Smithtown Is Among Districts Turning To Defibrillators For Emergencies

By Bill Kaufman

STAFF WRITER

October 14, 2001

LAST YEAR, Northport High School freshman lacrosse goalie Louis Acompora, 14, died after being hit in the chest by a ball, a tragedy that later caused his family to publicly call for automated external defibrillators to be on hand at athletic events.

Equally tragic was the 1999 death of Eric Sopracasa, a former Sachem High School lacrosse champ who was also struck in the chest with a ball while practicing with his team at the University of Massachusetts.

Aware of the rare but possible risk, an increasing number of Long Island school districts are getting the devices and training staffers and students in their use.

One is the Smithtown district, where the high school Booster Club recently bought six new defibrillators for $2,600 each, as a gift. The district had only one unit previously.

Now there are two of the portable lifesavers stationed at the high school, one at the freshman campus, two at the middle school and two at Great Hollow Middle School. The units are similar to ones carried by virtually every Suffolk police car, with officers trained in their use.

In Acompora's case, death was attributed to a lethal cardiac arrythmia brought on by the blow. Experts report that if an object strikes a person's chest at the wrong moment in the cardiac cycle, this rare event can occur. The only way such a victim can stand a chance of survival is to be electronically shocked into a normal rhythm by the defibrillator.

"Most coaches are already trained and certified in both CPR and using the [defibrillator]," said Nicholas Schroeder, Smithtown physical education and athletics coordinator. "Some of the secondary school nurses have also received the training." By next month, he said, all physical education teachers, coaches and others will be involved in training.

"We hope to teach our health education classes throughout the district about use [of the unit] and availability," Schroeder said. He added that students enrolled in first-aid and CPR electives will soon also receive the American Red Cross training and certification.

The district requires a unit to be instantly available for use in the afternoons during lacrosse and soccer practice and while games are being played. The rule is also being considered for other sports, such as baseball. A prime mover in approving funds for the devices was school board member Susan Moriarty, who said a group of concerned parents had approached her about procuring them.

"When I brought the request for defibrillators to the board of education, it was warmly received and unanimously approved," Moriarty said. "With our ever-increasing student and staff population, I felt these units were very much needed."

Schools superintendent Charles A. Planz said, "This enhances the quality of health and safety for children and adults in the district." Planz said the units are "user friendly" and are an "insurance policy if someone goes into cardiac arrest." He emphasized that the devices are a safety measure not just for student athletes but for everyone.

For some students the presence of the devices seems to be a confidence-building measure. "I see our trainer with the defibrillator every day on the practice field, and it makes you feel that if something should occur you are in the safest possible situation," said Michael Petrucci, 16, a soccer and lacrosse player at Smithtown High School.

"I'm here every day in every season, and the trainer always has that yellow box with him in reach," said Petrucci's classmate, Ashley Grzetic, 16, referring to the box containing the defibrillator. "It makes me feel that someone is ready for any problem."

Copyright © Newsday, Inc. Produced by Newsday Electronic Publishing.

Town of Huntington Implements AED Program

August 28, 2001 - A Northport family has made tremendous strides in trying to protect Long Island's young athletes from losing their lives on the field.

In 2000, John and Karen Acompora lost their 14-year-old son, Louis, when a lacrosse ball hit him in the chest. Louis died soon after the incident.

His parents have insisted that if there had been a defibrillator nearby, their son would be alive today.

For the past year, the Acomporas and Suffolk County Legislator Andrew Crecca have been working to get defibrillators installed countywide. By October, the Acomporas may see their wish become a reality.

Karen Acompora fought back tears as she and her husband proudly unveiled a new program in the Town of Huntington that calls for six new defibrillatros to be placed in certain town owned buildings. The program is in honor of their son Louis.

The Acomporas lost their 14-year-old son Louis last March during a lacrosse game. Louis was struck in the chest by the lacrosse ball and immediately went into cardiac arrest. His father John is convinced that had a defibrillator been close by his son would have lived.

