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Two phrases that are sure to strike terror into every athletic trainer's heart are sudden cardiac death and spinal cord injury. Even though the chances of either of these injuries happening are small, it is reasonable to assume that every athletic trainer will either care for an athlete who suffers one of these injuries or will know of a colleague whose athlete has suffered one of these events. For all involved, the event is catastrophic and will never leave them. After 23 years, I can still see the eyes of the 17-year-old football player who said “Fran, I can't move my legs.” That image will never leave me.
This issue of the Journal of Athletic Training contains an article in which John W. and John A. McChesney describe important assessment tools for evaluation of the chest and abdomen and 2 articles that deal with sudden cardiac death. In athletic training, we emphasize injury prevention, and rightly so, but Michael Koester shows that we are not doing an adequate job when it comes to preventing sudden cardiac death. No matter how sophisticated we get with electrocardiograms and echocardiograms, the best screening tool is still a thorough history and physical examination by a qualified practitioner. Yet most schools are not using this more economical and more effective tool. We must do better.
The article by Glenn Terry and colleagues deals with resuscitation, a topic dear to my heart. Two issues come to mind here: should athletic trainers receive training in the use of automated external defibrillators (AEDs), and should institutions purchase AEDs? I suppose that 30-some years ago, there was a debate over whether athletic trainers should be certified in cardiopulmonary resuscitation (CPR), and the result is that we are all CPR certified. We need a card to take the certification test, and we need the card to maintain our certification. We receive continuing education units (CEUs) for it. We dread having to pound on poor Annie's chest every 2 years, but we do it. Well, guess what? The AED has become an integral part of CPR training. The American Heart Association (AHA) has recently revised many of the cardiac care standards for adults and children.1 This revision requires all CPR instructors to become certified as AED providers and instructors. Every CPR course is to include a demonstration of the AED and how it fits into the chain of survival. In my opinion, AED training should be added to the educational competencies for student athletic trainers. Certified athletic trainers should train on the AED each year that they are not required to take a CPR class. That way, at least once a year, you practice your cardiac resuscitation skills. It uses 4 hours of your time at most. The Board of Certification should offer CEUs for AED training. Police officers, firefighters, and security guards have demonstrated they can use the AED effectively. Do we really want a mall guard to have a higher level of medical certification than a certified athletic trainer? We must do better.
The AHA is promoting public-access defibrillation in its newest guidelines.1 We know that survivability depends upon early defibrillation. The goal is a call-to-shock time of less than 5 minutes, but emergency medical services (EMS) agencies cannot reliably and consistently meet this goal. Indeed, Cady and Lindberg2 reported on EMS delivered by the largest 200 cities in the United States, and they found no universal method to measure or define response time. Public-access defibrillation is a way to meet this goal.3 If you work in a sports medicine facility, don't think you are immune to this issue. The AHA has set a goal of collapse-to-shock time of less than 3 minutes for all areas of the hospital or ambulatory-care facility.1 We must do better.
Sudden cardiac death in athletes is truly a rare event. Cardiac arrest in the general public is not. Athletic trainers have a greater chance of having to resuscitate a spectator, coach, or official than an athlete. We must be prepared. At a cost of US $3000 each, mandating the purchase of an AED by every institution would be difficult. Yet many schools are doing so, and they are buying more than one. Every school beyond the 50% mark that obtains an AED makes a stronger case that it is the standard of care. Athletic trainers should examine their own situations and decide what is best. It may be feasible to rely on campus security to have AEDs, but response time must be examined closely. Can they reliably and consistently get that AED to you in less than 5 minutes? Be reasonable in that assessment. Think outside the box. Work with your local EMS agency to obtain AED training. They can probably guide you to available grant money. Also, if campus security is buying 2 units, why not buy 2 more for the athletic department? Bulk purchases usually offer cost savings. We must do better.
Every institution should have an emergency action plan for injuries at every venue. The plan must be comprehensive and common knowledge. It should be practiced and revised on a regular basis—that is a given. Providing an AED at the side of every cardiac-arrest victim in less than 5 minutes should be a part of that plan. There are many ways this can happen, but it must happen. Having an AED readily available at every spectator event and at the victim's side in less than 5 minutes must be our goal. Although I can still see Jeff's eyes from 23 years ago, I can also see the eyes of several cardiac-arrest survivors who said thank you. We will do better.
Francis Feld, MS, MEd, CRNA, ATC, NREMT-P, is a certified, registered nurse anesthetist at the Veterans Administration Pittsburgh Health Center. He has been a certified athletic trainer at the high school, university, and professional football levels and is a paramedic with the UPMC St. Margaret Hospital Paramedic Response Team and Ross West View EMSA.