who has lately taken solo?

[rick stoehrer]

who has taken a WFA/WFR class lately that was oriented to kayaking and what was the recomendation on how to deal with compressions/rescue breathing WHILE ON WATER?

[PeterB]

who has taken a WFA/WFR class lately that was oriented to kayaking and what was the recomendation on how to deal with compressions/rescue breathing WHILE ON WATER?

I took a WFA class by SOLO, which was geared for watersports. It was a pilot course.

The class had a third day of on-the-water training (standard WFA is 2 days), but, as it overlapped with standard kayak incident management stuff (assess situation, get patient off the water) this third day has since been dropped from the class, with students encouraged to take kayak incident management training.

The on-the-water part of this class did not include CPR –performed –on-the water, presumably because there’s (yet) no tried -and true way to do it and a class wouldn’t be taking time teaching unproven methods.

[Brian Nystrom]

When Linda and I took it, we were told that there really isn't any practical way to perform CPR on the water. If you happen to be in flat conditions with a large group that could raft up quickly to create a platform of sorts, you might be able to do something useful. Otherwise, forget it.

[JohnHuth]

That's an interesting question. With all the experience here, maybe someone might have a clever idea that could be tested and brought back to Solo. It does seem like it would be difficult.

I guess the main thing would be to keep up compressions until help arrives. How you manage that, I have no idea.

[rick stoehrer]

That's an interesting question. With all the experience here, maybe someone might have a clever idea that could be tested and brought back to Solo. It does seem like it would be difficult.

I guess the main thing would be to keep up compressions until help arrives. How you manage that, I have no idea.

it's the compression thing that got me thinking....

what i <think> you might be able to manage and what i'd really like input from somone who has TAUGHT (or nurses or medical doctors out there?) the class as opposed to those of us that have just taken it at one point or another is...

with the boats rafted as i've got illustrated (see photo album for details) i think that you've got a pretty iron clad platform in reasonable conditions (there's ALWAYS bigger)...so you've got the one assist beside the victim...now a 2nd person could climb onto the back deck of the vic boat, take off the vic pfd and wrap their legs around the vic and hug them close, vic back to 2nd assist chest....from this position the 2nd assist MIGHT have the leverage to perform some kind of compressions a la a heimlick sort of thing...the 1st assist could easilly admin rescue breaths from their position alongside. meanwhile you've got that whole thing under tow and someone else on the radio calling for help, giving position, condition, etc.

i know that mostly folks don't do compressions right as it's taught standard...i know that giving compressions in the position described above would be difficult and still might not be done right BUT what/how else would you administer compressions on water? persons already dead if you do nothing....can't hurt, can it?

[spuglisi]

it's the compression thing that got me thinking....

what i <think> you might be able to manage and what i'd really like input from somone who has TAUGHT (or nurses or medical doctors out there?) the class as opposed to those of us that have just taken it at one point or another is...

with the boats rafted as i've got illustrated (see photo album for details) i think that you've got a pretty iron clad platform in reasonable conditions (there's ALWAYS bigger)...so you've got the one assist beside the victim...now a 2nd person could climb onto the back deck of the vic boat, take off the vic pfd and wrap their legs around the vic and hug them close, vic back to 2nd assist chest....from this position the 2nd assist MIGHT have the leverage to perform some kind of compressions a la a heimlick sort of thing...the 1st assist could easilly admin rescue breaths from their position alongside. meanwhile you've got that whole thing under tow and someone else on the radio calling for help, giving position, condition, etc.

i know that mostly folks don't do compressions right as it's taught standard...i know that giving compressions in the position described above would be difficult and still might not be done right BUT what/how else would you administer compressions on water? persons already dead if you do nothing....can't hurt, can it?

I took the WFA/H20 course in Salem. Todd Wright was the instructor. I think everyone agreed he was excellent. I have his contact information at home. It would be interesting to get his opinion.

Aside from Rick's scenario I certainly can't think of any other way to get enough leverage for the compressions.

