Dive Centers with AED On Board Dive Boat?

[funrecdiver]

Most dive boats I dive with in Thailand have emergency oxygen and a first aid kit on board; however, I have yet to dive on a dive boat here with an AED.

Does anyone know of dive boats in Thailand that also have an AED? If so, which boats and dive centers?

Thanks!

 

[limbo]

Although I teach the use of AED's in EFR and EFRI courses, I've yet to see a functioning, real AED machine anywhere in Thailand. Let alone one being on a dive boat.

 

[funrecdiver]

That is also my experience to date. Giving the fact that AEDs are now between $1500 to $2000 USD, and some good ones are selling for as low as $1200 USD; and that the odds of restarting a stopped heart with an AED is nearly 10 times greater than with CPR alone, it seems odd that dive boats do not have AEDs.

After all, in EFR, we are taught that the primary purpose of CPR and rescue breaths are to keep oxygen/blood circulating in vital organs after near drowning (and other) diving incidents until AED; and we are taught ABCDS, where D is AED; basically a dive boat more than a few minutes away from AED translates to a very gloomy outcome for most serious victims (see chart below, only 4% chance of survival with rescue CPR and 30% with AED/CPR).

Why do divers learn all these EFR ABCDS when the D part of this EFR cycle is basically non-existent on dive center boats?

It really seems a bit odd to me (for PADI) to require divers to learn/pay for an EFR course and be taught how critical AED is in EFR/Rescue and then for almost no dive boats to have an AED on board. I was really surprised to learn this. What up with that?

Only a little bit of CPR research shows that AED is really critical for a patient as quickly as possible after a victim is on the boat:

Why not have an AED for patients on board and increase the chance of survival from 4% to 30% in the event of a heart attack, near drowning diving accident, etc?

$1200 USD does not seem like a lot of money for a dive center to spend to increase the probability of survival in a diving emergency. After all, all PADI Rescue divers and PAID professional divers DM and above) are required to learn (and teach) EFR where AED is perhaps one of the most critical components.

 

[limbo]

You're right in stating that an AED increases the chances of survival when somebody's hart stops beating, however, don't forget that we're in a dive environment, so how many dive accidents require reanimation and how many require 100% oxygen?

In my opinion PADI should shift their attention to making the Emergency Oxygen Provider a requirement for all PADI instructors rather than the EFRI course. That's just my two satangs.

 

[Quero]

I agree, Limbo. I also think we need to look at actual incidences of heart failure on dive boats. While DAN statistics lead us to suspect that significant numbers of dive fatalities are health related and are likely triggered by events such as heart attacks while on scuba, it is quite unusual for a heart attack victim to fall ill while actually on board the boat. If the heart has stopped and the defib machine is not used immediately (since the victim first has to be removed from the water), the beneficial effects are greatly diminished. In fact, after three to five minutes permanent brain and tissue damage sets in, and for every minute defibrillation is delayed the survival percentages drop an additional 10%. I doubt that even if every dive boat put an AED on board, we would save lives.

 

[funrecdiver]

Yes, I agree as well. The likelihood of needing to provide O2 is much higher than the likelihood to provide CPR.

Also, as Quero pointed out, time is of the essence when a victim is not breathing (and therefore we assume the heart is also not beating in EFR), and the chance of getting a victim on the boat within the 6 minute window of time where permanent brain damage is done, is quite low.

On the other hand, CPR can and does save lives in all walks of life, including scuba diving. CPR involves AED. As we are taught in EFR training, chest compressions by themselves do not restart the heart because the heart, in the vast majority of cases, must be defibrillated to restart.

This means, of course, that a panicked diver, for example, who is now in a state of near drowning, will more than likely need to be defibrillated when rescued back to the boat. EFR teaches this, and AED is the key element of CPR because chest compressions do not restart the heart.

So, without an AED on board, teaching EFR is pretty much useless in most dive accident scenarios that require CPR. As limbo said, it would be much better to focus on realistic scenarios like providing 02; or requiring dive boats to keep an AED on board if the dive community really believes that CPR is a mandatory training requirement.

If every student must learn CPR (Rescue and above) and all instructors much teach CPR (requirement for OWSI), then something is amiss, because CPR/EFR requires defibrillation "by the book" and without AEDs on board, the EFR training is more of a "money making scheme" than realistic training to save near drowning victims.

I was disappointed to learn this after my completed EFR/Rescue training this week.

Statistically, the likelihood of a near-drowning victim to survive in a scuba accident can be quite low; and in the less likely event that the victim can be rescued and on the boat within 5 minutes or so, AED increases the survival likelihood dramatically.

I feel like the EFR part of the Rescue training was teaching us what to do, in theory, but without AED, we learn the theory without the tools to properly execute what we are taught. Something is amiss in the PADI training program. (No real surprise here, I guess).

 

[stevenl]

I feel like the EFR part of the Rescue training was teaching us what to do, in theory, but without AED, we learn the theory without the tools to properly execute what we are taught.

Quite a few DC's will teach the EFR course including AED.

 

[stiggy]

AED use in Thailand is restricted by law to Thai medical personnel.

Hence they are not in shopping ctrs etc.

Fact is any first aid beyond basic first aid MUST be authorized by a Thai registered DR on the scene .This includes AED- Intubation-Invasive airways LMA OP-Canulation/IVs -Catheters any drugs including basic heart meds.

In the past we used to have signed letters from a Dr just in case we got pulled for acting on the scene, The Thai ressus council is however looking at reviewing this but its a loooooooooong process.

Also the import duty of AEDS is nasty even a training unit must be approved by the Thai Food and Drug Administration, ( most units here have dodged customs)
First batch ( training units) we brought in where subject to 18000 bht in taxes , as the pads could be used on skin and needed approval .

Thankfully there is no issue with providing training beyond basic FA here, just officialy cant use it.

Oxygen use here also by law requires a recognised liscense.

 

[funrecdiver]

Quite a few DC's will teach the EFR course including AED.

I think you may have missed the point. Teaching AED is not the same as having an AED on the dive boat. I have also been taught AED, but, as limbo and others have posted, AEDs are not on any dive boats in Thailand, to our knowledge.

In other words, you can be well trained in AED, but without an AED to use, what is the point?

 

[funrecdiver]

AED use in Thailand is restricted by law to Thai medical personnel.

Hence they are not in shopping ctrs etc.

Fact is any first aid beyond basic first aid MUST be authorized by a Thai registered DR on the scene .This includes AED- Intubation-Invasive airways LMA OP-Canulation/IVs -Catheters any drugs including basic heart meds.

In the past we used to have signed letters from a Dr just in case we got pulled for acting on the scene, The Thai ressus council is however looking at reviewing this but its a loooooooooong process.

Also the import duty of AEDS is nasty even a training unit must be approved by the Thai Food and Drug Administration, ( most units here have dodged customs)
First batch ( training units) we brought in where subject to 18000 bht in taxes , as the pads could be used on skin and needed approval .

Thankfully there is no issue with providing training beyond basic FA here, just officialy cant use it.

Oxygen use here also by law requires a recognised liscense.

Will confirm (or otherwise) this with one of my friends who is a Dive Medical Officer (DMO) with the Thai Royal Navy in Sattihip.