HYPERTROPHIC CARDIOMYOPATHY AED AND HB383

Hypertrophic Cardiomyopathy AED And HB383

Sudden Youth Athlete Death can result from the onset of ventricular tachycardia or another heart arrhythmia 2° to Hypertrophic Cardiomyopathy.

The only symptoms might occur during exercise and/or at rest and include:

• Shortness of breath
• Chest pain or tightness
• Fainting or dizziness
• Heart palpitations: heart beating rapidly or irregularly
• Sudden drop in blood pressure

When athletes voluntarilly complain or answer when questioned during Sports, Recreation and Exercise (SRE) Preparticipation Physical Examination with any of the above symptoms, they must undergo screening with an Electrocardiogram and an Echocardiogram. These are essential diagnostic tests to rule in or out HCM.
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Hypertrophic Cardiomyopathy – HCM
A Common Heart Disorder
By Richard N. Fogoros, M.D.

Hypertrophic Cardiomyopathy is passed through generations as autosomal dominant and genetic testing is available to rule in or out the inherited form of HCM.

Affordable Genetic Test as www.genedx.com/hcm

What Is HCM and What Causes It?

HCM is a form of heart muscle disease in which the muscular walls of the ventricles (lower chambers of the heart) become abnormally thickened.

The thickening of the heart muscle causes the muscle itself to function abnormally. The thickening also can cause the ventricles to become distorted, which can interfere with the function of the aortic valve and the mitral valve, which regulate blood flow.

HCM is caused by a genetic abnormality that produces a disorder in the growth of the heart muscle fibers. In some families, HCM is passed on as an “autosomal dominant” trait, which means that if the gene for HCM is inherited from a single parent, the child will have the disease.

However, in almost half the patients with HCM, the genetic problem is not inherited at all, but occurs as a spontaneous mutation – in which case, parents and siblings of the patient will not be at risk for this condition (but children of the patient can be.) [It is acquired and not inherited.]

What Problems Does HCM Cause?

There are four kinds of cardiac problems caused by HCM:

1) HCM can cause diastolic dysfunction. “Diastolic dysfunction” refers to the fact that thickened ventricles become stiff, making it more difficult for the ventricles to fill with blood. This stiffness causes the blood to “back up” into the lungs, causing shortness of breath – usually with exertion. The diastolic dysfunction also makes it more difficult for patients with HCM to have arrhythmias, especially atrial fibrillation.

2) HCM can cause systolic dysfunction. “Systolic dysfunction” means that the heart’s pumping action is not normal – that is, when the heart beats, an insufficient volume of blood is ejected. In HCM, systolic dysfunction is usually caused by abnormal functioning of the mitral or aortic valves, which, in turn, is caused by distortion of the ventricles resulting from the abnormal thickening of muscle.
[An abnormally low ejection fraction.]

3) HCM can cause dilated cardiomyopathy. This condition leads to heart failure, and is caused by an eventual “burning out” of the thickened heart muscle. Dilated cardiomyopathy occurs late in the course of the disease.

4) Finally, HCM can cause sudden death. The sudden death in HCM is usually due to ventricular tachycardia or ventricular fibrillation – severe heart flutters. While many of these sudden deaths occur during vigorous exertion, it can also occur during minimal exertion or at rest, with no warning whatsoever. The risk of sudden death has been estimated being as high as 5% per year in patients in their teens and 20s, though it drops off somewhat after that.

How Is HCM Diagnosed?

In general, the echocardiogram is the best method of diagnosing HCM. The echocardiogram allows accurate measurement of the thickness of the ventricular walls, and can detect abnormal heart valve function as well. The electrocardiogram (ECG) also can give important clues as to the presence of HCM.

Both an ECG and echocardiogram should be performed in close relatives of a patient diagnosed with HCM, and an echocardiogram should be performed in any person in whom the ECG or the physical examination suggests ventricular hypertrophy.
How Is HCM Treated?

HCM cannot be cured, but it can be managed. Beta blockers and calcium blockers can help reduce the “stiffness” in the thickened heart muscle. In some patients – especially those who have significant heart valve dysfunction – surgery to remove portions of the thickened heart muscle is necessary. Atrial fibrillation, if it occurs, often causes severe symptoms and needs to be managed more aggressively in patients with HCM than in the general population.

How Can Sudden Death Be Prevented?

Sudden death in HCM is often seen in younger patients – often before symptoms have occurred, or even before a diagnosis has been made. While sudden death is always a devastating problem, it is particularly so when it occurs in young people.

Many methods have been tried for reducing the risk of sudden death in patients with HCM – including avoiding exercise, using beta blockers and calcium blockers, and using antiarrhythmic drugs – these methods unfortunately met with mixed results. In recent years it has become apparent that in patients whose risk of sudden death appears high, an implantable defibrillator should be used. The implantable defibrillator is a pacemaker-like device that is implanted under the skin, monitors the heart rhythm continuously, and automatically delivers a shock to the heart to restore a normal rhythm should a dangerous ventricular arrhythmia occur. While it sometimes seems a drastic step, it is much less drastic than allowing a young individual to die suddenly.

