Keep Youth Sports Safety Top of Mind: Guidelines from National Athletic Trainers’ Association

 

By Staff Editor

May 15, 2013 - 10:04:15 AM

(HealthNewsDigest.com) - DALLAS, May 15, 2013 - With the spring sports season well underway and summer preseason practices and youth league games around the corner, young athletes are already enjoying warm weather activities and competition. "Every team and athlete should have sports safety as a top priority," says Larry Cooper, chair of the National Athletic Trainers' Association Secondary School Committee and head athletic trainer at Penn Trafford (Pa.) High School. "It's vital for coaches, athletic trainers, parents and the athletes themselves to maintain go od communication and follow guidelines to ensure all participants are fit for play."

NATA hosted the 4th Youth Sports Safety Summit earlier this year with the support of the Youth Sports Safety Alliance, now composed of 109 organizations committed to keeping athletes safe, and launched the first-ever National Action Plan for Sports Safety and Student Athlete Bill of Rights (www.youthsportssafetyalliance.org). "Each athlete is entitled to appropriate care, prevention and treatment of injuries should they occur," says Cooper.

NATA offers several sports safety tips to keep athletes in the game:

1. Make sure the athlete is physically and mentally in the game: Parents, with assistance from coaches, should determine whether their children are physically and psychologically conditioned for the sport/activity level they're playing. Do not push children into something they do not want to do. Additionally, if an athlete has been injured and is returning to sport, it's critical for him or her to have the right mind set and confidence to return to play and avoid repeat injury.

2. Get a pre-participation exam: All athletes should have a pre-participation exam to determine their readiness to play and uncover any condition that may limit participation.

3. Follow a team approach to care: In the case of injury, find out who will provide care and ask to review their credentials. Many schools and sports teams rely on athletic trainers or parents with medical and first aid training and certification to keep kids safe. Yet less than half of high schools have access to athletic trainers.

4. Beat the heat: Acclimatize athletes to warm weather activities over a 14-day period. The goal is to increase exercise heat tolerance and enhance the ability to exercise safely and effectively in warm and hot conditions. Should heat illness occur, cool first and transport second: immediate cold water immersion is critical to reducing the athlete's temperature rapidly. Determine core body t emperature to best assess the athlete's condition.

5. Use your head: Athletes should be encouraged to speak up if they are suffering any related symptoms (dizziness, loss of memory, fatigue). Concussions must be carefully managed using follow up assessments of symptoms, neurocognitive function and balance, prior to initiating a gradual return to play. Should a more serious brain injury occur, the medical staff should be prepared to transport the athlete to a facility, while ensuring adequate ventilation and elevating the head to decrease intracranial pressure.

6. Maintain Heart health: Recognition is vital to treatment: sudden cardiac arrest should be suspected in any athl ete who has collapsed and is unresponsive. Public access to early defibrillation is essential: a goal of less than 3-5 minutes from the time of collapse to delivery of the first shock from an automated external defibrillator (AED) is strongly recommended. Most schools now have AEDS. Ensure that the medical expert and other personnel know where they are located, how to use them and that they are placed on sidelines during competitions and games.

7. Share an athlete's medical history: Parents should complete an emergency medical authorization form, providing parent contact information and permission for emergency medical care for the student athlete. Check with your school/league to obtain the form.

8. Ensure equipment is in working order: Make sure all equipment ranging from field goals, basketball flooring, gymnastics apparatus and field turf are in safe and working order. This also includes emergency medical equipment such as spine boards, splint devices, AEDs (which should be checked once per month; batteries and pads need consistent monitoring and replacing). All it takes is a slip on a wet surface or twist of an ankle on an ungroomed field to lead to lower extremity injuries, among others.

9. Ascertain coaches' qualifications: A background check should always be performed on coaches and volunteers:

-       Coaches should have background and knowledge in the sport they are coaching. They should be credentialed if that is a requirement in the state, conference or league.

-       Coaches should have cardiopulmonary resuscitation (CPR), AED and first aid training.

-       Coaches should strictly enforce the sports rules and have a plan for dealing with emergencies.

-       Ensure appropriate credentials for coaching from the respective sport governing body.

-       Coaches can also take an online course by visiting: http://www.nata.org/Sports-safety-for-youth-coaches-course

10. Check that locker rooms, gyms and shower surfaces are clean: With the advent of MRSA and related bacterial, viral and fungal skin infections reported in recent years, it is critical to keep these surfaces routinely cleaned and checked for germs. Athletes must be discouraged from sharing towels, athletic gear, water bottles, disposable razors and hair clippers. All clothing and equipment, including bags, should be laundered and/or disinfected on a daily basis.