[Phil Allen]

My 0.02$ worth:

I think the problem is getting enough leverage for sufficient compression. CPR often breaks ribs, heimlick (which is close to what I think RickS is suggesting) doesn't usually. It's the upper body mass in CPR that drives the chest compression and the stiff arms carry that to the chest. You'd have to be quite bearlike to do it with just squeezing your arms.

Phil

[EEL]

persons already dead if you do nothing....can't hurt, can it?

If we are talking cardiac arrest situations. Just to be picky, its not that the person is dead if you do nothing. Without getting into a debate about when death occurs and with few exceptions, the person is dead period. You may be able to forestall irreversible brain damage long enough for them to be revived in an adequate medical setting since it usually takes the right electrical impulses to get the heart working again. People have different views about how long that can be. My assumption has been that starting CPR in a remote setting in the vast majority of cases means having to make an agonizing decision that may haunt for a long time, but the whole thing may haunt no matter what you do or do not do.

[rick stoehrer]

My 0.02$ worth:

I think the problem is getting enough leverage for sufficient compression. CPR often breaks ribs, heimlick (which is close to what I think RickS is suggesting) doesn't usually. It's the upper body mass in CPR that drives the chest compression and the stiff arms carry that to the chest. You'd have to be quite bearlike to do it with just squeezing your arms.

Phil

i understand the dynamics at work on land and the limitations of what i've described on water...but is there a better solution?

[JohnHuth]

I think the general idea of chest compressions to keep blood flowing and oxygenated until help (e.g. debibrillation) can be obtained. That requires a fairly strong compression at the sternum, and having them on something squishy like a kayak or another person's body would make it difficult.

For example, if you bear hugged them and compressed the sternum, it would probably compress your own ribcage in the process - two squishy bodies together. I don't know if I'd recommend putting your knee against their back to make this happen, but in a life-or-death situation, maybe that would provide enough stiffness to make the compressions effective. It would probably take some timing, and I have no idea how you could maintain this posture for very long in the water.

[Phil Allen]

about the only thing that I think could work would be two support boats on the sides of the victim/patients boat with the compression person astride the foredeck of the vics boat doing compression with the vic supported by the rear cockpit bulkehead/back deck/dayhatch. I can't imaging doing that in anything approaching lumpy, but better than not I guess.

Phil

[EEL]

Just to add another complicating factor, if a person has any heartbeat at all then CPR is contraindicated since you will likely cause the heart to stop. Now think about ascertaining if a person has a pulse at all while they and you are dressed for paddling and both in a boat moving about.

Ed Lawson

[glil]

about the only thing that I think could work would be two support boats on the sides of the victim/patients boat with the compression person astride the foredeck of the vics boat doing compression with the vic supported by the rear cockpit bulkehead/back deck/dayhatch. I can't imaging doing that in anything approaching lumpy, but better than not I guess.

Phil

The problem is the lack of a solid surface under the patient. Most of the movement would be the kayak being pushed down into the water-hence the bear hug idea. I doubt many people would have the strength and endurance to be effective, but I'm curious to hear what other people have been taught. The WFA course with Todd did not address this.

Gay

[Brian Nystrom]

persons already dead if you do nothing....can't hurt, can it?

While that's certainly true, the cardinal rule of rescues is not to create more victims while attempting to save someone. In anything but truly benign conditions, there would be a significant risk of someone else getting hurt when you're rafting up, clambering over wet, slippery decks, straddling boats, etc. Whether to even attempt any type of resuscitation and what method to attempt is going to be completely situation-dependent. No matter what you do, it's going to be a difficult decision and the biggest challenge may be maintaining emotional control and making rational decisions based on what's best for the safety of rest of the group. Hopefully, none of us will ever face such a situation.

[Shaila_27]

If we are talking cardiac arrest situations. Just to be picky, its not that the person is dead if you do nothing. Without getting into a debate about when death occurs and with few exceptions, the person is dead period. You may be able to forestall irreversible brain damage long enough for them to be revived in an adequate medical setting since it usually takes the right electrical impulses to get the heart working again. People have different views about how long that can be. My assumption has been that starting CPR in a remote setting in the vast majority of cases means having to make an agonizing decision that may haunt for a long time, but the whole thing may haunt no matter what you do or do not do.