"His heart was quivering," he explained. "The only way to reverse that is with a defibrillator, it would have shocked the heart, put it at rest and the natural heart cycle would have taken over."

Town Supervisor Frank Petrone says this is just the first phase of this program, which they plan to expand. "The Crab Meadow Golf Course will have a unit," he explained. "The Dix Hills ice rink and the senior citizens center. We are also going to place one on our Harbor Master's vessel."

And the Town of Huntington program will likely be expanded to a county wide level. The Acompora's are also working with County Legislator Andrew Crecca who has drafted seven pieces of legislation calling for defibrillators to be placed in county buildings and county parks.

The defibrillators are easy to use, you stick the paddles to a victim's chest and simply press a button. A simple procedure that could save hundreds of lives.

Copyright © 2001 News12.com. News 12 and Rainbow Media. All rights reserved.

Pitch Wasn't Teen's Last, Thanks to Defibrillator

By Lucio Guerrero, Staff Reporter.

June 15, 2001 - With his team up by three runs and a runner on first, Sean Morley was looking to maybe knock in another score.

What he got was an inside pitch that set off an improbable chain of events that probably would have cost the Buffalo Grove boy his life if not for a lucky set of circumstances: a pair of doctors who happened to be in the stands, a quick call to 911 and a police officer who was on patrol nearby with a defibrillator in his trunk.

The pitcher hurled a fastball, chest high, but way inside. It hit the 13-year-old in the chest. The thud could be heard in the dugout.

The young ballplayer went into cardiac arrest--something that experts said would have happened only under the most precise conditions. The ball would have to be going more than 30 miles an hour. It would have to strike Sean in a small area just above the heart. And his heart would have to be in between beats.

That's such a rare confluence of events that, out of millions of kids who play baseball each year, it happens to only about 60, a study reported in the New England Journal of Medicine found.

Sean's heart raced up to 400 beats a minute, and he fell to his knees. He collapsed face-first onto the ground at Jewett Park in Deerfield.

"The people in the stands knew that something serious was going on," Arnie Harris, the team's manager, said of the scene Wednesday afternoon. "It was very apparent that something was wrong."

Harris ran onto the field, and spectators yelled out to call 911. One parent did. Two other parents of kids on Sean's team joined the coach. Luckily, both of the men--Fred Duboe and Robert Molnar--are doctors and were able to keep the boy alive.

"The first thing we did was turn him over to see if he was breathing," said Molnar, an anesthesiologist at Gottlieb Memorial Hospital. "He was, but he was not conscious."

Sean was breathing fairly normally when the doctors first arrived--about 12 to 16 times a minute--but then slowed to just a couple of times a minute. The doctors found a weak pulse and tried elevating his legs to get the blood flowing.

They were losing the boy when a police officer arrived with a portable defibrillator.

"I was on patrol near the park when I was flagged down by a woman who said that a kid was hit with a baseball," said Deerfield Police Officer Geoffrey Ruther.

Ruther was on his way to help when the dispatcher warned that the ballfield victim was in cardiac arrest.

"Then, I knew it was more than just some kid getting hit in the arm," Ruther said. "That's when I grabbed the defibrillator."

The portable defibrillator--a suitcase-sized device that delivers a powerful electric shock to restore a normal heartbeat--is one of six that the Deerfield police carry in patrol cars.

Ruther placed the pads on the unconscious boy, and the machine read that the boy needed to be shocked.

"I pressed the button, and [Sean] flinched," Ruther said.

The boy's heartbeat quickly returned to normal. By the time he was taken to the hospital, he was awake and alert. On Thursday, Sean was in good condition at Children's Memorial Hospital.

Everyone involved said they were lucky to have been there, but they all point to the portable defibrillator as making the difference. The devices are becoming more readily available in public places such as airplanes, shopping malls and parks to cardiac victims.

"Without it, this could have had a different outcome," Ruther said. "It was the real lifesaver."

