Automated external defibrillators on board merchant vessels? Preliminary report article for discussion

Acute heart diseases are the most frequent causes for fatalities on merchant vessels. Presently there is no sufficient therapy available to treat ventricular fibrillation. The aim of this study was to test whether common automated external defibrillators [AED] may be appropriate for the use aboard merchant vessels. In 2005, nine seafarers were introduced to four common models of AED (HeartStartFR2+, Lifepak500, AEDplus, FREDeasy) using standard video or DVD presentations. AED handling by the subjects was tested in standardized simulated emergency scenarios. After training, they subjectively rated each AED on 24 factors involved in the introduction and handling of the device. An actual ECG was then obtained with each AED at a site located beside the ship's main engine to test under maximum vibration. The ECG data were extracted and sent as an e-mail attachment via satellite to the German Telemedical Maritime Assistance Service [TMAS] in Cuxhaven. All subjects handled the AED correctly. The AED received a total amount of points in the range between 2125 to 2241 (of 2400 possible). The subjects preferred AED with coloured as well as light marked buttons which gave a feedback (e.g. audible tones) when they were pressed. All AED were able to register an ECG in the vibrating ambient. Due to interface problems it was only possible to extract three ECG files, and only two files (data < 300 kB) could be sent as e-mail attachment via satellite to the German TMAS. In noisy areas the AED must guide the user, e.g. by screen massages and/or pictograms. Displays should provide additional data to help assess resuscitation effectiveness. A special procedure is necessary to ensure that ships and TMAS own the same software to read the transmitted ECG files, which are not allowed to exceed a size of 300 kB.