W-AEMT here and here's what I concluded after researching renting or buying one for my last Canyon trip (short version, I decided it wasn't worth it).

• Less than 1/2 of out of hospital cardiac arrests (CA) have a rhythm that is shock-able by AED. Even less so in CA resultant from downing (without underlying cardiac conditions - see next point).
• My group did not contain at-risk members. No known chronic conditions (or ages) that could predispose a them to sudden cardiac arrest or infarction.
• If you were to get a CA with a shock-able rhythm and convert it with AED to perfusing rhythm (pulses) the management of these patients is often extremely complicated and repeat loss of pulses is not uncommon.

-Lastly, as you noted AEDs are expensive and require regular upkeep compared to the likelihood of use (statistically most injuries occur in camp, and statistics for river deaths usually include health risk factors and often the lack of PFD).

I might reconsider the calculus if my group contained members with cardiac risk (age, obesity, or chronic conditions).
Absolute most important thing you can do to improve the survival of drowning patients is make sure everyone in the group is trained and refreshed in HIGH QUALITY CPR and rescue breathing. Generally, (otherwise healthy) drowning patients need oxygen and the quicker breaths and chest compressions are provided the better the outcome. Everyone needs the training because you don't know who's gonna be the one to pull them out of the water, also you may end up performing CPR for a while and will need to rotate compressors to maintain quality.

With regards to the Hamilton incident, most of the experts I read agree it was likely Commotio cordis (usually suffered by youth baseball players). Basically its getting hit in the chest in the exact right spot, in the right way, at the exact right time in the cardiac cycle- relatively rare.

This is just what I've found. I know there are a good handful of other emergency medical people on this forum and I'm curious to read their calculations.

 

Zac, while I agree with your well thought out decision I suggest you research again and deeper. You may, or may not, reach the same conclusion. I think you will find that the two shockable rhythms, (VFib and VTach) occur in 68% -- 2/3 not 1/2 -- of Sudden Cardiac Arrest (SCA) victims.

That, especially post COVID, many more are experiencing than previous experience. Please note the database of youth athlete deaths in school sports, few of which were Comitia Cordis, found in the Safer Sidelines investigative series out of Louisville. I tried to post the link, but I guess it is not allowed. Worth the Google search.

Finally AEDs now cost less than a cell phone and will last up to 20 years, bet all of our cell phones are newer than that. The upkeep is no more difficult that the upkeep on your flashlight. Even size and weight are down to the size of your palm and weigh 1.8 pounds for one model.

Again, you may reach the same decision, and it is not an unreasonable one, just a few things to consider from a 40 year firefighter/paramedic that has done more than a few wilderness rescues. Air Evac will allow follow-up care in a reasonable amount of time in many post resuscitation events.

 

One of my boating clubs owns one. It is available for members to check out if it's not currently in use for a club event.

That said, an AED won't save your life. An AED can correct a specific type of arrhythmia. Advanced care is still needed immediately. Until/unless a normal rhythm is restored, it's CPR that keeps blood (and oxygen) flowing to organs including the brain. If you are somewhere really remote, the AED may not provide the life-saving treatment some assume it will.

The AED is only part of the chain of survival. The next link is early activation of EMS and advanced care. That's not going to happen in the wilderness.

 

Nice response (zaczac4fun).

I was wondering about the after-care. In some situations, (closer to life flight/urban areas) maybe it could bridge the time to extraction and more advanced care? Good comment on having an understanding on who in the group has recent training.

Recent CPR and AED training was enlightening and an excellent reminder on rescue breathing and AED use (e.g., only 2 of 4 rhythms are shockable).

 

I've been carrying one on all my multi-day trips in a Pelican case for about ten years. I replace the battery every 5 years. It has never been used but my group of boaters feel like it is an important part of our first aid kit. It only weighs a couple of pounds and is very easy to use. It will only work if it determines that the person needs to be shocked.

