Is Your Student Safe?

teacher-running-with-aedThe beginning of another school year means the beginning of school sports including football, soccer, cross country and swimming. All too often, school sports result in injuries to athletes and, in some cases, incidents of sudden cardiac arrest (SCA). Although SCA in athletes makes the headlines, it’s important to know that SCA can happen to anyone including a seemingly healthy child.

Sudden cardiac arrest in a young person usually stems from a structural defect in the heart or a problem with the heart’s electrical circuitry. The most frequent cause, accounting for about 40% of all cases, is hypertrophic cardiomyopathy or HCM.

HCM is a genetic heart condition that affects 1: 500 individuals, including men, women and children of all ages. HCM is characterized by a thickening of the heart muscle and can lead to sudden cardiac arrest.

sca incidenceApproximately 50% of individuals with HCM experience no symptoms, and don’t even know they have the condition, until tragically, sudden cardiac arrest occurs.  In 9:10 cases the outcome is fatal, resulting in unimaginable grief for families and fellow students.  Yet better outcomes can be achieved with early electrical stimulation of the heart – delivered by a small, fully automated, easy to use box.

Given that educational institutions house more than 20% of the American population every day, you’d think they would be fully prepared for this eventually. But sadly, they are not.

At the time of writing, only 19: 50 states in the U.S. require that at least some of their schools have automated external defibrillators [AED’s].  In some states, AEDs are required in public, but not private schools. In other states, AEDs are required in high schools, but not elementary schools. Some states require AEDs only in schools offering athletics. Only two states – Hawaii and Oregon – require AEDs in colleges.

To find out whether your state requires AEDs in schools, click here to view an interactive map.

Chain of Survival full sizeAlthough schools and colleges are ideal and obvious locations for AED deployment, concerns regarding legal liability and litigation have been perceived as a barrier to purchasing and deploying AEDs.  Fortunately this is slowly changing.  Recognition of the need to protect youth from sudden cardiac arrest is gaining momentum in many states:

In Pennsylvania, Sen. Andrew Dinniman has sponsored Senate Bill 606, Aidan’s Law, named for Aidan Silva, a seven-year-old Chester County resident who succumbed to SCA in September 2010.  Aidan had no symptoms of a heart condition prior to his death. Aidan’s Law will help ensure that every public school in Pennsylvania has an AED that is up to date and ready to use.

Rep. Connie Pillich, of Cincinnati, has introduced a bill focused on SCA in student athletes. House Bill 180 requires the Ohio Department of Health and the Ohio Department of Education to jointly develop guidelines and materials to educate students, parents and coaches about SCA. The measure bans a student from participating in a school-sponsored athletic activity until the student submits a signed form acknowledging receipt of the guidelines and materials created by the health and education departments. Individuals would not be allowed to coach a school-sponsored athletic activity unless the individual has completed, within the previous year, a sudden cardiac arrest training course approved by the health department.

John Ellsessar, whose son Michael died during an Oxford High School football game in 2010 from cardiac arrest, believes automated external defibrillators should be as readily available at school settings as fire extinguishers.

Ellsessar, is pushing for legislation to require all schools to have defibrillators, said he and his wife were horrified when they learned that at most schools that have the medical devices, but they are locked away in nurses’ offices, instead of being ready for emergencies.

CPR-AED-lgAnd in Rhode Island, high school seniors will be required to be trained in CPR and the use of a defibrillator before they can graduate. Under the legislation signed into law by Gov. Lincoln Chafee, students will receive training that includes a hands-on course in cardiopulmonary resuscitation and an overview of the use of an AED.

The National Parent Teacher Association has also adopted a resolution calling for public schools to develop emergency response plans that include summoning help, performing CPR and using automated external defibrillators to save lives. The PTA also called for ongoing CPR-AED training in schools and legislation that would fund placement of AEDs in every school, while providing immunity for people who use the lifesaving devices in good faith.

To learn more about sudden cardiac arrest and how you can help please visit http://www.sca-aware.org

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SATS & CPR

Go Gov. Beverly Perdue!  SRxA’s Word on Health applauds the North Carolina Governor who has just passed a law requiring all high school students in the state to have basic emergency-response training before they can graduate.

Although high schools have been required to teach CPR since 1997, until now this has been unenforced.

But starting with the class of 2015, the bipartisan plan requires that schools teach American Red Cross or American Heart Association curriculum for cardiopulmonary resuscitation and obstructed airway treatment.

The new law comes as great news to Tracey Stell, assistant director of education services at Durham Regional Hospital.  “It melds wonderfully into Durham County’s strategic plan to increase the rate of bystander CPR and it’s really going to help people get more immediate care, which will make a difference in survival,” Stell said. “You shouldn’t have to wait for an ambulance to arrive for CPR to start. Man, that’s a huge win.”

The new law signed on Thursday joins another aimed at saving lives: a law requiring at least one defibrillator kit in every state building in North Carolina and training for state employees to use them.

