Cardiac Screening
October 31, 2014
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.”
Heads and Heat
August 16, 2012
We are engaged in very serious discussions. They’re not only complicated, with unintended negative consequences possible from what are thought to be positive actions; they’re also a matter of life and death.
The topic is football – the high school sport under most scrutiny today and suffering from the most criticism it’s seen since the 1970s when catastrophic neck injuries spiked, liability awards soared, many insurers balked, and most helmet manufacturers abandoned the business altogether.
During recent years we have learned about the devastating long-term effects of repeated blows to the head; and we’re trying to reduce such hits. We’ve learned that 70 percent of concussions in football result from helmet-to-helmet contact, and we’re trying to have coaches teach blocking and tackling differently and have officials penalize “high hits” consistently and rigorously.
During the past several years we’ve learned that serious heat illness and heat-related deaths are 100 percent preventable, yet nationwide there were 35 heat-related deaths in high school football alone from 1995 to 2010; and we’re promoting practices that acclimatize athletes more gradually than “old school” traditionalists might advocate.
As we simultaneously address issues of heads and heat in football, some coaches may think we’re being overbearing, while many in medical fields say we’re out of date, citing higher standards of the American Academy of Pediatrics, National Athletic Trainers Association and National Federation of State High School Associations, as well as many of our counterpart organizations across the country.
As we consider in-season changes to improve athlete acclimatization and reduce blows to the head, we should be open to making out-of-season changes that work toward rather than in opposition to those objectives. There can be no sacred cows. The topic is too serious.
Ultimately, if we err in the outcome of this year’s discussions about heads and heat in football, it must be on the side of safety, on minimizing risks for student participants. They deserve it and, once again, the sport of football needs it.