Blow to chest can be fatal in child athletes, study finds

CHICAGO, Illinois (Reuters) -November 13, 2006 - Children who play hockey, football, lacrosse or baseball risk sudden death from a hard blow to the chest even if they are clad in protective gear, researchers said Monday.

Commercially available equipment may not adequately protect young athletes if the chest is hit in a manner that triggers an irregular heartbeat called ventricular fibrillation, according to a study presented at the annual American Heart Association meeting in Chicago.

"If the blow occurs directly over the heart at a particular time in the heart's cycle, the results can be catastrophic," said the report's lead author, Dr. Barry Maron, director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation.

The heart's electrical activity becomes disordered and its lower chambers contract in a rapid, unsynchronized way, allowing little or no blood to be pumped. Collapse and sudden death can follow unless immediate medical help is provided.

Such a rare but tragic blow can come from a ball, bat, hockey stick, puck or hard contact with another person, according to the study.

Of the 182 cases of ventricular fibrillation tracked by Maron since 1995, 47 percent occurred during practice or competition in organized sports. Thirty-nine percent of the children suffered fatal chest blows despite the presence of protective equipment. Their average age was 15 years.

The remaining 53 percent occurred during recreational sports or normal activities around the home.

Among the athletes were 14 hockey players, 10 football players, six lacrosse players and three baseball catchers. In 23 of the deaths, padding did not cover the chest at the time of the blows, and 10 deaths occurred when projectiles directly struck the chest protector.

The athletes wore standard, commercially available chest barriers made of polymer foam covered by fabric or a hard shell.

Further research conducted at the New England Medical Center and Tufts University School of Medicine in Boston, Massachusetts, found ventricular fibrillation could be caused by a baseball moving 30 mph, but only if impact occurred directly over the heart during a 20-millisecond window when the lower heart chambers are relaxed.

The findings indicate a need for better chest protection to make the athletic field safer for young participants, Maron said.

Those involved with youth sports also must be taught to recognize when a child has suffered the potentially deadly heart rhythm -- known as commotio cordis -- so that prompt resuscitation and defibrillation can occur, he said.

"Hopefully, these data will represent a stimulus for developing a truly effective chest barrier that will be absolutely protective against the risk of these commotio cordis catastrophes," he said.

Copyright 2006 Reuters. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed

Prescreening Young Athletes:

Medical experts recommend ensuring children are healthy enough to play sports

BY ELLEN MITCHELL

Special to Newsday

October 10, 2006

On March 25, 2000, Louis Acompora died on the playing field at Northport High School. He was 14 years old, full of life and playing lacrosse, his favorite sport.

The ball slammed into Louis' chest. It was a routine shot, not at high speed, and Louis was wearing a chest protector. But the impact came in a split second between heartbeats, striking in just such a way as to cause a fatal arrhythmia. The teenager's life and the lacrosse ball collided at precisely the wrong time in the wrong place.

"This was Russian roulette," said Karen Acompora, Louis' mother. "It's disgusting terminology, but that's what it was."

The arrhythmia that killed Acompora's son is called commotio cordis, which translates as commotion of the heart. It is the second leading cause of death in young athletes.

On Sept. 27, 2005, at a Merrick Little League practice, 9-year-old Robbie Levine was running the bases. He had been playing baseball since he was a preschooler. On that fateful day, he collapsed at home plate and died. Robbie's father, Craig, the team manager, tried to revive his son to no avail. Robbie died of some form of cardiac arrhythmia, for which - despite an autopsy and the passage of time - his parents do not yet have a precise name.

Once, several months before his death, Robbie felt dizzy and faint while playing baseball. A pediatric cardiologist did tests and declared Robbie had "the healthiest heart he had ever seen," according to Robbie's mother, Jill.

Could either of these boys still be alive today? In Louis' case, perhaps if a defibrillator had been accessible, his heart could have been shocked back into a regular rhythm, and he might have survived. In Robbie's case, his problem might have been detected earlier if the doctor had performed more tests, in particular a stress test, when Robbie first complained of dizziness while playing ball.

Could more be done?

The tragedies call into question whether enough is being done to screen young athletes and try to identify those who may have heart problems and who could be at risk, and then to provide emergency treatment on the athletic field in the event of a sudden cardiac attack.

According to the American Academy of Family Physicians, of the estimated 10 million to 15 million athletes who participate in organized sports in the United States yearly, fewer than 300 die of sudden cardiac-related causes. Most studies say roughly one high-school-age male per 100,000 and one female per 300,000 suffer sudden cardiac death on the playing field.

Those are very low numbers ... unless it's your child, in which case it's "heartbreak for everyone," said Dr. Russell Schiff, director of pediatric cardiology at Winthrop-University Hospital in Mineola.

Schiff is among physicians who believe not enough is being done in the screening of young athletes. Winthrop is developing a pediatric program that will provide cardiopulmonary stress tests with treadmills and bicycles as well as other testing. The intent is to prevent cardiac deaths and to determine to what level children with known cardiac abnormalities can safely participate in sports.

Writing in the July 2006 issue of Cardiology Review, Dr. Daniel Montellese, a senior cardiology fellow at Stony Brook University Hospital, said most young people who suffer sudden cardiac death on the athletic field show no sign of symptoms or abnormalities before their deaths, and few undergo any form of pretesting to evaluate their risk.

Montellese said guidelines from such groups as the American Heart Association recommend that a family history and physical exam including blood pressure reading be taken, but they do not include an electrocardiogram or echocardiogram (which uses ultrasound), and surely not a stress test prior to allowing a young person to compete in athletics.

By contrast, Montellese said, in 2005 the European Society of Cardiology issued a statement mandating that every young competitive athlete undergo a standard, 12-lead EKG before participating in sports.

Schiff added that in a study done in Italy, which has had a formal national screening program mandating such an EKG since 1982, about 2 percent of would-be athletes were disqualified, and among athletes the rate of sudden deaths had fallen 89 percent since that time.

A disclaimer

However, though experts agree the Italian results are impressive, they say Italy and the United States cannot be compared, because the Italian population is more homogeneous and far smaller.

The American College of Cardiology recently said similar national obligatory screening would be difficult in the United States because of the huge number of young athletes here, the major cost-benefit considerations and the fact that it is impossible to eliminate all risks associated with competitive sports. EKGs can also yield a substantial proportion of false positive test results. The Italian study found a 9 percent rate of false positives. In this country, experts say such false positives could represent a burden to athletes and their families.

