Figure 1 - uploaded by Kimberly G Harmon
Content may be subject to copyright.
Management of sudden cardiac arrest. AED-automatic external defibrillator; CPR-cardiopulmonary resuscitation; EMS-emergency medical services; SCA-sudden cardiac arrest.
Source publication
Sudden death in athletes occurs approximately once every 3 days in the United States. Each school or venue should have an emergency action plan that is coordinated with local emergency medical services (EMS). Access to early defibrillation to treat sudden cardiac arrest (SCA) is critical. If EMS response times are greater than 3 to 5 minutes from c...
Context in source publication
Context 1
... rescuers available. When a victim collapses acutely, especially mid-exertion, and is unre- sponsive, the athlete should be assumed to be in cardiac arrest. Responsiveness can be checked by tapping or lightly shaking the athlete on the shoulder and asking if they are okay. If there is no response, the chain of sur- vival should be initiated (Fig. ...
Citations
... Recommendations suggest that when an athlete collapses during exertion and becomes unresponsive, bystanders recognize seizure-like movements and agonal breaths as cardinal signs for activating the EAP and initiating resuscitation (Bergfeldt, 2003;Drezner et al., 2007;Huggins et al., 2017). Bystanders also need to know where the closest AED is located and use it while directing emergency medical services to the affected individual's location (Harmon & Drezner, 2007;Huggins et al., 2017;Terry et al., 2001). ...
... A commonly cited barrier to bystanders' initiation of resuscitation is the fear of liability. This fear may be reduced by providing CPR/AED education and encouraging key members of the lay community to implement EAPs (Harmon & Drezner, 2007;Huang et al., 2019;Shams et al., 2016). In their systematic review and meta-analysis, Holmberg, Vognsen, Andersen, Donnino, and Andersen (2017) demonstrated an association between bystander AED use and survival to discharge from the hospital for all rhythms OR 1.73 [95% CI: 1.36, 2.18], and an association between bystander AED use and favorable neurological outcomes for all rhythms OR 2.12 [95% CI: 1.36, 3.29]. ...
Background
Children who participate in youth sports are at risk for sudden cardiac arrest (SCA) related to undetected cardiac anomalies or abrupt impact to the chest. Nurse-led interventions may prevent sudden cardiac death by helping leagues implement an emergency action plan to respond to SCA and improve safety. A youth soccer league in the Southeast with participants between the ages of 5–19 years, led by volunteer board members and coaches, did not have reliable access to automated external defibrillators or receive standardized education on SCA and cardiopulmonary resuscitation with a site-specific action plan.
Methods
A nurse-led quality improvement pilot project used partnerships to provide league access to automated external defibrillators, institute preseason SCA and cardiopulmonary resuscitation training, and establish an emergency action plan for the league's volunteers. Anonymous pre- and post-training testing was conducted to measure participant knowledge, confidence, and willingness to respond to SCA. A cross-sectional survey, using a convenience sample of board members and coaches, evaluated sustainability of the intervention at midseason.
Intervention
Training targeted board members (Blue Shirts) to serve as leaders on the field during an SCA event and educated coaches on activating the emergency action plan.
Results
Blue Shirts and coaches showed significant (p < .05) improvement of knowledge, confidence, and willingness to respond to SCA after receiving the standardized preseason intervention; Blue Shirts' changes were sustained at midseason.
Conclusion
Nurses are ideal for helping youth sports leagues implement a sustainable SCA action plan based on best-practice recommendations for emergency health and safety.
... Therefore, alongside the AED itself, bystanders must have knowledge of the presence of an AED and the willingness and confidence to use it. To aid in this process, both amateur and communitybased sporting organizations are increasingly being encouraged to have an emergency medical plan in place that is inclusive of best practice for storing, accessing, and maintaining an AED [6]. ...
... Medical emergencies are highpressure situations, and lay bystanders without previous medical training may find it difficult to remember skills learned during formal AED training. Thus, introducing procedural learning could be useful, where club members regularly practice their EAP with a run-through of potential scenarios [6]. ...
... In addition, 44.1% of clubs designated a single individual in their club as being responsible for AED maintenance and only 40% confirmed that their AED was checked in the last month [12]. The AED should ideally be checked to ensure it is working and available prior to every event in the club [6]. Further examination, such as an audit of AED location and function, to ensure the maintenance practices in GAA clubs is required. ...
