Three Deaths in One Week

Mary Newman | | Tuesday, March 22, 2011

Tragedy struck three high school students and their families earlier this month. Wes Leonard, Matthew Hammerdorfer, and Sarah Landauer never knew each other, but they suffered a similar fate. On March 3, star player Wes,16, had just taken the winning shot in overtime at a basketball game at Fennville High School in Fennville, Michigan, when he collapsed and died from sudden cardiac arrest (SCA). Two days later, Matthew, 17, captain of the Poudre High School rugby team in Fort Collins, Colorado, had just scored the winning shot during a match when he collapsed and died from SCA. The following Monday, star athlete Sarah, 17, an all-area soccer player, collapsed from SCA during track practice at Eastside High School in Gainesville, Florida. She passed away early Wednesday.

Both Wes and Matthew apparently had an underlying genetic heart condition—hypertrophic cardiomyopathy (HCM)—the most common cause of SCA in youth. HCM, or an enlarged heart, is a genetic abnormality present in approximately one in 500 people. It enlarges the left ventricle of the heart, which can trigger fatal heart rhythm disturbances, particularly during exercise. Sarah’s cause of death has not been reported.

There are approximately 5,760 to 7,000 sudden deaths among high school students each year.(1,2) Statistically speaking, this means that in addition to Wes, Matthew, and Sarah, more than 100 other high school students across the U.S. also died from unexpected SCA in the past week.

Should Schools Provide More Comprehensive Heart Screening for Student Athletes?
Could these deaths have been prevented? It’s hard to know, but more rigorous routine screening may be in order. There is no national screening standard for high school and college athletes in the U.S., although the American College of Cardiology and the American Heart Association (AHA) recommend that schools conduct pre-participation screening (PPS) that consists of a physical examination and a medical history.

The AHA recommends administration of a 12-point questionnaire about personal and family medical history. Questions address such matters as whether the student has a history of fainting, fatigue during exercise, or a heart murmur, and whether a close relative died of a heart condition before age 50 or has/had a condition such as HCM or Long QT Syndrome, a genetic mutation that produces an irregular heartbeat, which often leads to palpitations and fainting. If the answer to any of the questions is “yes,” further evaluation is recommended.

In contrast, the International Olympic Committee and the European Society of Cardiology recommend that all student athletes undergo heart screening. In Italy, routine use of electrocardiograms (ECGs) has been successful in identifying students at high risk for SCA and has led to a reduction of mortality of young competitive athletes by approximately 90%.

The AHA argues that routine screening in U.S. schools is much more complicated than in Italy because of the massive scope and the lack of infrastructure to manage such a program, and the follow-up required for abnormal findings—many of which are false-positives. The AHA estimates a mandatory program would cost more than $2 billion a year, based on the assumption that an ECG would cost $50.

“Although the frequency of these deaths in young athletes appears to be relatively low, it is more common than previously thought and does represent a substantive public health problem,” said Barry J. Maron, M.D., lead author of the AHA’s 2007 position statement on the matter.

Pioneers in the U.S., such as Joseph Marek , MD, of the Midwest Heart Foundation in Chicago, Illinois, have developed programs that provide free ECGs to student athletes and echocardiograms for those whose ECG results are inconclusive. He estimates the actual cost is less than $10 per ECG. According to the MHF, 40% of young adults at risk can be identified through the use of ECGs. With the help of community volunteers and volunteer cardiologists, Marek's team has screened 55,000 students since 2006 and found that approximately 2.5% of students needed further evaluation. More...

A new study from Israel, to be published March 15 in the Journal of the American College of Cardiology, reports that the use of ECGs to screen young athletes does not reduce the incidence of sudden death. A mandatory ECG screening program of athletes before participating in sports has been in place in Israel since 1997. In a review of a total of 24 cases of SCA deaths before and after 1997, researchers found that prior to mandatory ECG screening, the incidence was 2.54 events per 100,000 athlete-years, while it was 2.66 events per 100,000 athlete-years in the decade following legislation. These data challenge the benefits of screening observed in Italy and are consistent with results observed in Denmark and Minnesota, according to lead author, Sami Viskin, MD.

Dr. Marek disputes the conclusion of this study. “The Israeli investigators report that after instituting a mandatory national ECG screening program, there was no difference in the sudden death rate in athletes. They compiled deaths by tracking reports in the media. It was not a true registry. Therefore, it does not scientifically answer any questions regarding the efficacy of ECG screening.”

Jonathan Drezner, MD, a sports medicine specialist from the University of Washington in Seattle, indicates that tracking media reports identifies less than 55% of the actual deaths. According to Drezner, “The science surrounding the incidence calculation in Israel is incredibly flawed. You cannot calculate an accurate incidence unless you have an accurate account of the number of events during the study period (numerator), and an accurate estimate of the population at-risk (i.e., participating athletes/year, the denominator). This study has neither.”