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Prevention of Sudden Cardiac Death (SCD)

“Being diagnosed with a disease that can cause sudden cardiac death is NOT a death sentence. If an individual is predisposed to SCD, then it is actually good to have a diagnosis so that appropriate therapy can be initiated. Unfortunately, many people do not know they are at increased risk for SCD and thus do not have the treatments in place that can prolong their lives indefinitely. The information below lists some of the common measures used to prevent SCD. It is by no means complete, and anyone who is at risk for SCD, should see a physician for optimal care of their particular risk factor.”

Implantable cardioverter-defibrillator (ICD)

Automated external defibrillator (AED)

Radiofrequency Ablation (RFA)

Anti-Arrhythmic Medications

Lifestyle Modification [Prevention of Sudden Cardiac Death, Johns Hopkins Pathology Home]

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[Please see the complete article about the following report:  [Rothmier JD, Drezner JA. The Role of Automated External Defibrillators in Athletics. Sports Health. 2009;1(1):16-20. doi:10.1177/1941738108326979.]

“>> Sudden cardiac arrest is the leading cause of death in young athletes. The purpose of this review is to summarize the role of automated external defibrillators and emergency planning for sudden cardiac arrest in the athletic setting.

Early defibrillation programs involving access to automated external defibrillators by targeted local responders have demonstrated a survival benefit for sudden cardiac arrest in many public and athletic settings.

Conclusion: Schools and organizations sponsoring athletic programs should implement automated external defibrillators as part of a comprehensive emergency action plan for sudden cardiac arrest. In a collapsed and unresponsive athlete, sudden cardiac arrest should be suspected and an automated external defibrillator applied as soon as possible, as decreasing the time interval to defibrillation is the most important priority to improve survival in sudden cardiac arrest.

Sudden cardiac arrest (SCA) is the most common cause of death in the United States resulting in more than 300 000 deaths annually.32 Sudden cardiac arrest is also the leading cause of sudden death in young athletes20,35 accounting for approximately 75% of all cases.21 The death of an athlete is a catastrophic event that has devastating effects on a family, teammates,

school/university, and the local community. Athletes are regarded as the healthiest members of society, and their sudden death during practice or competition often sparks debate regarding the adequacy of emergency planning for athletic events.

The placement of automated external defibrillators (AEDs) in public locations has provided a means for early defibrillation for out-of-hospital SCA. Public-access defibrillation in locations such as casinos, airports, and universities has shown a clear survival benefit achieving survival rates of 41% to 74% if bystander cardiopulmonary resuscitation (CPR) is provided and defibrillation occurs within 3 to 5 minutes of arrest.§ This large-scale success has led many schools, universities, and sporting organizations to accelerate implementation of AEDs at athletic venues in an attempt to prevent sudden cardiac death (SCD) in both athletes and nonathletes attending athletic events.

Sudden cardiac death in athletes is usually related to an underlying structural cardiac abnormality. Hypertrophic cardiomyopathy and coronary artery anomalies are the most common causes of SCD in young athletes in the United States, representing 25% and 14%, respectively.20 Commotio cordis, involving a ventricular arrhythmia caused by a blunt,

nonpenetrating chest wall blow in a structurally normal heart, accounts for an additional 20% of SCD in young athletes.20 The remaining causes of SCD in athletes are a variety of structural and electrical abnormalities of the heart such as myocarditis, arrythmogenic right ventricular cardiomyopathy, Marfan syndrome, valvular heart disease, dilated cardiomyopathy, atherosclerotic coronary artery disease, and ion channel disorders such as long QT syndrome, familial catecholaminergic polymorphic ventricular tachycardia, and Brugada syndrome.6,20 In approximately 2% of cases, postmortem examination fails to identify a cause of death.14,20 These cases of so-called autopsy-negative sudden unexplained death likely represent inherited arrhythmia syndromes and ion channel disorders.

Unfortunately, survival following SCA in the young athletic population has been poor. The single greatest determinate of survival following SCA is the time from collapse to defibrillation, with survival rates declining 7% to 10% per minute for every minute defibrillation is delayed. In a small cohort of 9 intercollegiate athletes with SCA, only 1 athlete survived (11%) despite apparent early use of on-site AEDs in 5 cases.8 Analysis of 128 cases from the US Commotio Cordis Registry also revealed a low overall survival rate of 16%.23

Recently, Drezner et al5 reported a 7-year review of survival trends in exercise-related SCA in youth in the United States. After review of 486 cases of confirmed and suspected SCA, the overall survival rate in young athletes was only 11% (range, 4%-21%) from 2000 to 2006. Females were more likely to survive than males (2% vs 9%). There appeared to be a trend toward increasing survival in the later years of the study, and it was postulated that the increase in survival was related to earlier recognition of SCA and the increasing prevalence of on-site AED programs in schools and at athletic venues.5

The poor survival rates found in young athletes with SCA are disturbing given the overall good health and age of the athletes. Factors that may contribute to this poor survival include delayed rescuer recognition of SCA, inaccurate rescuer assessment of pulse or respiration, delayed access to AEDs and early defibrillation, the presence of intrinsic structural cardiac abnormalities such as cardiomyopathies that may be more resistant to defibrillation with increasing delays in resuscitation, and increased catecholamine levels in athletes, which possibly increases the defibrillation threshold.

