A new California law requires an automated external defibrillator (AED) at schools that offer interscholastic sports competition. The regulation is an important safety measure for athletes and spectators. Effective July 1, 2019, each school is required to have an AED available to respond to incidents of sudden cardiac arrest (SCA). The law reflects a nationwide emphasis on providing AEDs at interscholastic sporting events.
Assemblyman Brian Maienschein, R-San Diego, presented the California bill in 2018. “Although SCA can occur at any time, vigorous exercise appears to act as a trigger, making SCA more common during athletic practices and games,” he said in a statement. “SCA is the leading cause of death in athletes during exercise and usually results from intrinsic cardiac conditions that are triggered by vigorous exercise.
“If automated external defibrillators are more readily available for authorized personnel to use, the lives of more student-athletes and spectators will be saved,” he said.
The National Athletic Trainers’ Association (NATA) released a report in May 2019 regarding cardiac arrest in youth sports. It says that from 2007 to 2015, SCD accounted for 76% of the total deaths in youth sports. Basketball accounted for the largest proportion (36%), followed by baseball (16%), American football (16%), and soccer (13%). Seventy-three percent of sudden deaths occurred among individuals aged 12 to 14.
AED Use Requires Training and a Plan
Tom Gauthier and Kyle Raney, attorneys at the California education law firm Lozano Smith, issued a news brief in spring 2019 on the legal aspects of AED use.
“School districts and charter schools that offer athletic programs must obtain at least one AED and create or update a written emergency action plan which describes procedures to be followed in the event of medical emergencies related to athletic activities or events,” Gauthier and Raney wrote. “In addition, school districts and charter schools should review existing policies and procedures regarding training requirements for athletic coaches to ensure that coaches are appropriately trained on identifying and responding to symptoms of heat illness.”
While most California coaches were trained in AED use at the time the law was passed, only about 75% of schools had AEDs, Maienschein said, and many of those weren’t accessible during practice. In addition, no state money was appropriated to pay for the AEDs.
The website CPR & First Aid reports that if CPR is administered immediately after cardiac arrest, it can double or triple a person’s chance of survival, but about 90% of people who experience an out-of-hospital cardiac arrest die.
The Trend Toward AEDs in U.S. Schools
California joins many other states with laws requiring AED placement in schools, according to the Sudden Cardiac Arrest Foundation. States that have similar laws covering public and private schools include New Jersey and Oregon, and public schools in Alabama, Arkansas, Connecticut, Florida, Georgia, Louisiana, Maryland, North Dakota, Nevada, New York, Oklahoma, Rhode Island, South Carolina, and Texas.
Finding funding for the AEDs can be a challenge. The National Federation of State High School Associations (NFHS) donated more than 600 AEDs in 2019 and 400 in 2018 to high schools nationwide.
“No endeavor has been more important and required more resources than our AED project,” according to Davis Whitfield, the NFHS chief operating officer and president of the NFHS Foundation.
“The AED project, in addition to other research opportunities, provides resources that help our states and their member schools develop policies and procedures to address the ongoing health and safety concerns in sports and activities, as well as save lives should a catastrophic event occur during a practice or game.”
Writing an Emergency Plan
In addition to having an AED at sports competitions, school districts need a written action plan for its use and policies to protect coaches and others from liability.
Middle and high school athletic administrators should be prepared for a near-fatal event. Boston Scientific’s health equity initiative Close the Gap: Health Equity for Life reports that “Sudden cardiac arrest is the leading cause of death in young athletes. Most often, the death occurs during athletic training or competition.” In the United States, a young competitive athlete dies suddenly every three days, Close the Gap reports. Other statistics include:
- Young athletes are more than twice as likely to experience SCD than young non-athletes.
- Most victims are male (90%).
- More than half of hypertrophic cardiomyopathy (HCM) sudden death victims are black athletes (52%). HCM is a disease that causes thickening of the heart muscle.
- The average age when SCD occurs in young athletes is 17.5 years.
- The risk of SCD increases with age.
- More than two-thirds of young athletes who die suddenly are basketball and football players (67%).
When a defibrillator is used within the first minute of collapse, chances of survival are close to 90%.
Planning for AED Training and Use
Athletic administrators have a full load managing teams, schedules, and recruiters’ visits, but none of these tasks is as important as protecting the health of student-athletes. The availability and immediate ability to use an AED is an essential way to protect athletes, and making sure equipment and training are available are key responsibilities of the athletic administrator. Athletic managers, including administrators and trainers, may be the first to administer CPR and then an AED before emergency help arrives, according to the Journal of Athletic Training.
The Korey Stringer Institute advises that a written emergency action plan be widely available to the sports management team and practiced for readiness. In addition, the institute advises that athletes and parents be educated about risks, and that family histories of heart disease are reviewed.
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New law requires defibrillators at athletic events K-12 Daily
Student-athlete safety laws going into effect K-12 Daily
Study Finds that Sudden Death in Middle School-Age Student-Athletes Most Common While Playing Basketball National Athletic Trainers’ Association
How CPR is Changing (and Saving) Lives CPR & First Aid
NFHS Foundation Helps Send 600 AEDs to High Schools, State Associations National Federation of State High School Associations
CPR/AED Laws Sudden Cardiac Arrest Foundation
The Legal Duties of Athletic Departments Online Master of Athletic Administration
Sample Athletic Emergency Action Plan Korey Stringer Institute
Sudden Cardiac Arrest in Athletic Medicine Journal of Athletic Training
Sudden Cardiac Death Korey Stringer Institute
Sudden Cardiac Arrest and Young Athletes Close the Gap