AEDs in the Wild?

[Ruby Vee]

Recently, a poster on a boating forum I frequent has advocated purchasing an AED for use on off-shore passages (think in the middle of the Pacific Ocean, three weeks from land). The reasoning is that "simply jump-starting the heart could save a life, and I'd rather do something than nothing." The poster goes on to say that they and their spouse are nurses, and know what they're talking about. They advocate purchasing an AED for personal use because they can save lives in drowning or scuba diving accidents, electrical accidents and when someone onboard has an MI.

I really can't see advocating that boaters (or hikers, or backpackers or river rafters or anyone who engages in activity far from civilization, ambulances and hospitals) spend money and use the weight for an AED. Their usefulness is limited and without proper follow-up, the person is likely to die anyway. It's not like a Tom Cruise movie where you allow yourself to be electrocuted fall on a convenient defibrillator and get shocked back to life.

What do others think?

[Ruby Vee, BSN]

Too funny.

I've heard that most successful layperson aed use is in the airport... maybe it has to do with the availability of them everywhere. I also know of running groups keeping one on hand.

In one of the immunization clinics I worked for, they would describe people who want certain immunizations even if the risk of catching that disease/benefitting from immunization is low as "risk adverse" and "desiring maximal preparation". In the case of aeds, if people have the money to spend, it's no skin off my back.

You're right -- if someone has the money to burn, it's no skin off my nose. The guy on the boat next to ours has an AED on board. He's a physician. When he takes the boat out, he's usually alone but I can see how it would come in handy if DH or I DFO'd on the dock . . . someone would just have to run to the gate to let the EMS through afterward!

[~Mi Vida Loca~RN, ASN, RN]

First I have to admit I am way beyond tired and I for some crazy reason read this as SCD and I am like "What in the heck do boaters need SCD's in the wild for, as I read the first few lines I grew even more confused imagining SCD's floating in the sea. Then I realized I have completely lost my marbles and it was AED.

I can see them in certain situations because I have seen multiple instances where the person came to right after the shock and they were Alert and oriented and doing OK. So if they can radio in help and it's a situation where the person just needed that "CTRL+ALT+DEL" on their heart, can definitely be beneficial and life saving. There is a video recently released on youtube where a Teenage girl went down in a volleyball game I think it was and thankfully trained staff and a nearby AED saved her life she, a few hrs later I think I had read she had cardiac surgery and they discovered multiple blockages. I mean that wasn't out in the wild obviously but my point is if they can be brought back and OK until someone can get there to take them to emergency or something.

If we are talking about a hike miles up a mountain and no radio or cell service to alert someone and situations like that, not sure how useful it would be at all.

[kakamegamama]

Does anyone have statistics for the neuro health of a post-AED patient? Just curious. I would think the further away from civilization, the less the chance of survival for MI patients, and possibly for drowning victims as well due to all the potential post drowning sequelae that can occur. But, I suppose, using one even in those circumstance (out in the boonies) might give the victim a fighting chance.

[offlabel]

As far as "boating" goes, a PFD is at least if not superior to an AED. How about starting with that?

[MunoRN, RN]

I don't think it's pointless to have an AED in the middle of the ocean, it's probably not going to change the outcome of someone with a completely occluded LAD, but there are plenty of people for whom a shock is essentially curative, that's a big reason why implantable defibrillators exist.

I've worked at a hospital that received patients brought in from far offshore (the rescue helicopter's range was 1000 miles) so it's not as though they are completely without access to follow up care after a shock for the entire voyage.

[MunoRN, RN]

Does anyone have statistics for the neuro health of a post-AED patient? Just curious. I would think the further away from civilization, the less the chance of survival for MI patients, and possibly for drowning victims as well due to all the potential post drowning sequelae that can occur. But, I suppose, using one even in those circumstance (out in the boonies) might give the victim a fighting chance.

