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From: Geo. Bergeron <heritage_at_europa.com>
subject: [Paddlewise] Incapacitated. . .
Date: Mon, 15 Jun 1998 18:42:11 -0700
	Just for the record: CPR is NOT the "chest flex from the elbows" that you
see on "ER" "Chicago Hope" and "Doogie Howser, MD." CPR entails lunging
full force from the shoulders, locked-arm, with the heels of the hands on
the victim's sternum. If the victim is conscious when you do this there's a
good chance of breaking ribs. The reason I bring this up is because it's
unlikely that one could perform effective CPR in boats on the water.
Getting into position is impossible, and the thrust would likely capsize a
boat. You can't perform effective CPR on a bed or cushioned couch. . . a
floating boat would not provide the rigid platform necessary for CPR even
if you *could* get into position. 

	Hypothermia will aggravate cardiac rhythm problems as well as contribute
to shock --primarily respiratory and cardio-vascular shock. Towing a victim
in cold water has its own set of problems. 

	This hypothetical heart-attack scenario is a nightmare. On open water I'd
put the chance of survival at nil or very slim--particularly when the
patient loses consciousness, stops breathing, or suffers cardiac arrest. 

	The only other times a person might lose consciousness would be from
"psychogenic" shock. . . resulting from pain such as a dislocation or
broken bone. Once the victim's head is lowered, generally the victim
regains consciousness. 
	"Vasogenic" shock. . . from loss of blood can be controlled with pressure
bandages, but blood loss can lead to cardiac arrest. 
	"Allergic" shock. . . bee/fish stings, drug reactions can lead to cardiac
arrest or at least some significant respiratory distress. Allergic shock
takes antidotes which aren't usually available. CPR can serve as life
support until help arrives, but CPR is problematic at sea. 

	Inuslin shock is a whole independent medical problem. The diabetic patient
needs to monitor insulin levels and ensure that other paddlers are aware of
that person's need for insulin/food regulation. Fortunately, insulin shock
provides lot's of warning signs, and the diabetic usually has the
"antidote" at hand. 

	Which leads up to, I suppose, the main point here: An ounce of prevention
is priceless on the water. Seemingly, any formal paddly "sign-up" should
include a medical section on the form. Group leaders should be aware of
medical contingencies and should also be CERTIFIED in first-aid and CPR at
a very minimum. Much easier to alienate someone at the outset than to have
to make funeral arrangements for them later. 

	The informal paddling groups that fall together on the water are more
problematic. It seems wise to ensure that the group have a good
understanding of individual paddling skills and potential medical problems
before undertaking an extended or exposed crossing. White water and surf
zone paddlers need to take the same precautions, although the bank or beach
is *usually* within fast reach for these types of kayaking, certainly more
so than the hypothetical "cardiac arrest" scenario in the middle of the
ocean. 

	Death is best avoided through prevention. A kayaker who has a heart attack
on the open water stands a very poor chance of survival. Does your
cardiologist know that you're paddling a kayak on open seas??? 

______________________________
George Bergeron, Secretary '99
Oswego Heritage Council
www.europa.com/~heritage/"
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