Automated external defibrillators provide a means of early defibrillation and improved survival not only for athletes but also for other persons at athletic events who suffer SCA. Jones et al19 found a 2.1% annual probability of an SCA occurring on high school grounds and that most cases of SCA were in older school employees, spectators, and visitors on campus. At NCAA Division I universities, Drezner et al9 found that older nonstudents such as spectators, coaches, and officials accounted for 77% of SCA cases at sporting venues, and that use of AEDs produced a 54% overall immediate resuscitation rate.

Recent findings from the National Registry for AED Use in Sports demonstrate improved survival for both student-athletes and nonstudents with SCA in the high school athletic setting. Upon review of 1710 nationwide high schools with on-site AED programs (at least 1 AED on school grounds; mean 2.8 AEDs per school), 36 (2%) schools reported a case of AED use within a 1-year period from July 2006 to June 2007.7 Twenty-two of the cases were in older nonstudents, and 14 cases were in high school student-athletes. Thirty cases received defibrillation with use of an on-site AED. The overall survival rate to hospital discharge was 64%, including a 64% survival rate in student-athletes with SCA.7 These findings strongly support the value of on-site AED programs for the treatment of SCA on school grounds. The favorable survival rate in young athletes who suffer SCA in schools with on-site AEDs sharply contrasts the 11% overall survival rate found in a 7-year review of exercise-related SCA in young individuals in the United States where on-site AED use was rarely reported.5

Several national guidelines have also advocated for placement of AEDs in the athletic setting. In a Joint Position Statement issued in 2002 by the American College of Sports Medicine and the American Heart Association (AHA), placement of AEDs at all health/fitness facilities was encouraged, especially in facilities with a membership greater than 2500.1 The National Athletic Trainers’ Association (NATA) released an official statement in 2004 encouraging athletic trainers in every work setting to have access to an AED.29 In 2004, AHA recommendations for the Medical Emergency Response Plan in Schools stated that every school that cannot achieve an EMS call-to-shock interval of less than 5 minutes should have an AED program.18 And, most recently, an Inter-Association Task Force provided consensus recommendations for emergency planning for SCA in high school and college athletic programs, strongly recommending access to AEDs and a target goal of less than 3 to 5 minutes from collapse to first shock.6

Many schools and organizations have supported implementation of on-site AED programs. A survey of NCAA Division I universities showed that greater than 90% of institutions already had AEDs placed at selected athletic venues.9 In Washington State high schools, 54% had at least 1 AED on school grounds.33In addition, the riveting nature of SCD in young athletes and the desire to protect student-athletes from a catastrophic event has prompted many states, including New York, Texas, Ohio, and Georgia, to pass legislation mandating that every school have at least 1 working AED unit on-site. It appears the successes of public-access defibrillation and school-based AED programs support an evolving standard in favor of school AED programs.

Prompt recognition of SCA is essential to prevent critical delays in CPR and defibrillation. When a young athlete collapses, SCA can be confused for other less serious causes of collapse. Barriers to recognizing SCA include the presence of brief seizure-like activity and inaccurate rescuer assessment of pulse or respirations. In a series of student-athletes with SCA, greater than half were reported to have brief seizure-like activity immediately following collapse.31 Mistaking SCA for a seizure can prevent initiation of life-saving medical care. Thus, any unresponsive collapsed athlete should be assumed to be in SCA until proven otherwise, and an AED retrieved and applied for rhythm analysis and defibrillation (if indicated) as soon as possible.6 Automated external defibrillators are extremely accurate and will not recommend a shock in an athlete who is not in ventricular fibrillation or ventricular tachycardia, so applying the AED to an athlete who is not in SCA has minimal potential for harm.

Management of a collapsed athlete begins with an initial assessment of responsiveness (ie, “Are you all right?”). If the athlete is unresponsive, one or more rescuers should begin CPR while another activates the EMS system by calling 911 or the local emergency number and then retrieves the AED if available. When contacting EMS, the rescuer should be prepared to provide the exact location of the emergency, a brief account of what happened, and a summary of the initial care given. In the case of a lone rescuer, he/she should first activate the EMS system, obtain an AED if readily available, and then return to the victim and initiate CPR and AED use. An AED should be applied to the victim as soon as possible and turned on for rhythm analysis and defibrillation if indicated.

Conclusion: Sudden cardiac arrest in athletes is a catastrophic event that can be effectively treated through a prompt and coordinated emergency response, early CPR, and early defibrillation. The most important factor in SCA survival is decreasing the time to defibrillation through the presence of a trained rescuer who can initiate CPR and has direct access to early defibrillation through the use of an on-site AED. The athletic community is in a unique situation having trained targeted responders such as athletic trainers and coaches present at practices and competitions. The presence of on-site AED programs in the school and athletic setting is strongly recommended as a means for early defibrillation in both athletes and nonathletes who suffer SCA.