Objectives:
To identify availability and accessibility of AEDs in Irish GAA clubs and the knowledge, willingness and confidence of club members to use AEDs in a medical emergency.
Methods:
A self-report survey was completed anonymously by GAA club members (n=267). The survey captured demographic information, previous formal AED training, awareness of AED access in their local GAA club and knowledge, confidence and willingness to use an AED in a medical emergency and awareness of a written club emergency action plan (EAP). Descriptive statistics were used to examine survey responses and independent samples t-tests to compare differences in outcome scores between those who have or have not completed formal AED training and those that have or have not studied towards or worked in a healthcare provision role.
Results:
Three in every five GAA club members reported that their club owned an AED and almost half of all respondents had access to a club AED in the event of a medical emergency in their club. Formal training was noted by 53.2% of respondents; this group demonstrated significantly better knowledge, confidence and willingness (p<0.0001) than those without. Few (7%) respondents knew where the club EAP was or how to access it.
Conclusion:
To ensure the chain of survival works effectivelyit is essential that an AED is available, is accessible, and that club members know its location, know when to use it and are willing and confident to use it. GAA clubs should design an individual emergency action plan and disseminate it widely among club members. Formal AED training should be encouraged among club members and at least one trained member should be present during all club activities.
... Orthopaedic surgeons have the privilege of providing medical coverage for a diverse range of athletic events and are among a growing range of providers who share these responsibilities: certified athletic trainers, physical therapists, emergency medical technicians, nurses, and nonoperative physicians. 18 While caring for athletes on the field, these providers may need to treat a broad array of injuries not limited to the musculoskeletal system, [6][7][8]10,11,13,14,17 despite the fact that the education and training for each type of provider varies greatly. 3,5,20,22,23,25 Many orthopaedic residency programs require residents to work as independent or assistant sideline physicians, but the training needed to effectively treat the wide variety of conditions, clinical situations, and ethical dilemmas 12 encountered is not standardized. ...
Background
Orthopaedic surgery residents may cover athletic events, although the training provided to prepare residents for this role and oversight from attending physicians during these activities is not well understood.
Purpose
To survey orthopaedic residents about the training provided by their residency program for on-field athletic coverage and to understand their levels of preparation for this role and confidence in treating commonly encountered on-field conditions.
Study Design
Descriptive epidemiology study.
Methods
An anonymous survey was emailed to residents in all American College of Graduate Medical Education–accredited, allopathic, nonmilitary orthopaedic surgery residency programs. This survey queried residents about their demographics, the opportunities their residencies require or allow for athletic coverage, their level of preparation for serving an on-field physician, and their comfort level with treating a number of on-field conditions. Likert-type scales were used to assess resident comfort level for treating 13 orthopaedic and nonorthopaedic conditions as well as their perceived level of preparedness.
Results
Of 148 residency programs contacted, 57 programs responded (39%). Of the 57 programs responding, 51 (89.5%) allowed or required residents to cover athletic events, and 27 of 51 (52.9%) reported that training to prepare for this role was provided. Only 6 of 24 programs without training available (25%) had direct attending supervision of residents at all athletic events. Residents who answered that their residency programs mandate training prior to their participation in athletic coverage activities reported a higher level of preparation for this role than those with no training, optional training, or those who were unsure of their training requirement (P < .0001, P = .035, and P = .013, respectively). In addition, the more senior the resident was, the higher the level of confidence was in treating all orthopaedic and some nonorthopaedic conditions. Residents who had mandatory training displayed a higher comfort level in treating on-field orthopaedic and nonorthopaedic conditions than those without training.
Conclusion
Formal training of orthopaedic residents prior to their covering athletic events can improve confidence in treating orthopaedic and nonorthopaedic conditions. Many programs do not ensure that residents are familiar with key and potentially life-saving equipment. An opportunity exists to improve resident education.
... Alert other individuals on-site so they can assist in guiding EMS to the scene. 3. Emergency equipment location and maintenance 6,7,15,17,[19][20][21]25 a. Develop a plan to locate the nearest accessible AED and other emergency equipment. Ideally, an AED is present on-site in a central location so that the device can be immediately retrieved and applied to the individual in need. ...
... Use of the AED within 1 to 3 minutes of collapse results in the best chance of survival from a cardiac-related, shockable rhythm. 19 The Task Force supports recommendations from the American Academy of Family Physicians and American Academy of Pediatrics 33 and American Medical Society for Sport Medicine 30 as the minimum standards for screening using the comprehensive personal history, family history, and physical examination. ...
