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The Essential Athletic Trainer’s Guide to AEDs

Sudden Cardiac Arrest

Sudden Cardiac Arrest (SCA) refers to a condition in which the heart stops pumping blood abruptly due to a disruption in the heart’s electrical rhythm. Without a proper heartbeat, SCA disables the flow of blood to vital organs, including the brain, and causes death within minutes. 

SCA is not a Heart Attack 

Contrary to popular belief, SCA and a heart attack are not the same. While SCA occurs due to a disruption in electrical signals of the heart, heart attacks are caused by blockage of an artery which prevents the heart from receiving essential nutrients and oxygen required to keep beating. The survivability of these conditions is also disparate, with SCA being much more life-threatening. Heart attacks can cause SCA, but SCA does not cause a heart attack. 

Society commonly equates heart attacks with an unhealthy lifestyle – such as a poor diet, obesity, and smoking. Noting the difference between SCA and a heart attack is critical. SCA impacts victims of all ages, races, and genders, including those who are entirely healthy and have expressed no prior signs or symptoms.

Unfortunately, if the general public thinks all heart problems are the same, or that only those with unhealthy lifestyles are susceptible to problems, SCA may get lost in the noise and not be properly identified. 

By the Numbers

According to the latest statistics from the American Heart Association (AHA), 356,461 cases of non-traumatic, out-of-hospital SCA occurred in 2018, with over 90% of the victims succumbing to death. In the United States, sudden cardiac death is listed as the cause of death in 13.5% of death certificates.[2] 

The best chance someone has of surviving cardiac arrest is by receiving a timely and effective shock from an automated external defibrillator (AEDto get their heart pumping again. The sooner the heart starts pumping by itself, the more likely the patient is to survive and have a positive long-term outcome. 

Characteristics of and Outcomes for OHCA

Adults

Sudden Death & Children

Why Kids Go Into SCA?

 The underlying causes of SCA in children can be complex and multifactorial, but SCA usually results from a primary cardiac cause. Generally, something is wrong with the heart rather than another system or organ causing SCA as a secondary result. 

The underlying reason for SCA in children can be broadly grouped into two categories: electrical problems, where there is an abnormality of the conduction system that makes the heart beatSuch abnormalities include, but are not limited to, Long QT and Brugada Syndrome. Then there are structural problems, like Hypertrophic Cardiomyopathy (HCM) and others, that affect the shape or structure of the heart. 

While the incidence of SCA in children is much lower than in adults, 7,037 of the EMS-assessed SCAs in 2018 occurred in children with over 6,000 dying as a result. SCA in children typically has a hereditary link, with a two-fold increase in likelihood of getting the condition if a family member has it.[3]

Leading Cause of Death Amongst Athletes

SCA is the leading cause of death among young athletes. The incidence of SCA, although hard to pinpoint accurately, is estimated to be 2.5 times higher among athletes than non-athletes of a similar age. 

The US Sudden Death in Youth Athletes Registry estimates that SCA kills over 100 athletes in the US every year, a rate of 1 case every three days.[4] There is also a notable susceptibility among male athletes and black athletes. 

Sudden Death in Athletes: Causes of Sudden Cardiac Death

A. Sudden death in overall population (n=357)
B. Sudden Death <18 Years
(n = 79)
C. Sudden Death 18-35 Years
(n = 179)
D. Sudden Death > 35 Years
(n = 99)
A comparison of athlete and recruit deaths across the MSHSL, the NCAA, and the military.

 

Why are Athletes More Susceptible to SCA?

Among age-matched cohorts, athletes are disproportionately affected by SCA.

SCA in athletes is associated with underlying structural heart anomalies, which is then exacerbated because of vigorous exercise. In athletes with these underlying heart diseases, vigorous exercise causes ventricular arrhythmias. 

