Saving Lives on the Sidelines
Lawmakers Mandating Lifesaving Devices

Three Houston-area high school athletes died of heart attacks within a 10-day span in September 2006. A month later, two more Houston athletes died from heart attacks while running track. The rare concentration of deaths that occurred in Houston brought attention to the dangers of sudden cardiac arrest (SCA). SCA kills more than 325,000 Americans each year, according to the American Heart Association.

To prevent these deaths, the University Interscholastic League (UIL), an organization that governs extracurricular activities at public schools in Texas, is mandating portable defibrillators-Automated External Defibrillators (AEDs)-at all member schools. An AED is a computerized medical device that recognizes heart failure and administers an electric shock to get the heart going again.

Texas legislators want to take the UIL mandate one step further and require AEDs at all Texas schools.

To find out what the new policy means, how AEDs are used and what the benefits will be to Texas schools, Fiscal Notes writer Ann Holdsworth spoke with Kim Rogers, a UIL spokesperson, Mark Cousins, a UIL athletic coordinator, Richard Lazar, CEO of consulting firm AED Risk Insights and Laura Friend, of advocacy group Parent Heart Watch.

What does an AED do?
KR: An AED basically shocks a person's heart back into a normal rhythm. People go into cardiac arrhythmia and when the AED shocks their heart, it shocks their heart into a normal rhythm.

Can an AED accidentally shock a healthy heart?
KR: No, the AED device can sense whether it is a shockable rhythm or not.

Can an AED help anyone with a heart problem?
MC: There are a number of things with sudden cardiac arrest that a defibrillator is not going to correct. Certainly we do not want to give a false sense of security that just because an AED is available, every student that has an issue is going to be saved. But certainly the chances of a student surviving or an adult surviving with an AED being available-if the particular rhythm that an AED can correct is present-goes up the faster that device gets there.

What causes SCA?
RL: SCA is caused by two kinds of heart abnormalities. It kills about 350,000 people a year in this country; it's the leading cause of death. That equates to three 747s full of people every day crashing and killing everyone on board.

It kills 7,000 to 9,000 kids every year. It's a problem.

LF: This is an electrical disturbance that causes these cardiac arrests. It's the number one cause of death among student athletes, but it is not an athlete's disease.

Is there something parents or kids can do to check for heart ailments?
KR: We don't know of any particular factors that [the athletes] might have had in common. But, we've had our medical advisory committee review the cases, and all the doctors have said there is no one test that can find every heart ailment out there. All athletes are required to undergo physicals, but there really is no foolproof method to find out everything that is out there.

LF: There's not a government agency or a private agency that tracks all of these deaths. A heart screening would be preventative medicine, but since we do not have any standardized heart screening for our children, the next thing would be to react to a sudden cardiac arrest with an AED. The only device we have against sudden death is an AED and CPR.

Why aren't AEDs already required?
KR: We've had a medical advisory committee that was formed in 2001 that had been looking at making AEDs mandatory since that time. They've always been advocates of having them, but at the time they were formed, the prices were at $3,000 to $4,000. It wasn't good to mandate them when we couldn't fund them and had no information on what schools had them.

Is it feasible now?
KR: We started researching the number of schools that had them and those that didn't, and why they didn't have them. The data from this past fall was that over half of our 1,300 schools already had AEDs. So, we felt that this year was the first year we could mandate them.

How will schools pay for them?
KR: Schools are paying for them themselves, but many companies are donating them to schools. Hospitals are also donating them. St. Jude Hospital alone has donated 48 AEDs to our schools. We also got several AED companies to send us prices to show them that if schools bought them in bulk or through a deal, it actually made more sense for us to allow the schools to work with the companies to get better deals.

Where will schools keep them?
RL: That determination would be made on a campus-by-campus basis based on its size and configuration issues. Because time is so critical with Sudden Cardiac Arrest- that is, the treatment must be delivered in four to five minutes, and that includes recognizing there's a problem, notifying somebody that there's a problem, retrieving an AED and using an AED. Remember, though, that you can move devices around over the course of a day so that during a regular school day, devices might be positioned near classrooms, auditoriums and cafeterias. It's important for schools to build awareness about where they are. Put them in conspicuous places where they're easily accessible. People pass them every day, and you put signs up so there's a constant recognition that these devices are there.

Ann Holdsworth