11. Be smart about sickle cell trait: All newborns are tested at birth for this particular inherited condition and those results should be shared during a pre-participation exam. Red blood cells can sickle during intense exertion, blocking blood vessels and posing a grave risk for athletes with the sickle cell trait. Screening and simple precautions may prevent deaths and help the athlete with sickle cell trait thrive in his or her chosen sport. Know the signs and symptoms (fatigue or shortness of breath) to differentiate this condition from other causes of collapse.

12. Ensure an emergency action plan is in place: Every team should have a written emergency action plan, reviewed by the athletic trainer or local Emergency Medical Service. Individual assignments and emergency equipment and supplies need to be included in the emergency action plan. If an athletic trainer is not employed by the school or sport league, qualified individuals need to be present to render care. Knowing that a school has prepared for emergency will give parents peace of mind.

13. Adopt a "Time Out" system: Each health care team should take a "Time Out" before athletic events to ensure emergency action plans are reviewed and in place. Determine the role of each person; communication coordination; presence of ambulance; designated hospital; test of all emergency equipment; issues that could impact the plan such as weather or other considerations.

14. Build in recovery time: Allow time for the body to rest and rejuvenate in between practices, games and even seasons. "Recovery time is essential," says Cooper. "Without rest and a change of motion and activity, we put young athletes at risk of repetitive or chronic injury."

15. Breathe easier: Athletes with asthma should be properly educated about their condition, appropriate medications, use of inhaler equipment and how to recognize "good or bad" breathing days to prevent exacerbations. A warm up protocol may decrease the risk of asthma or reliance on medications.

16. Stay smart about steroids: Use of anabolic-androgenic steroids can lead to a host of negative effects on the health and well-being of athletes and non-athletes alike. Be aware of signs and symptoms of misuse including: rapid body mass or increase in performance; extreme muscular growth; abnormal or excessive acne, unexplained hypertension, moodiness, aggression, depression or obsession with exercise and diet. Report this immediately to the athletic trainer or other school medical professionals.

"It's critical that all members of a school's athletic health care team, parents, teachers and others involved in the care of the athlete have ongoing communication to ensure a safe sports setting," says Cooper. "With those protocols in place, athletes can enjoy the great spirit, competition, and ac complishment that come from safe and fair play."

"And, if your school is following the right protocols, enter it in the NATA Safe School award program that recognizes schools implementing appropriate steps to keep athletes safe. It is a win-win for students, the athletic health care team and school at large."

For more information on the award program, visit www.athletictrainers.org.

About NATA: National Athletic Trainers' Association (NATA) - Heal th Care for Life & Sport

Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity, and provide immediate care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers' Association represents and supports 35,000 members of the athletic training profession. Visit www.nata.org.

Chest protectors may not prevent sports-related heart trauma

Tuesday, May 14, 2013    Last updated: Tuesday May 14, 2013, 7:24 AM

BY  KARA YORIO

STAFF WRITER

The Record

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Once it was apparent that 8-year-old Ian McGreevy was doing "great" after being struck in the chest by a ball during a youth baseball game last weekend, many North Jersey parents focused on safety.

KEVIN R. WEXLER/STAFF PHOTOGRAPHER

McDavid USA makes a shirt with built-in chest padding that sells for $39.99.