The AHA associated the following conditions with SCA in youth athletes 

  • Hypertrophic cardiomyopathy (36%)
  • Coronary artery abnormalities (19%)
  • Myocarditis (7%)
  • Arrhythmogenic right ventricular cardiomyopathy (5%)
  • Coronary artery disease (4%)
  • Commotio cordis (3%)

Therapy

The chances of surviving a SCA are highly dependent on the immediacy of intervention. The survival rate drops 7-10% for every minute that the victim waits for defibrillation.[5] The sequence of actions needed to successfully manage an out-of-hospital cardiac arrest are well documented, and training is easy to access. 

 

 

CPR and the Role of an AED

In an athletic setting, if there is an unexpected, non-traumatic collapse, assume the athlete has suffered Sudden Cardiac Arrest and respond by calling 911, performing CPR, and using an AED. If someone is unresponsive and not breathing normally, also respond by calling 911, performing CPR, and using an AED.  CPR chest compressions are essential in maintaining blood supply to the organs, drastically increasing the patient’s chances of life after cardiac arrest. While delivering good quality chest compressions can buy the victim time, using an AED is the only way to restart the heart of someone experiencing Sudden Cardiac Arrest. 

The best chance someone has of surviving cardiac arrest is by receiving an effective shock from a defibrillator to get the heart pumping by itself. The sooner the heart starts pumping by itself, the more likely the patient is to survive. 

A delay in defibrillating a “shockable” heart rhythm can mean death, or significant damage to the brain and other organs. These tragic outcomes could be avoided if an AED is nearby, no more than a 2-minute roundtrip away from the victim.  For sports facilities with multiple venues, having mobile AEDs or AEDs distributed throughout the campus helps ensure that cardiac arrest victims are nearby a lifesaving device.  

To improve survival rates, many athletic communities and schools have sought to make CPR and AEDs more accessible through training and proper equipping of sports venues. In institutions where there is an AED policy, survival rates tend to rise as much as 70% with proper implementation of CPR and defibrillation.[6]

“AEDs are a must have piece of equipment for any AT to have at all events. They’re an investment that has to be made.”

– Tara Grubbs Head Athletic Trainer at Pearce High School, Richardson, Texas

Preventative Approaches

EKG Screening Programs

There are several possible reasons for SCA, and some of them can’t be easily anticipated. Some risk factors, however, can be identified with simple non-invasive cardiac imaging called an echocardiogram (a cardiac ultrasound) and an electrocardiogram (EKG). 

Some groups are campaigning for these types of tests to be included in routine child health checks, or for screening programs in schools to identify children and athletes at risk of SCA and other conditions. 

The Role of an Athletic Trainer

Given their skill set, background, training, and proximity to those in need, athletic trainers (AT) are commonly the first to provide aid to SCA victims. 

ATs are highlyqualified, multi-skilled health care professionals who collaborate with physicians to provide preventative services, emergency care, clinical diagnosis, therapeutic intervention, and rehabilitation.[7]

It’s important that ATs are not just trained in CPR, but that they are also equipped with an AED.

“While we’re seeing more AEDs at road games, we call ahead to make sure that they have one. If they don’t have one or if we’re not sure, we bring ours.”

– Tara Grubbs Head Athletic Trainer at Pearce High School, Richardson, Texas

AED Requirements for Athletic Trainers

Given the diversity of environments that ATs encounter and the transitory nature of their profession, ATs need AEDs that meet their unique needs.  

 

  • AED Portability: AED Portability: ATs are often on the move! They treat athletes in the rehab facility, provide care out on the field during games, and travel to other schools for competitions. Given that ATs already carry a large bag of gear, the size and weight of the AED are important. If their AED is too heavy or bulky, it runs the risk of being left behind.

“For Athletic Trainers, portability is vital. We’re always carrying so much gear; it’s another piece of equipment that we have to lug around. It’d be nice if they were smaller and lighter so that we could keep them in our normal bags.”

