Portable Defibrillators ?

[Peakbagr]

I was asked to organize a hike program for my local YMCA and its been a nice success so far. With the warm temps forecast, the local official are concerned about the welfare of members out hiking on the hot days that are coming over the summer.
I've been asked about carrying a portable defibrillator on hikes, 'just in case'.
My pack is already large and I carry extra gear and clothing for hike participants as well as a decent first aid kit.

Anyone know how common is it for organizations to require trip leaders to carry one of these and do backcountry rangers customarily carry them?
Not sure what they weigh, but another addition to the pack is not something I'm looking foward to.

 

[DougPaul]

Google "portable defibrillator".

Most (all except one?) seem to require a prescription. One sold for home use that doesn't require a prescription is 11x7x9 inches and 5.6 lbs and costs US$1300. (http://www.amazon.com/Philips-HeartStart-Home-Defibrillator-AED/dp/B00064CED6)

<editorial>
If you carry enough safety gear, you should be safer because you won't be able to carry it beyond the trailhead...
</editorial>

The search also brings up "Study Finds Home Defibrillator Is No Help" http://www.nytimes.com/2008/04/02/business/02heart.html.

Doug

 

[bcskier]

Popular conceptions seem to lag behind science. The latest findings about defibrillation no longer see it as quite the panacea it's often touted as in the popular press. It can certainly reverse certain heart arrhythmias and for something like commotio cordis is the definitive treatment but it's value is now seen as an important supplement to properly performed CPR and not the other way around as it is often popularly portrayed.

I would therefore think it's value in the backcountry, absent first line cardiac meds and all of the other requirements for maintaining a viable rhythm, as not much more than another CYA in our society's ever-escalating attempt to avoid litigation.

My humble opinion as a non-cardiac trained EMT. I would defer to those with better judgment obviously.

 

[ALGonquin Bob]

Sounds like a burden to have to carry equipment like that. ADK does not require anything more than a liability waiver, basic first aid kit, and common sense. I would expect that any organization that mandates someone to carry a defib unit will find a profound lack of outing leaders.

 

[NewHampshire]

I recently certified in Wilderness First Aid and CPR. Honestly I don't see the AED as being useful enough to warrant the extra space and weight in a pack. In my WFA class we were basically taught that backcountry first aid reqiures a different sort of expectation from "street" CPR where an ambulance and assistance is mere minutes away. If it were me I would tell the person asking you that this is an unwarranted and a wasted use of recourses (mainly yours since you would have to carry it ). As was mentioned by bcskier an AED when combined with proper CPR MIGHT make a difference, but is an iffy proposition. I guess the first thing I would ask is, are you trained in CPR? If not then that instantly makes the AED of no use to you anyways.....

Brian

 

[nietzschescat]

Aed

Even in the hospital when we call a code and have all that immediate support, there isn't always a good outcome. I can't imagine carrying a defibrillator up a mountain just in case. You won't have any medications or other support for hours. I wonder if there have been any studies about how successful this might actually be.

As I get older, it's something I think about and I have decided that if I die climbing a mountain, it won't be a bad thing for me, just for whoever is with me and who ever has to carry my body down.

It might make more sense to screen people before the hike about their physical condition, current activity level and expectations.

I have seen people carrying the portable defibrillators at my daughter's cross country races, but I never lifted one up to see how heavy it would be.

 

[ALGonquin Bob]

It certainly makes sense to have a defib unit at organized athletic events where it’s not practical to have an ambulance parked on stand-by, but if there is some existing physical condition in one of the participants that would cause enough concern to consider carrying a AED on a hike, than perhaps that individual shouldn't be traveling in remote areas. If it's just a general "just in case" as if it's merely an addition to your first aid kit, then I don't see it as justified. Proper screening of participants in back country activities should render a AED as unnecessary baggage. The instructor in my Wilderness First Aid course came right out and said that attempting CPR in remote (wilderness) situations is more of a comfort to family members and friends of the stricken person, but ultimately, it rarely results in saving a person’s life. In the case of our fellow Winter 46er, Shin Murnane, he was stricken near Marcy Dam last month with the DEC ranger outpost just a short walk away, and none of the medical attention that he received there was able to save him.

My approach to leading outings is to describe the activity in enough detail that people will make their own call as to whether they want to participate. If it involves minors, providing that information to the parents is the first level of screening, then I make inquires as to who is going, their experience in similar activities, and their physical condition. I also ask if there is any physical condition or required medications that the trip leader should be aware of, and I decide if that individual is qualified to participate. Before beginning the activity, each person, parent or guardian signs a liability waiver, and only then does the outing begin. I would tell the YMCA that a AED is not, and should not be considered normal gear to take on any back country outing, but it’s your back, and you would likely be the person responsible for performing CPR and/or using the defibrillator.