Ian's mother, Lisa McGreevy of Northvale, said Sunday that she will lobby for children to wear chest protectors on the field, similar to those worn by lacrosse players.
While chest protectors could help with traumatic injuries like broken bones and serious bruising, there is no evidence that they protect against cardiac events caused by the trauma of being hit in the chest.
"If there is any evidence on that topic at all, it is actually to the contrary," said Mike Oliver, executive director of National Operating Committee on Standards for Athletic Equipment (NOCSAE), an independent and non-profit standard-setting organization trying to improve athletic safety through scientific research and the creation of performance standards for protective equipment. "It's a real difficult issue."
The evidence goes against common sense.
"Logically if there's a chest protector that would prevent the transmission of the energy of that blunt trauma to be transmitted to the chest and then to the heart then, theoretically, it might prevent it," said Fuad Kiblawi, pediatric cardiologist at St. Joseph's Children's Hospital in Paterson.
However, none of the chest protectors on the market, according to Kiblawi, have been proven to decrease the chance of ventricular fibrillation, a problem with the heart's rhythm that will cause victims to collapse within seconds and stop breathing.
Kiblawi added it might be worth taking a chance that a chest protector could slow down the impact to a speed that wouldn't cause the medical chain reaction.
"Chest protectors, they haven't been proven to help, but there's no reason to assume it's impossible that they would have any sort of benefit," he said.
What happened Saturday to Ian McGreevy and the conversation about safety equipment that has followed isn't new.
In 2010, 16-year-old Garfield resident Thomas Adams was hit in the chest with a baseball during a practice. He was wearing a catcher's chest protector at the time and died.
In 2006, Wayne's Steven Domalewski, was 12 when he was hit in the chest by a line drive. He was left brain-damaged after his brain was denied oxygen.
Thomas' death and Steven's disability were both attributed to commotio cordis, ventricular fibrillation caused by blunt trauma to the chest.
Commotio cordis is the second highest cause of death in athletes younger than 14, according to the American Academy of Pediatrics (AAP). Children ages 5 to 14 may be uniquely vulnerable to this blunt chest impact, the AAP said, because their chest walls are more elastic and more easily compressed.
It is unknown if commotio cordis caused Ian to stop breathing, but descriptions of the event make it a possibility, according to Kiblawi.
A policy statement from the AAP's Council on Sports Medicine and Fitness in 2012 said, "Although protective gear can be a key preventive measure, it is not always effective. Research has shown that even with protective gear, the fatality rate for commotio cordis is alarmingly high at 90 percent."
Beyond typical chest protectors worn by baseball and softball catchers, as well as lacrosse and hockey players, there are commercially available items like shirts with chest pads or plastic "heart guards."
Charlie Coleman, who owns Farrier Sporting Goods in Wyckoff, regularly sells a protective shirt that has a pad in the chest area.
Coleman can date the uptick in sales to the Domalewski tragedy. After that incident, there was a call by some to take aluminum bats out of the youth games. Now, there is a discussion about chest protectors. There is no single, simple answer, however.
"Anything that would alter these variables might help," said Kiblawi. "The softness of the ball and compactness of the ball, they're directly related to the incidence of commotio cordis. So softer, more like safety balls for kids may help. Still, there's no studies showing that."
One issue with certain types of protective shirts, according to Oliver, is that the padding is typically in the center of the chest and not the "cardiac silhouette" where impact causes commotio cordis.
Preparation is as important as possible prevention, according to Gregg Heinzmann, director of the Youth Sports Council at Rutgers University.
"We should do all we can to minimize the risk of injury in young athletes," Heinzmann said. "And we should include this injury among the considerations. The appropriate strategy on the part of the leagues and the recreation departments that administer youth sports is to train the coaches and re-evaluate their emergency action plans so that in the event of a serious injury, emergency medical personnel can arrive on the scene as quickly as possible."
The Youth Sports Council recommendation is that there is one person at every game and practice with the skill and training to effectively administer CPR and use an automated external defibrillator.
Death is preventable, the AAP policy notes, by immediate response of CPR and the use of an automated external defibrillator. It was the quick-thinking CPR of Maureen Renaghan that Lisa McGreevy credits with saving her son Ian's life.
Email: yoriok@northjersey.com

Defibrillator used to revive parent at Lakeland High School

 May 2, 2013
  Coach, trainer, cop save life of man at Lakeland

YORKTOWN — A father in his mid-50s who collapsed on his way to watch his daughter’s softball game at Lakeland High School on Wednesday was brought back to life by a trainer and a coach using a portable defibrillator.
The father, who had lost consciousness and wasn’t breathing when Lakeland athletic trainer Amanda Tiffany and John Jay High School lacrosse coach Patrick Chiappetta rushed to his aid, was recovering in stable condition Thursday at Westchester Medical Center in Valhalla, school officials said.
“There is a family that is not mourning the loss of a father today because people acted, and that is heavy stuff,” said Chiappetta’s boss, Christian McCarthy, the athletic director for the Katonah-Lewisboro school district. “Their decision to act saved a life, and there is no greater classroom lesson than that.”
It was the second such life-saving act in northern Westchester this week tied to the use of an automated external defibrillator, or AED.
It was one of those busy after-school weekdays in spring with multiple games in progress across a single campus, and scores of spectators, players and school officials on the scene.
The man was headed to the junior varsity softball game and was just outside the fence surrounding the school’s all-purpose athletic field when everything stopped. MaryLu Fiori, a Lakeland field monitor, saw the man collapse and yelled for help.
“I knew my AED was at the end of the bench so I grabbed it and I ran as fast as I could across the field,” said Chiappetta, 29, John Jay’s junior varsity girls lacrosse coach and a father of two. “He was in bad shape, on his back, so I hopped the fence and the Lakeland trainer already had his shirt pulled up.”
“I opened my AED and the trainer put the pads on him and pushed the button,” Chiappetta said .
The device can scan for irregular heartbeats and deliver a shock to restore a healthy rhythm. It was enough to bring the man, whom officials declined to identify, back to consciousness.
As Tiffany and Chiappetta were at the man’s side, Yorktown police Officer Larry Paniccia, the school’s resource officer, called 911 and joined in the lifesaving efforts. Mohegan Lake ambulance responded and took him from the scene.
“He is awake and speaking with his family,” Lakeland High School Principal Lorrie Yurish said Thursday. “The family is so grateful.”
The incident came four days after a Lewisboro police officer used an AED to revive a man who collapsed after mowing his lawn in Vista.
Other AED success stories this year have come from schools and sporting events.
On April 7 at Suffern Middle School, a trainer and a coach revived a 72-year-old South Salem referee after he collapsed during a lacrosse tournament. On April 1 at Lakeland’s Copper Beech Middle School, teacher’s aide Janice Mills collapsed in a classroom and was revived by staff members.
On March 31 in Yonkers, 21-year-old Jim Murphy was revived by Yonkers police after he collapsed playing an Easter Sunday basketball game.