High suspicion for SCA should be maintained in any collapsed and unresponsive athlete, and the EAP initiated without delay. An AED should be applied immediately for rhythm analysis and defibrillation if indicated, and CPR provided until a defibrillator is available. Automated external defibrillator programs should be part of a comprehensive EAP for SCA that includes an effective communication system, training of potential first responders in CPR and AED use, acquisition of appropriate emergency equipment, and routine practice and review of the response plan. By decreasing response times and increasing access to early defibrillation, survival from SCA in athletics will be optimized. <<”

References

  1. American College of Sports Medicine; American Heart Association American College of Sports Medicine and American Heart Association joint position statement: automated external defibrillators in health/fitness facilities. Med Sci Sports Exerc. 2002;34:561-564 [PubMed]
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  6. Drezner JA, Courson RW, Roberts WO, Mosesso VN, Jr, Link MS, Maron BJ. Interassociation task force recommendations on emergency preparedness and management of sudden cardiac arrest in high school and college athletic programs: a consensus statement. Clin J Sport Med. 2007;2:87-103 [PubMed]
  7. Drezner JA, Harmon KG, Heistand J, Cramer M, Rao A. Adequacy and effectiveness of emergency response planning for sudden cardiac arrest in high schools with automated external defibrillators. Clin J Sport Med. 2008;18:182
  8. Drezner JA, Rogers KJ. Sudden cardiac arrest in intercollegiate athletes: detailed analysis and outcomes of resuscitation in 9 cases. Heart Rhythm. 2006;3:755-759 [PubMed]
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  26. Myerburg RJ, Fenster J, Velez M, et al. Impact of community- wide police car deployment of automated external defibrillators on survival from out-of-hospital cardiac arrest. Circulation. 2002;106:1058-1064 [PubMed]
  27. NCAA 2008-09 NCAA Sports Medicine Handbook: Guideline 1c: emergency care and coverage. http://www.ncaa.org/wps/ncaa?ContentID=283Accessed November 5, 2008
  28. Nichol G, Hallstrom AP, Kerber R, et al. American Heart Association report on the second public-access defibrillation conference, April 17-19, 1997. Circulation. 1998;97:1309-1314 [PubMed]
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  31. Rao A, Drezner JA, Cramer M, Harmon KG. Details and outcomes of resuscitation following sudden cardiac arrest in high school student athletes. Clin J Sport Med. 2008;18:184-185
  32. Rosamond W, Flegal K, Furie K, et al. ; American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25-e146 [PubMed]
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  34. Valenzuela TD, Roe DJ, Nichol G, et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000;343:1206-1209 [PubMed]
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[Rothmier JD, Drezner JA. The Role of Automated External Defibrillators in Athletics. Sports Health. 2009;1(1):16-20. doi:10.1177/1941738108326979.] ______________________________________________________

Autopsy: Clayton High baseball player died from heart condition

Clayton High (North Carolina) baseball player dies
Clayton student-athlete dies after collapsing on track
Mar 13, 2013

A Clayton High School baseball player who died during a workout in December likely died as a result of an irregular heartbeat coupled with a weakened heart muscle, according to an autopsy report released Wednesday by the Office of the Chief Medical Examiner.

William Hogan Teem, 17, collapsed Dec. 13 during an off-season conditioning session and later died at a local hospital.

A preliminary autopsy report in December found that Teem died of hypertrophic cardiomyopathy, a genetic condition involving a thickening of the heart muscle.

Wednesday’s report, however, lists Teem’s cause of death as “fatal cardiac arrhythmia secondary to cardiomyopathy.”

“The typical findings of an inherited/genetic hypertrophic cardiomyopathy were not identified in this case,” the report stated.

According to the American Academy of Pediatrics, there are approximately 2,000 deaths each year in people under 25 who are involved in strenuous sports. About 40 percent of them have hypertrophic cardiomyopathy.

Generally, there are no symptoms of the condition, and although it is a detectable condition, it isn’t usually discovered in standard sports physicals
[High School Sports, Capitol Broadcasting Company, Inc]
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House Bill 383 became Kentucky Law 2009

“Dr. Michael Minix Sr., a Nicholasville physician and former University of Kentucky football player, testified [before the KY House of Repersentaives, Education Committee] that coaches don’t always abide by medical guidelines and that they need to be better educated about risks to players.”

“Athlete abuse is on the rise in the United States,” Minix said.

Courier Journal Newspaper, Louisville, KY “Panel OKs Athlete Safety Bill”

http://www.courierjournal.com/article/20090225/NEWS01/902250396/House-panel-OKs-athlete-safety-bill

HB 383—Following the death August 2008 of a Pleasure Park High School football player, Max Gilpin, this bill requires high school coaches to become certified in student safety, with a focus on automated external defibrillators. The bill also requires a certified person to be present at every practice and game.