“Good scientific data neither supports nor refutes the benefit of ECG screening,” according to Marek. “We will therefore give the youth in our community the benefit of the doubt and continue with our incredibly successful and efficient Youth Hearts for Life Cardiac Screening model.”

The Importance of CPR-AED Programs in Schools
Screening is just part of the picture for protecting young athletes. All schools should have comprehensive emergency plans to help save lives when SCA does occur.

Toward that end, the Sudden Cardiac Arrest Foundation advocates the following measures:

Every school in the U.S. should have an emergency response plan for SCA that includes mandatory CPR-AED training for every student before high school graduation—ideally, multiple times before graduation.

All school personnel should undergo CPR-AED training. This includes school nurses, teachers, coaches, athletic directors, administrators, parent volunteers, and other frequent school visitors.
AEDs should be placed throughout the school campus, including sports venues, to ensure an AED can be retrieved and delivered to the SCA victim within 3-5 minutes after apparent sudden death. It’s important to note that many students who suffer SCA are not engaging in sports, but rather are engaged in other school or community activities when sudden death strikes.

An emergency response plan that involves the school, the local emergency medical services system—including 9-1-1 dispatchers, first responders, EMTs, paramedics, and local hospitals—should be developed and implemented.

To learn more about the Sudden Cardiac Arrest Foundation’s “You Can Save a Life at School” campaign, and to download a free copy of a mini-magazine, click here.

Facts About SCA in Youth
Regular exercise is beneficial and only a small number of athletes with silent cardiovascular disease are at increased risk of sudden cardiac death during exercise.

Approximately 10% of SCA events occur among people less than 40 years old. More than 7,000 people under 18 years of age die from undetected heart conditions each year.
Children and adolescents are twice as likely to survive SCA than either infants or adults.
Young athletes suffer sudden cardiac death at a rate two to three times as high as their less active peers.

The median age of young athletes who suffer sudden cardiac death is 17 years (range 12-40 years). Most young SCA victims are male (90%). Just over half of victims (52%) are white; 44% are black.
Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death in young adults, accounting for more than one-third of cases.

Most SCA deaths in student athletes are precipitated by strenuous physical activity, particularly during football and basketball.

The effectiveness of ECGs varies, depending on the student’s athletic activity, age, race, and sex, and the skill of the physicians who conduct the tests.


Screening young athletes using 12-lead EKGs, plus cardiovascular-focused history and medical examination, may be cost effective.

The Bottom Line
Whether or not screening with ECGs should be adopted as a standard of care to prevent sudden death in young American athletes remains an area of controversy. In any event, SCA in young athletes is undoubtedly underreported.(3) “The significant numbers of SCA deaths occurring in school children is not fully appreciated,” said Norman Abramson, MD, FACEP, FCCM, chairman of the board of the Sudden Cardiac Arrest Foundation. “And so many of these deaths from SCA can be prevented. It is time for serious reconsideration of the best approach to prevent these tragedies.

Call to Action
Find out whether schools in your community are prepared to save lives threatened by sudden cardiac arrest. If they are not, provide them with copies of You Can Save a Life at School™, available for downloading here. To order print copies, contact info@sca-aware.org. The first copy is free. A donation (recommended amount: $1.00 per copy) is requested for multiple copies (www.sca-aware.org/donate). Shipping and handling is provided by our project partner, School Health.


References
1. Circulation. 2010;121:e1-e170.
2. Midwest Heart Foundation
3. See the Sudden Cardiac Arrest Coalition’s call for making SCA a reportable condition here.

Note: This article was originally posted on the SCA Foundation website.

Another happygram from a grateful patient

"Many thanks to all of you who came to my rescue - on Thanksgiving - no less!
Your quick response to my daughters house and expert care helping me get to the hospital so quickly was greatly appreciated. Of course, I remember nothing but this has all been explained to me. I feel that you folks saved my life and I will be forever grateful.

Love,
CD"



Staff Note: Many of us spend our holidays at WAVES either by choice or by scheduling. We enjoy the company of our co-workers and friends so the time goes by quickly but never the less we miss time with our traditional families. Notes like this remind us that the public appreciates our small sacrifice as well.

The crew for this call was Jeff Elwood (Lead Provider) and Daniel Taylor.

A few words from a grateful patient...

WAVES received a call from a happy patient. Jeannie Potanas took the call and transcribed the message which is below:

"I just wanted to call to let you know that those people that came were the best. They took me to the hospital because I really needed to go. I was dehydrated and felt terrible. I'm feeling 95% better now, but honestly, I think that just a trip around the block with those fellows in the ambulance would have worked as well. They really were so nice. I mean, I know you're supposed to be, but it was so genuine - they really cared about me. I'm sure that people call and complain and I wanted to call and tell you something good. Will you please make sure to tell them I said thank you?"