In the H2O Solo course they basically said that CPR isn't going to work on the water (not that people should give up). The big thing that they stressed with any injury while out in a kayak was that when you run through the ABC's for life threatening issues (Airway, Breathing, Circulation) you never get past "Airway" until you are on land. Even if the injury is a broken bone, concussion, heart attack, separated shoulder... the first and most important thing is airway and when you are on water, that is always compromised. The chest compressions are tough because they are only an oxygen circulator to keep tissue viable until real help can come. It really is a catch 22 with not a lot of optimistic outcomes.

[JohnHuth]

It really is a catch 22 with not a lot of optimistic outcomes.

Does anyone know the statistics on this? I recall hearing something like 10% of victims who have compressions performed on them are successfully revived (I don't know if this is the right statistic, but it sticks in my mind). I'd imagine that this is because whatever injury/trauma/illness caused the cardiac arrest or fibrillation in the first place is something that is irreversible.

On the good side, I think the statistics on Heimlich's are much better - but that's to solve a different kind of problem (obstructed airway).

[rick stoehrer]

I think the general idea of chest compressions to keep blood flowing and oxygenated until help (e.g. debibrillation) can be obtained. That requires a fairly strong compression at the sternum, and having them on something squishy like a kayak or another person's body would make it difficult.

For example, if you bear hugged them and compressed the sternum, it would probably compress your own ribcage in the process - two squishy bodies together. I don't know if I'd recommend putting your knee against their back to make this happen, but in a life-or-death situation, maybe that would provide enough stiffness to make the compressions effective. It would probably take some timing, and I have no idea how you could maintain this posture for very long in the water.

i thought of that...i was wondering if the 2nd assist keeping their vest on may offer a little more insulation/resistance to having their torso compressed while trying to do any of this. i don't think it would be possible for have the 2nd assist knee's anywhere near the vic back and still have the 2nd assist perform compressions let alone stay on the boat....unless the 2nd assist is an orangutan and then you have a whole host of other problems....like where do you find an orangutan with cpr training?

[Phil Allen]

The problem is the lack of a solid surface under the patient. Most of the movement would be the kayak being pushed down into the water-hence the bear hug idea. I doubt many people would have the strength and endurance to be effective, but I'm curious to hear what other people have been taught. The WFA course with Todd did not address this.

Gay

First off, let me be clear be stating that my discussion of doing compressions on the water is HIGHLY THEORETICAL. I emphasize this not for those contributing to the thread but anyone else who might read this later. Shaila's point about airway always being #1 while on the water is right.

If it's going to work, the CPR giver and the victim have to be on the same surface, hence the straddle boat idea. If my understanding of physics is correct, only when the vic and the rescuer are supported by the same boat(s) do we have any hope of compressing the chest and not just moving the boat/body up and down in the water.

That said, I think the reality is that one's not going to be effective at doing compressions on the water so the only answer to the problem is to pay attention to ANY early warning signs and get off the water ASAP.

Phil

[Brian Nystrom]

Does anyone know the statistics on this? I recall hearing something like 10% of victims who have compressions performed on them are successfully revived (I don't know if this is the right statistic, but it sticks in my mind). I'd imagine that this is because whatever injury/trauma/illness caused the cardiac arrest or fibrillation in the first place is something that is irreversible.

As I recall, the CPR success rate for anyone suffering a heart attack or stroke is near zero. OTOH, it's quite favorable (over 60%?) for drowning, electrocution and inhaled poisons.

[glil]

That said, I think the reality is that one's not going to be effective at doing compressions on the water so the only answer to the problem is to pay attention to ANY early warning signs and get off the water ASAP.

Phil

Good point. That seems to make the most sense to me. Another thought would be to get the person into any larger boat that may be nearby so you have a place to work. There are plenty of power boats out and about in the summer. I don't know how many monitor their radios closely to hear a call and respond quickly, but hopefully it would be quicker than a tow to shore.

Gay

[flipe8]

I don't really see it working for the simple reason the surface of the deck is going to plunge deeper into the water with each compression, pretty much negating the compression in the first place. It's nearly impossible to perform CPR on a surface like a bed, so a floating boat would be very similar. As it was mentioned earlier, keeping an airway open while on the water would be very diificult as well, eventhough there is enough O2 in the bloodstream without performing breaths for a while. And the % of success are very low without defribillation within the first few minutes.