... 3. Procedures for proper management of SCA 7,17,19,20,25,28,29 Note: Any youth athlete who has collapsed and is unresponsive should be assumed to be in SCA until proven otherwise or another cause of the collapse is identified. Member leaders and member coaches should be a. ...
This document is intended to serve as a call to action for all youth sport NGBs to provide support systems for member organizations through the education of league leaders and their members on the current policy and procedure best practices regarding EAPs, SCA, brain and neck injury, EHS, and other potentially threatening medical conditions (Appendix B). This document also discusses preexisting medical conditions, environmental conditions, and emergency medical care, such as athletic training services. The Task Force recognizes that each organization is unique and, therefore, will need to address policy and procedure recommendations differently to ensure the implementation of best practices. Furthermore, the Task Force recognizes that all best-practice policy and procedure recommendations may not be necessary for each sport (eg, lightning policy for indoor sports). Many of the deaths in youth sports are preventable, and it is the goal of the Task Force to support youth sport NGBs in this mission of prevention.
... An adequate emergency response begins with establishing a comprehensive emergency action plan (EAP), consulting local emergency medical services (EMS), establishing a communication system to activate emergency services, training school staff and anticipated responders in cardiopulmonary resuscitation (CPR), and reviewing and rehearsing the emergency response regularly. 6,7 We sought to determine if having an AED on a high school campus was a predictive marker of the school's comprehensive emergency preparedness for SCA and to compare the demographics of high schools with and without AEDs. ...
Sudden cardiac arrest (SCA) is the leading cause of death in athletes during exercise. The effectiveness of school-based automated external defibrillator (AED) programmes has not been established through a prospective study.
A total of 2149 high schools participated in a prospective observational study beginning 1 August 2009, through 31 July 2011. Schools were contacted quarterly and reported all cases of SCA. Of these 95% of schools confirmed their participation for the entire 2-year study period. Cases of SCA were reviewed to confirm the details of the resuscitation. The primary outcome was survival to hospital discharge.
School-based AED programmes were present in 87% of participating schools and in all but one of the schools reporting a case of SCA. Fifty nine cases of SCA were confirmed during the study period including 26 (44%) cases in students and 33 (56%) in adults; 39 (66%) cases occurred at an athletic facility during training or competition; 55 (93%) cases were witnessed and 54 (92%) received prompt cardiopulmonary resuscitation. A defibrillator was applied in 50 (85%) cases and a shock delivered onsite in 39 (66%). Overall, 42 of 59 (71%) SCA victims survived to hospital discharge, including 22 of 26 (85%) students and 20 of 33 (61%) adults. Of 18 student-athletes 16 (89%) and 8 of 9 (89%) adults who arrested during physical activity survived to hospital discharge.
High school AED programmes demonstrate a high survival rate for students and adults who suffer SCA on school campus. School-based AED programmes are strongly encouraged.
... An adequate emergency response begins with establishing a comprehensive emergency action plan (EAP), consulting local emergency medical services (EMS), establishing a communication system to activate emergency services, training school staff and anticipated responders in cardiopulmonary resuscitation (CPR), and reviewing and rehearsing the emergency response regularly. 6,7 We sought to determine if having an AED on a high school campus was a predictive marker of the school's comprehensive emergency preparedness for SCA and to compare the demographics of high schools with and without AEDs. ...
Context:
School-based automated external defibrillator (AED) programs have demonstrated a high survival rate for individuals suffering sudden cardiac arrest (SCA) in US high schools.
Objective:
To examine the relationship between high schools having an AED on campus and other measures of emergency preparedness for SCA.
Design:
Cross-sectional study.
Setting:
United States high schools, December 2006 to September 2009.
Patients or other participants:
Principals, athletic directors, school nurses, and certified athletic trainers represented 3371 high schools.
Main outcome measure(s):
Comprehensive surveys on emergency planning for SCA submitted by high school representatives to the National Registry for AED Use in Sports from December 2006 to September 2009. Schools with and without AEDs were compared to assess other elements of emergency preparedness for SCA.
