How Much Caution Is Too Much?

Anthony Troupe, Jr., 13, collapsed in the third week of August on a St. Louis high school football field while running laps before football practice. Unfortunately, this story does not have a happy ending. Inspite of heroic CPR attempts, Anthony died of a sudden cardiac event related to a previously undiagnosed heart problem. He had passed his mandatory sports physical shortly before, but that physical did not include any sort of EKG heart testing. In Anthony’s case, there was a family history of heart disease evidenced by his father’s sudden death at the age of 45 after working a night shift in April, 2007.

Could Anthony’s life have been saved if a EKG test was a requirement prior to playing prep sports? There are an estimated 7 million high school athletes in the United States; should every one be tested for subtle heart defects that could potentially cause cardiac arrest during strenuous sports? In Italy, there is a national screening program that is credited with lowering the incidence of sudden cardiac death among young athletes. Can such a program be attempted in the much bigger United States with the same results? Should it?

Perhaps the answer does not lie in an all or nothing approach. Bruce Whitehead, the executive director of the National Interscholastic Athletic Administrators Association of middle and high school athletic directors, believes that such tests are indicated when a student athlete’s background indicates the presence of heart disease. This middle ground would no doubt catch undiagnosed heart conditions in a number of cases, but there will still be some victims with no known risk factors. Perhaps the parents of all student athletes should be given the information and the statistics and make their own informed decisions about whether to test or not. An unnecessary EKG would be far better than living with the pain of losing your child the way Anthony’s mother lost him.

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Healthy Schools: Wellness and AED units

Many column inches in the daily newspapers have been devoted lately to increasing the nutritional value of the food offerings in our public schools. Like it or not, nearly all of America’s students eligible for free or reduced school lunch programs now eat both breakfast and lunch at school. Effectively, the American taxpayer is responsible for two thirds of the students’ daily nutrition. This is a significant charge for all of us and the fact that we are not doing very well by these children and young adults was recognized recently by 250 nation-wide “eat-ins.” In many areas these well organized “slow food” events did encourage people to think about the possibility of offering more local, fresh ingredients to our students on a daily basis. Certainly, wellness is a topic deserving mush more media attention. Unlike reactive solutions like prescription drugs, emergency treatment options, and health insurance overhauls, or preventative techniques like health screenings, cholesterol testing, or colonoscopies, wellness is a solution to train individuals to make positive, transformative, life-altering decisions – forever.

But what of a more pressing and immediate health issue; that of sudden cardiac arrest, an interruption in the normal heart rhythm, taking the lives of 7,000 to 10,000 school children each year. What about an organized “heart-in” in which cardiac screenings, CPR training, and AED Defibrillator instruction would be available for all student athletes? Of course a healthy diet is desirable, but a healthy heart is much more immediately necessary for any student engaging in vigorous physical activity.

Why limit CPR and AED training to the adults in charge of youth sports? The students themselves are much more likely to work out with peers on and off the field, thus far more likely to be closer to a victim in a sudden cardiac emergency than is the coach or referee or even the paramedic assigned to the event, if there is one.

Preparedness could easily be as much a part of sports training as are the ubiquitous push ups and crunches. The audience is already there and willing to be instructed. Because of the nature of the leisure time activities in which this age group engages, the idea of using an AED device is a natural and not to be feared. There exists a huge untapped resource of potential life savers today in our own schools. Train them to save lives today and continue to work toward providing them healthy nutrition in the longer run.

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Individuals are the Numerator with SCA Saves

Anne Kelly’s piece, Odds of Surviving Cardiac Arrest Unchanged (KFYR-TV 12/9/09), accentuates disturbing and, perhaps, counter-productive figures related to out-of-hospital cardiac arrest. Kelly cites national Sudden Cardiac Arrest survival rates and stubborn statistical data that industry insiders see time and time again – Out-of-hospital survival rates are less than 5%, according to the American Heart Association (AHA). Correctly, Kelly correlates this “stagnant” data to poor and/or inadequate training, even in the face in increased awareness and deployment of life-saving Automated External Defibrillators (AED Units).

Kelly fails to mention, however, that “minor” adjustments to a numerator in any equation wherein the denominator is large, will provide a similar quotient to that which was previously calculated. That is, since SCA kills approximately 350,000 people each year (a HUGE denominator) and only 5% are saved (17,500; a SMALL numerator, relative to the denominator) to see a one-percent adjustment in survival rates, 3,500 new lives must be saved! When stepping away from the long-division and humanizing the math, 3,500 people becomes a meaningful number of lives. For reference, UNICEF reports that child abuse leads to 3,500 child deaths each year.

For arguments sake, let us assume that we’re rounding to the hundreds place – after all, these are just numbers, right? Saving an additional 1,749 lives would result in just under a 0.5% increase to national survival rates, yielding a new quotient of …. 5%!!! (17,500 + 1,749 = 19,249 / 350,000 = 5%) Therefore, when we look at a societal problem such as SCA, far-and-away America’s greatest killer and one that is preventable in most cases (studies indicate with early defibrillation survival rates can exceed 70%), we mustn’t be concerned with national averages unless we’re also prepared to weigh the humanistic reality of the numbers – the numerator. Regularly speaking with SCA Survivors gives me strong reason to believe that they’d like to be counted as more than 0.00028% or a part of the Numerator in a division problem. So I ask, are the daily SCA saves meaningful and are AED units and wide-spread CPR training making a difference or are they irrelevant, leaving the national averages “unchanged?”

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