Case Study: An Emergency Action Plan Report from OCSC

When a Life Hangs in the Balance – Emergency at the Club
 
By Rich Jepsen and Steve Saul

All sailing instructors and program directors are trained in the ‘what ifs’ of safety and risk in our jobs teaching kids and adults how to sail, while providing them opportunities to enjoy their new found skills.

We all know it is a question of when rather than if we will need to use that training and planning. On April 30, 2014 OCSC Sailing, a keelboat school in Berkeley, CA, had its staff training and preparation put to a heavy test when one of our staff members was struck with cardiac arrest while traveling on a 21’ Zodiac with another instructor just outside our marina.

This staff member is an OCSC instructor and has been with us for well over a decade, teaching sailing from the basics to bareboat cruising and helping to lead international flotillas of OCSC members and friends around the world.

Below in italics is a slightly edited version of the official incident report from Steve Saul, the driver of that Zodiac, the victim’s fellow instructor and the person who set the entire process of saving this individual’s life into motion.


I was working the Wednesday Night Sail event as skipper of the Mobile Support on the Zodiac. The instructor had just finished an afternoon shift at OCSC as skipper with a group of high school students. He asked if he could join me on the Zodiac as he did not want to get on the freeway during the peak commute time. We left the dock together on the Zodiac at 5:45 PM and checked off the boats in the Wednesday Night Sail as they left the marina. The instructor was animated, talkative and in good spirits as he greeted many of the charterers on the boats as they were preparing to leave. 

There were ten boats scheduled to go out that evening and all of them had left the marina by 6:30 PM except for the last two boats. They were raising their mainsails and preparing to depart the marina as I took the Zodiac just outside the seawall in order to make sure that the other departing boats all left the Berkeley Marina without incident.
 
We were about 50 yards west of the seawall and the instructor was on the port side of the Zodiac standing between the console and the pontoon holding onto a stainless steel railing. I looked to starboard to see if any boats were there and when I looked back to port, he was leaning backward on the pontoon with his arms outstretched and his head facing upward and outward. His body was bent over the pontoon and I thought he was trying to touch his hair to the water. I told him to get back in the boat, but seeing no response; I grabbed his right arm and pulled him into the Zodiac.

I could see immediately that he was unresponsive. His eyes were wide open, but completely fixed and unmoving. As soon as he was lying face up in the boat, I raced toward the south entrance of the marina. As I rounded the corner, I could see Anthony Sandberg, OCSC President, at the helm of the Tartan. I yelled to him as I passed his boat that I had a medical emergency on board and I needed an ambulance at the dock as soon as possible. Less than a minute passed between the time I saw him unresponsive and when I asked Anthony’s help in calling for medical assistance.

It took another minute or so to reach the OCSC dock where Greg Reft from Fleet Service was on the dock. I told Greg that I had a medical emergency and he asked what he could do to help. I asked him to secure the Zodiac to the dock so I could begin CPR. At the dock I checked him for a pulse and I could not detect one. I tried to see if he was breathing and it did not appear that he was breathing.  The color in his face and neck had changed from normal pink/red to ashen grey. There were no life signs I could detect as CPR began at the dock. 

While I was administering CPR, Geoff Byrne, another of our instructors went to get the AED (automatic external defibrillator). After several minutes of CPR, the color in his face and neck began to go from grey to red. Sometime during this period, he began to gasp for air intermittently (maybe once every 30 to 60 seconds). Johnny from OCSC Customer Service helped Geoff find the defibrillator and Geoff arrived at the dock with the defibrillator several minutes after we arrived at the dock. We applied the electrodes to his chest. Shannon from our landlord, Berkeley Marine Center, was now on the dock near his head and she checked that he was not swallowing his tongue. The defibrillator analyzed his heart rhythm and then provided a shock to his heart. After several minutes, the unit re-analyzed his heart rhythm and did not recommend another shock. We continued with CPR.

At some point before the paramedics arrived, someone recommended a dose of ground up aspirin.  Shannon poured the aspirin behind his tongue. 