The cardiologists interviewed for this article said that although an EKG would not detect all cardiac problems, it could raise suspicion of some potentially fatal conditions. Among them is the most frequent cause of sudden cardiac death in young people, hypertrophic cardiomyopathy. In this usually genetically transmitted condition, the heart muscle of the left ventricle is abnormally thickened and may obstruct the flow of blood out of the heart.

"In the age group from ninth to 12th grade, I'd say a third to 40 percent of sudden cardiac deaths are from hypertrophic cardiomyopathy," said Dr. Frederick Bierman, chairman of the department of pediatrics at Schneider Children's Hospital in New Hyde Park. Bierman said hypertrophic cardiomyopathy may not always be apparent on an EKG and is usually not detectable by testing before the age of 14. But, he said, after that age an EKG could add information and may help identify the condition.

At Schneider, there is a special program that provides EKG prescreening for young athletes from several high schools in the vicinity. Bierman knows of no other area hospital doing this.

Slipshod requirements

The cardiologists said ideally a physician should do a detailed medical and family history, a general physical exam including an EKG, and an echocardiogram. However, some school districts require nothing more than a cursory medical questionnaire and a brief exam by a school nurse.

Montellese said any prescreening and history taking should involve parents. Asking a 12-year-old if there is any history of cardiac death in his or her family is "laughable," he said.

Dr. Stanley Weindorf of Woodbury Pediatric Associates in Plainview is a general pediatrician who for the past year and a half has been performing EKGs on all teenage athletes in his practice. He said no school districts request that he do so. "You have to realize a lot of coaches are just thinking of getting their kids fit to play in the game. They're not thinking of any medical consequences," Weindorf said.

However, the National Athletic Trainers Association, which represents some 30,000 members, just this year developed guidelines on dealing with sudden cardiac arrest during high school and college athletic practices and competitions. They recommend that all schools have an emergency action plan, with a defibrillator and a first responder trained in cardiopulmonary resuscitation on site. The association, however, does not have any formal recommendations on prescreening for high school students, according to representative Robin Waxenberg.

Weindorf, meanwhile, said he is finding "more and more" cardiac conditions, which he refers to pediatric cardiologists. It is "frightening, disconcerting" he said, that EKGs are not mandated for student athletes.

The physicians agreed that the cost of universal testing for so many millions of athletes, and the low numbers of cardiac problems that would be found, are the prime reasons prescreening EKGs are not regularly done in this country.

"Some of the HMOs refuse to reimburse for a routine EKG that is not recommended by the American Academy of Pediatrics," Weindorf said. "But we're not talking a lot of money when you think of the repercussions of even one major heart event."

"In the U.S., everything we do deals with cost-benefit analysis, how much it is going to cost, and who'll pay for it," Schiff said. "But if you can save even one life, that can't be disregarded."

Liability issues

Schiff said there also is fear on the part of the medical community. "What if I or someone else performs a test and misses something?" And, he said, he has known parents who "when things are going well" choose to avoid medical tests for children for fear of jeopardizing a possible college sports scholarship.

Bierman questioned who should or should not be screened. "What about the young girl who plays the violin and doesn't pick up a tennis racket? Probably the risk is slightly higher for those who participate in highly competitive sports, but you have sudden death in individuals who are not doing competitive sports. So how do we manage universal screening? That's a difficult question to answer," Bierman said.

Today, the Acompora and Levine families are trying to educate the public that the lives of young, seemingly healthy athletes can be taken suddenly. They are advocates for EKG prescreening and for placement of defibrillators in schools and at athletic events.

The two families are planning to hold an EKG screening session, possibly in January, which will be open to all children, because any child can harbor a silent heart condition.

Because of lobbying efforts through the Louis J. Acompora Memorial Foundation, New York State has Louis' Law. Signed in 2002, the law mandates that public schools have an automated external defibrillator on site and easily accessible at school athletic events. The law further requires that a staff person trained to render emergency aid using the AED be readily available.The AED, as Bierman explained, is not difficult to operate. It has a recording that talks the first responder through the process. Pads are applied to the victim's chest, and the machine takes and interprets an EKG. If there is evidence of a life-threatening rhythm, the device will automatically react and, hopefully, shock the heart back into regular rhythm. On the evening of Oct. 14, the Acompora Foundation is holding a Save-a-Heart Benefit at the Crest Hollow Country Club in Woodbury to raise funds for distribution of AEDs. The event will include the raffling off of three 2007 Mercedez-Benz sedans.

At Robbie's 5k Run last April in Merrick, the Levine family raised $35,000 to buy and distribute AEDs. They are now producing a short video, which they will give to Little League chapters throughout Long Island in hopes team leaders will see fit to have AEDs on the playing fields. Levine said most chapters she's contacted in the past have showed little initial interest.

But some chapters have taken the initiative on their own. About five years ago, Joe Heid, president of the Huntington-Tri-Village Little League, first ordered that an AED be available at games.

"We house the defibrillator in the field house," said Andy Terc, safety officer for the chapter. Terc trains all the directors and board members to use the AED, which, he said, "we've never had to use in five years - and, God willing, we never will."

While the Levines and the Acomporas say the public is receptive once they understand the gravity of the problem, and certainly as each tragic death receives mass media attention, sudden cardiac death in a young athlete is, for most people, "one of those things, if you don't think about it, it won't happen," Levine said.

RESOURCES

The Louis J. Acompora Memorial Foundation

www.la12.org

631-754-1091

The Robbie Levine Foundation

www.robbielevinefoundation.org

The National Athletic Trainers' Association

www.nata.org

214-637-6282

Information on the AED mandate in New York State public schools

www.htconsult.com/AEDlaw.html

Cardiology Review

www.cardiologyreviewonline.com

July 2006, Vol. 23, No.7

Court Sides with Parents in Wrongful Death Suit

16-year-old collapsed in Beall High classroom more than four years ago

Alison Bunting

Cumberland Times-News

CUMBERLAND - (Sept. 6, 2006) - More than four years later, the parents of a 16-year-old Beall High School student who died after she suddenly collapsed in the classroom each were awarded $300,000 Friday in Allegany County Circuit Court.

Cora J. Houdersheldt and David Sines were represented by Cumberland attorneys Jason C. Buckel and S. Ramani Pillai in a jury trial for the civil case presided over by Judge W. Timothy Finan.

Kelly Sines was in science class April 12, 2002, when she got up to turn in a test or quiz and collapsed, according to Greg Smith, then principal at Beall High.

The state medical examiner later named the cause of death as cardiac arrhythmia, a change from the normal rate or control of the heart’s muscle contractions. She was not on drugs and there was no evidence of foul play, according to C3I investigators.