 

If it gives you good feels then great. The bottom line is that if you have to use an AED and the patient doesn't get to an ICU PDQ then it isn't going to matter. Hauling one into a wilderness canyon doesn't really make a lot of sense, IMO.

In the post-forced-experimental-mRNA vax world, the unfortunate truth is that we're all at much higher cardiac risk. Evidence is showing that some measure of heart damage is likely universal, and several nations (not to mention life insurance underwriters) have raised the alarm about the impossible to ignore massive increase in sudden death of healthy prime-aged people. Not to mention elite athletes in their prime collapsing on field. But, you know, it's all tin-foil hat conspiracy theories, I'm sure the vaccines are perfectly safe and Big Pharma and their government partners in crime have only our best interests in mind.

It is a terrible shame that Hamilton is in such bad shape and was likely entirely avoidable. I hope he pulls through. He was a teammate of my nephew at Pitt and by his account a great kid.

Edit: it seems he was able to open his eyes and grip the hands of family members so...good sign.

 

Damar seems to be pretty lively on the field the last few weeks for a dead man, and the medically induced coma and hypothermia are well accepted post-resuscitation treatments were are doing for most SCA patients the last 10 years.

 

I’d be more inclined to bring oxygen over an AED if I was choosing between the two.

 

Very good points made regarding the limitations of an AED. I have been personally involved with performing CPR on an individual where an AED was not applicable. We actually had one on hand, but no shock was ever advised, and would not have been helpful at all. They are great tools to have, but just be very aware of what they can and cannot do, and be sure to have a follow up plan for evacuation.

 

I work in schools as maintenance. Anyways I gotta do a certain amount of training for stuff. You know , how to escape a gun man , epi-pen yada yada. We have one and even though I wasn’t paying attention during my training , the deal is so dumbed down that you basically follow very specific instructions and then when it’s hooked up it tells you what’s going on. So to have it doesn’t mean you have to do the thing and it monitors the patient so…I dunno? Why not ? It’s like all things over the top , only need one when you need one. Can’t use one unless you have one. I may have borrowed ours for a trip, think the head nurse said it was a few hundred dollars? I dunno ? Just kinda remember it from that training day I was day dreaming about skiing or something other than the subject at hand. Now iam thinking a guy should put together a hospital raft and get invited in lots of trips??? That’s probably a real bad idea huh?

 

I am a retired paramedic. My wife is a firefighter/paramedic. I’ve taken part in countless resuscitation efforts. I see absolutely no need for an AED on a remote multi day trip. Even in the incredibly rare event of a non traumatic cardiac arrest with a shockable rhythm, the care needed following cardioversion is not available. You still need a massive amount of oxygen, IV anti-arrhythmia drugs, etc…and definitive care, meaning a cardiac catheterization.

This is a similar discussion as with epi-pens. An epi-pen only buys time. If you don’t follow it up with cortico steroids it only gives you the opportunity to say a nice farewell. Not that you shouldn’t carry an epi-pen, but you need the rest of the drugs to go with it when you are far from advanced care.

 

This is a similar discussion as with epi-pens. An epi-pen only buys time. If you don’t follow it up with cortico steroids it only gives you the opportunity to say a nice farewell. Not that you shouldn’t carry an epi-pen, but you need the rest of the drugs to go with it when you are far from advanced care.

Per UpToDate: Biphasic (repeat) reactions only occur in approximately 5% of anaphylaxis cases following epi....

 

So can a guy survive a heart attach on the Grand Canyon? Say he’s with you and you get him back to beating and breathing and you have a good sat phone? Just curious

 

I’d say not at all likely, but it depends on the cause. A likely cause, on a river trip, would be hypoxia from a near drowning. If they hadn’t been under for too long and you were able to get them oxygenated, it’s possible.
If the cardiac arrest was due to trauma, or an ill heart, start digging.

