# AED On Hockey Player



## robbaN28

Here's the Scenario:

Hockey player collapses on the ice.
He's 55, no history of any cardiac problems. Teammate begins CPR while another teammate gets the AED. 
When they are about to attach the AED, they notice that the hockey player is laying in a small pool of water.
Remember, this rink has excessive amounts of water on the ice because they just zamboned the ice. 
What do you do? Take him off the ice or shock him there? This was a real scenario that came up in discussion in class.


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## DrParasite

yes.  take him off the ice.  imagine how hard it is gonna be to do CPR while slipping on the ice


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## xgpt

Agreed. Move him off the ice, definitely move him if there isn't suspected spinal injury, the ice is enough of a safety hazard without adding electricity to the mix.


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## mycrofft

*See posts about second hand defib and pool rescues.*

I never thought about ice as a conductor. Hm. 
Delay versus inconvenience.


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## xgpt

mycrofft said:


> I never thought about ice as a conductor. Hm.
> Delay versus inconvenience.



I think the key point here is that it was recently wetted ice by the zamboni


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## Motojunkie

True, but wouldn't the water put on by the Zamboni freeze fairly quickly since it's a thin layer?


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## spike91

Based on the limited information, if there's reason to suspect C-spine issue I'd get someone on head stabilization and get him moved off the ice as quickly as possible, then AED him. If no reasonable expectation of c-spine compromise, I'd haul him off the ice and then hook him up. I'd rather not be the poor SOB who finds out the hard way that we should've moved him. 

The extra few seconds is DEFINITELY worth the assurance that you have ONLY one patient, not 3 or 4.


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## FLEMTP

Nah.. i say leave em and zap em... besides.. you'll already have a head start on your induced hypothermia!


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## CAOX3

There is some scientific studies that have been conducted with some positive results with the use of AED in standing water.

http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Im not sure if Im bringing this thing in the pool with me yet but there have been some positive results


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## robbaN28

Motojunkie said:


> True, but wouldn't the water put on by the Zamboni freeze fairly quickly since it's a thin layer?



Depends on the rink. This rink had a pretty unusual high temperature in it. So the water freezes slowly. Takes about 5-15 minutes for it to freeze completely.



spike91 said:


> Based on the limited information, if there's reason to suspect C-spine issue I'd get someone on head stabilization and get him moved off the ice as quickly as possible, then AED him. If no reasonable expectation of c-spine compromise, I'd haul him off the ice and then hook him up. I'd rather not be the poor SOB who finds out the hard way that we should've moved him.
> 
> The extra few seconds is DEFINITELY worth the assurance that you have ONLY one patient, not 3 or 4.



C-spine was not an issue. The player just fell for "no reason" and collapsed on the ice. Remained unresponsive.


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## Mountain Res-Q

I would follow the accepted guidelines from AHA.  While it is true that water conducts electricity, remember that we use two pads because the electricity will travel between the two pads.  It is not as if we are throwing a live wire at them and it might hit the puddle of standing water.  So, you expose the chest, quickly wipe the chest of moisture, and shock ASAP!  Since CPR is one of those basic skills that you all should have down pat I would recommend rereading the 2005 guidelines from AHA, which includes:

_Water is a good conductor of electricity. Do not use an AED in the water. If the victim is in water, pull the victim out of the water. If the victim’s chest is covered with water, water may conduct the electricity across the skin of the victim’s chest. This prevents the delivery of an adequate shock dose to the heart.

If water covers the victim’s chest, quickly wipe the chest before attaching the electrodes. You do not have to completely dry the chest — just quickly wipe. *If the victim is lying on snow or in a small puddle, you may use the AED*. _

As far as that back boarding idea goes…  Beyond the fact that back boarding is an overused and often unnecessary skill, unless there is a specific glaring indication for the boarding, I will not waste time (remember that death outweighs all other medical conditions in severity).  However, if time and manpower exists (and it does not take time away from resuscitation efforts) I might slip a board underneath in order to have a more stable platform and for ease of movement.

But, I will not waste time with moving the patient from the ice or in back boarding.  TIME IS HEART!!!  Shock Him.


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## JPINFV

CAOX3 said:


> There is some scientific studies that have been *conducted *with some *positive *results with the use of AED in standing water.



That's kinda of shocking. Ohm... I guess water doesn't decrease resistance that much to be a safety hazard.


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## JPINFV

I think we need to specify the difference between cervical spine precautions and backboarding when it comes to arrests. Placing the patient on a long spine board allows easier movement both at the facility and from the ground to the gurney if transport is required. Additionally, it will provide a more stable surface for compressions since there the compression is transmitted through more of the mattress (less force lost to compressing the mattress). Additionally, cervical spine precautions can help prevent ET tube dislodgement. Thus, depending on the totality of the circumstances, a back board can be used as a movement adjunct, even without the full c-spine precaution gear (i.e. C/C and head beds). Additionally, since it is being used as an adjunct to facilitate movement, if it needs to be discontinued, there shouldn't be the problem of removing a patient from c-spine precaution because the patient was never in c-spine precaution.


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## trevor1189

Consider collapse (fall) from standing height and the amount of protective gear a hockey players wears, I would the odds of spinal compromise is slim. Emergency drag off the ice.


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## Aidey

robbaN28 said:


> Depends on the rink. This rink had a pretty unusual high temperature in it. So the water freezes slowly. Takes about 5-15 minutes for it to freeze completely.