Once the paramedics arrived (I think it was about 10 minutes from the time we called them) they pulled him from the Zodiac onto the dock and began assisting him professionally. They provided an automatic heart pump externally to his chest, an IV, checked for pulse and respiration, etc. They asked how long he had been unconscious before he started breathing again. I estimated that it was somewhere between two and five minutes. Michelle Yim, another OCSC staffer, contacted the instructor’s wife on cell phone to let her know what had happened and to which hospital he was being taken in the ambulance.

Once he was in the ambulance, one of the paramedics said that he was now breathing independently and had a pulse which he considered to be a good result under the circumstances.

The instructor was transported to the hospital where he began a fortnight long recovery.  Soon after he was admitted, his doctor described his survival as unusual; that sort of cardiac arrest is seldom survivable. In fact, according to The Sudden Cardiac Arrest Foundation, of the 424,000 people who experience sudden cardiac arrest each year, 9 out of 10 victims die. For each minute after the arrest that the victim does not receive CPR their survival rate decreases by 10%. The doctor said only with the staff doing everything right and a little luck was he able to survive.

The instructor hopes to make a full recovery and is very thankful for the speedy and professional response by the OCSC staff and the many people that were praying for him. He expects to start Cardiac Rehab in mid June to complete by late August and is looking forward to getting back on the water.

Where luck played a part in survival
His leg caught in the console frame so he didn’t go overboard when he had his cardiac arrest. With him in the water, unconscious and separated from the boat, the outlook would have been dimmer. One of our staff happened to be in the parking lot and redirected the firemen from the launch ramp next door to our facility which is one driveway further to go. That saved crucial seconds.

While the room housing the AED was open for Wednesday Night Sailing this evening, if it had been locked precious seconds would have been lost if there wasn’t immediately available a staff member with a key.

Lessons learned
We learned that two more AEDs are called for and to be placed strategically. Because of our location at the end of a road, it is predictable that if we have emergency responders come to OCSC again, they might get confused with the right driveway to choose. We’ll post someone at the street in the future to ensure they find us as quickly as possible.

What went as planned
Just two months ago, our staff, including Steve and the instructor, had just gone through their required CPR/FA renewal training. Fresh reminders on proper CPR techniques are critical.  Also, our routine of holding this training at the club, after work, for the convenience of our staff and subsidizing the course fees improves attendance and sends the message that we are serious about CPR/FA training.

Lifejackets, lifejackets, lifejackets. If he had gone overboard, his auto-inflate lifejacket would have righted him and kept his airway reasonably clear even though he was unconscious.

We provide a support boat for our biggest event of the week, Wednesday Night Sailing, where we have numerous boats going out for a short two hours after work in the breeziest conditions of the day. That support boat has helped several boats with breakdowns, or skipper mistakes to prevent injuries or damage.

What you can do
Ensure that you have enough AEDs and they are in the right place/accessible. Ensure that use of and location of those AEDs is included in your CPR/FA training. Ensure that you pro-actively handle any ‘increased risk’ points, like large events or difficult weather periods, by adding staff and equipment ‘just in case’.  

Do the heavy lifting to make CPR/FA recertification easy for your staff and volunteers. Make the sessions social magnets. Staff members enjoy spending time with each other in a group activity outside of work. Organizing these courses at your facility also makes it easier to prod/remind your staff of their responsibility to keep their skills and certifications current.

Emergency Action Plans, (EAP) shared with staff, can be both galvanizing and reassuring in the panicked early moments of a crisis like this. Have discussions about ‘what if’ scenarios to help inform your plan and to get your staff engaged in the process. If your program has yet to create an EAP, US Sailing can help you with templates from Gowrie Insurance Group.

Investing in your emergency preparations can pay big dividends. Just ask the instructor and his family.

Epilogue
I don’t wish this sort of experience on anyone or any program, but I am so grateful that we had the tools in place and, more, that the staff reacted so quickly and professionally. Hopefully our experience will inspire you to give your organization a quick check up. Even if nothing ever happens, everyone will be more confident and prepared whether running races or teaching sailing.