Schools try to deal with athletes’ undiagnosed conditions
YORK, Pa. (AP) — Nothing had seemed off with the Big Spring basketball player.
J.T. Kuhn’s sophomore season had just ended, a campaign in which he helped pave the road to a Bulldog district playoff berth by averaging more than 10 points per game as a sharpshooting forward.
But on Feb. 28, seven days after his season ended, Kuhn’s mother found him unresponsive.
His heart had stopped working after a massive heart attack.
And after a four-day stay at Hershey Medical Center, Kuhn died on the morning of March 4.
Kuhn is one of hundreds of young athletes to fall victim to a heart attack or sudden cardiac arrest because of undiagnosed warning signs. It’s an issue that schools across America are battling, searching for ways to both find the undetected conditions lingering in students and respond if those conditions manifest themselves.
While all high school student-athletes undergo a physical prior to playing sports, those tests do not include advanced heart screenings, which can be expensive and don’t have a clear medical consensus on their effectiveness.
Additionally, not all schools have the same access to automatic external defibrillators.
According to the Peyton Walker Foundation — named for the former Trinity High School student who died of sudden cardiac arrest in 2013 at 19 — SCA is the No. 1 killer of student athletes in the United States and the No. 2 medical cause of death in people under 25.
Parent Heart Watch, a national nonprofit that works to protect youth from SCA, reports that 1 in 300 student-athletes have undetected heart symptoms. The electrical symptoms that manifest themselves via abnormal heart rhythms often aren’t found in time.
Big Spring High School hopes the tragedy can serve to educate parents and athletes alike. The school has encouraged families to bring their athletes to the numerous screening events put on by the Peyton Walker Foundation.
“I think the big part of it is we have to educate our student athletes and parents on the topic and make them aware of (the dangers of sudden cardiac arrest),” Big Spring athletic director Joe Sinkovich said. “That is our first step.”
Can heart screenings prevent tragedies before they happen?
Sudden cardiac arrest is the abrupt loss of heart function, breathing and consciousness, according to the Mayo Clinic. It often results from an electrical disturbance in someone’s heart. It is not the same as a heart attack, though the two are closely linked.
Mandatory physicals that students get before playing sports include basic cardiovascular tests with a stethoscope. But a physical is unlikely to find underlying electrical issues in someone’s heart.
The best screening process for those issues is an electrocardiogram (EKG), which can detect almost 86% of these conditions, according to Julie Walker, the mother of Peyton Walker and the director of the foundation named after her.
It’s not a perfect method, but it is the most thorough, and one that Parent Heart Watch executive director Martha Lopez-Anderson believes to be a necessary step in helping prevent cardiac arrests in people like her son, who died in 2004.
“All screenings, diabetes, cholesterol, colonoscopies, mammograms, prostate tests, those screenings are done why? Because they save live,” Lopez-Anderson said. “We’re talking about doing a screening for the most vital organ in the body, for youth, to identify this so we can take the proper actions.”
Students and their parents are also required to fill out sections on a physical form related to the family’s history with heart problems.
And a state law signed by former Gov. Tom Corbett in 2012 requires parents of student-athletes to sign a form about the warning signs of sudden cardiac arrest. Coaches must take an annual course on SCA and must remove players showing signs of it from competition. Players need to be cleared by a doctor before they can play again.
Why ‘selective use’ of EKGs is the best approach
While it would seem ideal for EKGs to be an operating procedure of every sports physical, many medical professionals don’t believe it’s that simple.
The costs, the need for a trained interpreter of the results and the debate about their efficiency make it difficult to be a mandatory procedure.
An EKG test can cost between $30 and $100 if covered by insurance, and much more if not. A normal physical might cost just $15.
That can just be the beginning. According to a report from the ABIM Foundation (American Board of Internal Medicine), the results of an EKG test can sometimes be unclear. That can lead to a doctor prescribing more tests, which might end up being unnecessary.
Those tests can still give a family peace of mind about a child’s health, but they can also rack up costs and keep a healthy student-athlete off the field.
“The issue is you are trying to catch a rare entity across a population (young people) that is typically the healthiest,” said Dr. Pete Barclay, a cardiologist at WellSpan in York. “When you cast such a wide net and the testing isn’t perfect, you will read things on an EKG that seems abnormal but ends up unnecessarily eliminating kids from participating.”
A former football player at Princeton, Barclay understands the painful emotions that come with this issue.
He’s the father of two star football players from York Suburban. He recalls learning about SCA as a medical student, and he attended the York Suburban-York Catholic lacrosse game this spring where former Irish player Brendan O’Connor was honored. O’Connor died suddenly this fall shortly before his 23rd birthday from hypertrophic cardiomyopathy, and his family has pushed for increased EKG testing.
“It’s horrifying to think about,” Barclay said. “How sudden and horrible it is.”
Barclay noted that EKGs tests are very useful. He said WellSpan has started a program funded by grants for student-athletes who are “interested” to get the tests on a voluntary basis. The program has onsite echo testing if an abnormality is found.
Ultimately, he thinks the best course of action is for parents of student-athletes to be conscious of their family’s heart history and to work with their doctor to see if additional heart testing is necessary.
“I’m thankful these issues are extremely rare, and with proper family history and selective uses of EKG, we can dramatically reduce these issues from occurring,” Barclay said.
Schools are adding more AEDs to improve student safety
For Bermudian Springs athletic trainer Kim Fry, listening to Walker speak was a breakthrough moment.
She frequently gives talks on SCA, and Fry attended one last year with Bermudian AD Dave Orwig. The talk made the pair think hard about what they were doing to ensure safety at their athletic events.
Both school officials decided the athletic department needed more resources available in case of emergency.
“That really hit home for us,” Fry said of Walker’s speech.