 

One more thing I guess…

 

What saves lives is early CPR and early defibrillation (from an AED). AEDs DO save lives, seen it plenty of times. Will it save every cardiac arrest... no, but if a person arrests out in the middle of nowhere AEDs are the only thing that we have available that could save their life. That being said, I don't carry one just because I don't want the responsibility for upkeep in case it fails. Also using an AED on a wet person with wet rescuers could end badly! If I were to do a longer trip with an "at risk" individual, I could borrow one form work.
I think instead if it were me and I had witnessed someone's arrest, I think I would try a pre-cordial thump and see if it had any effect (chances of working are pretty slim) if not, then its CPR until your arms fall off.

 

Early CPR, and AEDs absolutely save lives in conjunction WITH diffinitive care. They rarely, if ever, work alone.

Per UpToDate: Biphasic (repeat) reactions only occur in approximately 5% of anaphylaxis cases following epi....

I have very rarely (maybe once or twice) seen anaphylaxis stopped entirely by epi alone.

 

Something I concluded at CPR training last month is that a Stop the Bleed kit IS something we should all be carrying. Packable gauze, tourniquet, large absorbent pads, etc. I too work in a school and sadly we are trained to use these to pack bullet holes in people; great times we live in. But I can see it's usefulness with tending to a deep cut, deep puncture from a stick, or post-bear attack on the Smith River.

https://www.bleedingkits.org/all-products/premium-personal-stop-the-bleed-kits.html

 

No one should go anywhere without a tourniquet handy.

 

I think it's interesting most of this conversation has revolved around multi-day trips but many of the more technical (dangerous) rivers around here are still well over an hour out from advanced life support. Length of trip matters to me when I am considering aid kit contents like wound dressings and medications that will relieve discomfort or prevent someone from needing to be evac'd but when it comes to cardiac arrest and similar- it's the same stuff whether out for a day or a week.

 

It would make far better sense to carry an AED on shorter day trips where you are much closer to advanced care and diffinitive care.

 

Same for commercial sections of the Ark.

 

I'd rather bring an AED than an anit-vaxer spouting a bunch of shit. And a tourniquet can easily be made from many things that have other uses but feel free to bring whatever you're comfortable using. Keep your 55 gal drums of beans and rice dry.

 

So we’re going to pretend that 20 something elite athletes dying on the field is normal now?

https://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Boards/BOH/Meetings/2021/Public%20Comments%20324%20to%20328.pdf

Use a search engine with an independent algorithm and educate yourself. What will it take to overcome your child like suspension of disbelief and naive trust in an industry that has screwed us time and again?

Or just throw around derogatory labels. That’ll change the fact that we’re all paying tax money to be Pharma’s lab rats and it’s having predictably negative results.

While we’re at it, as you are fumbling to try to exert enough pressure with a belt or a boat strap or shoestrings and a stick, your patient with a brachial or femoral artery bleed is dying fast. I hope it’s not me you’re trying to save, McGyver. Or you could spend (er ma gerd) thirty whole dollars!

https://www.narescue.com/combat-application-tourniquet-c-a-t.html

CAT Tourniquet - GEN 7 - North American Rescue

The North American Rescue CAT Tourniquet GEN 7 is the official U.S. Army tourniquet, lightweight, rugged, and 100% effective in stopping blood flow. Trusted for combat and emergency use.

www.galls.com

Don’t ask me for rice and beans when you’re starving — you don’t get any now.

 

I understand why this can’t happen, but I wish a doctor could write up a couple days of opiate pain meds. It could really make a difference to someone while evacuation is arranged.

 

pre-installed doses in your garmin satellite device which sends out a bat signal when you “break the glass” to access said pain killers. Now we are on to something…

 

Lifetime EMS here, can't dispute anything that's been said here from a medical standpoint. At the end of the day, to me anyway, taking an AED isn't a bad idea, but the chances of needing one, or that using one given protracted evacuation times, is minimal. If you really wanted to carry something that has a likelihood of being helpful, carry a Lucas AutoPulse.

