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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Having the heart for sport?

One moment: a perfect shot to end a perfect season. The star player, just 16, lifted off the floor in celebration.  Teenagers triumphant, crowds cheering, the playoffs ahead and his future wide open. The next: Wes Leonard was on the gym floor, his enlarged heart failing and his life fading as paramedics struggled in vain to revive him.

Then there was Matthew Hammerdorfer, 17 and captain of his high school rugby team. During a match Saturday, he took a hit to the chest, collapsed and died.

Sudden death in an athlete inevitably stirs public concern as well as front-page headlines.   As healthcare professionals, we question what more could have been done? Parents wonder if this could happen to their child. Some may even ask whether the benefits of sport are worth the risk.

While Leonard and Hammerdorfer’s friends, family, team-mates and coaches struggle to come to terms with their untimely passing, doctors at the University of Michigan Cardiovascular Center are helping to explain what happened. Non-traumatic sudden death in young athletes is always disturbing. Fortunately, it is also extremely rare.  It most commonly occurs in males, who have estimated death rates nearly 5-fold greater than female athletes.

According to the National Center for Catastrophic Sports Injury Research, the incidence of non-traumatic sudden seath in athletes is as follows: 

Population group                                                            Age                                                              Incidence

High school/college athletes                                           13-23                                                    7:1,000,000 per year (male)

U.S. Air Force recruits                                                       17 -28 years                                       1:735,000 per year

Rhode Island joggers                                                          <30 years                                            1:280,000 per year

Rhode Island joggers                                                            30 -65 years                                      1:7,620 per year

Marathon runners                                                                Mean 37 years                                   1:50,000 race finishers

Congenital cardiovascular disease is the leading cause of non-traumatic athletic death, with hypertrophic cardiomyopathy being the most common cause. Hypertrophic cardiomyopathy is a genetic disease which results in thickening of the heart muscle. It is the leading cause of sudden death in children and adults and accounts for 40% of all athletics-related deaths. While it is estimated to affect 1:500 Americans, the onset and severity varies. Although some people experience  signs and symptoms, such as shortness of breath, chest pain, dizziness, lightheadedness, fainting or palpitations, in others, such as Leonard, the first symptom may be cardiac arrest or sudden cardiac death.

In Hammerdorfer’s case, the cause of death has been attributed to a complex congenital heart defect known as Tetralogy of Fallot.

Other causes of sudden cardiac death in athletes include:

Even though  deaths in young athletes are rare, each one is one too many.  So what can be done?  Doctors are now suggesting that schools improve their pre-participation sports screening forms and refer selected children for electrocardiograms (ECG’s) and additional screening.

In the meantime SRxA’s Word on Health sends our condolences to the families of all those who have lost loved ones from sudden cardiac death.