AED Use in Diving Emergencies

[Reck Diver]

No. I do not feel an AED is needed as "standard" equipment. The likelihood of it being "life-saving" is extremely low. The purpose of an AED is to shorten the time to defibrillation in the event of a sudden death event -- an event where a couple of minutes difference in time to defibrillation can make a huge difference in survival and quality of life. An AED might be helpful for a sudden death event while onboard a dive boat(extremely unlikely), but is unlikely to be of benefit for an in-water or underwater event due to the prolonged delay there would be in getting the victim back onboard, out of their gear, dried off, and the device applied.

That having been said, if a given dive operation wants to purchase one to have available I am all in favor of it. I just don't think the very small likelihood of it saving a diver's life for the reasons above justifies the expense of "every" dive boat having one.

They make a lot more sense in areas where there are large goups of people -- airports, convention centers, sports stadiums, cruise ships, etc.

Just my 2 cents.

Doug

I have to say, your answer surprised me. Not all events happen on the bottom, 20 minutes from the boat. If a 50 something came out of the water and had an "event" on the vessel, without an AED he is dead.... Period. He will not survive the boat ride to the dock. With an AED you know that if he was treated immediately he might have a 50-50 chance of surviving.

Granted that is not a likely scenerio, but I'm sure you know the gratification of giving someone their life back. Makes AED money seem like chump change.

Now if the Narcosis did indeed have a defibrillator on board, I'd be willing to bet its received more use than their Coast Guard required fire extinguisher.

 

[SC_Hoaty]

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A ScubaBoard Staff Message...

This thread has been split off from an accident discussion in the A&I forum

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Thanks!

 

[TSandM]

Okay, guys, let's get a reality check. I work as an ER doc in a town of 25,000 people, with a catchment area of about twice that. It's heavily skewed toward the elderly, because it was settled when Grand Coulee dam started providing irrigation water. I work six or seven shifts a month, so 70 to 90 shifts a year. In the last year, I have used defibrillator paddles on about three patients, maybe four. None survived to hospital discharge.

I don't know how long a dive boat would have to operate to put 50,000 people through the boat -- and remember that that 50,000 would NOT include people with significant known heart disease, or many people of 70 or above. Yes, the presence of an AED could save a life. Do we insist that all grocery stores have them? I suspect more people move through the average grocery store in a year than go on the average dive boat.

It's a cost-benefit thing. There are lots of things that are nice to have, but don't merit the expense of having them everywhere.

 

[dumpsterDiver]

Okay, guys, let's get a reality check. I work as an ER doc in a town of 25,000 people, with a catchment area of about twice that. It's heavily skewed toward the elderly, because it was settled when Grand Coulee dam started providing irrigation water. I work six or seven shifts a month, so 70 to 90 shifts a year. In the last year, I have used defibrillator paddles on about three patients, maybe four. None survived to hospital discharge.

I don't know how long a dive boat would have to operate to put 50,000 people through the boat -- and remember that that 50,000 would NOT include people with significant known heart disease, or many people of 70 or above. Yes, the presence of an AED could save a life. Do we insist that all grocery stores have them? I suspect more people move through the average grocery store in a year than go on the average dive boat.

It's a cost-benefit thing. There are lots of things that are nice to have, but don't merit the expense of having them everywhere.

Have you ever order a diagnostic test(s) that cost a few thousand dollars with the primary objective of limiting liability exposure to yourself and/or you employer?

 

[danvolker]

Jim Fix comes to mind. World class runner no sign of heart problems. Dropped dead, heart attack he was over 50. A clean bill of health means the doctor didn't find anything, not that there isn't anything to find.

From an article on the Mercola website...