Researchers determine where best to place defibrillators

 Researchers determine where best to place defibrillators
May 2, 2013 in Cardiology TORONTO:
Prompt use of an automated external defibrillator, or AED, can greatly increase the survival rates of people who suffer a cardiac arrest. And MIE Professor Tim Chan, working with Dr. Laurie Morrison at St. Michael's Hospital, has developed a formula to determine where best to place these costly but life-saving devices.In a paper published in Circulation, Chan and Morrison note that publicly registered AEDs in Toronto are not in the best locations to help victims of cardiac arrest. In fact, less than one in four of all cardiac arrests had an AED close by (within 100 metres is the required distance). The average distance to the nearest AED was closer to 300 meters. Current guidelines suggest areas associated with the highest risk of cardiac arrest should be targeted for AED deployment, after they have been placed in obvious high-traffic areas such as transportation hubs or major sports venues. But it's not clear how to identify these "cardiac hot spots." Timothy Chan and Morrison looked at the locations of all 1,310 public cardiac arrests in Toronto between December 2005 and July 2010 and the locations of all 1,699 AEDS registered with Toronto Emergency Medical Services. They found that 304 cardiac arrests occurred within 100 metres of at least one AED (23 per cent).One hundred metres was chosen as the yardstick because it's the approximate distance a bystander could transport an AED in a 1.5-minute walk—the maximum recommended by the American Heart Association. There were almost three times as many public cardiac arrests in downtown Toronto as the rest of the city – 3.5 per square kilometer per year vs. 0.4 – said Chan. Almost half of all downtown cardiac arrests were near an existing AED compared to only 17 per cent those outside of downtown. Chan then looked at the 1,006 cardiac arrests that did not take place near an AED. He said that be placing AEDs in the top 30 cardiac arrest "hot spots," they could have covered an additional 112 historical arrests, or 32 per cent. The average distance between a cardiac arrest and an AED would fall to 262 metres from 281 meters. "Reducing the distance a bystander needs to travel by 20 metres or up to 40 meters in a roundtrip has the potential to save close to half a minute in response time," said Morrison, an emergency medicine specialist who heads Rescu, the largest research team of its kind in Canada dedicated to improving out-of-hospital resuscitation. "If you have a cardiac arrest, every second counts. Out-of-hospital cardiac arrest kills an estimated 300,000 people in North America annually," she said. "Only five per cent of people who suffer out-of-hospital cardiac arrest survive to be discharged from hospital. The probability of survival decreases up to 10 per cent with each minute of delay between collapse and treatment." Chan said his mathematical model is more accurate than a population-based model, in which AEDs are placed in areas of densest daytime population. "Our optimization model should be viewed as a decision-support tool to help prioritize placement of AEDs, make efficient use of public, donor or private funds directed toward public access defibrillator programs, and potentially maximize survival on the basis of geographic patterns of cardiac arrest," said Chan. "Because AEDs are expensive and cannot be placed everywhere, our model allows a decision-maker to quantify the trade-off between the number of AEDS deployed and coverage."