Copyright 2001 © Digital Chicago, Inc. Produced by Chicago Sun-Times.

Planning for Scholastic Cardiac Emergencies: The Ripley Project

James M. Kyle, M.D., F.A.C.S.M.

Chief of Rural Emergency Medicine, Marshall University School of Medicine, Huntington; Director, Emergency Department, Jackson General Hospital, Ripley; Team Physician and Athletic Primary/Emergency Care Physician at Olympic Stadium for the 1996 Centennial Olympic Games in Atlanta, GA.

Joseph Leaman, A.T.C.

Program Director of Sports Medicine, Health South, Parkersburg; Athletic Trainer for the Track and Field Venue for the 1996 Centennial Olympic Games in Atlanta, GA.

Gregory A. Elkins, M.D.

Medical Director, Lincoln Primary Care Center, Handin; Clinical Assistant Professor, Department of Family and Community Health, Marshall University School of Medicine, Huntington.

Abstract

Fatalities during sports participation are usually cardiac in origin. Sudden Cardiac Arrest (SCA) from ventricular fibrillation has been reported in several sporting venues over the last decade. Successful treatment of stadium SCA requires a rapid response team equipped with defibrillator capabilities. The use of automated external defibrillators (AED) by responders in sports arenas is critical to help prevent catastrophic scholastic athlete and spectator cases of unexpected sudden cardiac death.

Introduction

High school athlete medical coverage has received increasing emphasis over the past decade. Mandatory pre-season physical examinations have been standardized and expanded to detect athletes at risk for emergency medical conditions (1).

Many school systems now employ full-time certified athletic trainers for year-round sporting event coverage. In West Virginia, the State Board of Education requires all high schools participating in interscholastic football to have an athletic trainer present at all practices and games.

For the last 10 years, the Sports Medicine Committee of the West Virginia Chapter of the American Academy of Family Physicians (WVAAFP) and the West Virginia Secondary Schools Activity Commission (SSAC – the state governing body of scholastic sporting events) has monitored event coverage utilizing a report card system. Prior to kickoff, documentation of "on the field" athletic trainer, ambulance, and team physician attendance is recorded for future analysis.

The coach’s role in injury prevention and emergency response has also been expanded in scope. The National Federation of High School Sporting Associations routinely conducts workshops and seminars to enhance the health care of the student athlete. This includes safe wrestler weight loss, preventative programs for anabolic steroid abuse, and catastrophic health and neck injury prevention.

In West Virginia, the SSAC conducts mandatory pre-season programs on injury management provided by the Sports Medicine Committee on the WVAAFP and representatives of the West Virginia Athletic Trainers Association (WVATA). Coaches are encouraged to maintain a current CPR certification. The American Heart Association (AHA) recommends the Heart Saver classification of certification for all individuals responsible for adolescent emergency care. To maximize outcomes, automated external defibrillators (AED) training was incorporated by the AHA in the fall of 1998.

Sudden Cardiac Arrest

Sudden cardiac arrest (SCA) has an estimated annual incidence of 0.7 to one per 1000 population (2,3). High school athlete sudden death is rare; however, sudden cardiac arrest in adult spectators has been reported (4,5). In fact, one of these unfortunate incidents occurred at a major college basketball game when the author of this article was in attendance.

Professional and collegiate sporting venues typically employ emergency medical response teams for spectator care coverage. High school event coverage is less organized and typically falls under the responsibility of the athletic director or school administrators.

The entry of automated external defibrillators into the sporting arenas has become attractive as the result of numerous studies documenting increased survival rates with police and first responder programs (6,7). In addition, the AHA has endorsed the newly introduced, sophisticated, safe and relatively inexpensive AEDs for targeted responder groups. At the 1998 National Athletic Trainer Association (NATA) meeting in Baltimore, MD, most NFL trainers reported utilizing AEDs.