LUCAS 3, v3.1 chest compression system

Deliver high-performance, continuous chest compressions.

www.lucas-cpr.com

They ain't cheap, but they are effective, and with 2 batteries they can run almost 2.5 hours. I've used one a couple times, and while I hope never to have one sitting on me, they do work, and work well. Reports of a powerline worker in MI being on one for 2.5 hours and living support my case.

While you're at it, you might bring along a transport ventilator and a selection of ET tubes or King Airways, a Lifepack 15 patient monitor, normal saline, drip set, selection of angiocath's, Epi, Morphine, versed, clot busters...

This above was mostly tongue in cheek, I guess my point would be, that you really don't need to lug an expensive delicate piece of equipment that may or may not help in a backcountry situation, when in many instances, simple CPR (that everyone here SHOULD know) is relatively foolproof, needs nothing other than your hands and your weight, and has a decent chance of helping the patient having a cardiac incident, until they can be moved to the next level of care.

If there isn't a rapid way to move that patient to the next higher level of care, then all bets are off. Even in Grand Canyon, where they do run a chopper for evac, the chopper has to have the right conditions to fly,and a place to land..

Ya do what you can, with the materials you have available, to render the best patient care you can. Sometimes the patient dies. We all are going to suffer that, but you can have a little consolation that at least you gave it your best. Despite that, some patients die anyway.

At least they will have passed, doing something they love, which would be my wish for when the time comes..

Edited<

All that being said, my lifetime EMS has most always involved a fully stocked ambulance, and a package and transport mentality.

 

My point on the tourniquet was bring whatever works for you-that means having it with you, cost, and use. Personally, I bring 2-3 triangular bandages (cravats) pretty much anywhere I’m more than 5-10 minutes from care. You can buy 40 of them for $5. If I bought 40 actual tourniquets, I’d be out $1,200. Triangular bandages are tiny and live in all my packs, first aid kits, and glove boxes. They have more than one aid use from tourniquet to emergency toilet paper. All that said, I do have an actual tourniquet in my big aid kit which doesn’t go on a day ski trip, bow hunting out of my backpack, or a mtn bike ride from my house.

If looking cool with a $30 tourniquet Velcroed to some molle on your plate carrier is your thing, that is your prerogative. My experience has been most people I’ve seen carrying these when asked don’t know what the term distal means or why it’s important.

 

If looking cool with a $30 tourniquet Velcroed to some molle on your plate carrier is your thing, that is your prerogative. My experience has been most people I’ve seen carrying these when asked don’t know what the term distal means or why it’s important.

Uncle Sam didn't give a shit what looked cool on our PCs, we had tourniquets because they save lives. Many thousands of lives over the course of the War on Terror. And soldiers didn't need to know medical terminology to know to put the CAT between the hole and the heart.

Don't worry, though, bud, even though you think your slick I'll still stop on the river to pull my CAT off my PC to save your life while your buds are fumbling around with bandages trying to stop a bleed.

 

Having brought two people back to life with an AED (one in a hotel bar and one in an airport), I think it's a good question.

That said, I've never bought one and don't carry one on my raft. I don't carry a Bag Valve Mask either but have seen some people do so. I carry a pretty beefy first aid kit but all anybody ever seems to want is bandaids.

 

MNichols was waiting to hear your point of view,
Thanks, SomeYeahoo taking the time to provide some wisdom point by point.