Read more at: http://medicalxpress.com/news/2013-05-defibrillators.html#jCp

May 2, 2013 in Cardiology TORONTO: Prompt use of an automated external defibrillator, or AED, can greatly increase the survival rates of people who suffer a cardiac arrest. And MIE Professor Tim Chan, working with Dr. Laurie Morrison at St. Michael's Hospital, has developed a formula to determine where best to place these costly but life-saving devices. Ads by Google Dry Eye Clinical Trials - Now Running in Your Area Learn About the DryEye Study Now! - www.HealthCentral.com/DryEyeStudy 2013 Best Skin Tighteners - An Unbiased Review List of The Top Performing Skin Tighteners In 2013 - www.SkinCareSearch.com/FaceLifting In a paper published in Circulation, Chan and Morrison note that publicly registered AEDs in Toronto are not in the best locations to help victims of cardiac arrest. In fact, less than one in four of all cardiac arrests had an AED close by (within 100 metres is the required distance). The average distance to the nearest AED was closer to 300 meters. Current guidelines suggest areas associated with the highest risk of cardiac arrest should be targeted for AED deployment, after they have been placed in obvious high-traffic areas such as transportation hubs or major sports venues. But it's not clear how to identify these "cardiac hot spots." Timothy Chan and Morrison looked at the locations of all 1,310 public cardiac arrests in Toronto between December 2005 and July 2010 and the locations of all 1,699 AEDS registered with Toronto Emergency Medical Services. They found that 304 cardiac arrests occurred within 100 metres of at least one AED (23 per cent).One hundred metres was chosen as the yardstick because it's the approximate distance a bystander could transport an AED in a 1.5-minute walk—the maximum recommended by the American Heart Association. There were almost three times as many public cardiac arrests in downtown Toronto as the rest of the city – 3.5 per square kilometer per year vs. 0.4 – said Chan. Almost half of all downtown cardiac arrests were near an existing AED compared to only 17 per cent those outside of downtown. Chan then looked at the 1,006 cardiac arrests that did not take place near an AED. He said that be placing AEDs in the top 30 cardiac arrest "hot spots," they could have covered an additional 112 historical arrests, or 32 per cent. The average distance between a cardiac arrest and an AED would fall to 262 metres from 281 meters. "Reducing the distance a bystander needs to travel by 20 metres or up to 40 meters in a roundtrip has the potential to save close to half a minute in response time," said Morrison, an emergency medicine specialist who heads Rescu, the largest research team of its kind in Canada dedicated to improving out-of-hospital resuscitation. "If you have a cardiac arrest, every second counts. Out-of-hospital cardiac arrest kills an estimated 300,000 people in North America annually," she said. "Only five per cent of people who suffer out-of-hospital cardiac arrest survive to be discharged from hospital. The probability of survival decreases up to 10 per cent with each minute of delay between collapse and treatment." Chan said his mathematical model is more accurate than a population-based model, in which AEDs are placed in areas of densest daytime population. "Our optimization model should be viewed as a decision-support tool to help prioritize placement of AEDs, make efficient use of public, donor or private funds directed toward public access defibrillator programs, and potentially maximize survival on the basis of geographic patterns of cardiac arrest," said Chan. "Because AEDs are expensive and cannot be placed everywhere, our model allows a decision-maker to quantify the trade-off between the number of AEDS deployed and coverage."

Read more at: http://medicalxpress.com/news/2013-05-defibrillators.html#jCp

May 2, 2013 in Cardiology TORONTO: Prompt use of an automated external defibrillator, or AED, can greatly increase the survival rates of people who suffer a cardiac arrest. And MIE Professor Tim Chan, working with Dr. Laurie Morrison at St. Michael's Hospital, has developed a formula to determine where best to place these costly but life-saving devices. Ads by Google Dry Eye Clinical Trials - Now Running in Your Area Learn About the DryEye Study Now! - www.HealthCentral.com/DryEyeStudy 2013 Best Skin Tighteners - An Unbiased Review List of The Top Performing Skin Tighteners In 2013 - www.SkinCareSearch.com/FaceLifting In a paper published in Circulation, Chan and Morrison note that publicly registered AEDs in Toronto are not in the best locations to help victims of cardiac arrest. In fact, less than one in four of all cardiac arrests had an AED close by (within 100 metres is the required distance). The average distance to the nearest AED was closer to 300 meters. Current guidelines suggest areas associated with the highest risk of cardiac arrest should be targeted for AED deployment, after they have been placed in obvious high-traffic areas such as transportation hubs or major sports venues. But it's not clear how to identify these "cardiac hot spots." Timothy Chan and Morrison looked at the locations of all 1,310 public cardiac arrests in Toronto between December 2005 and July 2010 and the locations of all 1,699 AEDS registered with Toronto Emergency Medical Services. They found that 304 cardiac arrests occurred within 100 metres of at least one AED (23 per cent).One hundred metres was chosen as the yardstick because it's the approximate distance a bystander could transport an AED in a 1.5-minute walk—the maximum recommended by the American Heart Association. There were almost three times as many public cardiac arrests in downtown Toronto as the rest of the city – 3.5 per square kilometer per year vs. 0.4 – said Chan. Almost half of all downtown cardiac arrests were near an existing AED compared to only 17 per cent those outside of downtown. Chan then looked at the 1,006 cardiac arrests that did not take place near an AED. He said that be placing AEDs in the top 30 cardiac arrest "hot spots," they could have covered an additional 112 historical arrests, or 32 per cent. The average distance between a cardiac arrest and an AED would fall to 262 metres from 281 meters. "Reducing the distance a bystander needs to travel by 20 metres or up to 40 meters in a roundtrip has the potential to save close to half a minute in response time," said Morrison, an emergency medicine specialist who heads Rescu, the largest research team of its kind in Canada dedicated to improving out-of-hospital resuscitation. "If you have a cardiac arrest, every second counts. Out-of-hospital cardiac arrest kills an estimated 300,000 people in North America annually," she said. "Only five per cent of people who suffer out-of-hospital cardiac arrest survive to be discharged from hospital. The probability of survival decreases up to 10 per cent with each minute of delay between collapse and treatment." Chan said his mathematical model is more accurate than a population-based model, in which AEDs are placed in areas of densest daytime population. "Our optimization model should be viewed as a decision-support tool to help prioritize placement of AEDs, make efficient use of public, donor or private funds directed toward public access defibrillator programs, and potentially maximize survival on the basis of geographic patterns of cardiac arrest," said Chan. "Because AEDs are expensive and cannot be placed everywhere, our model allows a decision-maker to quantify the trade-off between the number of AEDS deployed and coverage."

