Guest Dies on Half Moon Cay

[nrdsb4]

Just back from the Elation 4/28 sailing and sad to report a guest died on the beach an apparent drowning or heart attack victim while snorkeling. Carnival people performed CPR on him for nearly an hour. The victim was only 35. His wife had to be found by someone going down the beach asking if anyone was missing from their party who may have gone snorkeling and was wearing black swim trunks. Needless to say his wife and daughter were hysterical when they found them. I spoke to a woman who is a former first responder back home in Mass. who told me the AED was not charged when they tried to use it. She was in the water near shore as the carried him past her to the beach. Carnival also did not have a back board on hand to put the victim on. They also kept him with his head and torso elevated up the slope of the beach when working on him, first at waters edge. He was blue then. I just completed my CPR and AED training and know the feet must be elevated about 8 to 10 inches and the victim must be placed on a hard surface. Both were not done. Carnival personnel had to yell for towels as they tried to dry him off so they could attempt to use the AED on him. I heard one of them say the machine said, "No shock advised" and they continued compressions. I'm sure more news will come out soon and hopefully the exact cause of death will be determined as to whether he drowned or had a heart attack and then drowned. There needs to be a serious investigation of the training and procedures for emergency first aid there.

 

There apparently are no officials of the Bahamian government on Half Moon Cay and the body was brought back to the ship and put in the morgue. After we docked in Nassau the next day, according to ship's personnel, the body was taken off in Nassau to be claimed by his parents who flew down.

 

I think as others have described, this poor man likely did not have a heart rythm that was appropriate for defibrillation. Not having a backboard or not elevating the feet 8-10 inches did not impact this man's survival. As none of us know what exactly happened, it seems a little inappropriate to hint that malpractice occurred or that those involved were negligent or incompetent in some way. Defibrillation is not a cure all, it's very effective when used at the proper time and in the proper circumstances, but don't assume that just because someone is "down" that AED is indicated or that it will even be effective if done appropriately. Some people simply cannot be saved.

[nrdsb4]

They were doing mouth to mouth. I did not get close enough to observe the chest, but according to another witness I spoke to who is in law enforcement, they were not watching for chest rises. There is a building near the pier that says First Aid but I did not see what I would consider medical personnel in attendance. If they were properly prepared they would not have had to put the body onto beach towels to carry him.

 

If he had no pulse, there would be no need to check for "chest rises." No pulse, no breathing.

 

And I would be wary of considering a bystander's assessment of what the responders were watching or not.

[wizard-of-roz]

These types of occurances are very frightening! Even the most trained professionals (although they are doing something), they are mostly reacting! Then they become pro-active and go into their professional mode.........

As was stated....there isn't always emergency "stuff" around....sometimes you have to improvise!

Bottom line....he wasn't breathing/no pulse.....sudden death (if that's what this was) is so, so tragic and extremly difficult to watch and comprehend!

Don't blame those who tried to help him and don't carry the burden of guilt that you didn't do enough.

Fate steps in and life and death happens!

[Motorman23]

I wanted to offer some info on what most likely happened here and perhaps clear up some items. I work PT in the EMS business (EMT-D) and full time in the healthcare business. The AED was most likely charged and the fact that it said no shock advised means it had a non shockable rhythm such as asystole (no beating at all) or a very weak rhythm not capable of sustaining life. Neither of these can be shocked and CPR is the only chance you have to get someone into a shockable rhythm. It sounds like CPR was continued as it should have been and if they had been able to keep the circulation and oxygenation up, the pt may have moved to a shockable rhythm but it is a tough thing to do.

 

The only rhythms that are shockable with an AED are Ventricular Fibrillation (VFIB) and Ventricular Tachycardia (VTAC) in a pulseless patient. Both need to be shocked preferably within 5 minutes of onset or the likelihood of survival is low. Most likely this gentleman drowned and stopped breathing and then his heart went into asystole and he died. Sad but time was not on his side unless they had pulled him out very quickly. As far as CPR goes, it should be done on a hard surface to make it work best, but I have done it on soft surfaces such as a bed and still was able to get compressions that were palpable (pulse). AED's and CPR can save lives but it must be done usually within 5 minutes of the heart attack to have a 50% survival rate. You can get the survival rate up to apx 90% if the AED is applied within 1 min of the attack and CPR has started immediately when the pt drops.

 

Sadly, people die all the time. It sounds like the activities to help to save this man occurred but it just didn't work out. I have done CPR in an EMS situation many times and the few long term survivors were people who arrested in my presence and we were able to shock them, intubate them, and medicate them on the way to the hospital. In two separate occasions they were awake and talking before my crew and I had finished our paperwork. That is when it feels great, but it doesn't always work out that way.

 

Mike

[mcwebber]

As was stated....there isn't always emergency "stuff" around....sometimes you have to improvise!

