YACHT reader Benno Lensdorf's sailing life is characterised by two terrible incidents: "Death on the water. Both times it was a cardiac arrest among older sailors," he writes to the editors. Since then, he and his wife have asked themselves: "What if something like this happens at sea?" They finally bought a defibrillator for use on board, because they are "quite sure that the two situations would not have ended fatally if these devices had been available back then".
Many sailors may feel the same way as Benno Lensdorf, as acute myocardial infarction is the fourth most common cause of death in Germany, according to the German Heart Foundation. It affects people aged 65 and over particularly often, but the risk increases from the age of 45 - especially in men. A risk profile that roughly corresponds to the demographic composition of water sports enthusiasts. Other factors such as a lightning strike or a serious injury to the upper body can also cause a sudden cardiac arrest.
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If this is already a scenario on land in which many components have to interlock quickly for a rescue, it becomes much more difficult at sea: it can take a long time for rescue to arrive. Resuscitation measures must therefore begin immediately after an emergency call by telephone or radio via channel 16. An emergency paramedic from the sea rescue organisation can provide technical support by radio or telephone.
Holger Schwalbe, medical director of the sea rescuers, emphasises: "Anyone can take resuscitation measures. What's important is the impulse to want to help. If you're not sure whether the collapsed person is really in cardiac arrest, simply start with chest compressions. If he then resists, you know he's alive."
Heart attack at sea - what to do?
Not every heart attack leads to cardiac arrest. If the victim shows the classic symptoms of a heart attack and is conscious, medical help is required as quickly as possible. An automated external defibrillator (AED or defibrillator for short) can then do nothing. It is designed exclusively for one application: cardiac arrest with ventricular fibrillation. The circulation has stopped, the person is unconscious, shows no reaction to being spoken to and is not breathing. The heart vibrates in a chaotic pattern and no longer pumps blood through the body. The brain is no longer supplied with oxygen.
This can have fatal consequences very quickly, as Peter Tassani-Prell, Medical Director at the German Heart Centre, explains: "The brain's tolerance for a lack of oxygen is three minutes. After that, brain damage can occur. And you also have to act quickly because of the heart itself. Because the longer the ventricular fibrillation is in the heart muscle, the more difficult it is to interrupt it."
Rapid defibrillation of the heart can stop the prevailing chaos and bring the heart back into rhythm. Asystole can also show the same symptoms: a cardiac arrest with a zero line on the ECG that cannot be cancelled with an electric shock from a defibrillator. "The layperson cannot recognise the difference between asystole and ventricular fibrillation," explains Tassani-Prell. The AED takes care of this. "It uses an ECG to detect whether ventricular fibrillation is present. Only if it is present does it charge up and deliver the shock," explains the doctor. Incorrect operation, where someone is accidentally "shocked", is therefore practically impossible.
Schwalbe also recommends: "If there is an AED nearby, you should definitely use it. If it works optimally, the heart will take over again."
Defi alone is not the panacea
The patient's upper body should always be dry so that the electrodes stick. A dry environment would also be ideal, but this cannot always be guaranteed on board. If the affected person is lying in a pool of water, the electric shock can lead to burns - which are probably the lesser of two evils in this case. The helpers, on the other hand, must not stand in the same puddle under any circumstances, otherwise they will also receive an unintentional electric shock.
But: "The defibrillator alone is not the panacea," warns Tassani-Prell. "What's more important is a good first aid course, such as the one offered specifically for sailors by the Trans Ocean association." Because no matter what the cause of the cardiac arrest is - chest compressions or cardiopulmonary resuscitation is the most important part of the rescue chain.
The chest is pressed down and released again approximately twice per second. This keeps the blood flowing through the body and supplies the brain with oxygen. Once the heart has been successfully brought back into a stable rhythm thanks to chest compressions and a defibrillator, the emergency is not over. After the shock is before the hospital!
The heart muscle is damaged and, above all, the cause must be treated - ambulances or rescue boats and professional medical care are therefore required as quickly as possible.