Then what the heck were they doing on the ice? Going out before it's frozen ruins it....they may as well have not zamed it. 

zap him there, early defib. It is going to take a few mins to get him off the ice. You can't really just pick him up and drag him, it will be too slick for the rescuers.


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## robbaN28

Aidey said:


> Then what the heck were they doing on the ice? Going out before it's frozen ruins it....they may as well have not zamed it.
> 
> zap him there, early defib. It is going to take a few mins to get him off the ice. You can't really just pick him up and drag him, it will be too slick for the rescuers.



Okay, okay, haha. I realized that I didn't explained this fully through.
There are ice rinks with different temperature heating above the ice. This rink it's extremely hot for being a rink. It's still playable to be on the ice after the Zamboni has been on the ice. Also, they tend to dump a lot of water on the rink while Zamming, since they did have an incident when the ice was too thin a couple years ago.


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## joeshmoe

Where are our canadians at...how come they arent chiming in?


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## emt_irl

id just wipe the chest and shock.. unless the water is like more then an inch high around me

also if you remember abc or even acbc airway still comes before c spine


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## viccitylifeguard

joeshmoe said:


> Where are our canadians at...how come they arent chiming in?



ok since im canadian  ill chime in  i have used  an aed on a pool deck and on an ice rink  no ill effects  the only thing we were told is make sure you are  not in a large pool of water  when  using it . i agree with trying to do cpr on ice  it is not comfortable  but  with the equiptment we had(no equiptment)  leaving the patient on the ice was the right thing to do at the time.


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## Cprior

I play hockey all the time. I ve been to ice arenas where the conditions are terrible. Trust me..standing water on the ice can/does exist. Clear C-spine and get your patient off the ice. Additionally, this makes getting the patient to the ambulance when the responding crew shows up a lot easier.


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## Mountain Res-Q

Cprior said:


> I play hockey all the time. I ve been to ice arenas where the conditions are terrible. Trust me..standing water on the ice can/does exist. Clear C-spine and get your patient off the ice. Additionally, this makes getting the patient to the ambulance when the responding crew shows up a lot easier.



2 Questions:

How do you plan on "clearing c-spine" on on unconscious patient?

Why would you want to waste the time worrying about the slim chance of a c-spine injury, when the patient is at that moment CLINICALLY DEAD?  Why are we worring about c-spine and transport when there is a higher priority glaring you in the face... namely NO BREATHING and NO BEATING?


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## lightsandsirens5

Yea, forget full spinal precautions. Just pump and blow.^_^ I mean if there are definate c-spine injury MOIs, the yes, be careful, don't drag him aroung by his head. But really, a secure c-spine on a dead patient does not always look good for you.h34r:


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## robbaN28

Another question about this topic.

Would you cut his chest protector and jersey off?


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## Mountain Res-Q

robbaN28 said:


> Another question about this topic.
> 
> Would you cut his chest protector and jersey off?



Ummm... how would you do compressions otherwise... or attatch the AED pads... or visualize the chest (checking for medication patches, signs of surgery, internal pacemaker or defibrillator)?


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## robbaN28

Mountain Res-Q said:


> Ummm... how would you do compressions otherwise... or attatch the AED pads... or visualize the chest (checking for medication patches, signs of surgery, internal pacemaker or defibrillator)?



True, I wasn't thinking about that. I played with a goalie today who has a pacemaker, so it was interesting to talk to him about that.


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## ah2388

100% cut that stuff off, shock him where you sit....and get enough people to move him quickly off the ice and continue compressions


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## Shishkabob

Ice is not a great conductor.


And just a bit of trivia... pure water and pure ice, with no impurities, does not conduct electricity at all.


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## JPINFV

Yes, but how many ice rinks are using distilled or deionized water?


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## Aidey

ah2388 said:


> and get enough people to move him quickly off the ice and continue compressions



Don't have the people come and help you. Have them run and get every loose rug in the place and throw em down for traction.


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## johnrsemt

loose rugs,  jackets; shirts, and jersies   all make for better traction


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## rescue99

johnrsemt said:


> loose rugs,  jackets; shirts, and jersies   all make for better traction



None of you are from Michigan, eh? Arrest works the same on ice as it does on dirt...push and blow, quick board the guy and go. If ya do fall, get up and don't do it again. Boots do fairly well on ice....


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## xxdavis06xx

Solid ice does not conduct electricity because the ions are not free to move around. If there was no water then using the A.E.D. wouldn't be a problem. Depending on the amount and kind of shoes it could be possible to use it and then possible move the patient. And you could always put the patient on a backboard...


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## MediMike

I was a transmission lineman for a couple years, and headed up our safety program.  We did helicopter work, so they'd drop us off on the towers we'd do our work they'd pick us up etc. etc., anyways concerns were raised about an arrest up on a steel tower and the feasability of using an AED on the steel surfaces.

Anyways, I contacted Philips (manufacturers of our AEDs) and they sent us a detailed study they'd conducted regarding the use of AEDs in standing water, ice, steel, and a swimming pool. Their study showed no danger to the rescuers when using the AED.  

As was stated earlier in this thread, the current is designed to travel from one pad to the other, as long as the chest is dry there should be no issued regarding conductance. 

Now all that aside, I've seen a rescue done in a rink before...get him off the ice


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