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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.”

Program Priorities

January 10, 2014

Many school districts face more requests from their constituents for sports programs than they have the resources to accommodate, so they are forced to make very difficult decisions. For three decades, when I’ve been consulted, I have offered and stood by this advice.

First, I advance the premise that if the activity is educational, there is just as much potential for the education to occur at the junior high/middle school and subvarsity levels as at the varsity level. Just as we would not discriminate against one race or gender, we should not disadvantage one age or ability level. In fact, with a little less pressure to win, it is likely to see more education at subvarsity levels and more reason to sponsor them.

Second, I advocate the position that schools should avoid sponsorship of any activity for which a qualified head coach cannot be secured. Qualified personnel are, in order of priority:

  1.  a teacher within the building who has current CPR certification and completed CAP.
  2.  a teacher within the district who has current CPR certification and completed CAP.
  3.  a teacher in another district who has current CPR certification and completed CAP.
  4.  a certified teacher from the community who has current CPR certification and completed CAP.
  5.  a non-certified person who has current CPR certification and completed CAP.

I urge schools not to descend lower than this for program leadership. Coaches are the delivery system of the education in educational athletics; they are the critical link in the educational process. More problems occur than are worth the effort if the program is in the hands of an unqualified coach.

Next, I urge that schools rank sports on the basis of cost per participant, and give higher priority to sports that spread funds over the greatest number of participants.

Next, I urge that schools place lowest in priority the sports that cannot be operated on school facilities and create transportation, supervision and liability issues, and give higher priority to those conducted at or very near the school.

Next, I urge that schools place lowest in priority the sports which are most readily available in the community, without school involvement. If resources are precious, then duplicating school programs should be a low priority; doing what the community can’t do or doesn’t do should be given a much higher priority.

While I’m a fan of school sports, I recognize that an athletic program has as much potential to do harm as to do good. Programs without qualified coaches that are conducted for small numbers of students at remote venues and without comprehensive school oversight and support may create more problems for schools than the good they do for students.

Bare bones budgeting will require brutally honest assessments based on priorities like these.