Only a few AEDs on board private pleasure craft
It is not known how many pleasure craft actually have a defibrillator on board; the number is probably very small. This is confirmed by Doris Graf from the company Medisol, which offers devices specifically for the maritime sector, among other things. "We almost exclusively have customers from the commercial shipping sector," she explains, adding that pleasure boat owners are only sporadic customers at best.
All lifeboats and rescue cruisers of the sea rescuers, however, have an AED on board and the rescuers are regularly trained in resuscitation. They are called out to around 100 medical emergencies at sea every year and have to resuscitate people around five to ten times. From a purely statistical point of view, this is a negligible number of cases that cast doubt on the usefulness of a private on-board defibrillator. Nevertheless, perhaps the same applies here as for other safety equipment on boats: Having is better than needing.
More and more AEDs on land
However, more and more AEDs are being installed on land, as defibrillator apps and online maps show, especially in busier locations. This also includes harbours. The Lübeck Yacht Club (LYC), for example, has installed two defibrillators in its outdoor area and trained some of its members in their use. "We haven't had any emergencies like this so far, but it can happen to anyone - young or old," says Petra Röttger from the club's office.
Especially in more remote marinas and smaller club harbours, however, AEDs are few and far between. This is critical. At the same time, it is not always to be expected that the rescue service will arrive quickly with an AED and reach the area or jetty, as these are often equipped with barriers or locked. Long distances and unexpected obstacles can therefore mean the difference between life and death in cases of doubt.
Smaller clubs may also shy away from the costs. After all, an AED costs around 1,200 to 3,000 euros. In addition, there may be costs for an air-conditioned cabinet and annual expenditure of around 100 to 200 euros for maintenance, replacement electrodes and batteries.
However, the costs do not have to be a burden on the club's coffers. "The newsletter from the local Sparkassenstiftung made us aware that the purchase was being subsidised," explains Petra Röttger. There is no nationwide funding for defibrillators. However, non-profit organisations such as the LYC have a good chance of receiving full or partial reimbursement of the purchase costs - from foundations and service clubs, municipalities or local companies. In principle, the chance of receiving funding is greatest if the AED is publicly accessible. After that, it is to be hoped that it will never be needed.
The rescue plan for sudden cardiac arrest
The defibrillator is an important part of the rescue programme if the heart suddenly stops. Users only need to open it and the device will explain what to do. In principle, anyone can take resuscitation measures. The only mistake is to do nothing! Cardiac massage is of fundamental importance. Every sailor should know how to do it and apply it immediately in the event of unconsciousness with respiratory arrest. It should only be interrupted when the defibrillator is used.
1. check
Is the person breathing and responding when spoken to? If not, there is a high probability of cardiac arrest.
2. make an emergency call
Before taking any further action on land, call 112 and send a "Mayday" on channel 16 at sea.
3. revitalisation
Start chest compressions immediately and only interrupt if the defibrillator is used.
4. defibrillation
Ideally, a third person should operate the defibrillator. The voice computer in the device gives all further instructions.
Ready to hand, but well protected
In an emergency, when every second counts, the defibrillator should be at hand as quickly as possible. You often see devices stored behind closed doors, for example in the harbour master's office or the wash house. There they are well protected from the weather and vandalism, but in case of doubt, valuable minutes pass before the device is found and ready for use.
Unlocked and ready to hand on the outside wall of a centrally located clubhouse, the defibrillator can provide rapid assistance not only to water sports enthusiasts but also to passers-by. Ideally, another one should be installed directly on the jetty. When installed outside, the devices must be protected from the weather: If the gel structure of the electrodes becomes too cold in winter, it can no longer adhere. In addition, the devices contain lithium batteries, which - as with mobile phones - quickly lose power in the cold. The electrodes and batteries can also suffer in summer.
The defibrillators also require a certain operating or storage temperature, which can vary depending on the manufacturer. For this reason, an outdoor wall box that is heated in winter and ventilated in summer is mandatory for outdoor installations. This requires a permanent power connection. Accordingly, the devices should also always be stored on board out of direct sunlight or in areas at risk of frost.
Similar to a lifejacket, defibrillators should also be serviced regularly. Most devices have control windows that indicate the functionality of the batteries in particular. If they are weak, they can be replaced with new ones at any time.