 

There should be all the proper emergency supplies at a place like that. You bring 2 thousand people off a ship onto a beach. Feed them lots of alcohol, give them masks and snorkels, provide water slides for kids, you better be prepared with the proper equipment.

[tishie58]

AMEN..:) sometimes it just your time.....IMHO i can think of worse ways to go then in some beautiful island doing what you love...(i work pediatric oncology and realize some of you will find that statement appalling...but sometimes everything is just not enough............

[dforeigner]

That is very sad, I also took my CPR AED Training course last week, first remember that you will never be in a perfect world when you need to place a person on a flat surface in an emergency situtation.

 

Since the AED said "No Shock Advised" that means that it was fully charged but that the Pads were not making proper contact on the body or was not getting a signal from the heart as in fibrillation in order to go into Shock mode. Also some of those pads have a film you need to remove to get it to stick on the body.

 

They made the correct actions by jumpping back into CPR mode after the AED failed.

 

 

Fred

 

 

With all due respect, you may want to take the class over. If the pads were not making proper contact then the AED would state "apply pads" or something to that effect.

[nrdsb4]

I wanted to offer some info on what most likely happened here and perhaps clear up some items. I work PT in the EMS business (EMT-D) and full time in the healthcare business. The AED was most likely charged and the fact that it said no shock advised means it had a non shockable rhythm such as asystole (no beating at all) or a very weak rhythm not capable of sustaining life. Neither of these can be shocked and CPR is the only chance you have to get someone into a shockable rhythm. It sounds like CPR was continued as it should have been and if they had been able to keep the circulation and oxygenation up, the pt may have moved to a shockable rhythm but it is a tough thing to do.

 

The only rhythms that are shockable with an AED are Ventricular Fibrillation (VFIB) and Ventricular Tachycardia (VTAC) in a pulseless patient. Both need to be shocked preferably within 5 minutes of onset or the likelihood of survival is low. Most likely this gentleman drowned and stopped breathing and then his heart went into asystole and he died. Sad but time was not on his side unless they had pulled him out very quickly. As far as CPR goes, it should be done on a hard surface to make it work best, but I have done it on soft surfaces such as a bed and still was able to get compressions that were palpable (pulse). AED's and CPR can save lives but it must be done usually within 5 minutes of the heart attack to have a 50% survival rate. You can get the survival rate up to apx 90% if the AED is applied within 1 min of the attack and CPR has started immediately when the pt drops.

 

Sadly, people die all the time. It sounds like the activities to help to save this man occurred but it just didn't work out. I have done CPR in an EMS situation many times and the few long term survivors were people who arrested in my presence and we were able to shock them, intubate them, and medicate them on the way to the hospital. In two separate occasions they were awake and talking before my crew and I had finished our paperwork. That is when it feels great, but it doesn't always work out that way.

 

Mike

 

 

That's a great, clear, and simple explanation of what likely happened from someone who knows what they are talking about. Thanks for the informative post.

 

I've had people arrest in my presence, too, (if you are going to go into cardiac arrest or a lethal heart rythm, you would be wise to do it in a room with many lifesaving machines, medication, and medical personnel, lol) and it's great that we have all the proper equipment right at hand. Life, however, doesn't usually work that way.

[qprrules]

I'm very saddened by this tragic loss of a young life. Very saddened for his wife and child, very saddened for his parents, very saddened for all his family, very saddened for all that witnessed this event and very saddened for the whole cruise community that is affected by the news of this.

[wizard-of-roz]

Well said!!!

[mcwebber]

One of the main lessons to be learned from this is never to swim or snorkel alone. While it may have only been about 10 minutes, according some people who said they were talking to him 10 minutes before he was pulled from the water, if he was with someone, he might have been rescued in time.

[dforeigner]

I wanted to offer some info on what most likely happened here and perhaps clear up some items. I work PT in the EMS business (EMT-D) and full time in the healthcare business. The AED was most likely charged and the fact that it said no shock advised means it had a non shockable rhythm such as asystole (no beating at all) or a very weak rhythm not capable of sustaining life. Neither of these can be shocked and CPR is the only chance you have to get someone into a shockable rhythm. It sounds like CPR was continued as it should have been and if they had been able to keep the circulation and oxygenation up, the pt may have moved to a shockable rhythm but it is a tough thing to do.

 

The only rhythms that are shockable with an AED are Ventricular Fibrillation (VFIB) and Ventricular Tachycardia (VTAC) in a pulseless patient. Both need to be shocked preferably within 5 minutes of onset or the likelihood of survival is low. Most likely this gentleman drowned and stopped breathing and then his heart went into asystole and he died. Sad but time was not on his side unless they had pulled him out very quickly. As far as CPR goes, it should be done on a hard surface to make it work best, but I have done it on soft surfaces such as a bed and still was able to get compressions that were palpable (pulse). AED's and CPR can save lives but it must be done usually within 5 minutes of the heart attack to have a 50% survival rate. You can get the survival rate up to apx 90% if the AED is applied within 1 min of the attack and CPR has started immediately when the pt drops.