Long-distance runners can, in fact simply drop dead -- usually in the middle of a run, from fatal heart attacks. In 2010, three runners died at the 32nd Detroit Free Press/Flagstar Marathon.In fact, about 14 percent of athlete deaths are linked to heart problems. Although exercise reduces your cardiovascular risk by a factor of three, too much vigorous exercise, such as marathon running, increases your cardiac risk by seven.
Healthier Talk reports:

“That’s because the further you run, the more stress you put on your body ... [L]ong duration exercise releases chemicals that flood your body. And that leads to inflammation ... If you have hidden heart problems, this can be seriously risky.”
​

Dr. Mercola's Comments:

Running a marathon is often seen as the epitome of fitness and the ultimate show of endurance. As a former sub 3-hour marathon runner myself, I understand the drive that pushes many athletes and weekend warriors to compete in these strenuous events -- but when you examine the research it becomes clear that doing so may put your heart at risk.
You've likely heard the stories about fit marathon runners who die suddenly in the middle of a race. Though rare (one study put the rate of sudden cardiac deaths during a marathon at 0.8 per 100,000 participants), it is certainly not unheard of, and it seems no one is immune to this risk. Even Olympic athletes have died in the middle of training.
This is because in the case of exercise, more is not always better.
Excessive cardio like that performed during marathons or triathlons is likely not much better at improving longevity than being sedentary. In fact, according to a study presented at the Canadian Cardiovascular Congress 2010 in Montreal, regular exercise reduces cardiovascular risk by a factor of two or three. But the extended vigorous exercise performed during a marathon raises cardiac risk by seven-fold!
This is a powerful lesson to anyone who engages in large amounts of cardio exercise, because as it turns out, excessive cardio may actually be counterproductive.
​

What Makes Marathon Running So Dangerous?

To put it simply, it puts an extraordinary stress on your heart, one that your body was not designed for. In the study mentioned above, researchers found that during a marathon more than half of the segments in your heart lose function due to an increase in inflammation and a decrease in blood flow.
Research by Dr. Arthur Siegel, director of Internal Medicine at Harvard's McLean Hospital, also found that long-distance running leads to high levels of inflammation that may trigger cardiac events, and a separate study published in Circulation found that running a marathon lead to abnormalities in how blood was pumped into the heart.
Even if you don't end up dying from sudden cardiac death during a race, years of marathon running can take a toll on your health. Research emerging over the past several years has now given us a whole new understanding of what your body requires in terms of exercise, and many of our past notions have been turned upside-down. It's now clear that exercising too much is a blow to your health.
For example, two recent studies showed:

• Heart damage after lifelong cardio: In a study published in the Journal of Applied Physiology in February, researchers recruited a group of extremely fit older men. All of them were members of the 100 Marathon club, meaning athletes who had completed a minimum of 100 marathons. If running marathons provided cardiovascular benefit this would certainly be the group you would want to seriously examine. So what did they find?
  
  Half of the older lifelong athletes showed some heart muscle scarring as a result, and they were specifically the men who had trained the longest and hardest.
• Heart scarring after elite cardio training: Recently published in the journal Circulation, this animal study was designed to mimic the strenuous daily exercise load of serious marathoners over the course of 10 years. All the rats had normal, healthy hearts at the outset of the study, but by the end most of them had developed "diffuse scarring and some structural changes, similar to the changes seen in the human endurance athletes."

Separate research published in the journal Progress in Cardiovascular Diseases also recently concluded that the best fitness regimen is actually one that mimics the movements of our hunter-gatherer ancestors, which included short bursts of high-intensity activities, but not long-distance running such as is required to complete a marathon.
The point is, too much of something that is normally good for you can have the reverse effect. So, although most people who read this are not exercising nearly enough, it's still important to understand that it is indeed possible to over-exercise -- especially if your primary focus is on traditional cardio or aerobics.
​

Are You Still Spending an Hour on the Treadmill?