According to previous reports in the Times-News, Smith said an emergency medical technician was on staff and was able to begin working on Sines just after she collapsed. She reportedly collapsed at 1:37 p.m. and members of the crisis response team were in the school by 1:45 p.m.

Buckel and Pillai said in a press release Tuesday that Sines died as a result of negligence by the Allegany County Board of Education.

“At that time, Allegany County schools did not have automated external defibrillators and, as a result, school personnel trained in CPR and in how to use a defibrillator were unable to utilize the only medical device which could have saved Kelly’s life,” according to Buckel and Pillai.

“Significantly, the jury found that a substantial period of time went by from the moment of Kelly’s collapse until school officials notified appropriate emergency medical personnel,” according to the attorneys.

“The delay caused or contributed to Kelly’s death, as Dr. Larry Rhodes, the chief of pediatric cardiology at West Virginia University Hospital testified ...” and ... “that Kelly had a high probability of survival if she had been defibrillated within a 6- to-8-minute window from the time of her collapse,” Buckel and Pillai said.

The Cumberland attorneys noted that the Allegany County school system did not have a legal obligation to provide AEDs in the schools as of April 2002, however, in the 2006 legislative session, the Maryland General Assembly passed a law requiring all school systems in the state to have automated external defibrillators in their school buildings.

The Allegany County Board of Education was represented by Timothy E. Fizer of the Baltimore firm Krause, Fizer, Crogan and Lopez.

Defendants initially included Smith, Beall High School, Superintendent Bill AuMiller and Allegany County.

Alison Bunting can be reached at abunting@times-news.com

Preventing Sudden Cardiac Arrest in Young Athletes: Are Current Preparticipation Screening Guidelines Appropriate?

Daniel Montellese, MD

July, 2006

The first documented case of sudden cardiac death occurred in 490 BC, when Pheidippides, a Greek soldier who ran from Marathon to Athens to spread the news of his army’s victory over Persia, delivered his message and then collapsed and died. In the modern era, the sudden death of a number of high-profile athletes has raised public interest in this infrequent event. The public perceives young competitive athletes as robust invulnerable members of our society. Their unexpected death often incites heated debate among the public and, more specifically, the medical community on the prevention of sudden cardiac death and the appropriateness of the existing screening guidelines.

The largest available studies estimate the risk of sudden cardiac death among high school and collegiate athletes to be between 1 per 100 000 and 1 per 300 000 each year.1-3 An estimated 50 to 100 cases occur in the United States annually.3,4 Being symptomatic prior to a sudden cardiac death event is more often the exception rather than the rule. These devastating events are frequently the presenting clinical manifestation of an underlying cardiovascular disorder. One of the earliest clinicopathologic studies in young competitive athletes identified structural cardiovascular abnormalities in 28 of 29 athletes, with hypertrophic cardiomyopathy as the most likely etiology of sudden death in 14 of the 29 cases.3 In 1991, a review of prior studies found that the most common etiology of sudden cardiac death in athletes was hypertrophic cardiomyopathy, occurring 24% of the time, followed by coronary anomalies (18%) and myocarditis (12%).5 The remaining cases of sudden cardiac death in athletes relate to other cardiac electrical disorders, such as long QT syndrome and Wolff-Parkinson-White syndrome, or commotio cordis (ventricular arrhythmia induced by blunt chest wall trauma in a structurally normal heart), as well as complications of asthma and substance misuse.4

The American Heart Association Science Advisory and Coordinating Committee developed consensus recommendations and preparticipation screening guidelines in 1996. The purpose of screening is to identify preexisting cardiovascular abnormalities that place athletes at increased risk for sudden cardiac death and to provide medical clearance by means of routine and systematic evaluations. The Committee recommended that a screening history and physical examination be performed on all athletes before participation in high school and collegiate sports. For high school athletes, the screening should be repeated every 2 years, and an interim history should be obtained in the intervening years. For college athletes, a history and blood pressure measurement should be obtained each year after the initial evaluation. The examination process does not currently include the use of electrocardiograms (ECGs) or echocardiography. The question of whether this approach is adequate remains.

In 2005, the European Society of Cardiology (ESC) issued a consensus statement recommending that every young competitive athlete undergo cardiovascular screening. As in the United States, the recommended protocol calls for a complete physical examination and personal and family medical history. However, the ESC also mandates a 12-lead ECG, which has not been required in the United States to date. These recommendations are largely based on Italy’s experience, which spans 25 years of mandatory systematic prescreening of athletes. The findings of a study published by Corrado and colleagues in 2005 indicated that the risk of dying of sudden cardiac death among young athletes was 2 1/2 times that of nonathletes.6 The lead author, Domenico Corrado, from the University of Padua, said he believed ECGs could screen as sensitively as echocardiograms, while producing a false-positive rate of about 10%.

Under ESC guidelines, the recommended cardiovascular evaluation should consist of complete personal and family history, physical examination with blood pressure measurement, and 12-lead ECG. The inclusion of a 12-lead ECG represents the additional value of this screening protocol and is based on the fact that the ECG offers the potential to detect, or to raise clinical suspicion of, potentially lethal conditions, including hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, dilated cardiomyopathy, myocarditis, long QT syndrome, Brugada syndrome, Lenègre disease, catecholaminergic ventricular tachycardia, short QT syndrome, and Wolff-Parkinson-White syndrome. Based on published studies from the United States and Italy, these conditions, including hypertrophic cardiomyopathy, account for up to 60% of sudden deaths in young competitive athletes.7,8

The screening of US high school and college athletes, based on medical history and physical examination without ECG, does not adequately identify those cardiovascular abnormalities that increase the athlete’s risk of sudden cardiac death. In 1 retrospective study, only 3% of US-trained athletes who died suddenly of heart disease confirmed on autopsy had been suspected of having cardiovascular abnormalities on the basis of preparticipation screening, and none with hypertrophic cardiomyopathy were previously identified.7 By comparison, the European experience shows that screening is able to identify asymptomatic athletes with hypertrophic cardiomyopathy, and observation of these athletes during long-term follow-up suggests that withdrawal from competition has the potential to improve their survival.8 Analysis of the Italian data shows that fewer than 25% of young competitive athletes diagnosed with hypertrophic cardiomyopathy had an abnormal physical examination or positive family history. Thus, the majority of them would have not been identified by a screening protocol without 12-lead ECG.

The European experience has shown that a systematic preparticipation evaluation including 12-lead ECG can be a practical effective tool to identify patients with hypertrophic cardiomyopathy, the most common cause of sport-related sudden cardiac death. The American Heart Association current consensus panel states that “cardiovascular screening for young competitive athletes is justifiable and compelling on ethical, legal, and medical grounds.”9 The Italian experience suggests that adding ECG to the process used in the United States may improve the current system, which many feel is inadequate.