To be honest, when I see AEDs in grocery stores, churches, schools, and parks around the area I live in I wonder how often any of these get used. Like across the US. I live in a wealthy suburban area with an average EMS response time

I'm not berating AEDs by any means. I just think the situations they're most useful in is when ems will be there soon but not very soon.

The availability of an AED on average decreases the time to the first shock by 4 to 5 minutes, according to the AHA each this increases the potential for a meaningful recovery by 10% for every minute, which means if AED's were available everywhere it would save about 40,000 lives every year.

[KatieMI, BSN, MSN, RN]

The question is: what is going to happen after that first shock is delivered? Do these people also have access (and know how to place/use) IV, fluids, pressors, BP monitoring, etc., etc.? If not, then the guy is probably will die just as well, just a few minutes late. Deadly shockable arrythmias rarely, if ever, happen with absolutely no underlying reason.

I was in the like situations more than once in my wild young years, and it was all to no good if there was nothing else nearby. It sure was a good feeling to play The Miss Savior but everything it actually did were those few minutes with pulse, plus burns, broken ribs, torn liver and all other bells and whistles of "saving life with our hands alone".

If AEDs would become widely available on American mainland (with corresponding number of people trained to use them right), that could save someone sometimes. Otherwise, it is burning money, but as long as it is not my money, I do not care that much.

[Boomer MS, RN]

The survival rate for out of hospital cardiac arrest is less than 10 %. And I am also interested in the definition of survival as in quality of life and further outcomes. Having said that, if there is any chance of someone surviving/improved outcomes, I am in favor of AEDs. The anecdotal stories touch me, including someone I know. The current AHA data would also influence me.

[canoehead, BSN, RN]

If they've got money to spend, I'd go with oxygen and a BVM before an AED. Or they could buy lottery tickets with the money and get better odds.

[bgxyrnf, MSN, RN]

What do you do after you've defibrillated? Mask ventilate? Intubate? Start an epi infusion?

Immerse them in a mountain stream or tow them behind the boat... therapeutic hypothermia.

[yourshoesareuntied]

I sometimes think I want one as part of my prepping gear. There are some programs and other offers for refurbished units at a price that I find reasonable. When I go to my parent's lake house I often think about getting one for their place. It takes a bit of time for EMS services to arrive at an emergency, and the nearest hospital is a minimal small town facility. Having something like this could save a life. Plus my aunt has a place near my folks and at any given time a majority of my family can be at the lake. Our grand parents both have known heart conditions, so we all have that going for us. However I should also mention my mother, wife, and cousin are all nurses..I am starting nursing school in August, and another cousin is a general surgeon, one if not all of us are at the lake house/s on any given weekend. That said..I have a bit of hiking experience, you choose what amenities you want to carry and consider their weight to usefulness..some ultra light hikers are willing to give up comfort amenities and will even cut the handles of their toothbrush off and remove tags from clothing to save weight.. unless I were hiking with a known heart risky partner I would leave the AED behind, on a boat the weight would not be an issue...in my boating experiences if someone has an emergency on the water, time is your biggest enemy.. some people spend hours getting to their secluded spot getting back to the boat ramp or marina will take some time, then once you get to shore you may have to wait for EMS to arrive. The current AED's (the one's handing on the walls) are all automated, some even talk people through CPR..no reason not to have this if your budget and interest allows.

[Lunah, MSN, RN]

My experience has been in CCU and cardiac surgery ICU. The ACLS scenerio for drowning (at least the last few times I've certified) specifies a non-shockable rhythm, so I'm wondering how common it would be for drowning to result in a shockable rhythm? I would think it would be PEA, asystole or extreme bradycardia resulting from hypoxia.

Good point, I was just thinking more about things that didn't involve actual blockage of coronary arteries. Now I have to do a little research because I suspect you're right, though maybe with cold water drownings it might be a little different...

Edited to add: Thank you, NEJM — NEJM—Drowning

So yes, usually brady to PEA to asystole, except in cold water drownings/hypothermia, lots of epi/norepi, or in the presence of a hx of coronary artery disease when they may present in v fib. Interesting!