Even if you're not a marathon runner, you may still be cheating your body of the optimal exercise benefits if you are focusing your workouts on long periods of cardio. According to fitness expert Phil Campbell and author of Ready Set Go, getting cardiovascular benefits requires working all three types of muscle fibers and their associated energy systems -- and this cannot be done with traditional cardio.
Here's a quick review:

• Slow twitch (red muscle): Activated by traditional strength training and cardio exercises
• Fast twitch (white muscle): Activated by Sprint 8 exercises
• Super-fast (white muscle): Consists of fast twitch AND super-fast fibers, activated by Sprint 8 exercises

Unfortunately, most traditional cardio and strength training exercises work only red muscle fibers, completely missing your white muscle fibers, which then atrophy. If your fitness routine doesn't work your white muscle, you aren't really working your heart in the most beneficial way.
Your heart has two different metabolic processes: the aerobic, which require oxygen for fuel, and the anaerobic, which do not require any oxygen.
Traditional strength training and cardio exercises work primarilythe aerobic process and the slow twitch (red) muscle fibers. On the other hand, Sprint 8 exercises work youraerobic AND your anaerobic processes, which is what you need for optimal cardiovascular benefit.
This is why you may not see the results you desire even when you're spending an hour on the treadmill several times a week. You're only working HALF of your muscle fibers!
In the case of Sprint 8 exercises, less is more, as you can get all the benefits you need in just a 20-minute session performed twice a week. In fact, you should not do Sprint 8 exercises more than three times a week, as if you do it more frequently than that you may actually do more harm than good -- similar to running marathons.
Your body needs regular amounts of stress like exercise to stay healthy, but if you give it more than you can handle you will actually lose your health. So it is really crucial to listen to your body and integrate the feedback into your exercise intensity and frequency. When you work out it is wise to really push as hard as you possibly can a few times a week but you need to wisely gauge your body's tolerance to this stress.
​

How to Perform Sprint 8 Exercises

The key to performing Sprint 8 exercises properly is to raise your heart rate up to your anaerobic threshold. Keep pushing at maximum effort for 30 seconds, and then rest for 90 seconds. Repeat this cycle for a total of eight repetitions. In other words:

1. Warm up for three minutes
2. Exercise as hard and fast as you can for 30 seconds. You should be gasping for breath and feel like you couldn't possibly go on another few seconds
3. Recover for 90 seconds, still pedaling, but at slower pace and decreased resistance
4. Repeat the high intensity exercise and recovery 7 more times

In the video below, Phil Campbell and I demonstrate how it's done.

Total Video Length: 22:16​

When you perform Sprint 8 exercises properly it also helps increase your human growth hormone (HGH), which increases your muscle growth and effectively burns excessive fat. It also plays an important part in promoting your overall health and longevity.
I've been exercising for over 43 years, but for much of it I focused on running, or cardio. Adopting the Sprint 8 exercises instead has made a HUGE improvement in my exercise program and has boosted my level of fitness.
The take-home message here is that one of the best forms of exercise to protect your heart is short bursts of exertion, followed by periods of rest.
By exercising in short bursts, followed by periods of recovery, you recreate exactly what your body needs for optimum health. Heart attacks don't happen because your heart lacks endurance. They happen during times of stress, when your heart needs more energy and pumping capacity, but doesn't have it. So rather than stressing your heart with excessively long periods of cardio, give Sprint 8 a try.
I suspect you'll find the benefits to be as outstanding as I did.
Most importantly, during any type of exercise as long as you listen to your body you shouldn't run into the problem of exerting yourself excessively. And, with Sprint 8, even if you are out of shape you simply will be unable to train very hard, as lactic acid will quickly build up in your muscles and prevent you from stressing your heart too much.
​

 

[Reck Diver]

Have you ever order a diagnostic test(s) that cost a few thousand dollars with the primary objective of limiting liability exposure to yourself and/or you employer?

In private practice, actually it's all about reimbursement.

In the ER there is a lot of CYA. Those poor bastards get sued all the time. Now many put it all in the spouse's name, form an P.A. and drop Medical Malpractice Insurance. But the answer to your question is yes.... it happens.

