The Essential Athletic Trainer’s Guide to AEDs

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. 

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 beat. Such 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)

A comparison of athlete and recruit deaths across the MSHSL, the NCAA, and the military.

	Deaths per 100,000 athletes
MSHSL	0.24
NCAA Division I	3.45
NCAA Division II	2.38
NCAA Division III	1.05
Military	13

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.

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.

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. 

• 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 Ownership:It’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.

Case Study

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

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.

#2: Portable AEDs Save More Lives

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! 

#3: Via Heart Project

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 a 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