According to Parent Heart Watch, 95% of SCA victims die because of a delayed emergency response. While it’s common for school athletic departments to have a few AEDs on hand — usually at least in the gym and the trainer’s room — that still leaves the potential for tragedy if someone goes into cardiac arrest at an outdoor event when the trainer isn’t present.
AEDs are portable machines that send shocks that can save the life of someone who has gone into cardiac arrest. The machines use audio and visual commands to guide the person using it.
As a district, Bermudian Springs had five AEDs — one in the elementary school, one in the middle school, two in the high school and one with the athletic department. Fry and Orwig decided the potential for risk was great enough that every Bermudian team should have an AED with them at all times
The school district was able to purchase 10 additional AEDs this year for the athletic department — enough that every team has access to two in-season. For example, when the Eagles varsity baseball team has a road game, it takes one on the road while the JV squad keeps one at its home game.
According to Fry, the Bermudian Springs School District found enough funds in its athletic budget to purchase the AEDs.
Inspired by Bermudian, the Dover Area School District was able to do something similar this spring and purchase two additional AEDs for the athletic department. The school also had the available funds to purchase them, according to athletic trainer Dave App.
“Not only do we obviously care about our athletes, but you think of the officials and spectators, the sheer amount of people at an event at any time,” Fry said. “It was wise (to purchase additional AEDs).”
Why PA schools are not required to have AEDs
Some of the most publicized examples of AEDs being used at Pennsylvania high school sporting events have come when someone other than an athlete has suffered sudden cardiac arrest. Scranton Times-Tribune sportswriter Marty Myers was saved by a trainer at Freedom High School when he collapsed at a basketball game in 2016. And Cumberland Valley trainer Bob Wolf used an AED to save a spectator at a water polo match in 2017.
AEDs are designed for a layman to use (many schools teach their coaches how to use them), but there needs to one in the vicinity so it can be activated quickly when someone needs it.
Schools in Pennsylvania are not required to have AEDs, according to Mary Newman, the executive director of the Pittsburgh-based nonprofit Sudden Cardiac Arrest Foundation.
A state bill passed in 2014 requires school districts to report their amount, condition, age and placement of AEDs to the Pennsylvania Department of Education. Through the law, schools are able to use tax credits and grants to buy the defibrillators.
According to Department of Education press secretary Eric Levis, the registry has been updated through the 2017-18 school year. The registry shows some schools listed with “none” under AED location, and Levis confirmed the law does not include a penalty for schools that don’t comply.
Not all schools have the same budget size, so not all schools can purchase as many as Bermudian Springs has. Many schools rely on donations to get more defibrillators.
The Peyton Walker Foundation has donated more than 60 AEDs to public entities, including schools and athletic organizations. The Greg W. Moyer fund, started by the parents of a Notre Dame High School basketball player who died at halftime of a game in 2000, has donated AEDs to numerous schools in the northeast.
Two years ago, the School District of Philadelphia completed a program to equip all of its schools with an AED, largely through donations.
According to Myers, the Bethlehem Area School District received eight donated AEDs after his life needed to be saved at Freedom High School.
“I hope they never need any of them,” Myers said. “The fields there are so far out, so it’s important to have one close. By the time you run a mile, what are the chances you get there in time?
“I do know that less than a minute (after I collapsed), they were doing CPR on me ... I’m kind of a public person and when I walk into a gym now, everyone asks me how I’m feeling. It’s a reminder that you should always be thinking where the AED is.”
Before both regular and postseason games, District 3 schools read an announcement on SCA and tell attendees where automatic external defibrillators (AEDs) are located.
New legislation would require hands-only CPR training for students
The National Federation of State High School Associations, the governing body for high school sports in the United States, recently shipped more than 600 AEDs to high school associations in 24 states. PIAA associate executive director Melissa Mertz said the organization received 15 AEDs from NFHS.
Each of the 12 districts in the PIAA received one AED. The additional three were kept in the PIAA office to replenish old ones.
The PIAA has taken additional steps to help member schools. According to Mertz, the organization purchased booklet copies of Anyone Can Save a Life, an emergency action program developed in Minnesota, for all Pennsylvania schools.
And while there is still no law requiring AEDs in Pennsylvania schools, the state government is close to passing new legislation regarding heart safety. A bill sponsored by Sen. Tom Killion (R-Delaware County) that would require hands-only CPR training for high school students has unanimously passed the state Senate and House of Representatives and now needs to be signed into law by Gov. Tom Wolf
The bill would make Pennsylvania the 39th state to enact similar CPR legislation.
‘Parents assume the sport physical is enough’
There are non-profits that offer free EKGs tests, and the Peyton Walker Foundation frequently holds them at various schools in central Pennsylvania. Big Spring just participated in one at Red Land High School.
The school hopes to host one in the future.
“It’s a couple thousand dollars to get it done on your own (if) your insurance doesn’t cover it,” Sinkovich said. “We’re trying to provide students with options to get the free screenings and get evaluated as much as possible.”
These screening events depend on awareness, which is another challenge in combating cardiac arrest.
Walker wants parents and athletes to know how critical it is to take advantage of these initiatives.
“The biggest challenge is that parents assume the sports physical is enough, and that if anything was wrong it would be found,” Walker said. “Unfortunately, kids are getting the same physicals that maybe I got 40 years ago.
“We would love to see EKGs become the standard of care that would be incorporated into well child visits and sports physicals, but until then we will continue to reach out and provide these in the community free of charge.”
Big Spring wants to do its part to help in that process.
“It’ll be a topic that we make sure we put to the forefront,” Sinkovich said. “We need to make sure parents are aware of their options and know what they can do.”
Information from: York Daily Record, http://www.ydr.com