Okay, guys, let's get a reality check. I work as an ER doc in a town of 25,000 people, with a catchment area of about twice that. It's heavily skewed toward the elderly, because it was settled when Grand Coulee dam started providing irrigation water. I work six or seven shifts a month, so 70 to 90 shifts a year. In the last year, I have used defibrillator paddles on about three patients, maybe four. None survived to hospital discharge.

I don't know how long a dive boat would have to operate to put 50,000 people through the boat -- and remember that that 50,000 would NOT include people with significant known heart disease, or many people of 70 or above. Yes, the presence of an AED could save a life. Do we insist that all grocery stores have them? I suspect more people move through the average grocery store in a year than go on the average dive boat.

It's a cost-benefit thing. There are lots of things that are nice to have, but don't merit the expense of having them everywhere.

We've had three divers die since May. The first one back in May, the diver lost consciousness on bottom and was unable to be rescusitated. The Second was on a diver charter with Pura Vida Divers in Rivera Beach. He mysteriously became separated from his buddies and was found 3 hours later. I never heard any autopsy results, and I have heard nothing about a report from the op. The deceased diver had over 2,000 lbs of air in his tank. If he did have an MI and would have been lucky enough to have it after his dive, who knows what the results would have been had an AED been available. It took the dive op 3 hours to find the diver, but they did promptly start CPR! And of course the incident we have been discussing is the third fatality in 5 months. That doesn't count anyone who may have gone home and had an event or the bone head(s) that ended up in the chamber at St. Marys after diving way to deep.

I had to buy two air bags with my vehicle. What's the big deal about a commercial dive operator spending about the same to possibly save a life? At least an AED can be used more than once.

In your practice, you say is skewed towards the elderly. Losing a patient is difficult, however it is a lot harder to see a 40-50 year old with a wife and kids pass due to a sudden MI.

Hey D.D. is that Deep Water thing in the keys for real??? Simple minds want to know.

 

[danvolker]

The concept I use for bicycle training is very similar to this interval based concept Mercola discusses.....Sprint and interval days on the bike, and on the longer rides, lots of surges fast and slower sections, no longer do much very long steady distance ( LSD), as used to be the norm for many riders.

My point with this Mercola posting is that the supposedly fit athletes having unexpected deaths, is actually the fault of dangerously foolish training. In fact, Triathletes and marathon runners are training in about the most unhealthy manner they possibly could....I suppose they could start smoking ciggarettes to make it even less healthy

 

[dumpsterDiver]

Interesting information Dan. Unfortunately a long ride for me is 20 minutes!

As for the AED, I am not necessarily advocating for it to be required, but I can sure see how it can come to pass with liability exposure issues. The idea being that insurance companies mandate its presence simply to reduce their exposure.

If it were mandated as an industry standard (it costs the insurance industry nothing; another reason they may like it), the incremental costs would be negligible, every boat would have it and the costs would simply be passed on to the consumer. Probably less effect than a 5 cent bump in fuel costs.

As for Reck Diver's question about deep stuff and keys? Not sure what that is in reference to?

 

[danvolker]

Interesting information Dan. Unfortunately a long ride for me is 20 minutes!

Well, maximum benefit is between 30 and 40 minutes. After 2 hours of duration, I really don't think it is a health activity any longer. You can accomplish alot in fitness training even with just 20 minutes. And most spearfishing pace dives border on aerobic level training....so in all probability, you probably get more aerobic work than you give yourself credit for....and this is interval based, as we surge faster, than have plenty of points where we will slow down and heart and breathing rates will drop.