Results:
A total of 2784 schools (82.6%) reported having 1 or more AEDs on campus, with an average of 2.8 AEDs per school; 587 schools (17.4%) had no AEDs. Schools with an enrollment of more than 500 students were more likely to have an AED (relative risk [RR] = 1.12, 95% confidence interval [CI] = 1.08, 1.16, P < .01). Suburban schools were more likely to have an AED than were rural (RR = 1.08, 95% CI = 1.04, 1.11, P < .01), urban (RR = 1.13, 95% CI = 1.04, 1.16, P < .01), or inner-city schools (RR = 1.10, 95% CI = 1.04, 1.23, P < .01). Schools with 1 or more AEDs were more likely to ensure access to early defibrillation (RR = 3.45, 95% CI = 2.97, 3.99, P < .01), establish an emergency action plan for SCA (RR = 1.83, 95% CI = 1.67, 2.00, P < .01), review the emergency action plan at least annually (RR = 1.99, 95% CI = 1.58, 2.50, P < .01), consult emergency medical services to develop the emergency action plan (RR = 1.18, 95% CI = 1.05, 1.32, P < .01), and establish a communication system to activate emergency responders (RR = 1.06, 95% CI = 1.01, 1.08, P < .01).
Conclusions:
High schools with AED programs were more likely to establish a comprehensive emergency response plan for SCA. Implementing school-based AED programs is a key step associated with emergency planning for young athletes with SCA.
... Sudden death in athletes occurs approximately once every 3 days in the United States. Each school or venue should have an emergency action plan that is coordinated with local EMS (3). The estimated annual incidence of cardiac arrest was 0.18 per 100,000 person-years among students and 4.51 per 100,000 person-years for school faculty and staff in one report (4). ...
This study aimed to describe the characteristics of out-of-hospital cardiac arrest (OHCA) according to specific activity types at the time of event and to determine the association between activities and outcomes according to activity type at the time of event occurrence of OHCA. A nationwide OHCA cohort database, compiled from January 2008 to December 2010 and consisting of hospital chart reviews and ambulance run sheet data, was used. Activity group was categorized as one of the following types: paid work activity (PWA), sports/leisure/education (SLE), routine life (RL), moving activity (MA), medical care (MC), other specific activity (OSA), and unknown activity. The main outcome was survival to discharge. Multivariate logistic analysis for outcomes was used adjusted for potential risk factors (reference = RL group). Of the 72,256 OHCAs, 44,537 cases were finally analyzed. The activities were RL (63.7%), PWA (3.1%), SLE (2.7%), MA (2.0%), MC (4.3%), OSA (2.2%), and unknown (21.9%). Survival to discharge rate for total patients was 3.5%. For survival to discharge, the adjusted odds ratios (95% confidence intervals) were 1.42 (1.06-1.90) in the SLE group and 1.62 (1.22-2.15) in PWA group compared with RL group. In conclusion, the SLE and PWA groups show higher survival to discharge rates than the routine life activity group.
Although recognized as the most well-trained providers to address musculoskeletal injuries, many orthopaedic surgeons do not routinely treat patients with nonmusculoskeletal issues in their clinical practice. Nonetheless, when serving as a team physician, an orthopaedic surgeon may need to initiate management of or manage many nonmusculoskeletal issues. Knowing how to accurately diagnose and initiate management of sports-related medical and surgical conditions is an important facet of being an orthopaedic team physician. Common systems that may be involved include the cerebral/neurologic, ocular, dental, respiratory/pulmonary, cardiac, abdominal, and genitourinary systems. Each of these systems has specific pathologic processes and risks related to athletic or sporting participation. Orthopaedic team physicians must have a baseline familiarity with the most common nonmusculoskeletal issues to provide comprehensive quality care to athletes and patients.
This chapter reviews the principles of emergency cardiac care in sport at every level from an event held at a small school to the Olympic setting, focusing specifically on care of the athlete and not on spectator or mass-gathering issues. Efficient sudden cardiac arrest (SCA) management depends on the immediate onsite availability of well-maintained, fully functional, life-saving medical equipment. Prompt recognition of SCA in an athlete is the first step in the sport emergency cardiac care (SECC) treatment plan. Definitive cardiac critical care may require invasive cardiac catheterisation, coronary artery device insertion, therapeutic post-cardiac arrest hypothermia, ventilation, internal defibrillator device insertion and a number of other related pharmacological or surgical interventions that can only be adequately undertaken in an appropriately staffed and equipped facility. The occurrence of SCA on the sports field in a fit and healthy sportsperson may generate an emotional response locally, nationally and internationally.
