This document discusses sudden cardiac arrest (SCA) in athletes and recommendations for improving preparedness and management of SCA. It recommends that all coaches be certified in CPR and the use of automated external defibrillators (AEDs) given that SCA is a leading cause of death in young athletes. The document also calls for states to require coaching education programs to include certification in first aid, CPR and AED use to help coaches fulfill their ethical responsibility to be prepared to respond to medical emergencies.

1. Kimberly M. Robertello, Ph.D., ATC
Washington State University
Sharon K. Stoll, Ph.D.
University of Idaho, Center for ETHICS*
Justin Barnes, M.S.
University of Idaho, Center for ETHICS*
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2. Sudden cardiac arrest (SCA)

 Current practices – First Aid and CPR
Training Recommendations
 Ethical responsibilities
 Recommendations for action
Introduction
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3. Sudden cardiac arrest defined:

◦ The unexpected loss of heart function,
breathing and consciousness (Mayo Clinic, 2008)
SCA – usually arises from an electrical

disturbance which disrupts the pumping
action of the heart
Sudden cardiac arrest (SCA)
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4. SCA is the leading cause of death for

young athletes (Maron, 2003).
 SCA may be caused by structural cardiac
anomalies (myocarditis, Marfan’s
syndrome, valvular heart disease, etc.)
 20% of sudden cardiac death cases are
caused by a blow to the chest which
produces an arrhythmia (Drezner, Courson, Roberts, Mosesso,
Link, & Maron, 2007).
Sudden cardiac arrest
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5. SCA signs and symptoms

◦ Sudden collapse
◦ No pulse
◦ No breathing
◦ Loss of consciousness
◦ Preceding symptoms may include fatigue,
fainting, blackouts, dizziness, chest pain, or
vomiting
Sudden cardiac arrest
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6. Screening efforts

◦ “ In approximately 55-80% of cases of [sudden
cardiac death], athletes are asymptomatic until
the cardiac arrest …” (Drezner et al., 2007, p. 146).
Early activation of EMS

 Early CPR
 Early defibrillation
Preparedness and management of
SCA
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7. The single greatest factor affecting

survival after SCA is the time interval
between cardiac arrest to defibrillation.
Survival after SCA
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8. To what extent are coaches responsible

for the care of their athletes?
◦ National Standards for Sport Coaches, Domain
2, Standard 9: “Recognize injuries and provide
immediate and appropriate care.”
 Benchmark: “Implement an appropriate action
plan for emergency first aid and CPR in all
venues. (NASPE, 2006).
First Aid & CPR standards
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9. National Federation of State High School

Association (NFHS) recommends high
school coaches are certified in First Aid
and CPR
 Some have begun to require CPR/AED
training as well
◦ American Sport Education Program, in
conjunction with the American Safety and
Health Institute (ASHI) has introduced
CPR/AED for Coaches
Current standards for coaches
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10. Check the NFHS website for your state’s

requirements:
 http://www.nfhslearn.com/StatePricingRe
gs.aspx
Current standards for coaches
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11. For example, Idaho DOES NOT require

CPR or First Aid certification for coaches.
 Data from a 2004 study indicates that
from 141 public and private high schools
in the state of Idaho:
◦ 93 schools responded (66% response rate)
◦ 54.8% did not employ someone to handle
sports related injuries
◦ Only 20 respondents employed a Certified
Athletic Trainer
Idaho as an example
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12. Establishing an emergency action plan

 Ensuring public access to defibrillation
A call to action
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13. Based on:

◦ Probability of AED use within 5 years of training
◦ High-risk children or adults present at the
school
◦ EMS call to shock interval less than 5 minutes
American Heart Association
Recommendations for AED
implementation
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14. U.S. House of Representatives passed the

Josh Miller HEARTS (Helping Everyone
Access Responsive Treatment in Schools)
Act on June 9, 2008
◦ Establishes a national grant program through
the Dept of Education to fund AED installation
and training in schools
AED Legislation
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15. States requiring or supporting AED

placement in schools:
◦ Colorado (donations), Florida, Georgia (2008),
Illinois, Maryland, Michigan, Nevada, New York,
Ohio, Pennsylvania, South Carolina (2008) and
Virginia require some schools to have portable
defibrillators; actual extent varies. Tennessee
quot;encouragesquot; placement in schools (2008.)
http://www.ncsl.org/programs/health/aed

.htm - to check your state’s laws!
AED Legislation
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16. Thomas Jefferson, “The law is socialized

ethics.”
◦ This is clearly an ethical issue that should
become law.
◦ An ethical issue: any case in which harm can
be avoided, and good can be done.
◦ My personal experience – Lewiston, ID. District
boys basketball.
 Lewiston HS – certified athletic trainer on staff
◦ But was not hired for event.
 Neither coach certified in CPR
 No AED in building available.
Ethical responsibilities
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17. It is not that we think too much sport,

rather we think too little of it.
 Many states have little expectations or
requirements for coaches. All that really
is required is a heart beat.
◦ Why has this occurred?
 Coaches no longer are teachers in school.
 Less individuals willing to coach – i.e., Grant
Putnam, Bowling Alone
 Lack of respect and belief in importance of
coaching education ????
Coaching – why so little
expectation?
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18. Coaching education

◦ Online certifications
 Idaho – ASEP – online
◦ Coaching principles- 5 Principles, 1 text, online test
◦ Sport first aid -16 units, 1 text, online test
 Florida –NFHSAA – online
◦ 2 hour coaching fundamental courses
◦ 4 hour safety courses
◦ Majors available
 General search – no majors except in NZ, UK
 Minors only, tied to physical education teaching
 Master’s degrees online - WVU
◦ Master’s degrees required:
 South Carolina
Education for Coaches
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19. CPR + AED certification for all coaches!

The evidence shows …

◦ SCA survival rates can improve from 5% to 48-
74% when AED and CPR are provided within 3-
5 minutes by the first person on the scene (National
Athletic Trainers Association, 2008).
Recommendations
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20. SCA Foundation’s You Can Save a Life at

School – national awareness campaign
aimed at implementing AEDs and
advancing training for school personnel
AED implementation and support
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21. American Red Cross (www.redcross.org)

◦ CPR/AED – Adult $35 (review $22)
◦ CPR/AED – Adult, Child, and Infant $50 (review
$30)
◦ Standard First Aid with CPR/AED $45 (review
$35)
◦ Standard First Aid with CPR/AED for Adult,
Child, and Infant $65
AED classes and fees
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22. American Heart Association

(www.americanheart.org)
◦ You can search by zip code to find courses
offered in your area
AED classes and fees
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23. Coaches have an ethical responsibility to

prepare for emergency care situations
◦ CPR/AED certification
◦ Coaching certifications
Ethical issues can only be resolved if …

the principle guides the process and
people are willing to make changes in
what and how we do things – especially
coaching education.
Recommendations
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