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SPORTS MEDICINE: Being unprepared for SCA is heartless
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SPORTS MEDICINE

SPORTS MEDICINE: Being unprepared for SCA is heartless

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For its 47 years of publication, The Physician and Sportsmedicine’s motto has been, “Exercise is medicine.”

The scientific data to support such a statement are compelling. Regular exercise, as simple as a daily brisk walk of 30 minutes, has been found to lower the risk of a heart-related medical event by 50%.

Unfortunately, there is a flip side to exercise for young athletes with an undetected heart condition that is typically genetic.

According to the Sudden Cardiac Arrest (SCA) Foundation, there are in excess of 350,000 cases of SCA outside of hospitals across the United States annually, roughly one every 90 seconds, 98% of which occur to adults. However, that means there are 7,000 cases of SCA among children annually, nearly 20 per day.

Of those, roughly half experience warning signs in the days, weeks, or months prior to the potentially fatal event. For the other half, though, the first sign of trouble is actually dropping dead.

Consequently, many experts have called for a national program that would screen athletes via electrocardiogram on a periodic basis, such as is done annually in Italy for athletes between the ages of 12 and 35. The concept is endorsed by the European Society of Cardiology. However, the ESC’s counterpart in the United States, the American College of Cardiology, has not concurred.

Reasons for resistance to universal cardiac screening of athletes include a high rate of false positives and the exorbitant financial outlay required to find so relatively few afflicted athletes among the millions who participate.

Thus, high school athletes in the United States are generally mandated only to complete an annual physical that includes a questionnaire designed to catch those with symptoms and/or those with a family history of SCA at a young age. For younger American athletes, the demand for a pre-participation physical exam varies by league or team.

Regardless of the rigor of the screening program, though, there will still be cases where even an EKG will miss a potentially fatal condition and the unthinkable will occur. It could be during an informal recreational activity, or a practice or game in an organized sport. (For youngsters, the greatest dangers may be drowning or getting struck in the chest with a baseball. For teenagers, the riskiest activity for the heart is playing basketball.)

When such a tragedy strikes, ideally, an athletic trainer with an automated external defibrillator (AED) is present. Again, the statistics are compelling. A study published in 2018 in Sports Health identified 132 cases of SCA suffered among athletes age 11-27 between 2014 and 2016. Survival to discharge from a hospital was the result for 64, or 48% of the victims.

However, if an AED was present and used promptly, the survival rate increased to 89%. Furthermore, whether an AED was available or not, if an athletic trainer was in attendance the survival rate was 83%.

Two days after Christmas, a 15-year-old hockey player at University of Detroit Jesuit High School collapsed during practice but an athletic trainer was in attendance with an AED. By the time paramedics arrived, the young defenseman had been resuscitated.

On Tuesday, St. Louis Blues defenseman Jay Bouwmeester collapsed while sitting on the bench during the first period of a game against the Anaheim Ducks. Blues' general manager Doug Armstrong said he became unresponsive and medical staff used a defibrillator to revive him. Bouwmeester regained consciousness immediately, Armstong said, and is recovering.

Still, while athletic trainers are nearly universal at the high school level in the Calumet Region, youth leagues are unlikely to be able to afford or even to find an athletic trainer to attend all practices and events. In spite of those barriers to athletic training coverage, there is no excuse for a sports organization not having an AED. They are relatively inexpensive, usually less than $1,500, and often available via charitable grants.

Obtaining one is only the first step. Then, coaches and league organizers need to be trained on how to use the device because seconds count. For every minute that passes after collapse, the chance of successful resuscitation drops by 10%.

Yet, training means time, travel and expense. The typical CPR/AED course takes at least three hours and costs $30-$40 per person.

In anticipation of February being American Heart Month, the American Heart Association (AHA) last month unveiled its “CPR & First Aid in Youth Sports Training Kit,” which is designed to limit expense and time. According to the AHA, the kit “contains everything needed for a facilitator to teach the lifesaving skills of child and adult CPR, how to use an AED, and how to help during sports–related emergencies. Training 10-20 people at once in CPR and sports injury-related first aid can be completed in less than an hour.”

Including 10 manikins, 10 AED training simulators, instructional DVD, and facilitator guide, the kit costs $699. For complete information, go to www.heart.org/cprinyouthsportstoolkit. For any youth sports program without an athletic trainer, purchasing and using the kit is imperative. The training may help save a young athlete's life but is just as likely to rescue a coach, referee, or spectator.

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

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