– Robbie Bowers Head Athletic Trainer at Rancho Bernardo High School, San Diego, California
  • AED Durability: ATs are required to observe many athletes and travel quickly to-and-from one location to the next. To make sure they are where they’re needed the most, ATs must grab their gear and go! This means that AED units get tossed in gear bags, in vehicles, or backpacks. Fragile AEDs are likely to break, and, if ATs have to worry about the durability of their AED, the AED runs the risk of being left behind for fear of being broken 
  • Maintenance: All AED units need to be maintained and checked regularly to ensure that they’re in proper working order. The easier the unit is to maintain, the more likely it’ll be ready in the case of an emergency. Connectivity helps simplify and streamline AED maintenance 
  • Total Cost of OwnershipIt’s hard to find an AT who doesn’t face budgetary pressure. The lower the initial cost of the AED and the future costs they’ll incur to replace items like pads and batteries, the more AED units ATs can acquire, allowing for broad placement in the areas where these lifesaving devices are needed the most.

What is the best AED for schools?

Read our guide on how to choose the best AED for your school and how to build a successful school AED Program!

Case Study #1: It’s Not Just About Protecting the Athletes

Robbie Bowers

Head Athletic Trainer at Rancho Bernardo High School

Location: San Diego, California
Enrollment: 2,300
Number of AEDs: 3

AED Crusader

Robbie Bowers wasn’t handed an automated external defibrillator (AED) program from his school board. He wasn’t asked to buy a lifesaving unit and make it available during his school’s events –actually, quite the opposite. Mr. Bowers built the Rancho San Bernardo High School AED program from the ground up when AED units were rare, typically only seen at airports.  

At the time, his school board didn’t think AEDs were needed, and, worse, they felt that they posed a new liability. With the support of the principal, Mr. Bowers brought his personal AED to campus and made it available during events. 

“During some of our events, we can have 8,000 people in one location – we’re essentially a small city.”

– Robbie Bowers Head Athletic Trainer at Rancho Bernardo High School, San Diego, California

Advocacy Leads to Life-Saving Action

Sudden Cardiac Arrest doesn’t just happen to the athletes,” Bowers shares, “it’s spectators, referees, and the athletes.” Two-and-a-half years ago, long since winning the fight for AED deployment and developing a robust AED program at his school, a well-known spectator collapsed in the stands. Bowers and his team were ready to respond. 

“We had practiced our Emergency Response Plan one week prior for a wrestling event and again that day. I don’t remember exactly why, but my wife said something, and I whipped off my jacket and headed for the stands,” he shares. “I knew the victim. He was in agonal breathing and cyanotic, and so I began performing CPR. I turned, and before I could call for the AED, my college intern was running into the stands toward me with the AED! I didn’t need to holler for it since it was already on the way.” 

By the time the ambulance arrived, Mr. Bowers had delivered one shock and “thirty-seconds into my next round of CPR, after the shock was delivered, he started to regain signs of life, and was breathing on his own,” shares Bowers. The two – victim and his rescuer – were communicating when the ambulance arrived, 11 minutes after collapse.

Case Study #2: Portable AEDs Save More Lives

Tara Grubbs

Head Athletic Trainer at Pearce High School

Location: Richardson, Texas
Enrollment: 2,300
Number of AEDs: 5

General AED Info:

  • High School has had AEDs for over 12 years. 
  • The program has expanded since it started, and older models have been replaced over time. 
  • AEDs are spread across the campus. A mobile AED is placed in a golf cart, and ATs bring one to all outdoor events. 
  • The school nurse oversees the campus program; department owners perform day-to-day maintenance. 

What makes Athletic Trainer AED ownership unique?

  • They’re very mobile. “We carry them to all events, including out to the soccer and baseball fields.” 
  • AEDs have to be durable. “We have ours in a backpack. We toss it in the back of the golf cart and go! It has to be ready for the elements, like the rain, because we take it everywhere.”

“The stadium was so quiet. When the unit arrived, I applied the pads and began CPR. After calling for the AED, a few parents from the stands, a police officer and a doctor, ran out to help. I performed rescue breaths while they performed CPR.”

– Tara Grubbs Head Athletic Trainer at Pearce High School, Richardson, Texas

Tips:

  • Maintain your AED. “Not only do you need an AED, you need to maintain your AED.” Check the battery, readiness status, and expiration date of the electrode pads. 
  • Call ahead to see if the game venue has an AED. “While we’re seeing more AEDs at road games, we call ahead to make sure that they have one. If they don’t have one or if we’re not sure, we bring ours.” 