The sad thing is, many of the unexplained deaths we see in the 40 to 60 year olds, could easily be prevented if they trained properly, and maintained low sugar, limited carb diets--these being Serious factors in cardiac health.....Adanced Glycation End Products from the typical high carb diet of Americans, leads to inflammation in blood vessels..this is a huge threat, potentially a much greater threat than any other dietary considerations.....Another Mercola issue he has spectacular science on, considerably ahead of the "industry"

One reason I have such a hard time getting on board the AED direction, is that if people really care, then they need to do the exercise, and they need to attempt to eat correctly--and if they did this, the probability is that the cardiac events would not be occurring. Why not prevent the heart attacks in the first place, instead of attempting to re-animate the dead, and then only having a fraction of their original heart function left--if resuscitation is successful. it just seems like such a foolish program to push the AED agenda on boats, when what we need to do is fix the problem that leads to cardiac incidents....and the chances of succeeding here, are MUCH GREATER than the chances of reviving the dead. I mean, we are talking about "future" developments, and what we should do or hope for. If we were going to push for anything as divers, it would be preventing the cardiac incidents in the first place.

As for Reck Diver's question about deep stuff and keys? Not sure what that is in reference to?

Either he thinks you were serious about me doing something with the deep air wankers in the Keys and he smelled a pay day of comedy material....or he was interested in the story you mentioned about the deep adventure trip, just on the merits of how foolish the group sounded....which I think all of us here would agree with.

---------- Post Merged at 12:28 AM ---------- Previous Post was at 12:09 AM ----------

For those not familiar with Advanced Glycation End Products, and I will even quote a source far more mainstream than Mercola
Insulin resistance ( with varying levels in MANY people 40 years and older in the US population) , and Metabolic Syndrome are factors in this ( according to Mercola articles) just as much as Diabetes can be.
Think: people that drink lots of soda, or, or eat lots of food with high fructose corn syrup in it, or eat lots of pasta or bread, or just lots of carbs in general....when the blood sugar index gets high, the Glycation issue gets to be a big deal....Of course this is not popular science with the big food companies, or the drug companies making a fortune on Statins.
:
Advanced glycation end products and diabetic cardiovascular disease.

Prasad A, Bekker P, Tsimikas S.
Source

Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. anandprasadmd@gmail.com

Abstract

Advanced glycation end products (AGEs) are formed by a nonenzymatic reaction of sugar moieties (eg, glucose, fructose, glycolytic adducts) with the free amino groups on amino acid residues of proteins. A growing body of data demonstrate that AGEs are intimately involved in the pathophysiology of cardiovascular disease by stimulating inflammation, contributing to atheroma formation, and modulating vascular stiffness. The role of AGEs as potential biomarkers for disease presence and prognosis in patients with diabetes mellitus remains an active area of study. Epidemiologic and angiographic studies suggest that AGE levels may be related to the presence and extent of atherosclerosis, and may predict future outcomes in select populations. The present review summarizes the relevant evidence supporting the role of advanced glycation in promoting atherosclerosis and the epidemiologic studies demonstrating an association between AGEs and diabetic cardiovascular disease.

____________________

Mercola would have people at risk, drastically cut their carb intake, and go on close to absolute minimal sugar in any food consumed....and with the help of the right doctor, even reverse insulin resistance and some cases of Adult onset Diabetes...A doctor using this diet on a patient along with a few supplements like Vandyl sufate (which will act like an Insulin mimic, and pull sugar out of the blood--preventing the release of insulin) , can after a few months, RE-SET insulin sensitivity. Along the way, with the ultra low sugar , low carb, and no trans fat diet, the AGEs disappear I.e., my expectation would be a major change in cardiovascular health---and lower likelihood or a cardiac incident.


Perhaps I have no business posting this level of information, as I am NOT a Doctor or medical professional....and hopefully my posting this is not annoying to Lynne or Debersole, or other Doctors potentially visiting this thread......
I have always used nutrition for sports, and have always tried to stay ahead of the curve on the research. This AGE area really got my attention, and given the nature of the AED discussion, I could not help myself--I had to share this info..

 

[dumpsterDiver]

Oh, I forgot about that silly joke already..