Sports medicine

JOHN DOHERTY: Cardiac safety legislation well-intended but not well-aimed

2013-02-11T16:30:00Z 2013-02-11T20:05:11Z JOHN DOHERTY: Cardiac safety legislation well-intended but not well-aimedBy John Doherty Times Correspondent
February 11, 2013 4:30 pm  • 

Over the last four years, the NFL and like-minded groups have had one success after another promoting youth concussion safety legislation in statehouses nationwide.

It is no wonder then that Simon's Fund, a Pennsylvania nonprofit dedicated to preventing sudden cardiac death in children, has started a similar effort. The charity's first success was in its home state, with a bill establishing standards for preventing sudden cardiac arrest and death in student athletes signed by Governor Tom Corbett in May of last year.

Last month, Simon's Fund found sponsors in Springfield and Indianapolis to introduce similar legislation.

Both bills, if passed, would require public and private schools to provide information about the symptoms of sudden cardiac death to parents, players, and coaches. So far so good.

In each bill, the symptoms are listed as: fainting, difficulty breathing, chest pains, dizziness, and an abnormal racing heart. A player with any of those symptoms is then to be removed from the game or practice and may not return until medically cleared. This section of the bill is well-intended but opens a potential Pandora's Box.

Any one of those symptoms for any reason? If the answer is yes, then unnecessary office visits and expense will be a frequent outcome.

Years ago, I read a medical journal article which advised, “Any unexplained syncope (fainting) is ominous.”

However, if there is a relatively benign explanation, is a trip to the doctor still warranted? Dizziness and/or syncope may be the result of dehydration, medication, fever, low blood sugar, or even a blow to the head. In the last case, a doctor's visit is required but for head, not heart.

Bruises and muscle strains will often cause chest pain. Difficulty breathing? A chest cold and already diagnosed asthma are common causes which don't necessarily merit medical clearance.

In the original and Illinois versions of the bill, that medical clearance must come from a “physician licensed to practice medicine in all its branches, certified nurse practitioner, or cardiologist.”

When there is good reason to suspect a cardiac condition, I wouldn't have it any other way.

In the Indiana version of the bill, though, that clearance may come from any “licensed health care provider trained in the evaluation and management of cardiac arrest.” That means chiropractors, dentists, physical therapists and occupational therapists could conceivably provide such clearance.


As for failure to comply, Indiana would specify no penalty. However, in the original and Illinois versions, non-compliant coaches are to be suspended for the remainder of the season for a first offense and permanently suspended by the third.

In effect then, Pennsylvania and, if the proposed bill passes, Illinois are demanding coaches double as athletic trainers.

A better solution than legislatively micromanaging medical conditions would be to mandate the presence of athletic trainers at schools with interscholastic athletic programs.

Ironically, another bill is being considered in the Indiana legislature which would, among other things, eliminate state regulation of the athletic training profession. Regulation of other medical professions would continue. With the recent and justified increase in concern regarding the health of student athletes across the nation, such a step by Indiana may be penny-wise but certainly pound-foolish.

John Doherty is a certified athletic trainer and licensed physical therapist. This column reflects solely his opinion. Reach him at Follow him on Twitter @JDohertyATCPT.

Copyright 2014 All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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