenting and found out that if you slamming the heart and chest, the forcibly circulates the blood and moves enough oxygen into the brain, so that breathing is not necessary.
The survival rate is still calculated as dropping by 10% for every minute that CPR is delayed, i.e. 90% if you start CPR within the first minute, zero if it take ten minutes to get started.

I could a guy with a 6-pack saying "oh no, another thousand dollars and I need training and liability to go with that??"but on a cattle boat, it doesn't seem so unreasonable. I think free soft drinks would probably mean more to the average diver booking a ride though.

 

[Rred]

"Certified divers are supposed to stay dive fit, folks are supposed to have regular medical. ...
...DM an the op he worked for being sued because while his CPR efforts were successful the individual did suffer a hairline fracture on a rib and his wife was traumatized. Really?"

Um, staying fit seems to be a matter of personal choice, I don't recall any certifying agency requiring me to "drop and do fifty" every morning. Nor do I recall any diving authority requiring me to have regular medical exams, even if the medical industry and "common sense" might require that. Or any definition of regular. Consider the way that the medical establishment has changed the age ranges and frequency for colonoscopies and prostate checks among other things, they've changed wildly over the years.

As to being sued, I have no idea what the laws in the Caymans are. Here in the Colonies of course anyone can sue anyone for anything, but if the person DOING CPR has been trained within the past two years, and has the certification to prove that, they are largely immune to prosecution. There are "good samaritan laws" in most states (if not all) that provide additional protections. Sure, you can still be sued but unless there are extenuating circumstances, the lawyer who brought that case could be disbarred for a "bad faith" lawsuit.

In every CPR class there's something that says they're afraid they'll crack a rib if they push any harder, and the instructor inevitably says "Yes, you might and probably will. Cracked ribs heal, death doesn't."

If the local laws suck...change them. Or move. Or hide any evidence that you've ever had CPR training, and just stand around and look helpless like the other sheep.

 

[TMHeimer]

Q: If your CPR cert. has expired (ie. it's been over the 2 -- or 3-- years that it says it's good for)---
Are you in a more precarious situation lawsuit-wise giving CPR than if you're within the 2-3 years?
Interesting that all dive certs., including Rescue Diver, never expire.

 

[TeamBubbles]

Tom, as a private citizen you are typically granted some form of immunity under the various Good Samaritan statutes. If, however, maintaining a CPR certification (and proficiency) is a requisite part of your job, then you can expect much less or no such protection.

I'm firmly in the pro-AED camp. With that said, however, it's often not as simple as going down to Costco, buying one, and bolting it to the nearest wall. In many jurisdictions, placing an AED in a public area and for public use comes with considerable regulation. Not surprisingly, New York State has just such a process:

https://www.health.ny.gov/professionals/ems/pdf/09-03.pdf

 

[TMHeimer]

Tom, as a private citizen you are typically granted some form of immunity under the various Good Samaritan statutes. If, however, maintaining a CPR certification (and proficiency) is a requisite part of your job, then you can expect much less or no such protection.

I'm firmly in the pro-AED camp. With that said, however, it's often not as simple as going down to Costco, buying one, and bolting it to the nearest wall. In many jurisdictions, placing an AED in a public area and for public use comes with considerable regulation. Not surprisingly, New York State has just such a process:

https://www.health.ny.gov/professionals/ems/pdf/09-03.pdf

Thanks, makes sense. & agree NY has a regulation for everything.

 

[Rred]

It looks like that NYS regulation is NOT regulating the use or installation of AEDs at all. Rather, it is a regulation saying who may participate in a PROGRAM which appears to have the main intent of gathering statistics on standardized use of AEDs. The regulation itself says "there are no approvals or certifications required".

Whether someone is formally trained, or formally trained as part of their occupational duties, or has perhaps been negligent about not maintaining their certification (getting retained in current procedures in a timely manner) all are questions. There was a case, IIRC in NYC about five years ago, where a paramedic was being sued for spinal injuries caused when they removed a victim from a car wreck. Rule number one, you don't move a possible spinal injury until it has been stabilized. Except, the other Rule number one, if you think they may burn to death in the wreck, you get them out even if you can't stabilize them. It got more complicated from there.

Case law, precedent, statute, all vary from state to state, and change from time to time.