On the collegiate level, officials from the Southeastern Conference documented eight of 12 member schools with plans to provide AED coverage at practice and games in the upcoming school year. The University of Georgia initiated a program in 1997 which has become a model for other member schools. This program is designed for time to shock under five minutes from deployment, from one of the three training rooms equipped with Lifepak 500 AEDs.

Several high school trainers attended the AED workshop at the Baltimore convention. Many expressed a keen interest for incorporating AEDs into their existing emergency event coverage; however, no existing high school AED programs were reported.

The Ripley Project

High school sporting events traditionally enjoy a high priority in rural communities. In many locations, the high school campus becomes a focal point for public gatherings and a potential site for cardiac emergencies (8).

In Jackson County, WV, the Board of Education operates two high schools with an average enrollment of 1,200 students. During the summer of 1997, the Board approved the purchase of two Lifepak 500 AEDs for deployment at high school sporting events. This action was prompted by encouragement from Emergency Department personnel at Jackson General Hospital, located in Ripley, in response to a case of SCA in a 16-year-old high school baseball player in an adjacent county. This student had died when he was struck in the chest by a baseball from 90 feet as he attempted to slide into third base. Commotio Cordis (cardiac concussion) was the expected cause of death.

Prior to the start of fall football practice, school administrators invited each appointed high school football trainer and coaching staff to attend a CPR re-certification and AED workshop. This five-hour course was conducted by the staff form Jackson General Hospital, local Emergency Medical Services personnel, and the regional EMT coordinator. It was attended by the hospital’s AHA coordinator and nurses from the Emergency Department, as well as 26 school personnel, including various head coaches and principals.

The course was actually modeled from a casino responder program which was initiated in select Las Vegas properties during early 1997. Components of initial education included emphasis on signs and symptoms of pending cardiac arrest and video CPR instructions. All students were tested in one person CPR by AHA instructors prior to AED in-service and subsequent testing. Continuing education at three-month intervals was facilitated by impromptu drills during scheduled team practice and Faculty Senate Day teacher workshops combined with a quarterly newsletter with an educational focus.

The Ripley pilot project received endorsement from the State Board of Education and prior to initiation of the project, the West Virginia Legislature approved a grant providing funding for the placement of three additional AEDs to first responder fire departments units in strategic county locations. Members from the educational team for the coaching in-service also provided education for local fire departments.

Reports indicated that Jackson County was among the first school systems in the United States implementing early defibrillation programs (9,10).

Discussion

Most cases of indirect fatalities during sports play are cardiac in origin (11). In addition to structural and congenital causes precipitating SCA, the syndrome of cardiac concussion has received recent attention (12,13,14,15). A laboratory model of commotio cordis reported by the Cardiac Arrhythmia Services at Tufts New England Medical Center has defined late repolarization induced ventricular fibrillation as "the insult in Little League baseball" (16).

Although the incidence of SCA in the athletic arena is low, the impact on the community is devastating when a young, vibrant, apparently healthy athlete succumbs to sudden death during sports play. The recent availability of automated external defibrillators has provided a mechanism to prevent such loss.

The decision to investigate the feasibility of early defibrillation programs at the high school should consider the strength and motivation of current community CPR initiatives. School administrative personnel can structure sports team AED purchase with student CPR classroom teaching justification. Good citizenship mandates early defibrillation awareness during initial CPR teaching exposure.

Medical supervision for targeted responder AED program is an essential component fo success. Emergency Department personnel are traditionally in charge of the community cardiac emergency response and can provide invaluable insight into early defibrillation programs. Initial organization must include coordination with existing pre-hospital care providers to maximize survival rates. Adherence to the AHA chain of survival concept must be strictly enforced (1,2). The addition of a cellular phone to the AED carrying case is ideal for rural settings to promote 911 activation prior to initial resuscitation.