[rick stoehrer]

I don't really see it working for the simple reason the surface of the deck is going to plunge deeper into the water with each compression, pretty much negating the compression in the first place. It's nearly impossible to perform CPR on a surface like a bed, so a floating boat would be very similar. As it was mentioned earlier, keeping an airway open while on the water would be very diificult as well, eventhough there is enough O2 in the bloodstream without performing breaths for a while. And the % of success are very low without defribillation within the first few minutes.

i posted it and i am skeptical of it working too but you aren't getting where the players are...the victim is in their boat...in the cockpit. the first assist is rafted up. the second assist is BEHIND the victim on the vic rear deck with their arms wrapped around the vic and then the compressions would be performed a la heimlick. there is no pressure going down into the hull and so your bed anology is way off.

keeping the airway open would actually be pretty easy...the vic's in their boat; lean them back over the rear of their cockpit...the mouth/airway opens, ya?

in any event, i don't think it's too do-able.

[Lisa]

As a CPR instructor for more than 19 years, I wanted to add my thoughts.

There are some great ideas in this thread. The question was raised about statistics so this is what I found from the American Heart Association website:

CPR facts and statistics

 About 75 percent to 80 percent of all out-of-hospital cardiac arrests happen at home, so being trained to perform cardiopulmonary resuscitation (CPR) can mean the difference between life and death for a loved one.

 Effective bystander CPR, provided immediately after cardiac arrest, can double a victim’s chance of survival.

 CPR helps maintain vital blood flow to the heart and brain and increases the amount of time that an electric shock from a defibrillator can be effective.

 Approximately 95 percent of sudden cardiac arrest victims die before reaching the hospital.

 Death from sudden cardiac arrest is not inevitable. If more people knew CPR, more lives could be saved.

 Brain death starts to occur four to six minutes after someone experiences cardiac arrest if no CPR and defibrillation occurs during that time.

 If bystander CPR is not provided, a sudden cardiac arrest victim’s chances of survival fall 7 percent to 10 percent for every minute of delay until defibrillation. Few attempts at resuscitation are successful if CPR and defibrillation are not provided within minutes of collapse.  Coronary heart disease accounts for about 450,000 of the nearly 870,000 adults who die each year as a result of cardiovascular disease.

 Approximately 310,000 of all annual adult coronary heart disease deaths in the United States are suffered outside the hospital setting and in hospital emergency departments. Of those deaths, about 166,200 are due to sudden cardiac arrest.

 Sudden cardiac arrest is most often caused by an abnormal heart rhythm called ventricular fibrillation (VF). Cardiac arrest can also occur after the onset of a heart attack or as a result of electrocution or near-drowning.

 When sudden cardiac arrest occurs, the victim collapses, becomes unresponsive to gentle shaking, stops normal breathing and after two rescue breaths, still isn’t breathing normally, coughing or moving.

http://www.americanheart.org/presenter.jht...ntifier=3034352

The most common cause of cardiac arrest is ventricular fibrillation. The most effective treatment for ventricular fibrillation is defibrillation via an AED.

Thus, I would recommend calling for help and getting to land ASAP. The first part of CPR is making sure “the scene is safe.” So removing life jackets, climbing on kayaks, etc, creates an unsafe environment and will prolong getting effective treatment.

I asked Todd Wright about CPR on the water last year. Essentially, it is not possible to do effectively. He did make reference to attempting to perform CPR the way Rick has described……similar to the Heimlick, etc.

After teaching CPR to kayakers, we have had a very similar conversation as this thread. I was also asked about putting the victim in the water (assuming you are in New England & the water is cold.) The thought behind it is to slow the metabolism. When I posed this to a cardiologist at work, he was impressed with the thought process but said the idea would not work. First, it is not safe. Second, you would need to submerse the head but not the face & make sure no water gets in the mouth. He said that CPR is not effective on the water and the victim would need to get to land.

If CPR is needed while in a kayak, the out come is not likely to be a positive one.

