Cardiac Screening

October 31, 2014

The American Heart Association has once again concluded that sophisticated and expensive heart screening is not practical or appropriate as a precondition for youth and young adults to participate in competitive organized sports.

On Sept. 14, 2014, the AHA online publication Circulation stated:

Sudden death among 12 to 25-year-olds is “a low event rate occurrence.”

“There is insufficient information to support the view that ECGs in asymptomatic young people for cardiac disease is appropriate or possible on a national basis for the United States, in competitive athletics or in the general population.”

“At present, there is no mechanism available in the United States to effectively create national programs of such magnitude, whether limited to athletics or including the wider population of all young people.”

“There is insufficient evidence that particularly large-scale/mass screening initiatives are feasible or cost effective within the current US healthcare infrastructure . . .”

“The ECG . . . cannot be regarded as an ideal or effective test when applied to large healthy populations.”

“An additional, but unresolved, ethical issue concerns whether students who voluntarily engage in competitive athletic programs should have advantage of cardiovascular screening, while others who choose not to be involved in such activities (but may be at the same or similar risk) are in effect excluded from the same opportunity.”

The AHA’s Sept. 14 AHA writing group “does not believe the available data support significant public health benefit from using the 12-lead ECG as a universal screening tool. The writing group, however, does endorse the widespread dissemination of automated external defibrillators which are effective in saving young lives on the athletic field and elsewhere.”

Our Tools

March 11, 2014

MHSAA staff does very many things, including these two tasks: (1) we use the tools we have; and (2) we strive to develop more effective tools.

The tools we have are limited. We don’t have a huge staff to conduct investigations. We don’t have subpoena power to coerce disclosure of testimony and documents. We don’t have rules to cover every situation.

Thus, it feels like some people get away with things; and sometimes they do. We don’t have the tools to catch them or convict them. That is the inescapable condition of every voluntary statewide athletic association in the US.

But the other thing we do is keep working on better tools. Rules with broader reach and/or fewer holes. Penalties that are a greater deterrent to some people, and more punitive to others when deterrence doesn’t work.

Developing new rules is a tough process. Sometimes it takes months or years to get membership buy-in. Sometimes the “no-brainers,” so-called “easy solutions,” get shot down by lawyers who demand the most narrow remedy to each and every excruciatingly detailed problem.

We work today with the tools we’ve been given through the democratic processes of our voluntary association. And we keep working on ways to sharpen and strengthen those tools in ways that are reasonable in breadth and depth, rationally related to the basic tenets of a voluntary association, one of which is local control. Obviously, these are two of the more difficult things we do.