 

Sadly, people die all the time. It sounds like the activities to help to save this man occurred but it just didn't work out. I have done CPR in an EMS situation many times and the few long term survivors were people who arrested in my presence and we were able to shock them, intubate them, and medicate them on the way to the hospital. In two separate occasions they were awake and talking before my crew and I had finished our paperwork. That is when it feels great, but it doesn't always work out that way.

 

Mike

 

Remember that an AED only checks for a cardiac rhythm as has no way of knowing whether the patient has a pulse. Hence, the patient may be in ventricular tachycardia with a pulse and potentially, the AED will recommend to shock that rhythm.

 

Also a word of advice to all those bystanders who may at one point want to use a AED. If the patient is lying in a puddle of water and you allow the AED to discharge an electrical shock. Guess what, you just potentially killed yourself and those standing, kneeling in the puddle of water.

[dforeigner]

I forgot to mention that one of the rules before using an AED is that one must confirm that the patient is unconscious and does not have a pulse.

[vital1]

AMEN..:) sometimes it just your time.....IMHO i can think of worse ways to go then in some beautiful island doing what you love...(i work pediatric oncology and realize some of you will find that statement appalling...but sometimes everything is just not enough............

As an ER nuse at a Level 1 trauma center I was thinking the same thing! It's a traumatic situation for those that don't deal with death every day, and for some that do. I can understand everyone's concern but when it's your time to go, it's your time to go. Backboards, elevated feet, shocking, Level 1 trauma centers, helicopters, code drugs.......nothing will save you when it's your time to go. That's why you should hug your family every day and let them know how much you love them. Live every day to the fullest b/c it could be your last.

I will say a prayer for his family tonight. I can't imagine how they feel.

[wander2beaches]

nrdsb4--your quote was....

"If he had no pulse, there would be no need to check for "chest rises." No pulse, no breathing."

 

A person administering CPR needs to check for "chest rises" even if they don't have a pulse. The reason to check for "chest rises" is to assess for adequate ventilation. If the chest doesn't rise, the head may need to be respositioned OR the airway may be completely blocked due to a foreign obstruction.

 

The only reason I make this correction is so that if you have a loved one who needs CPR, you will know.

[nrdsb4]

nrdsb4--your quote was....

"If he had no pulse, there would be no need to check for "chest rises." No pulse, no breathing."

 

A person administering CPR needs to check for "chest rises" even if they don't have a pulse. The reason to check for "chest rises" is to assess for adequate ventilation. If the chest doesn't rise, the head may need to be respositioned OR the airway may be completely blocked due to a foreign obstruction.

 

The only reason I make this correction is so that if you have a loved one who needs CPR, you will know.

 

You are so right. I wrote that very poorly and didn't re-read it until later, and couldn't change it. In fact, my sentence made absolutely no sense at all, lol. I think the point I was trying to make was that he was basically dead, therefore the mouth to mouth wasn't going to result in oxygenation regardless of how perfect ventilation was.

 

I felt the OP was concentrating on all the details: feet not elevated 8-10", no backboards, etc., (things which would be optimal, but yet not necessary in and of themselves to assure a good outcome) vs. the big picture (the guy had no pulse, was blue, was not in a physical environment ideal for resuscitation). I know from doing CPR in the hospital with an ambu bag you can get big, full lung chest rises like you do in CPR class. In other patients, it may be less obvious. But with mouth to mouth (and particularly with someone lying in soft sand), they can be quite subtle. It always looks more dramatic and "perfect" on the plastic dummy guys. There may have been chest rises that weren't all that obvious to someone standing several feet away in a crowd, so I sincerely doubt that a bystander in "law enforcement" could really say for sure that the responders were not bothering to assess their mouth to mouth. When performing CPR it's not required for responders to announce "I am now checking for chest rises." It's something done in an instant. The guy was already essentially dead and critiquing the mouth to mouth technique after the fact based on hearsay was unfairly second guessing the competence of those involved, imo. Concerned individuals were giving mouth to mouth and CPR as best they could in a difficult environment and should get some credit, not criticism, particularly from someone who was not right there in a position to observe the entire event.

 

You are right, though, one should assess the proper angle of the head when giving mouth to mouth to maximize effectiveness!