AN ACT relating to interscholastic athletics.

Amend KRS 156.070 to require high school coaches to be trained in cardiopulmonary resuscitation and in the use of automated external defibrillators; require automated external defibrillators be on-site for every high school practice, athletic activity or sporting event; require an ice pool to be readily available if the temperature is ninety-four degrees or higher; prohibit the Kentucky Board of Education from adopting policies that are contrary to these provisions.

HB 383 – AMENDMENTS

HCS/FN – Retain original provisions, except create a new section of KRS Chapter 160 to allow a local board to specify school personnel to receive training in the use of automated external defibrillators (AEDs) if the device is provided in the school; require the Kentucky Department of Education to provide districts a list of possible funding sources for the purchase of AEDs; encourage local boards to make an AED available at each high school athletic activity; require a local board to request local emergency medical services personnel be on-site for a high school athletic activity if no AED is available on-site; provide immunity from civil liability for personal injury that results from the use of an AED; require the Kentucky Board of Education or agency designated to manage interscholastic athletics to revise its procedures and criteria for avoiding heat injury.

HFA (1, J. Jenkins) – Retain original provisions except delete the requirement that an ice pool be available at outdoor high school sports activities or practices; require the Kentucky Board of Education to review, and revise if appropriate, procedures and criteria for avoiding heat injury; require the board to determine if regulations or policies should be adopted to provide guidance as to how to deal with athletes who experience heat-related injury or illness.

HFA (2, D. Graham) – Prohibit emergency medical services personnel or the employer or provider from being held liable if they are requested to attend a high school athletic event and are unable to attend.

SCS/FN – Delete provisions; direct the Kentucky High School Athletics Association, with assistance from the Kentucky Department of Education, to staff and coordinate a study of sports safety; establish issues to be studied including the requirements and adequacy of sports safety education in public middle and secondary schools; establish the membership of the formal work group; require a report to the Interim Joint Committee on Education by October 30, 2009.

SFA (1, A. Kerr) – Create a new section of KRS Chapter 160 to require high school coaches to complete a sports safety course; identify the components to be included in the course; require coaches to pass an online test prior to receiving credit for course completion.

SFA (2, A. Kerr) – Direct the Kentucky Board of Education to require high school coaches to complete a sports safety course; identify the components to be included in the course; require coaches to pass an online test prior to receiving credit for course completion.

SFA (3/Title, A. Kerr) – Make title amendment.

SFA (4, A. Kerr) – Direct the Kentucky Board of Education to require high school coaches to complete a sports safety course; identify content to be included in the course; require high school coaches to complete the course and pass an end-of-course examination; beginning with the 2009-2010 school year, require at least one person who has completed a sports safety course to be on-site at every high school athletic practice and competition; EMERGENCY.