The chain of survival includes:

1. Fast EMS activation (call 911);
2. Early CPR by a first responder (target responder);
3. Early defibrillation (the greatest single impact on survival statistics);
4. Early advanced life support (such as intubation, external pacing and cardiac medications); and
5. Late advanced life support involving dwelling pacemakers and defibrillators, medications and surgery (17).

Quality assurance issues can be facilitated by critical review of AED usage provided by data display programmed into newer AED units. Emergency Department physicians anticipated to be utilized in the event of cardiac emergency should be incorporated into plans for the initial course and subsequent continuing education at three-month intervals. This concept must be augmented with excellent cellular phones or radio communication in rural areas.

Conclusion

Recent technological advances in automated external defibrillator equipment design privde an opportunity for advanced treatment to become safe and expedient in the hands of targeted responders. As a result, communities need to develop a mechanism for education and equipment acquisition.

Historically, most communities support local high schools for noteworthy projects. Additional grant funds are currently being sought for additional studies in an even more rural West Virginia county. Physician directed CPR and AED training for teachers, coaches, school administrators, and athletic trainers provides and attractive model for improving the safety of athletic participation and spectator safety at athletic events.

References

1. Kyle JM, Walter RB, Forbase JK, Leaman JR, Hanshaw SL. Exercise induced bronchospasm in the young athlete: guidelines for routine screening and initial management. Medicine and Science in Sports and Exercise; August 1992.

2. American Heart Association Report on the Public Access Defibrillation Conference – December 3-10, 1994. Circulation 1995; 92:2740-7.

3. Automatic external defibrillators for public access defibrillation: recommendations for specifying and reporting arrhythmia analysis algorithm performance, incorporating new waveforms, and enhancing safety. Circulation 1997; 95:1677-82.

4. Spaite DW, Criss EA, Valenzuela TD, Mclalin HW, Smith R, Nelson A. A new model for providing pre-hospital medical care in large stadiums. Ann Emery Med 1988; 17:824-8.

5. Weaver WD, Sutherland K, Wirkus MJ, Bachman R. Emergency medical care requirements for large public assemblies and a new strategy for managing cardiac arrest in this setting. Ann Emery Med 1989, 18:155-60.

6. White R. Police AED, Ann Emer Med 1996.

7. Alonso-Serra HM, Delbridge TR, Auble TE, Mosesso VN, Davis EA. Law enforcement agencies and out-of-hospital emergency care. Ann Emer Med 1997; 29:4.

8. Kyle JM, Walter RB. Sports medicine education for rural practice. The Physician and Sports Medicine; Vol. 16, No. 8.

9. Kyle JM, High schools help conquer cardiac arrest. School Business Affairs 1998; 48-50.

10. Sobel RK. A shocking story: handy defibrillators. U.S. News & World Report. September 1998; 77.

11. Maron MD, Thompson P, Puffer J, McGrew C, Strong W, Douglas P, et al. Cardiovascular pre-participation screening of competitive athletes. American Heart Association: Med Sci Sport Exerc, December 1996; 28(12)1445-52.

12. Maron MD, Pollac MD, Kaplan MD, Mueller, PhD. Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. NEJM August 1996; Vol. 333, No. 6.

13. Estes NA. Sudden death in young athletes. NEJM August 1996; Vol. 333, No. 6.

14. Amerongen MD, Rosen MD, Winnik MD, Horwitz DO. Ventricular fibrillation following blunt chest trauma from a baseball. Ped Emer Care 1997; Vol. 13, No. 2.

15. Kaplan MD, Karofsky MD, Volturo MD. Commotio cordis in two amateur ice hockey players despite the use of commercial chest protectors: case reports. J of Trauma 1993; Vol. 34, No. 1.

16. Maron MD, Pollac MD, Kaplan MD, Mueller PhD. Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. NEJM August 1996; Vol. 333, No. 6.

17. Automatic external defibrillators for public access defibrillation: recommendations for specifying and reporting arrhythmia analysis algorithm performance, incorporating new waveforms, and enhancing safety. Circulation 1997; 95:1677-82.