A dilemma, however, still remains. How do we implement an effective prescreening process that is realistically applicable in the United States, with its large population, ongoing emphasis on cutting health care costs, and an increasingly litigious atmosphere? The main criticism of the European protocol points toward the 9% false-positive rate (in the targeted population, to identify 1 patient, there would be 1999 false positives). The detractors contend that such a system would prevent “normal healthy” individuals from participating in athletics. Many will argue, however, that this is a small price to pay to prevent the untimely death of a young person in the prime of his or her life.

References

1. Van Camp SP, Bloor CM, Mueller FO, et al. Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc. 1995;279(5):641-647.

2. Ades PA. Preventing sudden death: cardiovascular screening of young athletes. Phys Sportsmed. 1992;20(9):75-89.

3. Ragosta M, Crabtree J, Sturner WQ, et al. Death during recreational exercise in the state of Rhode Island. Med Sci Sports Exerc. 1984;16(4):339-342.

4. Basilico FC. Cardiovascular disease in athletes. Am J Sports Med. 1999;27(1):108-121.

5. Maron BJ, Roberts WC, McAllister HA, et al. Sudden death in young athletes. Circulation. 1980;62(2):218-229.

6. Corrado D, Pelliccia A, Bjørnstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol: Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26(5):516-524.

7. Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes: clinical, demographic, and pathological profiles. JAMA. 1996;276(18):199-204.

8. Corrado D, Basso C, Schiavon M, et al. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med. 1998;339(6):364-369.

9. Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular preparticipation screening of competitive athletes. Circulation. 1996; 94(4):850-856.

"The Shocking Truth"

The June 2006 newsletter from the AED Institute of America, Inc. provides community awareness of Automated External Defibrillators. Read about the latest issues regarding AEDs and training.

Saving a Life With a Defibrillator

By Jay Romano

New York Times

May 14, 2006

In recent years, an increasing number of automated external defibrillators have been provided in office buildings, shopping malls and health clubs and even on commercial airliners. Why, then, are there so few of them in apartment buildings, particularly co-ops and condominiums?

"This issue has come up in a bunch of buildings we manage," said Neil Davidowitz, the president of Orsid Realty in Manhattan. "And the reluctance to install them basically comes down to concerns about potential liability."

It turns out, though, that such concerns may be unwarranted. Modern defibrillators — electronic devices about the size of a briefcase that administer an electric shock to restore heart rhythm — "are basically foolproof," said Dr. Diane Sixsmith, the chairwoman of emergency medicine at New York Hospital Queens, in Flushing. Dr. Sixsmith said that with the models now on the market, the operator has only to attach two pads to the victim's chest and turn on the machine.

"The machine will analyze the heart rhythm and tell you whether or not to administer a shock," she said. "As far as we know, these machines have never shocked someone who didn't need it and never failed to shock someone who did."

And while having defibrillators in commercial buildings is certainly helpful, Dr. Sixsmith said, having them in the buildings where people live is even more important.

"The majority of cardiac arrests happen in the home," she said. "And in 98 cases out of 100, the victim does not survive."

With cardiac arrest, every second counts. "If you restore the rhythm within four minutes, most people survive with no permanent damage," Dr. Sixsmith said. "For every minute beyond that, there is a 10 percent increase in mortality and an increase in the likelihood of brain damage." After about 10 minutes, she said, death is virtually certain.

"And when you live in a place like New York, traffic and other problems usually make it very difficult for an ambulance to get to a victim quickly enough to save him," Dr. Sixsmith said. But having a defibrillator on hand has pushed survival rates from 2 percent to as high as 75 percent, she said.

Sarah Gillen, chief executive of Emergency Skills Inc., a Manhattan company that sells defibrillators, said buildings that want to buy one need a "medical director" — a licensed physician — to provide a purchase authorization, monitor the training and report any use of the machine to the state.

Building employees and others who would use the machine can receive training from the American Heart Association; it takes about four hours, Ms. Gillen said.

Cardiopulmonary resuscitation, aid for choking victims and hands-on practice with the defibrillator are included.

The cost of each machine is about $2,000; training costs $100 a person.

Arthur I. Weinstein, a Manhattan lawyer and the vice president of the Council of New York Cooperatives and Condominiums, said the state's Good Samaritan Law protects from liability anyone who "voluntarily and without expectation of monetary compensation" uses a defibrillator in an attempt to revive someone in an emergency. The law also protects a co-op or condo, as long as it met the training and medical director requirements.

Errol Brett, a co-op and condominium lawyer in Great Neck, N.Y., said that one of his clients, North Shore Towers in Floral Park, Queens, bought five defibrillators several years ago. And last year, he said, a building employee, Deokaran Gunpat, received an award from the New York City Fire Department for using one to save the life of a resident who went into cardiac arrest.

"In my opinion," Mr. Brett said, "it would be negligent not to have one."

Outside the Coaching Manual: Knowing CPR, AED use can save young lives

Wednesday, May 03, 2006

By Mary Niederberger, Pittsburgh Post-Gazette

Tony Tye, Post-Gazette
Sam Nicholson, 12, right, and his friend Tommy
Wahl, 13, left, were playing basketball March 17
in Sam's driveway, when Sam went into cardiac
arrest. Tom called 911 from the phone in the
garage, a neighbor performed CPR, and medics
arrived and used an automatic external
defibrillator. Sam now has a defibrillator in his
chest. "Everything in the chain was there," said
his mother, or the outcome might not have been so good.

Early activation of the emergency medical-services system, early bystander cardiopulmonary resuscitation and early defibrillation: Those are the recommended responses by emergency medical professions to a sudden cardiac arrest.

Lynn Nicholson, of Bethel Park, saw that protocol save the life of her son, Sam, 12, after he collapsed in their driveway March 17 while playing basketball with a friend.

Lynn Nicholson, of Bethel Park, saw that protocol save the life of her son, Sam, 12, after he collapsed in their driveway March 17 while playing basketball with a friend.

Sam was stabilized at St. Clair Hospital before being flown to Children's Hospital of Pittsburgh. There, a pacemaker and defibrillator were implanted into his chest.

"They told us that everything in the chain was there," Mrs. Nicholson said. "That chain was absolutely flawless, but if any part had broken down, the results might not have been as good."

Now, the Nicholson family is working with Nora Helfrich, director of Tri-Community South, in an effort to encourage coaches of community sports leagues to get CPR training and to have automated external defibrillators at fields and gyms.