Read more at: http://medicalxpress.com/news/2013-05-defibrillators.html#jCp

May 2, 2013 in Cardiology TORONTO: Prompt use of an automated external defibrillator, or AED, can greatly increase the survival rates of people who suffer a cardiac arrest. And MIE Professor Tim Chan, working with Dr. Laurie Morrison at St. Michael's Hospital, has developed a formula to determine where best to place these costly but life-saving devices. Ads by Google Dry Eye Clinical Trials - Now Running in Your Area Learn About the DryEye Study Now! - www.HealthCentral.com/DryEyeStudy 2013 Best Skin Tighteners - An Unbiased Review List of The Top Performing Skin Tighteners In 2013 - www.SkinCareSearch.com/FaceLifting In a paper published in Circulation, Chan and Morrison note that publicly registered AEDs in Toronto are not in the best locations to help victims of cardiac arrest. In fact, less than one in four of all cardiac arrests had an AED close by (within 100 metres is the required distance). The average distance to the nearest AED was closer to 300 meters. Current guidelines suggest areas associated with the highest risk of cardiac arrest should be targeted for AED deployment, after they have been placed in obvious high-traffic areas such as transportation hubs or major sports venues. But it's not clear how to identify these "cardiac hot spots." Timothy Chan and Morrison looked at the locations of all 1,310 public cardiac arrests in Toronto between December 2005 and July 2010 and the locations of all 1,699 AEDS registered with Toronto Emergency Medical Services. They found that 304 cardiac arrests occurred within 100 metres of at least one AED (23 per cent).One hundred metres was chosen as the yardstick because it's the approximate distance a bystander could transport an AED in a 1.5-minute walk—the maximum recommended by the American Heart Association. There were almost three times as many public cardiac arrests in downtown Toronto as the rest of the city – 3.5 per square kilometer per year vs. 0.4 – said Chan. Almost half of all downtown cardiac arrests were near an existing AED compared to only 17 per cent those outside of downtown. Chan then looked at the 1,006 cardiac arrests that did not take place near an AED. He said that be placing AEDs in the top 30 cardiac arrest "hot spots," they could have covered an additional 112 historical arrests, or 32 per cent. The average distance between a cardiac arrest and an AED would fall to 262 metres from 281 meters. "Reducing the distance a bystander needs to travel by 20 metres or up to 40 meters in a roundtrip has the potential to save close to half a minute in response time," said Morrison, an emergency medicine specialist who heads Rescu, the largest research team of its kind in Canada dedicated to improving out-of-hospital resuscitation. "If you have a cardiac arrest, every second counts. Out-of-hospital cardiac arrest kills an estimated 300,000 people in North America annually," she said. "Only five per cent of people who suffer out-of-hospital cardiac arrest survive to be discharged from hospital. The probability of survival decreases up to 10 per cent with each minute of delay between collapse and treatment." Chan said his mathematical model is more accurate than a population-based model, in which AEDs are placed in areas of densest daytime population. "Our optimization model should be viewed as a decision-support tool to help prioritize placement of AEDs, make efficient use of public, donor or private funds directed toward public access defibrillator programs, and potentially maximize survival on the basis of geographic patterns of cardiac arrest," said Chan. "Because AEDs are expensive and cannot be placed everywhere, our model allows a decision-maker to quantify the trade-off between the number of AEDS deployed and coverage."