Why AEDs are necessary

In February of 2018, while working at a soccer game, Tara sprang into action, saving the life of an opposing player. 

“The game was really close and there were only about two minutes left,” says Tara, “and a player on the other team collapsed. At first, we all thought he did it to slow the game, so our response was ‘get up.’ Then, when we ran out to see him, we thought that he had had a concussion, but the players near him said that he didn’t knock into anyone, he just fell. I looked at him and his eyes were open, but he wasn’t responsive. Then, he started taking these big gasps and I knew something bigger was wrong with him.” Tara’s CPR training kicked in, recognizing that these gasps weren’t “real breathing,” and she sent a player to grab the AED from her mobile golf cart. 

“The stadium was so quiet, you could hear a pin drop. When the unit arrived, I applied the pads and began CPR. After calling for the AED, a few parents from the stands, a police officer and a doctor, ran out to help. I performed rescue breaths while they performed CPR.” 

After a “shock” and two minutes of CPR, the AED analyzed and delivered a second “shock” of energy. “By the second shock, I could see a difference in him and at that time the ambulance had arrived.” While Tara felt like the ordeal took an eternity, her time-to-defibrillation was only 1-2 minutes from the victim’s collapse! 

Why does rapid defibrillation save lives?

Read our guide on the importance of early defibrillation and the odds of surviving sudden cardiac arrest.

Case Study #3: Via Heart Project

Via Heart Project is a non-profit organization dedicated to saving lives in schools, communities, and organizations across the globe. Via seeks to increase the survival rate from sudden cardiac arrest by implementing comprehensive AED programs, offering CPR training, and conducing youth heart screenings. 

Via’s screening process: 

Each person who attends a free Via Heart Project heart screening follows these steps: 

  1. Complete a health history questionnaire 
  2. Measure height and weight 
  3. Take blood pressure 
  4. Medical volunteers review the health history, height/weight, and BP, ask follow-up questions, and highlight anything they want to be sure the cardiologist sees 
  5. Learn hands-only CPR and AED skills 
  6. A 12-lead EKG is recorded 
  7. Each person meets with volunteer cardiologist to review the health history and EKG 
  8. Most also receive a focused echocardiogram 

Saving Lives, One ECG at a Time! Via has…

  • Held 12 screenings at 10 different school locations where several schools are served during each event 
  • Screened 4,370 young hearts, each receiving an EKG 
  • 1700 students received a focused echocardiogram referred for follow-up care 
  • 43 students had a potentially serious issue 
  • Had over 1,714 volunteers help with their events 

Endnotes

  1. https://www.nata.org/sites/default/files/automatedexternaldefibrillators.pdf
  2. Benjamin, E., et al. (2018). Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association. Circulation, 137(12). doi: 10.1161/cir.0000000000000558
  3. Benjamin, E., et al. (2018). Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association
  4. Benjamin, E., et al. (2018). Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association
  5. American Heart Association, “Part 4: The Automated External Defibrillator: Key Link In The Chain Of Survival”, Circulation 102, no. 1 (2000): I-60-I-76, doi:10.1161/01.cir.102.suppl_1.i-60.
  6. Rothmier, J., & Drezner, J. (2009). The Role of Automated External Defibrillators in Athletics. Sports Health: A Multidisciplinary Approach, 1(1), 16-20. doi: 10.1177/1941738108326979
  7. https://www.nata.org/about/athletic-training

The National Athletic Trainers’ Association (NATA), as a leader in health care for the physically active, strongly believes that the treatment of sudden cardiac arrest is a priority. An AED program should be part of an athletic trainer’s emergency action plan. NATA strongly encourages athletic trainers, in every work setting, to have access to an AED. Athletic trainers are encouraged to make an AED part of their standard emergency equipment. In addition, in conjunction and coordination with local EMS, athletic trainers should take a primary role in implementing a comprehensive AED program within their work setting.[1]

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