Feb 10-introduced in House
Feb 11-to Education (H)
Feb 13-posted in committee
Feb 24-reported favorably, 1st reading, to Consent Calendar with Committee Substitute
Feb 25-2nd reading, to Rules; posted for passage in the Consent Orders of the Day for Friday, February 27, 2009; taken from the Consent Orders of the Day, placed in the Regular Orders of the Day
Feb 27-floor amendments (1) and (2) filed to Committee Substitute
Mar 2-3rd reading, passed 97-0 with Committee Substitute, floor amendments (1) and (2)
Mar 3-received in Senate
Mar 5-to Education (S)
Mar 9-reported favorably, 1st reading, to Calendar with Committee Substitute ; floor amendment (1) filed to Committee Substitute, floor amendment (2) filed
Mar 10-2nd reading, to Rules
Mar 11-floor amendments (3-title) and (4) filed
Mar 12-posted for passage in the Regular Orders of the Day for Thursday, March 12, 2009; 3rd reading; floor amendments (1) and (2) withdrawn ; passed 38-0 with Committee Substitute, floor amendments (3-title) and (4) ; received in House
Mar 13-posted for passage for concurrence in Senate Committee Substitute, floor amendments (3-title) and (4); House concurred in Senate Committee Substitute, floor amendments (3-title) and (4) ; passed 93-0; enrolled, signed by each presiding officer; delivered to Governor
Mar 24-signed by Governor (Act ch. 90)
AN ACT relating to interscholastic athletics and declaring an emergency.
Be it enacted by the General Assembly of the Commonwealth of Kentucky:
âSection 1. (1) The Kentucky High School Athletics Association, with assistance from the Kentucky Department of Education, shall staff and coordinate a study of sports safety to be completed no later than October 1, 2009.
(2) The study shall include a review of:
(a) The requirements and their adequacy for sports safety education in public middle and secondary schools, including heat-related and air quality issues, chronic and overuse injuries, and other risk factors;
(b) Required training programs for secondary school coaches, to include how training is certified to demonstrate knowledge and competencies of participants;
(c) Required first aid and medical assistance protocols or standards of care for students suffering minor and major injuries during practices and competitions;
(d) Data regarding sports injuries, by sport, in Kentucky and an examination of data reporting requirements and responsibilities for oversight when injuries occur;
(e) Education for high school coaches, volunteers, parents, and student athletes relating to nutrition, weight training, and the dangers of steroids and other illegal supplements;
(f) The availability of sports injury prevention programs and other safety resources; and
(g) Other information as deemed appropriate by the study group to fully examine the status of sports safety in Kentucky for high school students.
(3) The Association shall have a formal work group composed of:
(a) At least two (2) members of the Kentucky Board of Education, selected by the board chairman;
(b) At least two (2) representatives from the Kentucky Department of Education, selected by the commissioner of education;
(c) At least two (2) high school coaches selected by the Chair of the Board of Control;
(d) At least two (2) members from the Kentucky Medical Association, appointed by the executive director;
(e) At least three (3) certified sports trainers; and
(f) Others as deemed appropriate by the commissioner of education and the executive director of the Kentucky High School Athletics Association.
(4) The commissioner of education or designee and the executive director of the Kentucky High School Athletics Association shall identify the work group members within thirty (30) days of the effective date of this Act.
(5) The Association shall submit a written report to include findings and recommendations to the Interim Joint Committee on Education by October 30, 2009. The report shall include but not be limited to recommendations to improve the safety of students participating in high school athletics and any legislation that might be necessary to implement the recommendations.
âSECTION 2. A NEW SECTION OF KRS CHAPTER 160 IS CREATED TO READ AS FOLLOWS:
(1) The Kentucky Board of Education or organization or agency designated by the board to manage interscholastic athletics shall require each high school coach to complete a sports safety course consisting of training on how to prevent common injuries. The content of the course shall include but not be limited to emergency planning, heat and cold illnesses, emergency recognition, head injuries, neck injuries, facial injuries, and principles of first aid. The course shall also be focused on safety education and shall not include coaching principles.
(2) The state board or its agency shall:
(a) Establish a minimum timeline for a coach to complete the course;
(b) Approve providers of a sports safety course;
(c) Be responsible for ensuring that an approved course is taught by qualified professionals who shall either be certified athletic trainers, registered nurses, physicians, or physician’s assistants licensed to practice in Kentucky; and
(d) Establish the minimum qualifying score for successful course completion.
(3) A course shall be reviewed for updates at least once every thirty (30) months and revised if needed.
(4) A course shall be able to be completed through hands-on or on-line teaching methods in ten (10) clock hours or less.
(5) (a) A course shall include an end-of-course examination with a minimum qualifying score for successful course completion established by the board or its agency.
(b) All coaches shall be required to take the end-of-course examination and shall obtain at least the minimum qualifying score.
(6) Beginning with the 2009-2010 school year, at least one (1) person who has completed the course shall be at every high school athletic practice and competition.
âSection 3. Whereas there is no existing requirement for a medical professional to be on-site during high school athletic events and the safety of student athletes is sometimes compromised, an emergency is declared to exist and this Act takes effect upon its passage and approval by the Governor or upon its otherwise becoming a law.
KRS 160.445 Sports safety course required for high school athletics coaches.
(1) The Kentucky Board of Education or organization or agency designated by the board to manage interscholastic athletics shall require each high school coach to complete a sports safety course consisting of training on how to prevent common injuries. The content of the course shall include but not be limited to emergency planning, heat and cold illnesses, emergency recognition, head injuries, neck injuries, facial injuries, and principles of first aid. The course shall also be focused on safety education and shall not include coaching principles.
(2) The state board or its agency shall:
(a) Establish a minimum timeline for a coach to complete the course;
(b) Approve providers of a sports safety course;
(c) Be responsible for ensuring that an approved course is taught by qualified professionals who shall either be certified athletic trainers, registered nurses, physicians, or physician’s assistants licensed to practice in Kentucky; and
(d) Establish the minimum qualifying score for successful course completion.
(3) A course shall be reviewed for updates at least once every thirty (30) months and revised if needed.
(4) A course shall be able to be completed through hands-on or online teaching methods in ten (10) clock hours or less.
(5) (a) A course shall include an end-of-course examination with a minimum qualifying score for successful course completion established by the board or its agency.
(b) All coaches shall be required to take the end-of-course examination and shall obtain at least the minimum qualifying score.
(6) Beginning with the 2009-2010 school year, at least one (1) person who has completed the course shall be at every high school athletic practice and competition.
Effective: March 24, 2009
History: Created 2009 Ky. Acts ch. 90, sec. 2, effective March 24, 2009.
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Section 1. KENTUCKY LAW