Read more at: http://medicalxpress.com/news/2013-05-defibrillators.html#jCp

"Our optimization model should be viewed as a decision-support tool to help prioritize placement of AEDs, make efficient use of public, donor or private funds directed toward public access defibrillator programs, and potentially maximize survival on the basis of geographic patterns of cardiac arrest," said Chan. "Because AEDs are expensive and cannot be placed everywhere, our model allows a decision-maker to quantify the trade-off between the number of AEDS deployed and coverage."

Read more at: http://medicalxpress.com/news/2013-05-defibrillators.html#jCp

Middletown High's teamwork saves a life

By BY STEPHEN SACCO

Times Herald-Record

Published: 2:00 AM - 12/26/10

Trained staff take quick action

 

There might not be anything sweeter to a 17-year-old than a free class period right before a holiday. This was true for Kenny Tillman-Myrie on Oct. 29 until his heart stopped working and he collapsed on the cold floor of a Middletown classroom.

Kenny's a little on the skinny side; he's a bit shy too, but he has an athletic build developed from his years of devotion to basketball. He also has a wining smile, the kind that could charm just about anybody.

When Kenny walked into Scott Cantara's classroom for a free period Oct. 29, he was laughing and joking with his best friend, Shaquille Green. They talked about Halloween, coming up on Sunday, and, of course, about basketball.

Defibrillators getting simpler to use

It's no accident that a defibrillator was on hand Oct. 29 and that Middletown High School personnel were trained to use it, says Jim Parker, senior director for health and safety for the American Cross of Greater New York.

The American Red Cross has been focusing its efforts on outreach and education to get automatic defibrillators in schools and other public places and to teach people how to use them to save lives, he said. In New York it's the law that there must be a defibrillator at sporting events.

Parker says the good news is that technology for these devices has rapidly improved. While chances of responding to a life-threatening incident successfully greatly improve with training, the new defibrillators are easier to use than in years past and most will give you instructions so you can use them even if you aren't trained.

The machine used on Kenny at Middletown High School automatically assessed his conditions within seconds.

Prices for the devices have gone down significantly, too. Some people have even purchased the machine for their home when a family member is at risk.

"I think there is a heightened awareness about the benefits of (having a defibrillator on hand)," Parker said. "And the science of assisting somebody (with the device) has been constantly improved."

Steve Sacco

He and Shaquille had distinguished themselves on the varsity team at Middletown High School.

There was some trouble for Kenny early in life with a foster family. That was behind him. Kenny has called his aunt Loraine Myrie "Mom" since he was five years old. Myrie took Kenny and his sister, Tara, and adopted and raised them both.

Tara is in college at Utica. Kenny is looking at college. He wanted to play college basketball. He wanted that bad.

Kenny was already being looked at by some college coaches, say Middletown coaches Jim Kelly and James Smith. A good student, Kenny had hopes of using basketball to help pay for college.

Life to Kenny on Oct. 29 was looking up. But walking into Cantara's classroom is the last thing he remembers about that day.

The next thing he remembers is waking up blurry eyed the next day in Westchester Medical Center with his aunt and girlfriend looking down at him, he says.

His life had changed forever in little more than an instant. "I thought it was a dream," he said.

He only had only seconds

"(Kenny) just fell back in his chair," said Shaquille about that day in October. "At first we thought he was joking or just laughing too hard." He wasn't.

Kenny's heart seized up and it wasn't pumping blood to his vital organs. He was most likely in this condition for half a minute. Seconds longer and the result might have been brain damage or death.

After Kenny hit the floor, school staff acted swiftly, according to an internal timeline provided by the school. Nurses Wendy Manis, Linda Blosser and Shelley Burr were called to the classroom. Security monitor James "Duke" Kimble ran to get the automatic defibrillator.

Manis listened to Kenny's breathing. Something was very wrong. The high school's security team members — Sam Barone, Nelson Reed, classroom teacher William Donohue and School Resource Officer Kevin Weymer — arrived to assist.

They put the paddles of the defibrillator on Kenny. The machine assessed his heart rhythm. He needed a shock. Blosser pushed the button. Manis performed chess compression while Donohue provided breathing for three cycles of CPR. The EMTs arrived and took Kenny to the Horton campus of Orange Regional Medical Center before he was flown to Westchester.

News spread throughout the school. "I couldn't believe it," said Laura Brissing, Kenny's guidance counselor. Healthy 17-year-old athletes don't go into cardiac arrest. Do they?

What just happened?

As far as Loraine Myrie is concerned, Kenny's being alive today is nothing short of a miracle.

The school was tremendously supportive, she said. Assistant Principal Carl Pabon drove Myrie to Westchester Medical Center after the incident.