North Carolina joins four other states that have signed CPR graduation requirements into law this year: Iowa, Alabama, Tennessee and Minnesota.

By making CPR as important as ABC’s, we hope the next generation of students will be better equipped to start college life and save the lives of others.

Emergency Epinephrine Act

SRxA’s Word on Health is pleased to start the week with some good news.  Last Friday a new federal bill known as the School Access to Emergency Epinephrine Act was introduced in the Senate.  The Bill encourages schools to prevent allergy-related deaths by allowing trained, qualified staff to give an injection of epinephrine to a student suffering from a severe allergic reaction.

The tragic deaths of teenagers in Georgia and Illinois, who did not have immediate access to epinephrine, underscores the importance of immediate treatment and the passage of this legislation. One, a 13-year-old student from Albany Park, IL who had previously suffered from only minor allergies died at her school because of a severe allergic reaction.

Following this, Illinois passed a law that allowed school nurses to administer epinephrine shots to any student suffering from a severe allergic reaction. The new legislation proposed by Illinois Senators Mark Kirk and Dick Durbin would expand the law by allowing all trained and authorized school personnel — not just school nurses — to administer the shot.

U.S. Senator Mark Kirk (R-IL) said, “For the millions of children suffering from serious, potentially fatal allergies, the safe and expedient administration of epinephrine can mean the difference between life and death. Something as seemingly harmless as a bee sting during recess or a peanut butter and jelly sandwich during lunch can quickly become a tragedy.”

For about 1 in every 13 children, school lunchtime or a classmate’s school birthday party can risk exposure to foods that can cause a severe and life-threatening reaction. For these children, the consequences of exposure to the wrong food can be fatal.  However, if epinephrine is available such consequences are preventable.

The legislation would reward states that require schools to maintain a supply of epinephrine auto-injectors, such as EpiPen, and train authorized school personnel to administer an epinephrine injection if a student experiences an anaphylactic reaction. The bill also contains a provision that requires those states to have Good Samaritan laws in place to protect school employees who administer an epinephrine injector to any student believed to be experiencing anaphylaxis.

Although students with severe allergies are allowed to self-administer epinephrine if they have a serious allergic reaction, a quarter of anaphylaxis cases at schools involve young people with no previous allergy who are unlikely to carry a personal epinephrine injector.

Attorney General Lisa Madigan applauded Durbin and Kirk on their push for federal legislation. “Growing numbers of children suffer from life-threatening food allergies,” Madigan said. “In Illinois, we were able to eliminate bureaucratic barriers that previously prevented schools from acting when a child could be suffering from a severe allergic reaction but whose medical records didn’t reflect an allergy diagnosis.”

Word on Health also applauds the introduction of a law that could save children’s lives and raise awareness that in anaphylaxis every second counts. We also hope it will stimulate a wider dialog that could eventually lead to epinephrine autoinjectors becoming available in airports and on airplanes, in restaurants, sports stadiums and other public places…much as automated external defibrillators (AED’s) are today.

Heart Patients want to share their Shocking Devices

Almost everyone has seen a doctor on television, yelling “Clear!”, then applying paddles to the chest of a patient to shock him “back to life”.

As dramatic, as the scene may be, defibrillation can only be used for the deadliest forms of arrhythmias – ventricular tachycardia (V-Tach) and ventricular fibrillation (V-Fib) and not for patients who have “flat-lined” (asystole).

For those who are at high risk of V-Fib and V-Tach  an internal “shocking” device may provide the best defense against sudden cardiac arrest. Such a device, known as an implantable cardiac defibrillator (ICD), is considered effective in fighting cardiac arrest over 90% of the time.

Each year, more than 100,000 patients in the U.S. undergo implantation of an ICD. This number constitutes a 20-fold increase over the last 15 years.

Current medical guidelines advocate discussion of end of life care of these medical devices, including deactivation. Now, researchers at the University of Pennsylvania School of Medicine say that discussions should also address post-mortem donation of ICDs for product improvement or reuse overseas as pacemakers, to help reduce global health disparities.

Penn researchers conducted a phone survey of 153 ICD patients concerning advance directives and ICD handling at the end of life. The study results which were reported at the 2011 American College of Cardiology meeting in New Orleans showed that half of the patients that were questioned said they would like their ICD deactivated in an end of life illness. Most also thought that a do not resuscitate (DNR) order justified ICD deactivation.

Although 17% reported ever thinking about ICDs in an end of life illness; just two patients had actually addressed the topic in an advance directive arrangement and only 5% of the patients had ever discussed ICD deactivation directly with their doctor.

Regarding donation of ICDs for reuse or review of the device for improvement purposes, 88% said they would donate their device to facilitate product improvement, 87% would donate for reuse overseas, and 80% for reuse in animals. When asked to choose just one donation option, the majority of patients would donate their devices for reuse in patients overseas.

Shocking or sensible?  SRxA’s Word on Health would love to hear your thoughts on this.