311.665 Legislative intent for use of automated external defibrillators.
It is the intent of the legislature that an automated external defibrillator may be used for the purpose of saving the life of another person in cardiac arrest when used in accordance with the provisions of Section 3 of this Act.
Section 3. AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
POLICY/PROCEDURE/PROTOCOL
The AED is intended for use by personnel who are authorized by a physician/medical director and have at a minimum, the following skills and training:
3.1. Procedures for Training and Testing in Use of AED
Personnel using the AED must complete a training session every 2 years, to include instruction in:
•The proper use, maintenance, and periodic inspection of the AED.
•Defibrillator safety precautions to enable the user to administer a shock without jeopardizing the safety of the patient, the user, or other persons.
•Assessment of an unconscious person to determine if cardiac arrest has occurred and the appropriateness of applying an AED.
•Recognizing that an electrical shock has been delivered to the patient and that the defibrillator is no longer charged.
•Rapid, accurate assessment of the patient’s post shock status to determine if further activation of the AED is necessary.
•The operations of the local emergency medical services system, including methods of access to the emergency response system, and interaction with emergency medical services personnel.
•The role of the user and coordination with other emergency medical support, and advanced life support.
•The responsibility of the user to continue care until the arrival of medically qualified personnel.
3.2. Procedures to Ensure the Continued Competency Required for AED Use
•Personnel using the AED must complete a review session every 2 years, using the AED training device to ensure continued competency in the use of the device.
•A record will be maintained documenting medical staff competency training on the AED.
3.3. Medical Control Reporting and Incident Review
•The AED digitally records patient data, including ECG rhythm and delivered shocks. Recorded data may be transferred by direct connection to a printer or computer or by modem to a remote computer.
•Following an incident of application, the data will be downloaded from the AED and reviewed by both the medical director and the attending physician(s) at the emergency facility where emergency care was provided. In addition, a report detailing the emergency scene and treatment will be documented in writing. The AED digitally records patient data, including ECG rhythm and delivered shocks. A digital audio recording of scene activity is available. Recorded data may be transferred by direct connection to a printer or computer or by modem to a remote computer.
3.4. Location of and Maintenance of the AED:
•Russell Independent Schools Health Services has four AED units. Each is housed near the front entrance of the school.
•All AED Units shall be kept protected in their cases, as supplied by the manufacturer, and shall be kept in a clean, warm, and dry location at all times when not in use.
•Daily Inspection: the supervisor assigned to the facility at which an AED unit is located, shall conduct, or direct a subordinate employee to conduct, a visual inspection of such AED to determine whether any of the self-diagnostic tests and the special service indicator lights (if equipped) indicate that attention is required.
•Monthly Inspection: the District Nurse shall, on the first business day of each month, inspect the AED unit stationed at such facility, and shall note on a monthly safety inspection report to be submitted to the District Health Office the status of the AED located at such facility.
•Each inspection shall include observation of all self-diagnostic indicators on the equipment, as well as verification that each Unit is complete, clean and in good operating condition.
•If a problem is detected in any such inspection, or if some attention otherwise seems warranted, then the AED unit should be serviced or attended to immediately. The person inspecting the unit and detecting problems or any other need for attention shall promptly notify the District Nurse to report the results of the inspection.
•In the event that such service or attention so warrants, arrangements must be made immediately to have a replacement AED unit provided until the AED unit is serviced or repaired and is again fully functional.
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AMERICAN HEART ASSOCIATION
Defibrillation
Defibrillation is a process in which an electronic device gives an electric shock to the heart. This helps reestablish normal contraction rhythms in a heart having dangerous arrhythmia or in cardiac arrest. In recent years small portable defibrillators have become available. These are called automated external defibrillators or AEDs.
AHA Scientific Position
It’s essential to integrate early defibrillation into an effective emergency cardiovascular care system. This means employing the four-part “chain of survival” concept.
•Early Access — quickly calling the Emergency Medical Services (9-1-1) system
•Early CPR — promptly giving cardiopulmonary resuscitation when needed
•Early Defibrillation — having proper equipment and being trained to use it when indicated
•Early Advanced Cardiovascular Care
All emergency personnel should be trained and allowed to use a properly maintained defibrillator if they’re likely to respond to cardiac arrest victims. This includes all first-responding emergency personnel, both hospital and non-hospital.
To make early defibrillation possible, a defibrillator must be immediately available to emergency personnel responding to a cardiac arrest. Thus, all emergency ambulances and other emergency vehicles that respond to or transport heart patients should have a defibrillator.
The American Heart Association recommends that AEDs be available wherever large numbers of people congregate. Such places include airports, convention centers, sports stadiums and arenas, large industrial buildings, high-rise offices, large health fitness facilities, etc.
The American Heart Association offers a four-hour training course called Heartsaver AED. It covers CPR and AED use. It’s for lay rescuers and first responders.
See the Related Items box above for links to the Cardiology Patient Page in Circulation, Journal of the American Heart Association:
•Cardioversion
•The Implantable Cardioverter-Defibrillator
Related AHA publications:
Automated External Defibrillator Information
Learn About Automated External Defibrillators (AED)
The AED: Man’s New Best Friend?
Although there is a lot of information available to you about Defibrillator Use, we have searched the internet to locate only the most relevant articles. Have a look around and you will find information about things like Defibrillator Paddles also. We hope you will find this article about Defibrillator Use to be of great help.
An AED (automated external defibrillator) is a computerized device used by emergency medical crews to attempt resuscitation of a victim of cardiac arrest.
Until a number of years ago these machines were only seen in formal medical settings, but in the last number of years as technological advancements have been made, and electronic miniaturization has impacted every facet of our daily lives, they are now able to be used by non-medical lay people. This is a great medical and electronic achievement, and a very positive step in the direction of saving lives in an area that to date left few victims alive to tell their harrowing stories.
AED’s have become extremely accurate and simple to use. Although formal training is recommended, it is not necessarily essential, as is evidenced by the burgeoning placement of AED’s in the home setting. Philips is the only company currently that has a defibrillator you can buy “over the counter”, as it does not require a prescription.
There are quite a number of different AED’s on the market, most of which do require a prescription. They are manufactured and sold under guidelines set down by the Food and Drug Administration (FDA). The more complex and costly devices are used by medical emergency crews and in hospital or medical settings, however all AED’s are designed to carry out basically the same function — re-starting the heart.
It used to be that an AED operator needed to know how to recognize the signs of sudden cardiac arrest in order to determine if defibrillation was indeed necessary. Fortunately, this is no longer the case as the more modern AED, being computerized, is able to assess the need for defibrillation before the operator proceeds. Most modern AED’s use text messages, voice prompts, lights, or all three, to “tell” the operator the correct steps to take and in which order to take them.
With the amount of information freely available on the web concerning defibrillator use and aed cpr, we have undertaken the task of choosing only the highest quality sources. By doing this, we hope to supply readers such as yourself with up-to-date Defibrillator Use information, as well as enabling you to learn more about related things like using an AED.
So who needs one? Well, first on the list would be known heart disease sufferers with a propensity toward cardiac arrest; second would be those people that simply have a known heart disease or defect; third, would be the rest of us.
Even children can suffer sudden cardiac arrest, and they can be treated using defibrillation in such an event. The American Heart Association does recommend that children under the age of eight be treated using attenuated pads, or paddles, which basically means that less voltage is delivered to the heart of the young child.
Because sudden cardiac arrest occurs without warning, and without much in the way of symptoms; because it can afflict “anyone”; and because the survival rate of SCA victims (around only 5%) is so abysmal, the placement of AED’s in public places, such as libraries, gated communities, office buildings, shopping malls, etc, is a very positive development. There is a program: PAD (public access to defibrillation), underway in some areas to increase AED placement many fold.
Due to the high mortality rate of sudden cardiac arrest, and because increasing numbers of people die from it every year (over 250,000 alone in the US last year), the new home-use AED’s offer a brilliant ray of hope in what has been, until recently, a very dark war. With the new breed of AED’s currently available, there is no reason why many more lives can’t be saved each year.
From mortality rates of around 95% in victims of SCA who are not defibrillated within several minutes of suffering sudden cardiac arrest, these statistics take a nose-dive to around a 5% mortality rate for those who are able to be treated with an AED shortly after the event.
If you or someone you love suffers from any kind of heart ailment consider talking to your Dr. about the AED’s available to you. If you do purchase one, it could well turn out to be the best money you ever spent.
You can help the push for Public Access Defibrillation (PAD) by writing to, or sending this article to, your local Congressmen or Congresswoman.
Graham Hobbs is a successful Webmaster and publisher of The Automated External Defibrillator, where you can learn more about the new breed of AED currently on or entering the market, and how they could save yours or a loved ones’ life.