Lets talk about why the military (TCCC) doesn't recommend improvised TQs and why they fail:
-they take longer to apply = more blood loss.
-without a proper windlass they are not tightened sufficiently leading to veinous but not arterial occlusion (basically allowing blood into the limb that is bleeding but not allowing any of it back into the body) = even worse blood loss than with intervention.
-They also tend to loosen over time leading to the same problem as above.
-they can be too narrow leading to permanent tissue and nerve loss loss. = back to the lose a limb to save a life.
Conundrum You probably already knew these things but now everyone else does too, and with those in mind, can you improvise and effective and safe TQ? Yes. You can apply direct pressure until a makeshift TQ is applied, you can select and utilize a windless and tighten to occlude arterial blood flow, you can repeatedly reassess the makeshift TQ to assure it is still effective, you can select a material and band that is appropriately wide (1.5-2"). Are they as good as a $40 CAT or SOFT-T (please don't buy discount TQs), probably not, but could do the job, almost everything in can improvised but with compromises and its up to each of us to decide that cost-benefit, hopefully with proper knowledge or good advise to back up those choices. Personally, I don't always carry a TQ with me, but they are in my backcounty and big kit.
For another example: I carry a BVM in my large med kit. Do I need it? No, but I prefer it over giving mouth to mouth or mouth to mask for an extended time and it is what I am most comfortable and familiar using. I don't fault SomeYeahoo for not carrying one as I'm sure he's thought that through.

Knowledge weighs nothing and the only cost is little humility (or a couple hundred bucks for a WFA).

I carry a pretty beefy first aid kit but all anybody ever seems to want is bandaids.

This, IBU, tylenol, aspirin, some pepto... and I'd just as soon it stay that way.

 

Totally agree with you on the tourniquet. The pre-made military ones are top notch and MUCH better than improvised for all the reasons you described. It's in my kit. I have sterile gauze too, but I consider that much less essentially since everyone always has clothes that can be cut up into gauze.

 

Our group kit has what is needed for probable life threatening stuff, but is primarily for minor things to keep you comfortable on a longer trip away from the grocery store. Cold medicine, Imodium, i-bus, ASA, naproxen, etc. Basic wound care for something that might need daily care, but not evacuation.

It seems we are into our kit daily for one thing or another, but have not needed it for anything serious.

Point being: most of the medicine practiced on a multi day trip will be like the rest of medicine practiced everywhere else; primarily comfort care. Be prepared for minor things as well as the critical.

 

to BSOE above....the current evidence of significant cardiac problems with the MRNA vaccines is statistically VERY SMALL....younger adult males statistically yes myocarditis (small fraction of 1% ever documented) but reality of actual real life cardiac problems again extremely small....I am a physician....show us the evidence if you think this is a real life issue....thanks, Chet

 

After a recent trauma, I have decided it's time to stop procrastinating and put together a very comprehensive first aid/medical kit.

Does anyone have a comprehensive list of what a kit should contain in the wilderness? I can recreate the kit we have at the aquarium. The biggest concern we have there is a large animal bite, but EMS is very close by. I know Pelican makes a couple sizes of nice cases. Aside from roll gauze, gauze sponge, gauze pads, Sam Splint, Israeli gauze, touniquet, coban, and basic "ouchie" stuff like band-aids, immodium, antibiotic ointment, hydracortisone, what's in your raft trauma kit?

Is there a good online resource to put a comprehensive kit together? Are any off-the-shelf kits worth looking at, or should I start from an empty box? If off-the-shelf, what are they likely to be lacking that I can add?

I'm a cheap bastard, but if $1000 will help me keep a friend alive, I'll be happy to have spent the money.

 

Few good threads out there already, think this is most recent:

A better First Aid kit

[What’s up buzzards I guess I’m still suffering from cabin fever here in NE Oregon, cause I’m going through all of my rafting gear and slowly getting ready for the next season. I’ve used a 50Cal ammo can for my group First Aid kit for like the last 10 years. If it’s one thing it’s...

www.mountainbuzz.com

I certainly appreciate those who do adding their advice and experience, thanks to the first responders/nurses/docs

 

For those wondering, @SomeYeahoo is an Emergency Medicine doctor.

He’s just too embarrassed to admit it publicly. Lol

 

For those wondering, @SomeYeahoo is an Emergency Medicine doctor.

He’s just too embarrassed to admit it publicly. Lol

Great, now that you’ve outed him to this group he’s gonna get a buncha DMs asking about butthole warts and strange discharge!