When Baltimore area middle school coaches take their teams to a sporting event, they are increasingly adding some new equipment to the list of necessary supplies: automated external defibrillators.
The devices are perhaps most frequently associated with helping people middle-aged and older in cardiac emergencies, but statistics show that sudden cardiac arrest is a leading cause of death and is a major concern for young athletes, too. According to Johns Hopkins Medicine, about 3,000 young people die every year from cardiac arrest. Though obesity and sedentary lifestyle are typically linked to heart problems later in life, for children and adolescents, circumstances are different. About 75 percent of all sudden cardiac arrest cases take place during a sporting event or practice.
With these statistics in mind, Dr. Theodore Abraham, the director of the Johns Hopkins Hypertrophic Cardiomyapathy Center of Excellence, launched the Hopkins Heart Hype program six years ago. "The focus was to intervene and reduce untoward cardiac events in young people, primarily athletes," he explains.
Hopkins has had a partnership with the Baltimore City Public Schools for about three years. Earlier this year, the Israel and Mollie Myers Foundation expressed interest in funding AEDs for city schools.
Dr. Abraham knew that all city high schools already had AEDs, in accordance with a 2006 state law requiring all Maryland high schools to have at least one AED on-site and mandating that at least one individual trained in AED operation be present at school-sponsored athletic events. Since the high schools had AEDs, Abraham says, his team "realized the real need was in middle schools. People were trained, but they had no equipment."
The Foundation's $10,000 donation, given this past September, purchased AEDs for 10 Baltimore City middle schools, including Roland Park Elementary/Middle, where Principal Nicholas D'Ambrosio says the machine will be accessible during the school day and also on fields and courts during after-school athletic activities.
"We have almost 1,400 kids, and we provide a lot of extracurricular and movement activities," says D'Ambrosio. The new AED "provides a safety net. It's comforting."
Automated external defibrillators are portable devices that deliver an electric shock through the chest to the heart, which can correct an irregular heart rhythm in a person experiencing sudden cardiac arrest. Operating an AED is straightforward enough that most people can handle it easily. The machine has two patches, connected to the device by cords. Those patches are placed on the chest, a button is pushed and the machine handles the rest.
The process is simple, says Dr. Abraham,. "Most people who can read will be able to deliver the shock."
Hopkins Heart Hype program includes screening young athletes for unseen cardiac problems — more than 1,000 have been screened since the Heart Hype program began — and to save young people who do experience sudden cardiac arrest. "That arm is supported by AEDs," says Dr. Abraham, explaining that when young people die of sudden cardiac arrest, it is usually due to the heart rhythm problem, not an underlying structural issue, so quick AED application can save a victim's life.
The chance of surviving a sudden cardiac arrest decreases by 7 percent to 10 percent for every minute that passes without defibrillation, says Bob Peterhans, the general manager of emergency care and resuscitation for Philips Healthcare, a company that manufacturers AEDs. "When an AED awareness program is implemented on school grounds, any person can be better prepared to help save the life of an athlete or bystander," he says.
In Harford County, where AEDs have been at interscholastic events since 2006 and in every school since 2009, the successful use of an AED likely saved the life of a girls basketball player who experienced a cardiac event at a game at C. Milton Wright High School last January. "We are proud to have every physical educator, coach and school nurse certified in CPR/AED use," says Harford County Public Schools nurse coordinator Mary Nasuta. "Emergency plans are in place at every site. Due to the proactive implementation of the AED plan, a student was revived due in large part to the quick and skilled attention of our staff."
At C. Milton Wright, the AED was operated by a state trooper who arrived on the scene.
Like Harford County, every Baltimore County public school has at least one AED on site and high schools have several. Howard County high schools each have at least one AED and the county school board is working to get AEDs into all the schools.
Maryland is one of 19 states that have specific school-related AED legislation on the books, and the state's aggressive efforts regarding AED school placement and training are to be commended, says Mary Newman, president of the Sudden Cardiac Arrest Foundation. "By deploying AEDs in middle schools, Baltimore is setting a great example for the rest of the nation," she says.
Increased access and availability of AEDs is good news all around, according to Abraham, who started Hopkins' Heart Hype program with a goal of raising community awareness of heart problems in young people. "We felt there was a significant lack of community awareness both in Baltimore City and outside the city limits," he says. "Just because you're healthy and young, you're not invincible."
Though young athletes are still at risk of experiencing sudden cardiac arrest, in Baltimore, Heart Hype's focus on screening, providing access to AEDs and training non-medical personnel in AED operation and CPR has expanded the awareness of the problem.
While AEDs have recently gotten a lot of attention, CPR is a critical part of life-saving efforts says Capt. Steve Adelsberger of the Baltimore County Fire Department. "CPR and AEDs go together," he says. "CPR buys time until the AED arrives." Captain Adelsberger notes that CPR — focusing on chest compressions — is now taught in schools throughout Baltimore County, preparing young people to be aware and jump in to help in an emergency situation.
And with AEDs on the sidelines and trained teachers and students on the field and in the stands, Baltimore's athletes, coaches and parents have peace of mind and can keep their heads where they belong: in the game.
AED use tips from experts
When sudden cardiac arrest occurs, bystanders with access to an AED can make a big difference. Here, experts offer tips for handling the situation in the most effective manner:
First call 911: When faced with a cardiac event, bystanders should first contact emergency personnel, then administer aid. "Always call 911 first, begin CPR and use the AED as soon as possible," says Bob Peterhans, the general manager of emergency care and resuscitation at Philips Healthcare.
Then start CPR: If an AED is not immediately available, start chest compressions, advises Capt. Steve Adelsberger of the Baltimore County Fire Department. "It's pretty easy," he says. "You don't have to be perfect. Call 911 and start pressing on the chest until an AED arrives." He notes that simple CPR awareness training does not take long and that training focuses on chest compressions, not mouth-to-mouth resuscitation.
Don't be intimidated: Bystanders should "feel confident they can only help an individual suffering sudden cardiac arrest if they act quickly and use an AED," says Peterhans. Dr. Theodore Abraham, director of the Hypertrophic Cardiomyopathy Clinic at Johns Hopkins, agrees, saying, "People should not be intimidated. The whole point is to make AEDs easy to use."
Follow directions: AED units are equipped with directions on the outside. Make sure the chest area is dry, then "for the most part, it involves placing the patches on someone's chest and hitting the power button," says Abraham. "Step back and the machine takes over."
Get training: AEDs are designed to be easy to use, but everyone can benefit from training. Abraham suggests 20-minute AED/CPR classes, saying that "they're easier than they were even five years ago," and online instructional videos. Philips Healthcare recommends that schools implement education and training programs for personnel.
Info on the Web
•For more information about AED use and in-school training, visit the Sudden Cardiac Arrest Foundation web site.
•To view a series of five videos demonstrating AED use, visit the Philips Healthcare Channel on YouTube.
•For more information about Johns Hopkins' Heart Hype program, visit their site.
AEDs for home use
While schools and other public places like stores and airports have increased the number of AEDs available to the public, in-home AEDs have also grown in popularity — and accessibility — over the past several years. Home AEDs were approved for sale by the Food & Drug Administration in 2002 and have been available over the counter since 2004. The Philips "HeartStart Home" costs approximately $1,500, and for individuals meeting certain medical criteria, that cost may be partially or completely covered by health insurance.