"Until it hits close to home like this did, people don't take it seriously," Ms. Helfrich said. "People are like, 'Oh ,well, you hear about it.' But you don't think it's going to happen to you."

Tri-Community currently is offering free CPR training to coaches in the Bethel Church (baseball) League and the Bethel Baseball Association as it has to other sports leagues. The training is free because Tri-Community instructors are volunteering their time.

Sam contracted a heart virus when he was 2 weeks old and had been treated for years with medication. His cardiologists had cleared him to play sports, Mrs. Nicholson said.

Sudden cardiac arrest is rare among young athletes, but it does occur.

In December, David Nelson, an eighth-grade high honor student at Norwin Middle School, collapsed and died while playing basketball. An autopsy was inconclusive as to his cause of death.

"It's not going to happen often, but when it does, having everything in place saves a life," said Dr. Robert Hickey, a pediatric emergency room doctor at Children's and chair of the American Heart Association's vascular care committee.

Both Dr. Hickey and Dr. Vincent Mosesso, associate professor of emergency medicine at the University of Pittsburgh School of Medicine and medical director for UPMC prehospital care, support CPR training for coaches.

More likely to survive

The doctors say cardiac arrest victims who receive CPR while awaiting defibrillation are much more likely to survive. Also, quick access to defibrillation increases survival. The doctors say survival rates decrease by 10 percent for each minute without treatment.

Dr. Hickey, who coaches his children's soccer teams, said he believes "most coaches would be in favor of learning CPR if you made it available. Coaches are, in general, people who want to give help."

The problem, he said, is that most coaches are parents who are taking care of their families, working and coaching teams several nights a week. "We need to find an efficient way to do this."

One way is with a self-directed learning program that can be ordered via the Internet and comes in a box with a mannequin and instructional DVD. Dr. Hickey said the kits, developed in part by the American Heart Association, can teach CPR in about 30 minutes.

More information can be found at www.cpranytime.org.

Dr. Mosesso said adolescence is the time that undetected heart ailments arise, and vigorous exercise appears to be a trigger.

An article in the Annals of Emergency Medicine in January 2004, to which Dr. Hickey contributed, said: "Many of these conditions will not be detected during routine screening for school physicals or sports activities, so sudden cardiac arrest may be the first sign of these problems."

Dr. Mosesso said young athletes may experience symptoms they might not recognize as signs of a heart problem.

The symptoms

The symptoms to be alert for during or after exertion are: heaviness or pressure in the chest, shortness of breath that is out of the ordinary, breaking into a cold sweat, a feeling that your heart is racing or beating irregularly, dizziness or light-headedness or any collapse or loss of consciousness.

The incidence of cardiac arrest increases at the high school and college levels, Dr. Mosesso said. Most occur to football players. Basketball produces the second highest number of deaths from sudden cardiac arrest, said Dr. Mosesso, who recently returned from a conference of the National Athletic Trainers Association.

While Dr. Mosesso and Dr. Hickey support CPR training for coaches at all levels, they stop short of insisting that AEDs be required at all athletic events because of the cost, which can be $2,000 or more.

Dr. Mosesso said he recently worked with the Upper St. Clair Athletic Association to install AEDs in the concessions stands at the fields at the municipal center and at Morton Field, two of the township's larger athletic complexes.

Getting AEDs, training

Joseph DeMarco, former president of the Upper St. Clair Athletic Association, which operates most of the community recreation leagues in the township, said Dr. Mosesso helped the group to get grant money for the AEDs.

In addition, Dr. Mosesso volunteered his time to teach CPR to all of the youth football coaches in the township league in recent years, said Mr. DeMarco, a commissioner of the Upper St. Clair youth football league.

Likewise, coaches in the athletic association's basketball program received training through the township recreation department in the use of AEDs, which are available in district schools where the basketball program operates.

"There was a lot of willingness to learn not only for the kids but also for the people in the stands," Mr. DeMarco said.

In Bethel Park, Assistant Municipal Manager Judy Miller said the municipality last year purchased six AEDs for community sports teams to use. The devices are kept at the municipal building, where they can be checked out by coaches to take to games.

The problem is they are not checked out as much as municipal officials had hoped.

"We sent a letter to the sports leagues and it's up to them. We can't force them," Ms. Miller said. "I think a lot of people are intimidated by the whole idea of doing CPR and using one of these on someone. But they are designed to be used even by someone with no training."

Ms. Miller said the municipality purchased the AEDs because of reports of young athletes dying from sudden cardiac arrest in other parts of the country.

"The chances of it happening are remote, but this whole thing with Sam really brings to light that it can happen here," she said.

Mr. Coffield, the neighbor who saved Sam's life, is a Bethel Park municipal employee who took advantage of the free CPR training the municipality offers its employees annually. This year's training will be offered in Bethel Park tomorrow.

Mr. Coffield said he's known CPR for about 10 years, but the first time he used it was on Sam.

"I hope I never have to do it again, but I'd be willing to if I had to. It was certainly worth it."

Sam has returned to school and most of his normal activities. But his participation in sports in on hold for now, his mother said. His implanted defibrillator shocked him once recently when he "was running around," his mother said.

"Right now he is under a restriction with athletics until they can figure out how to control things," Mrs. Nicholson said. "But we are hoping that he will be able to get back to it at some point because he really loves sports."

(Mary Niederberger can be reached at mniederberger@post-gazette.com or 412-851-1866.)

'True Miracle' Saves Driver's Life

April 27, 2006

Mary Blome and Steve Earle join Carolyn Holt
to talk about "miracle" life-saving
(CBS/The Early Show)
"The first thing I remember is waking up in
the intensive care unit of the hospital and
people saying to me, 'what do you remember?'
 And I said, 'Nothing.'"...Carolyn Holt

[Click here to watch "The Early Show" (CBS) interview]

(CBS) Luck was on the side of a Missouri woman who went into cardiac arrest while driving.

Carolyn Holt was alone in her car on Friday, driving in St. Charles, Mo., when her heart stopped beating. She drifted across several lanes of traffic and then crashed into a guard rail. Other drivers stopped to help and by sheer luck, two of them were nurses and one was a defibrillator salesman — who happened to have a defibrillator in his car.

A truck driver used his trailer hitch to smash through a window and pull Holt out of the car. The nurses performed CPR and then used the defibrillator to shock Holt back to life. She spent the week in the hospital and is expected to be released April 27.

Holt joined two of her good Samaritans, Mary Blome, the nurse, and Steve Earle, the salesman, for an interview with The Early Show Thursday morning. She told co-anchor Julie Chen she has no memory of those terrifying moments on the road.