Message received, and thank you, we don't receive "happygrams" as often as we'd like. The crew was Paramedic Jeff Elwood (Lead Provider) and EMT Jeff Isgar (Driver).

New law would criminalize the usage of laser devices against aircraft

Making this a criminal act may deter individuals from a seemingly harmless act which could cost the lives of an entire helicopter crew. Not only is the laser beam itself potentially harmful it could be attached to a rifle and used as a targeting device.
Story Here

WAVES Responds to Vehicle Roll Over with Ejection

WAVES responds to a roll over motor vehicle accident with one person ejected. 2 Ambulances responded: First Ambulance: Medic Daniel Taylor (Lead Provider), EMT Jeff Isgar, EMT Kelly Glynn, Second Ambulance Paramedic Jeannie Potanas (Lead Provider), and Paramedic Matt Maule. Additionally WAVES MD1 Chris Fullagar and MD2 Naveen Seth also responded to assist with assessment and care of the patients. Excellent job to all those who responded!
Story Here

STEMI Recognized and Treated by WAVES Paramedics

On 9/22/2010 WAVES was called for a patient having difficulty breathing. Upon arriving on scene paramedics were presented with an extremely anxious patient having severe respiratory distress. Based on their assessment the crew suspected the patient might have been having a heart attack and preformed a 12 Lead ECG which showed a large area of the heart was starving for oxygen. Thanks to technology integrated in to every heart monitor WAVES Ambulance uses in the field, a doctor in the Crouse Hospital Emergency Department was able to look at the patient's heart 17 minutes after 911 was called. Before the Paramedics had spoken to the doctor or even left the scene preparations were being made to treat the patient in the Emergency Department.
Here is the 12 Lead ECG sent to Crouse Hospital:

The patient was moved quickly from her home to Crouse Hospital with Paramedic Casanova and Paramedic Mawson treating her concurrently. The patient received multiple medications as well as repeated 12 Lead ECGs to monitor the progression of the AMI. Upon arrival at the hospital the patient was taken directly from the ambulance entrance to the Cardiac Catheterization Lab by passing admission to the ED all together. 14 minutes after arrival at the Cardiac Catheterization Lab the first stent was placed and blood began to flow correctly through the heart.

The Crouse Hospital Cardiologist who treated the patient, Anil George MD, noted that "The promptness of the treatment and ECG transmission by WAVES played a very large role in the excellent outcome of this patient. I look forward to working with you more frequently in the future. Great job!"

Below are the flouroscopic images obtained before and after stent placement:

The blue circle indicates the location of the blockage.

The blue arrow indicates the location of the stent.

By the numbers:
WAVES Ambulance arrived on scene 5 minutes after 911 was called.
The first ECG was obtained 7 minutes after arrival on scene.
The first ECG was transmitted 5 minutes after it was obtained.
The patient arrived in the Catheterization Lab 39 minutes after 911 was called.
The first stent was placed 53 minutes after 911 was called and 14 minutes after arrival in the Catheterization Lab.

WAVES is on Facebook

Our official Facebook page is now active. Look for more activity there soon.

WAVES Paramedic Interviewed by News Channel 9

Push for blue lights on ambulances



WAVES Paramedic Luke Gasowski interviewed for a story regarding a campaign to change NYS law to permit rear facing blue lights on ambulances.

Camillus (WSYR-TV) - A statewide movement to allow blue lights on the back of ambulances is taking shape among some emergency responders. It is meant to protect first responders and their patients on the side of the road, but would require a change in state law.

It's currently illegal for ambulances to have blue lights, but that rule doesn't apply to fire truck and police cars.

WAVES Ambulance Paramedic Luke Gasowski says paramedics deserve the same protection as officers and firefighters. "When you're out on the side of the road, unfortunately that's the most dangerous thing we do is work out on the side of the roadways," he said.

Gasowski says he and his peers have frequent close-calls with passing drivers. "We're on the side of the road and cars are coming very close and honestly, it's that they haven't seen us in time or they didn't realize where we were working around the emergency scene," Gasowski said.

It’s a situation that could be prevented if ambulances were able to use blue lights. The color is more reflective, allowing drivers to see it from farther distances than red lights.

Gasowski adds that the ambulances even came with blue lights, but the lenses had to be changed to red to comply with the New York State law.

Syracuse Police use blue lights on the back of some of their patrol cars and say it has improved their safety on the road.

Rural Metro Ambulance in Syracuse says they use amber-colored lights, which are usually associated with construction vehicles but not emergency vehicles. They say it helps tell passing drivers to slow down, but avoids creating a dangerous situation for curious drivers who might take their eyes off the road ahead.

New Horizons

This is the official blog of WAVES Ambulance in Camillus, NY. We are greatly changing our methods of reaching the public. Currently in the works are a new website, social media, and other electronic means of spreading our information to the public. Please check in here from time to time to see information about WAVES, health news, and other content relevant to everyone.