Clinically, Kenny didn't die. "Death is not a reversible diagnosis," said Dr. Mathew Pinto, a pediatric cardiac specialist who treated Kenny when he arrived at Westchester.

But he beat the odds. An adolescent going into cardiac arrests outside of a hospital has a 9 percent chance of surviving, says Pinto. Inside the hospital the chances of survival increase to just 27 percent.

Kenny not only survived, but also suffered no brain damage. This wouldn't have been the case if the school staff hadn't responded so quickly, Pinto said.

Kenny can't play competitive basketball again. He can shoot a few hoops. But he can't play to win.

The doctors still can't tell him what's wrong but they opened Kenny's chest at Westchester to install an internal defibrillator.

Pinto says the most likely answer is genetic but it will take some time until testing can prove this conclusively. It's likely Kenny has some type of cardiac dysrhythmia, also known as arrhythmia, meaning the electric activity of his heart is abnormal.

That's what the internal defibrillator is for; to shock the heart back into a regular beat. But it's too risky to play competitive sports when wires are attached to your heart, Pinto said. Goodbye, basketball.

'A purpose for this young man'

Sam Barone, a past fire chief in Middletown, has used a defibrillator before, but never on somebody so young, he said.

Barone, like many of the people who responded to Kenny's emergency, had the necessary training. The American Red Cross is currently looking at awarding medals to the people involved with the incident who received their CPR training with the Red Cross, according to Ken Eastwood, school superintendent.

"It's all worth it when you see Kenny walking around," Barone said.

On Dec. 14 Kenny turned 18. It's taken him some time to digest everything that happened since Oct. 29.

Shortly before his birthday he was sitting in the guidance office at school with Pabon, Brissing and a newspaper reporter. Kenny says he was brought to tears over not being able to play basketball anymore. He says this quickly, as if pulling off a bandage rapidly so it won't hurt.

"There's a purpose for this young man beyond basketball," said Pabon with complete confidence. "This (incident) proves it."

Kenny steals a look at Pabon, and then looks back at the floor. Then he looks back up, and there it is: Kenny's winning smile, impossible to resist.

ssacco@th-record.com

Teaming up to save a life

Tragedy was averted at a local lacrosse tournament on Sunday thanks to the rapid reaction of several people in attendance.
Referee George Beisheim, a South Salem resident, was revived by North Rockland trainer Carol Guzinski, Dr. Jim O’Brien, a Queensbury resident, and Greg Walker, a Suffern girls youth lacrosse coach, after suffering a heart attack at the third annual Hudson Valley Youthfest girls lacrosse tournament held at Suffern Middle School.
“It went like it was supposed to,” said Guzinski, who teaches AED, CPR and first-aid certification classes. “There was no panic or indecision time. It worked right away. It wasn’t chaotic as a lot of rescues can be.”
Beisheim, 72, who officiated other games at the event, was standing at midfield watching a game when he suffered the heart attack.
Guzinski, who was standing with Suffern JV coach Mickey DeSimone about 50 yards away, rushed over and began CPR after checking Beisheim’s vitals.
“(Guzinski) handled it like a pro,” DeSimone said. “She was amazing. Not a hesitation, no emotion. Just got right into it.”
While Guzinski, a trainer at North Rockland for 23 years, performed CPR, several others reacted in ways that proved vital to saving Beisheim’s life.
Walker brought over an AED defibrillator while DeSimone asked if there was anyone in the crowd able to help. Dr. O’Brien, a cardiologist who was in attendance to watch his daughter play, came down to assist Guzinski.
After calling 911, Suffern varsity coach John Callanan and DeSimone, unlocked the gates surrounding the fields and instructed parents as to where to guide the emergency vehicles. Suffern’s groundskeeper, Mark Nevele, made sure there was clear path to the field.
“It was great coordination with a little bit of luck that saved a guy’s life,” Callanan said.
Beisheim’s faint pulse disappeared after less than a minute of CPR. The defibrillator was used once to restart Beisheim’s heart. He was taken to Good Samaritan Hospital in Suffern.
“When I heard the doctor say we’ve got a strong pulse and you could see him breathing on his own, that was a great relief.” Walker said.
Beisheim was in the intensive care unit after undergoing open-heart surgery for five hours on Monday according to his sister, Susan, who was told by the medical staff that Beisheim was doing well.
“The stars were in the right location for this guy,” DeSimone said. “I just can’t believe everything went ... that well. It’s almost an impossibility.”
The experience served as an example that the medical training they’ve received is well worth it.
“Sometimes you’re like, oh this is a pain in the neck,” said DeSimone of the certifications required for coaches. “I have a new view in terms of that prep and having the AED ready.”