"Everybody finds it hard to believe, but the first thing I remember is waking up in the intensive care unit of the hospital and people saying to me, 'what do you remember?' And I said, 'Nothing,'" Holt told Chen. "So they started telling me the story about my very helpful friends."

Earle, who was driving with his wife to pick up their daughter, described the moment when he realized someone was in trouble. "We basically saw traffic slowing down, and Carolyn's car coming across the center line very, very slowly," he said. "At that point when I sort of swerved to go around her, I looked over and realized there was definitely something wrong. She looked to be unconscious at the wheel, and that's when we, along with several other cars, pulled over, and went over to see what was wrong."

Blome is a registered nurse and she jumped into action. "We went over to knock on the window. We thought this was just a small vehicle accident, and realized that Carolyn wasn't responsive. So the other man that is not with us today smashed in the window of the vehicle, and the gentleman got Carolyn out, and the other nurse and I assessed her and realized that she was in big trouble and we started CPR, compressions and breathing," she said. "Then Steve came with the defibrillator. It was a true miracle that evening."

As a salesman, Earle says he always carries defibrillators in his car — but it was unusual to be in his car at that point during the day. "It was strange luck that day because when we finish up work for the day, a lot of times we'll get in my wife's car and take it out to eat or to pick my daughter up. We just happened to get into my car for some reason."

Holt was full of thanks for her saviors and said, considering the amazing luck she's had, she might just buy a lottery ticket when she's released from the hospital.

©MMVI, CBS Broadcasting Inc. All Rights Reserved.

'Our Hero': School Nurse Saves Life With Defibrillator

April 13, 2006

Gary Bissaillon and Susan Decker
performed CPR on Marcellus school
psychologist Hans Smid, second from left.
At far right is school nurse Debbie
Bowman, who used the defibrillator,
which is on the table.

Debbie Bowman has been a nurse at Marcellus Middle School , 10 miles southwest of Syracuse , for 16 years. On Jan. 23, she learned she hadn't seen everything yet.

At 8:15 that morning, school psychologist Hans Smid was attending a routine meeting at Marcellus Elementary School when the unthinkable happened — his heart stopped.

The 38-year-old Smid collapsed from cardiac arrest. It would be another 15 minutes before the elementary school nurse would report to work. As one colleague dialed 911, another placed a frantic call to Bowman at the middle school.

Gut feeling

"I just dropped everything and ran," Bowman explained. "You just have a gut feeling about things sometimes."

Fortunately, the elementary, middle and high school are on the same campus. Bowman was at the scene in less than a minute.

School principal Gary Bissaillon and elementary teacher Susan Decker already were performing cardiopulmonary resuscitation on Smid, thanks to a program in which district nurses train school personnel throughout the year on life-saving techniques.

The bad news was that the emergency crew had not yet arrived and Smid was not coming around. Fortunately, the school was equipped with an Automated External Defibrillator.

A state law enacted in 2002 and backed by New York State United Teachers requires defibrillators in all public schools and at scholastic events.

The law has already saved several lives, including that of a 16-year-old student from Naples , near Rochester , in November. Teacher Courtney Conrad of the Naples TA and two colleagues used an AED after the student collapsed. Marcellus has had the AED devices since the legislation was passed, Bowman said.

"I screamed, 'Someone get me the AED!' and I had it within seconds," Bowman recalled. "You just go into tunnel vision."

AEDs read heart rhythms and will provide shocks only if they are necessary. The AED advised administering a shock and then a second one. After the second shock, Bowman said, the AED reported no further shocks were necessary.

Still, Smid remained unconscious. Bowman continued CPR and mouth-to-mouth resuscitation, aided by the building principal.

Several seconds later, Smid took a deep breath — and so did Bowman. Smid was breathing on his own and showing signs of regaining consciousness when the ambulance arrived.

"We didn't leave them much work to do," Bowman said.

Smid, who has a history of heart problems, is back at school. Whether he would have been so fortunate without the AED is debatable.

Unafraid

"You can't be afraid of the AED," Bowman said. "You're not going to hurt anyone. It won't let you."

For Bowman, Jan. 23 was a day of firsts. It was the first time she ever had to use an AED on school grounds, and it was the first time she had ever met Smid, a fellow member of the Marcellus Faculty Association.

"Debbie is our hero," said MFA President Terry McSweeney.

— Kevin Hart

NYSUT.org. Copyright New York State United Teachers. 800 Troy-Schenectady Road, Latham, New York, 12110-2455. 518.213.6000. www.nysut.org.

Port Authority Expands Award-Winning Defibrillator Program at Facilities

Nearly 10 years after the Port Authority pioneered the use of automated external defibrillators (AEDs) within its police department, the agency will greatly expand the program with the purchase of 1,200 new AEDs for use at its airports, PATH rapid-transit rail system, tunnels, bridges, bus terminals and port terminals in New York and New Jersey.

Getting to the heart of athletes' silent killer: Medicine tries to get a grasp on athletes' heart problems

PATRICIA ANSTETT (online@rgj.com)

DETROIT FREE PRESS

February 28, 2006

Are athletes engaged in intense training or competitive sports at risk of suddenly dropping dead from heart problems? Highly publicized cases over the years -- the latest involving Detroit Red Wings defenseman Jiri Fischer, 25, whose promising career might have ended after he collapsed on the bench with heart problems during a November game -- have triggered parental and public concern.

They raise these and other questions:

· Who needs to worry about sudden heart death?

· What are the warning signs?

· Should all competitive athletes be screened for heart problems starting in high school?

· What kinds of tests should they undergo?

· Can athletes with serious heart problems be treated and return to active sports?

For players, parents, coaches and fans, we've culled through the research and talked to half a dozen specialists in heart disease and sports medicine. Here is a summary of the problems, the warning signs, the treatments and prevention issues.

The Problems

A range of heart problems can affect athletes. Hypertrophic cardiomyopathy, a disease of the heart muscle that causes it to enlarge and weaken, has gotten the most attention. It is usually hereditary and relatively rare, occurring in one in every 300 to every 500 people. It is the most common cause of sudden heart deaths -- those that occur within one hour of initial symptoms -- among people under age 30 in the United States.

So what happens? Under a microscope, heart muscle cells appear disorganized, not parallel and neatly arranged as they should be. This molecular disorganization, most likely caused by genetic mutations passed along in a family, interrupts transmission of the heart's electrical signals, often causing the heart to beat irregularly.

The most dangerous type is ventricular arrhythmia, which occurs when the heartbeat races to as many as 300 beats a minute, compared with 50 to 80 beats a minute in a normal, resting heart. That's believed to be the type of heartbeat irregularity Fischer experienced when he collapsed and nearly died before he was shocked back to life with a rink-side automatic external defibrillator.

