AED's and Diving

[otter-cat]

Hello,

I am occasionally called upon to dive from an aluminum-hulled boat in my job as an aquatic research technician. We always carry a first aid kit and an o2 kit with us, and have been thinking about getting an AED for the boat as well, since we operate in a very remote area.

Can an AED be used safely on a metal-hulled boat? We (the research staff) are all CPR and AED trained and certified. I know that to safely use the AED, the patient's skin needs to be dried off -- potentially a tough job if he or she has just come out of the water. In that situation, would we need to just make sure the chest was dry between and around the shock pads, or does the whole body need to be dry. What about the deck? Is it dangerous to use on a metal deck of a boat in a body of water, even if the deck is dry?

Any info you could pass on is truly appreciated!

 

[ReneeC]

Those of us teaching AED use as part of our CPR/FA programs were notified a couple years back that "conductive services, such as metal bleachers or metal surfaces, are not a concern during the use of an AED."

However, if I was considering purchasing any AED I would contact a couple manufacturers and ask them if that statement holds in an environment where the conductive surface and the individuals involved are likely to be wet.

I think I will drop a note to a couple that I have worked with and I will let you know their response.

As far as drying the patient - you need to get the area where the pads will be attached as dry as possible so the pads can stick.

 

[Juls64]

Also, you might check with your boat insurance company. I know one captain that runs a charter here in Lake Michigan told us his insurance company told him no AED on board. I don't remember the reason why. I will try to find that out though.

Juls

 

[derwoodwithasherwood]

Those of us teaching AED use as part of our CPR/FA programs were notified a couple years back that "conductive services, such as metal bleachers or metal surfaces, are not a concern during the use of an AED."

Did my recert last week and that's not what they taught us. The Px should be removed from the metal. Throw a wool blanket under them first. Wet is OK provided the Px is not in a puddle -- defined as deep enough to make a splash if you stomp your foot. The issue is safety of the rescuer although we all know that no-one is supposed to be touching the Px when pushing the button.

The primary concern with wet skin on the Px is that the pads won't stick properly. We carry a disposable razor, alcohol wipe and towellete in the defib case to deal with excessively hairy, oily and wet skin, respectively.

 

[HammerNoMore]

From NCED:

Words of caution


AEDs are very safe and effective when used properly. Therefore, it is important to follow the operating instructions that come with each AED. For all AEDs, there are certain basic precautions:

• Attach the AED only to victims who are unresponsive, who are not breathing normally and who have no pulse.
• AEDs, as currently configured, are intended for use among adult victims of sudden cardiac arrest, not children. If the victim appears to be less than eight years old or appears to weigh less than 25 to 30 kg. (55 to 65 lbs.), do not attach the AED.
• It is safe to use AEDs in all weather conditions, including rain and snow. In wet weather, wipe the chest dry before placing electrodes. If the victim is lying in water, move him or her to a relatively dry area before attaching the AED.
• Never place AED electrode pads directly on top of medication patches, such as nitrogylcerin. Patches should always be removed and the skin wiped dry before placing defibrillator pads on the skin. Make sure to wipe your own skin dry if you come in contact with the medication.
• If the victim has a pacemaker or an internal defibrillator with a battery pack (visible as a lump under the skin about two inches long), avoid placing pads directly on top of the implanted medical device, if it is possible to do so and still maintain proper pad placement.
• If the victim is lying on a metal surface, such as bleachers or a stretcher, avoid contact of the electrodes with the metal surface.

 

[Corigan]

Great thread. I don't want to drive this too far off topic, but will all people with pacemakers have some sort of chest scar? I am not familiar with the procedure of having pacemakers implemented. I was just wondering what the procedure is to check for pacemakers before applying the AED electrode pads.

Matt

 

[Tide1100]

The biggest concern you should have in using an AED in a wet enviornment is to get the chest area dry. If the electrode pads are attached properly the energy delivered will travel through the chest. Since the energy will take the path of least resistance, if the area between the pads is wet you run the risk of the energy going over the surface of the chest instead of through it.

As far as noticing an implanted pacemaker, usually you are able to see a slight bulge in the patient's upper chest and never place an electrode directly over it.

 

[ReneeC]

I contacted two of the manufacturers and asked them if there had been any studies regarding boats. Medtronics has done several tests and the comments regarding drying the victim and not being in a very wet environment are correct. Metal hulled boats are not a problem as the units are self grounding. The only concern noted is that excessive movement may skew a reading so it is recommended that the patient and the unit are near each other and on the same level.

 

[Tide1100]

Medtronic actually has a white paper demonstrating the effectiveness of it's Shock Advisory System on boats. If you are interested you can read it here:http://www.medtronic-ers.com/documents/AED_aboard_ships.pdf

 

[otter-cat]

After insuring that the patient is reasonably dry, so that the pads can stick and the AED can work properly, my concern is for other people standing on the aluminum deck of the boat. No one is supposed to be touching the patient when the button is pressed, but since everyone else in the boat happens to be on the same aluminum deck as the patient, is there any danger of a shock being transmitted THROUGH the patient to the deck/hull of the boat and being conducted along the hull to the other people aboard the vessel?

Many thanks for all the helpful responses!