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HEARTFELT SCREENING

SUDDEN DEATH OF YOUNG ATHLETES IS OFTEN THE RESULT OF A HEART CONDITION CALLED HYPERTROPHIC CARDIOMYOPATHY, “ATHLETE HEART”

An Electrocardiogram and an Echocardiogram are the essential diagnostic tests required to make the clinical diagnosis.

On the West Coast Athletes are blessed with a screening procedure offered by Heartfelt Screening.

Heartfelt Screening is an affordable screening offered by Heartfelt Cardiac Projects. Holly Morrell, founder of Heartfelt Cardiac Projects, has performed thousands of screenings during the many years she has been involved with the Heartfelt Cardiac Projects.

“Screenings can be scheduled for a nominal tax-deductible donation or patrons can donate now to HCP to help us continue to offer these vital screenings”.

“Affordable screening can be provided on-site by Heartfelt Cardiac Projects at Schools, Companies, Churches, Senior Centers, Health Fairs, Community Sport Leagues & Organizations.”

Visit the web site:
http://www.heartfeltcardiacprojects.org/who_we_are.html
http://www.heartfeltcardiacprojects.org/contact.html

Contact Information:
Holly Morrell, Founder & Executive Director
1278 Glenneyre St., #244
Laguna Beach, CA 92651
Phone – 949. 494. 6575
Cell – 949. 933. 3848

Schedule a screening for a nominal tax-deductible donation OR You can donate now to HCP to help us continue to offer these vital screenings
For questions or comments, email
Heartfeltproject@aol.com

For athletes and others who do not have access to Heartfelt Screening they should be examined by their local doctor and have the screening EKG and Echocardiogram.
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