Other things that can cause sudden cardiac death in athletes include high blood pressure, diabetes, high cholesterol, obesity, smoking, inherited diseases such as Marfan's syndrome, heart valve defects and other heart abnormalities, steroids and recreational drugs.

Intense training can trigger a condition called athletic heart syndrome, which causes a thickened heart muscle. Up to now, most experts considered the condition rather harmless. If it does cause problems, they tend to be less dangerous heartbeat irregularities that can be easily fixed with medicine or minimally invasive operations. Detroit Lions quarterback Joey Harrington, for example, underwent such a procedure in March 2003 and later returned to NFL play.

Experts also thought athletic heart syndrome was relatively benign because muscle thickness often reverted to normal once the athlete stopped engaging in intense exercise. Although that often may be true, "it may not be all that simple," says Dr. Archie Roberts, a former NFL quarterback with the Cleveland Browns and Miami Dolphins who became a heart surgeon after his retirement from sports.

Some heart muscles don't automatically reduce in size on retirement from sports, says Roberts, who directs the Living Heart Foundation, a nonprofit New Jersey organization involved with heart disease research. The increasing size of some athletes, the absence of conditioning in retirement and joint pain from lifelong sports activities might limit an athlete's ability to exercise and maintain a heart-healthy lifestyle, he says. "What is apparent physically, like large body size or obesity, may be the tip of the iceberg in retired athletes," Roberts says.

Warning Signs and Testing

Athletes with these signs should see a doctor:

· Family history of heart problems before age 50, particularly sudden heart death.

· Heart murmur detected in an exam.

· High blood pressure.

· Fainting or dizziness.

· Shortness of breath during exercise.

· Diabetes or high cholesterol.

Pre-participation physicals required for high school and college sports vary. Parents and athletes need to take these physicals seriously and report any warning signs to doctors, says Dr. Steven Karageanes, sports medicine specialist for the Henry Ford Health System.

Those showing signs of heart trouble typically undergo a thorough medical history, an electrocardiogram, or EKG, and possibly an echocardiogram, an ultrasound test of the heart. Some countries, notably Italy, require heart screening and EKGs for high school and other athletes, but U.S. experts say that with as many as 15 million people involved with competitive sports, the costs would be too great for the few cases they might detect. Adults who begin sports or intense training at 40 and older also should consider heart screening tests, experts say.

Treatments

Drugs for heartbeat irregularities might help, but some athletes are reluctant to take the medicines because they fear the medicines decrease performance, doctors say. Athletes with less serious heartbeat irregularities could need a minimally invasive procedure, radiofrequency ablation, to correct the rhythm. It often cures the problem and the athlete no longer needs to take heartbeat medicines.

Implantable internal defibrillators help prevent sudden cardiac death from serious heartbeat irregularity problems, but the American Heart Association, does not recommend that athletes with the devices engage in intense sports because they can misfire or be disconnected during aggressive physical contact.

Athletes who have died from heart-related deaths:

-- Jim Fixx, 51, runner, author, heart attack, 1984

-- Len Bias, 22, all-American college basketball player, cocaine-related heart attack, 1986

-- Pete Maravich, 40, Hall of Fame NBA star, heart attack due to congenital defect, 1988

-- Hank Gathers, 23, Loyola Marymount basketball player, cardiac arrhythmia, 1990

-- Reggie Lewis, 27, Boston Celtics, cardiac arrhythmia, 1993

-- Flo Hyman, 31, Olympic volleyball player, heart attack due to Marfan's syndrome, 1986

-- Florence Griffith Joyner, 38, Olympic track and field athlete, heart seizure, 1998

-- Sergei Grinkov, 28, gold medal-winning Russian pairs skater, early-onset arteriosclerosis, 1995

-- Darryl Kile, 33, St. Louis Cardinals, heart attack due to arteriosclerosis, 2002

-- Sergei Zholtok, 31, Nashville Predators, cardiac arrhythmia, 2004.

-- Jason Collier, 28, Atlanta Hawks, abnormally enlarged heart, 2005.

Athletes diagnosed with heart problems:

-- Robert Traylor, Cleveland Cavaliers. Open-heart surgery for bad aorta in mid-November. Inactive.

-- Juwan Howard, Houston Rockets. Heart infection. Out six months; now active.

-- Eddy Curry, N.Y. Knicks. Heart arrhythmia episode last spring. Refused to take DNA test from Bulls. Active.

-- Joey Harrington, Detroit Lions. Irregular heartbeat in December 2002. Catheter ablation procedure corrected problem.

-- Mario Lemieux, Pittsburgh Penguins. Irregular heartbeat. Retired.

-- Jiri Fischer, Detroit Red Wings. Heart stopped in game Nov. 21. Out indefinitely.

-- Ronny Turiaf, L.A. Lakers. Surgery in July for enlarged aortic root. Inactive.

-- Fred Hoiberg, Minnesota Timberwolves. Surgery in June for enlarged aortic root. Inactive.

Source: Free Press research

http://news.rgj.com/apps/pbcs.dll/article?AID=2006602280316

Machebeuf JV Coach Collapses at Game

By Neil H. Devlin

Denver Post Staff Writer

Cherry Hills Village - (2/17/2006) Tom Young, the junior varsity boys basketball coach at Bishop Machebeuf, suffered what appeared to be a massive heart attack Thursday while his team was playing at Kent Denver.

He was taken to Swedish Medical Center, where a spokesman said he was in serious condition. Julie Lonborg also said doctors were attempting to confirm the reason for Young's collapse. Kent Denver varsity coach Todd Schayes visited Young late Thursday and said he was alert.

Young collapsed on the Buffaloes' sideline with 4:23 remaining in the fourth quarter and his team trailing 40-30. It devastated the players, coaches, fans and officials at Kent Denver's Black Field House, some of whom immediately rushed to Young's aid.

A plea for a doctor was answered through happenstance by Jonathan Branch, the father of Bishop Machebeuf varsity player Nick Branch, and a male nurse at Walter Reed Hospital in Washington, D.C., who recently traveled to Colorado to watch his son compete.

The elder Branch performed CPR and used a portable defibrillator that helped to revive Young. After several anxious moments, local EMTs arrived and took Young by ambulance to Swedish.

Jonathan Branch, who received thanks from several crowd members for his quick action, said Young "probably suffered a heart attack."

Through Lonborg, Young's wife, Joanne, said, "I'm terribly grateful for everyone's help."