[mcwebber]

But with mouth to mouth (and particularly with someone lying in soft sand), they can be quite subtle. It always looks more dramatic and "perfect" on the plastic dummy guys. There may have been chest rises that weren't all that obvious to someone standing several feet away in a crowd,

 

I was close enough to observe the fact that when attempting the mouth to mouth, the person doing it, who was not a medical person, did not do a chin lift. He was barely paying attention and had to be told twice. If you were there, you would have been surprised at how sloppy the whole thing was. It appeared that the victim did momentarily respond. They rolled him on his side when he appeared to vomit and were yelling at him to fight. He should have been turned downslope at that point. The absence of a back board, that I have seen many places where there are supposed to be some kind of lifeguards or medical help present, is really quite surprising and, IMHO, is evidence of a lack of preparedness. At the beach here they have surfboards at every lifeguard stand to use to get people out of the water and for a hard surface in such situations.

[nrdsb4]

I was close enough to observe the fact that when attempting the mouth to mouth, the person doing it, who was not a medical person, did not do a chin lift. He was barely paying attention and had to be told twice. If you were there, you would have been surprised at how sloppy the whole thing was. It appeared that the victim did momentarily respond. They rolled him on his side when he appeared to vomit and were yelling at him to fight. He should have been turned downslope at that point. The absence of a back board, that I have seen many places where there are supposed to be some kind of lifeguards or medical help present, is really quite surprising and, IMHO, is evidence of a lack of preparedness. At the beach here they have surfboards at every lifeguard stand to use to get people out of the water and for a hard surface in such situations.

 

 

If the personnel were in fact not properly trained, that's certainly something that should be looked at. In fact, even in events in which the outcome is good, the entire event should be reviewed as a matter of course to determine if ACLS protocols are followed and what could be improved in the future. I know that in my hospital, all codes are reviewed after the paperwork is done. This should be the focus more than the undue attention given about the lack of a backboard, JMO. Lack of a backboard should be remedied, but patients are not going to die due to that vs. poor training or an AED machine not properly maintained.

 

It's a shame someone so young died. I'm sure all the other details will be sorted out by people who are informed and qualified to make the ultimate call about what killed this young man and whether or not he could have been saved.

[Mimi1527]

I just wanted to say a sincere 'thank you' to all of the posters to this board.

I, too, am so saddened by the death of this young man, and will remember his family in my prayers during this difficult time.

Also, thank you to everyone who posted information about the jelly fish and other sringing sea creatures. I can't thank you enough, because now I know how to behave in order to possibly avoid trouble, and if I see someone in distress I can at the least give them some measure of comfort right away. I've made a list of things to take like the vinegar, tweezers, rubber gloves, etc. and will keep them with me if we're near the beaches.

You may never know how many people you've helped by sharing what you know, and the links, as well. While some people may be concentrating on "being scared" becaues of this new information, I for one will enjoy nature at it's best, and if I get into a tough spot, at least I can do something about it.

On another note.....if it were me or my dear husband of 42 years, I'd rather someone try to save him than doubt their abilities and stand by and watch him die.

Again, thank you so very much!!!

[mcwebber]

I've made a list of things to take like the vinegar, tweezers, rubber gloves, etc. and will keep them with me if we're near the beaches.

Just remember, if you don't have vinegar, you can pee on the jellyfish sting.

[Mimi1527]

Oh, yes, the "pee," urine thing. Got it! DH promised to do just that for me!!!:eek: Thanks for the reminder.

I know this isn't really funny, but I can't help but laugh at the thought!!! :) ....only because no one's in danger, for sure!!! Can you see that...."hold still buckaroo, I know it hurts like all get out, but I gotta pee on ya!!" (major snicker!!)

"They're coming to take me away, ha ha!!":p

Thanks again,

[petunia1167]

McWeber,

We were also on this cruise. We were down where they rent out the water bikes. We learned of the incident when a crew member came down to refill the bar station. He stated that a man had a heat attack and the family was upset becaus a plane could not be brought in to help him.

 

What a tragedy....so young.

It must have been so difficult for the wife and child, esp. with a huge party going on around her.

[petunia1167]

I'm sorry, I meant heart attack, not heat attack

[mcwebber]

McWeber,

We were also on this cruise. We were down where they rent out the water bikes. We learned of the incident when a crew member came down to refill the bar station. He stated that a man had a heat attack and the family was upset becaus a plane could not be brought in to help him.

 

By the time a helicopter could get there it would have been too late. I did notice the helipad near the dining area. The crew member must have talked to her long after since they couldn't find his family until he was already dead as they didn't know his name. I feel sorry for the person who was going down the beach asking if anyone was missing someone from their party.:( A very sad task. A lot of people left the island after they heard what happened. Nobody around me felt much like partying then.

[wizard-of-roz]

mcwebber: I'm so sorry that you and so many others were witness to this horrific experience and especially this poor mans family.

You plan a vacation and certainly don't ever expect to be confronted by these kinds of watershed moments. And, unfortunately, these kinds of experiences stay with us!!!!!

Look at all the postitives in your own life; cruise again; and have the expectation that it will be a truly enjoyable time!