 

[ALGonquin Bob]

$1545 and 4.2 pounds. 8.5" x 11.8" x 2.7 inches; it's a very large and heavy piece of "just in case" gear that looks a lot like a Spot Satelite messenger, but MUCH larger! (Replacement battery available for only $199 - no weight given).
http://www.aed4u.com/pd-defibtech-lifeline-aed-with-7-year-battery.cfm

 

[BlackBuffalo]

You have to be really commited to the Y to not consider this request as going too far for emergency preparedness. There must be some insurance clause that requires this for the org to be covered.

Unbelievable.

 

[Kevin Rooney]

Alan -

Is the Y going to provide the defibrillator?

And, when I lead hikes, I don't carry 'group gear'. I divy it up among the participants and make them carry it. The only caveat is remembering who is carrying what, and to get it back at the end of the hike.

Without entering into the discussion about whether a defibrillator on a hike is a good idea or not, I do know that for some type of heart attacks a normal rhythm cannot be regained without electrical stimulation. Not all, but some. I've living proof of the "some".

OTH - I helped administered CPR last summer to a fellow who had a heart attack and no pulse - we were in the middle of Iowa riding bikes. We were able to restore a heart beat using CPR - no defibrillator - in about a minute, and after medical care/procedures, he's alive and well today.

 

[peakbagger]

Out on a limb here compared to trained experts, but I had seen reference in the past and also heard it from an instructor once, that CPR used to treat lightning strike victims had a higher success rate than the typical heart attack victim seen at an emergency room. In theory, the individual struck by lightning in the backcountry has a healthy heart and is in resaonable shae compared to a typical elderly victim seen at the local ER. Could the AED requirement be a remnant from Western states where ridgeline lightning exposure is more likely?

 

[bcskier]

There is no AED requirement

The only requirement for AEDs that I'm aware of is that health clubs need to have one on hand. If you've been told that it's a requirement then probably the Y is extending what they see as a requirement for their in-building programs to it's out-of-building programming as well. They should check with their lawyer. I don't think the requirement was intended to apply to the backcountry. It's not a backcountry tool.

 

[Aviarome]

AED use

There can be several reasons a person might become unconscious, including cardiac and neurologic reasons. If it happens to be a sudden cardiac arrest, the prognosis is not very good in general -- about 33% can be resuscitated, but only about 10-15% make it out of the hospital.

AEDs and timing of defibrillation make a difference and have improved outcomes, but also timing to the hospital for medications, intubation, etc is critical.

In the wilderness, if a person has sudden cardiac arrest, it is unlikely that there will be timely medical care (under 10-20 minutes) to either EMS (paramedics or higher that can push drugs) or the hospital. Thus, I don't believe that as a group leader, carrying an AED, although it might help, would be sufficient and worthwhile.

As some have said, a thorough inquiry to the health of the participants would be more important, and as the group leader, you can recommend less healthy participants do an easier hike at some other time. They certainly do this at many guide services.

aviarome

 

[griffin]

They should check with their lawyer.

There's little chance their attorneys will know any more about backcountry first aid, etc. and what the relative risks are for participating in hiking and other backcountry activities than the folks currently suggesting Peakbgr bring a defibrillator along on hikes.

A better suggestion might be to have the Y's officials check with SOLO or another similar organization about wilderness first aid, and what their guidelines are for group first aid and emergency gear.

 

[erugs]

A better suggestion might be to have the Y's officials check with SOLO or another similar organization about wilderness first aid, and what their guidelines are for group first aid and emergency gear.

That's an excellent suggestion, Griffin. Takes the personal opinions right out of the discussion. It may sound cold to mention that it's not worth carrying, but it seems to me from what I've read and heard that that's the case.

As for a leader asking others to help carry group gear, Kevin's right. Not only does it take the burden of an overly heavy pack off the leader, but it shows the participants what is important gear to carry along and why. That made a difference for me when I started out. Then I got carried away and carried too much, before balancing out to what I consider "enough."

 

[Puck]

There's little chance their attorneys will know any more about backcountry first aid, etc. and what the relative risks are for participating in hiking and other backcountry activities

No but they will know the organizations liability exposure and how they could protect themselves. It also plausable that the insurance company may have a requirement.

 

[RoySwkr]

Anyone know how common is it for organizations to require trip leaders to carry one of these and do backcountry rangers customarily carry them?

To answer the original question, I don't know of any organized groups or rangers that routinely carry AED.

I agree with KR that participants should help carry gear.

If the Y wants to be among the first groups with such a requirement, I would instead lead trips for one of the laggards

 

[smitty77]

The AED is but a link in the chain of care that is Emergency Medical Services. The victim's survival depends as much or more on the care received post-defibrillation, so unless you're also carrying a helicopter in your pack, I'd say the "golden hour" will have long since elapsed before the victim has access to advanced care. I can see a possible benefit for SAR teams to carry one. In this case, faster methods of transport are sometimes available during a search. Or maybe one located at the huts, where there is also an active communications system where a medi-vac may be initiated. But to carry one where the activation of the EMS system could take longer than the "golden hour" itself is absurd.