Fans prayed out loud while Young was being treated, and Buffaloes players, many of whom refused to go to the locker room, were cheering for their coach to come out of it.

"I'm extremely proud of the kids and fans who witnessed this and handled it," Kent Denver athletic director Scott Yates said.

The rest of the junior varsity game was canceled. A decision on the postponed varsity game, which was to be the Class 3A Metropolitan League finale of the 2005-06 season, may be made today, Yates said.

All contents Copyright 2006 The Denver Post or other copyright holders.

Perry Wrestler Gets a Second Chance at Life

Scott Pitoniak

Staff Writer

Ben Rice, at home in Leicester with cousin Jesse
McBride, center, and sister Jenny, uses a device
that measures the volume of air he inhales
 Ben, whose life was saved by a defibrillator,
had open-heart surgery.
CARLOS ORTIZ staff photographer

(January 29, 2006) — It was a nightmare like none he had ever experienced. So frightening and so surreal. At the very moment an athletic trainer attempted to bring him back to life, Perry High School wrestler Ben Rice dreamt that people were trying to drown him.

Which explains why the 18-year-old senior panicked and leaped immediately to his feet after his heart resumed beating and he regained consciousness atop those bleachers two weeks ago. Disoriented and dazed, Ben began pushing away the very people who had just resuscitated him with a defibrillator. He mistakenly thought he was still dreaming and that they were attempting to submerge him against his will.

It was only after his father, Steve Rice, grabbed hold of him and assured him that everything was going to be all right that Ben settled down.

As he slowly regained his bearings, he realized he hadn't been drowning that day. But he could sense that something had gone terribly wrong, causing him to black out.

It wasn't until later that Ben learned he had suffered sudden cardiac arrest. He really had visited death's doorstep — that was no dream — and were it not for the quick response of several people and the presence of a defibrillator, he would have lost his life shortly after winning the 101st wrestling match of his illustrious high school sports career.

The subsequent double by-pass surgery he underwent at Strong Memorial Hospital 10 days ago corrected a condition Ben had since birth — a condition that restricted blood flow from his twisted arteries.

Though this strapping 6-foot-2, 189-pound young man won't be able to fulfill his dream of wrestling for Perry at the state tournament in March, you won't hear any complaints.

Ben understands he already has beaten his toughest opponent: death. He now understands there is no greater victory than life.

"When I think about the alternative," Ben said the other day from his family's home just up the road from their Livingston County dairy farm, "I realize that I am oh, so lucky."

A Lasting Legacy

Louis Acompora, a lacrosse player from Long Island, had not been as fortunate. He died six years ago, at age 14, while blocking a shot in a game for Northport High School. Had there been a defibrillator there to shock his heart back into rhythm, Acompora might have survived. But his death played a role in saving Ben's life and the lives of 21 other young people throughout New York state the past three years.

Not long after Louis passed away, his parents, John and Karen Acompora, formed a foundation in their son's memory that successfully lobbied for the passage of a law that requires defibrillators at each of New York's public schools. It was signed by Gov. George Pataki on the day Louis was scheduled to graduate from high school and has come to be known as "Louis' Law."

"Every time we hear about a success story such as Ben's, it warms our hearts," said Karen Acompora, a co-chair of the Louis J. Acompora Memorial Foundation (www.la12.org), which is pushing for other organizations and other states to follow suit as far as defibrillators are concerned. "Ben is living proof of how important this issue is."

Grateful for his second chance, Ben has agreed to become a spokesman for the foundation once he recovers completely.

"I might not be here if they hadn't campaigned for defibrillators in schools," he said. "If there hadn't been one at that wrestling match, I wouldn't be here talking to you. I would have been dead and buried. That's a scary thought."

Scary, too, are thoughts about all the other times cardiac arrest could have happened, especially when he was exerting himself while doing strenuous farm chores.

"If I had suffered it out in the fields or in the barn, I would have died," he said. "I'm fortunate it happened where and when it did."

Emotional rescue

Ben had just finished his second match of the day during that Jan. 14 tournament in Franklinville, an hour south of Buffalo, and although he had won again, he was not pleased with the way he had wrestled. He told his parents he would join them at the concession stand for a bite to eat in a little while.

Ben wanted some time to himself, so he climbed to the top of the bleachers and called his girlfriend on his cell phone. A minute or two into their conversation, Ben slumped over in the stands. Fortunately, a mother of one of his teammates noticed and immediately screamed for help.

Athletic trainer Melissa O'Brien sprinted up the bleachers. While she checked his vital signs, Ben became unconscious and stopped breathing. O'Brien called out for a defibrillator. She performed CPR to no avail while waiting for life-saving equipment to be plugged in.

With the assistance of two mothers who were nurses, patches were placed on Ben's chest and he was given a jolt from the defibrillator. His heart began beating again.

"It was an overwhelming experience," said O'Brien, who has been a certified athletic trainer in the Southern Tier for nine years. "I had never experienced anything this severe before. I felt a tremendous sense of relief. I was totally drained afterward. I'm still dealing with my emotions two weeks later."

So are Ben and everyone else familiar with his close call.

The outpouring of support from near and far has been overwhelming.

"Every day, there are 15-20 messages on our voicemail, and the cards and letters keep coming in," said Ben's mom, Polly Rice. "We've had people drop off meals when we were running back and forth from the hospital. The kids took up a collection for us at the school. And so many people showed up at Strong that they had to move Ben into a bigger room."

One of the nicest gestures occurred at last weekend's wrestling tournament at Hornell. Each year, special T-shirts are presented to the winning team. The meet came down to Hornell and Letchworth, but before the final match, the coaches from each school called Perry coach George West down from the stands. They presented him with a shirt to take to the hospital to give to Ben. The fans stood and cheered for nearly five minutes. West couldn't stop crying.

A beautiful reminder

Steve Rice was understandably nervous the morning of his son's open-heart operation.

"It was cloudy when we arrived at the hospital at 6 that morning, but when Ben went into surgery, I couldn't help but notice the sun come out," he recalled. "It stayed out the entire time he was being operated on, and then when the surgery was over, it got cloudy again. I told Ben that somebody up there had cleared the clouds out so he could keep an eye on him and making sure he was OK."

It will take nearly six months for his breastbone to heal, but he may be cleared to return to school within a week or two. Ben admits to being antsy. He's not used to taking it slow, but he's going to do his best to follow his doctor's orders.

Before the interview ended the other day, he lifted his T-shirt to show his visitor the fresh, 9-inch scar that divides his chest.

It may make some queasy, but to Ben and his family, it will always be a thing of beauty — a reminder of the day he got a second chance at life.