[rick stoehrer]

As a CPR instructor for more than 19 years, I wanted to add my thoughts.

There are some great ideas in this thread. The question was raised about statistics so this is what I found from the American Heart Association website:

CPR facts and statistics

 About 75 percent to 80 percent of all out-of-hospital cardiac arrests happen at home, so being trained to perform cardiopulmonary resuscitation (CPR) can mean the difference between life and death for a loved one.

 Effective bystander CPR, provided immediately after cardiac arrest, can double a victim’s chance of survival.

 CPR helps maintain vital blood flow to the heart and brain and increases the amount of time that an electric shock from a defibrillator can be effective.

 Approximately 95 percent of sudden cardiac arrest victims die before reaching the hospital.

 Death from sudden cardiac arrest is not inevitable. If more people knew CPR, more lives could be saved.

 Brain death starts to occur four to six minutes after someone experiences cardiac arrest if no CPR and defibrillation occurs during that time.

 If bystander CPR is not provided, a sudden cardiac arrest victim’s chances of survival fall 7 percent to 10 percent for every minute of delay until defibrillation. Few attempts at resuscitation are successful if CPR and defibrillation are not provided within minutes of collapse.  Coronary heart disease accounts for about 450,000 of the nearly 870,000 adults who die each year as a result of cardiovascular disease.

 Approximately 310,000 of all annual adult coronary heart disease deaths in the United States are suffered outside the hospital setting and in hospital emergency departments. Of those deaths, about 166,200 are due to sudden cardiac arrest.

 Sudden cardiac arrest is most often caused by an abnormal heart rhythm called ventricular fibrillation (VF). Cardiac arrest can also occur after the onset of a heart attack or as a result of electrocution or near-drowning.

 When sudden cardiac arrest occurs, the victim collapses, becomes unresponsive to gentle shaking, stops normal breathing and after two rescue breaths, still isn’t breathing normally, coughing or moving.

http://www.americanheart.org/presenter.jht...ntifier=3034352

The most common cause of cardiac arrest is ventricular fibrillation. The most effective treatment for ventricular fibrillation is defibrillation via an AED.

Thus, I would recommend calling for help and getting to land ASAP. The first part of CPR is making sure “the scene is safe.” So removing life jackets, climbing on kayaks, etc, creates an unsafe environment and will prolong getting effective treatment.

I asked Todd Wright about CPR on the water last year. Essentially, it is not possible to do effectively. He did make reference to attempting to perform CPR the way Rick has described……similar to the Heimlick, etc.

After teaching CPR to kayakers, we have had a very similar conversation as this thread. I was also asked about putting the victim in the water (assuming you are in New England & the water is cold.) The thought behind it is to slow the metabolism. When I posed this to a cardiologist at work, he was impressed with the thought process but said the idea would not work. First, it is not safe. Second, you would need to submerse the head but not the face & make sure no water gets in the mouth. He said that CPR is not effective on the water and the victim would need to get to land.

If CPR is needed while in a kayak, the out come is not likely to be a positive one.

thank you.

[flipe8]

i posted it and i am skeptical of it working too but you aren't getting where the players are...the victim is in their boat...in the cockpit. the first assist is rafted up. the second assist is BEHIND the victim on the vic rear deck with their arms wrapped around the vic and then the compressions would be performed a la heimlick. there is no pressure going down into the hull and so your bed anology is way off.

keeping the airway open would actually be pretty easy...the vic's in their boat; lean them back over the rear of their cockpit...the mouth/airway opens, ya?

in any event, i don't think it's too do-able.

I guess I didn't get where the rescuers would be and I suppose anything would be worth trying at this point, but I would maintain the difficulty of keeping an open airway in an uncontrolled environment like the open water. I've probably performed CPR the better part of 150 times and things just don't go as smoothly as one would think. That's why getting a tube in is so critical for a number of reasons(maintains airway, pushing certain kinds of meds, continuous compressions while providing breaths). Just having a PFD might be enough to close off the airway. My sincere hope would be that if this were to take place on the water, we'd be close enough to a landing to get the patient on land and get EMS on route. But again, anything would be worth trying should this emergnecy take place.