” Germany remains the only fl ag
state to pass legislation compelling
its merchant vessels to carry
defi brillators.”
FINLANDS SJÖFART J SUOMEN MERENKULKU 43
Sudden cardiac arrest is the
world’s biggest killer. Every
year, it claims the lives of
3m people worldwide and
140,000 in the UK alone -- more than
breast, prostate and lung cancer combined.
Obesity, smoking, excessive alcohol
consumption, high blood pressure and a
cholesterol-heavy diet can all be contributing
factors, but a healthy lifestyle doesn’t necessarily mean
that you’re free from risk.
Sudden cardiac arrest can strike anyone, anywhere, at
any time – even the most fi t and active. In recent years
there have been many high-profi le cases among sports
people: Fabrice Marumba the Premiership footballer who
collapsed on the pitch during a televised match; Marc-
Vivien Foé of Manchester City and Cameroon; Phil
O’Donnell of Motherwell; the golfer Bernard Gallacher,
ice-hockey players Rich Peverley and Jiے Fischer; and the
tragic deaths of rugby star Danny Jones and Belgian
footballer Gregory Mertens, who both died within the
space of a month.
Heart attacks (myocardial infarction) and sudden
cardiac arrests are both heart-related problems, but they
are very different. A heart attack is a plumbing problem
whereas a sudden cardiac arrest is electrical – a disrup-tion
in the heart’s rhythm which interrupts the pumping of
the blood. Sometimes a heart attack (which may not be
fatal) can trigger a sudden cardiac arrest. The victim will
then collapse and become unresponsive, stop breathing,
and have no detectable pulse. Many people have no idea
that they have an abnormal heart rhythm until they’re hit
by a cardiac arrest. Even regular screening isn’t guaran-teed
to identify a problem as symptoms aren’t always
present and heart conditions can develop at any time.
The probability of sudden cardiac arrest is also
increased signifi cantly by factors like gender and age. Men
are at greater risk than women and fall victim earlier in
life – generally over the age of 45. It’s estimated that over
25% of offi cers on ships from OECD countries are over 50
years old and well over 50% are over 40.
There are other considerations that come with condi-tions
onboard ship too. Cardiac infarction and electric
shocks after the failure of technical equipment are major
issues -- but drowning, hypothermia and trauma to the
chest caused by impacts or falls are also potential
contributors. Studies have suggested that ischemic heart
diseases are the most common causes of death onboard
merchant vessels and, in 2005, German ships were
reporting an average of fi ve cardiac arrest cases every
year.
The treatment of sudden cardiac
arrest depends on a chain of survival:
1. Immediate recognition of cardiac arrest and activation
of the emergency response system
2. Early CPR with an emphasis on chest compression
3. Rapid defi brillation
4. Effective advanced life support
5. Integrated postcardiac arrest care
The ‘rapid defi brillation’ is a life-saving electric shock that
restores the heart’s rhythm to normal, and it’s this link in
the chain that can prove problematic. A quick response
makes all the difference and if a victim is shocked within
60 seconds, their chance of survival can be as high as 90%.
Within fi ve minutes, there’s still a 70% chance -- but after
this it drops by 10% every minute.
Sir Ranulph Fiennes, who suffered a sudden cardiac
arrest while waiting on the tarmac at Bristol airport, said:
‘I was extremely lucky that a mobile defi brillator unit and
the expert assistance of the Blue Watch of the Bristol
Airport Fire Station were immediately on the scene.’
Fiennes, along with other famous names like Bernard
Gallacher and Steven Gerrard, have been prominent
campaigners to get defi brillators stationed in out-of-hospi-tal
settings and there’s certainly been a raising of public
awareness about the issue in recent years. The units
available on the market are increasingly simple to use,
even without any medical training, and rely on voice
prompts and visual cues to provide treatment.
Despite the panic some people may feel in an emergency
situation, an Automatic External Defi brillator (AED)
cannot be used to shock if the patient isn’t suffering from a
cardiac arrest and it’s practically impossible to make a
mistake. Because of this, more and more people have
access to AEDs in schools, sports venues, tourist locations
and workplaces – and they’re saving lives.
However, if your workplace is aboard a vessel out at
sea, hours away from a hospital or medevac, and a crew
member suffers a sudden cardiac arrest, their chances of
survival are practically zero if there isn’t a defi brillator in
the medical chest.
Germany was the fi rst country to recognise this and the
fi rst fl ag state to introduce legislation that legally requires
seagoing merchant vessels to carry AEDs. This was way
back in 2012 and the rest of the world has been very slow
to follow suit. The UK Maritime & Coastguard Agency
recommends that passenger vessels should undertake a
risk assessment and, in February this year, the Queens-land
state government in Australia made it law that all dive
operators must carry AEDs after 10 tourists died from
sudden cardiac arrest over a period of just six months.
While AEDs are becoming standard equipment on
cruiseships and ferries, merchant vessels – with all their
increased risks – are being neglected when it comes to
sudden cardiac arrest. After six years, Germany remains
the only country to take positive action to try and safe-guard
the lives of their merchant crews. •