Emergency Heart Devices on Athletic Fields? Not Always Practical, Coaches Say

It’s a nightmare scenario for parents of athletes: their child collapses in cardiac distress during or after playing a sport.

At , that became reality on Sept. 27, when a player from the visiting Perry Hall High School girls field hockey team .

Coaches and parents trained in CPR responded within seconds to Breanna Sudano and worked on her until paramedics arrived. Sudana survived and . Medical officials confirmed she had suffered cardiac arrest.

Catonsville High School has four Automatic External Defibrillators or AEDs, all of which were at the school but not on the field at the time of the incident, according to school officials.

"I cannot understand why a school that has four AEDS would not have one at every sporting event," wrote a reader, "Tess," about the collapse.

"The young lady is not the first seemingly healthy athlete to collapse on a field and the stands are filled with middle-age parents in their prime heart attack years...of course that AED should be at the field."

Sudano’s collapse has prompted Catonsville school officials to consider placing AEDs on athletic fields for every game -- a rare move among school districts across the region.

In commenting on such a plan, some districts in the Washington, D.C.-Baltimore area cited state regulations that interpret a 2006 state law as not explicitly requiring AEDs on athletic fields for all events.

Rather, state regulations say that at a minimum, there must be one AED in each public high school, which needs to be “available” for use at school-sponsored athletic events.

In Baltimore County, the school system policy states that schools and offices must make sure there is "access" to the AED and emergency equipment during the school day and for school-sponsored events. The policy does not specify whether the AED must be on the field during games.

Catonsville school officials told Patch after the incident that they were looking into keeping one AED locked in a shed closer to the athletic fields that can be brought out during games. School officials later confirmed that they are keeping an AED at the athletic fields.

Cardiac Arrest on the Sports Field Prompts Changes

The movement to put AEDs on schools and sports fields has advanced in recent years, as incidents of sudden cardiac arrest among teens playing sports makes national headlines.

Most recently, in September, 16-year-old Angela Gettis collapsed as a result of sudden cardiac arrest while cheering at a football game at Fremont High School in Los Angeles. She was pronounced dead at the hospital shortly after the incident, according to ABC News.

Sudden cardiac arrest, an unexpected loss of the heart function, is rare, especially among those under 18. David Monroe, medical director of The Children’s Care Center at Howard County General Hospital, said about one in 200,000 children are at risk for sudden cardiac arrest. Incidents are higher during times of exertion, such as sporting events.

AEDs boost survival rates during such events, Monroe said. With each minute without the intervention from an AED, the chances of the person’s survival plunge 10 percent, he said. After 10 minutes, the AED doesn’t do much good, he said.

Monroe and other health advocates said AEDs should be on athletic fields during games, not just in school buildings.

“I can imagine it would be difficult to have an AED for every single sport, and every single game, but how important is it to school communities to protect students?” said Mary Newman, president of the Sudden Cardiac Arrest Foundation, a Pennsylvania-based foundation with a mission to prevent deaths from sudden cardiac arrest.

“I don’t think schools should wait for a death to get prepared,” she added.

A board member from the SCA recently posted on its blog about the Catonsville incident and how, at the time of Sudano’s collapse, the AED was “some distance from the field.”

So Many Games, Not Enough AEDs

Some regional athletic directors interviewed this month said it was logistically difficult---and expensive—to ensure an AED is at each an every field for school-sponsored sports event.

“It’s not practical,” said Mike Williams, coordinator of athletics for the Howard County Public School System. “You know, it’d be ideal to have a designated AED at every game, but you could have a game in the stadium, a game in the gym, in the field hockey field...”

Each of Howard County’s 12 high schools has two AEDs, and each school has an athletic trainer, who keeps the device on his or her person, school officials said.

“They are a cell phone call away,” said Williams, who added that all 800 of the school system’s coaches are trained in AEDs and CPR.

“They have a golf cart, and they can be there in less than 2 or 3 minutes if they are not already on site,” he said.

Similarly, other districts, such as Carroll County, do not have requirements that explicitly state that AEDs must be on the field for every athletic event.

Rather, after school hours, the devices are considered “roving” for trainers to use, and the devices' presence at a game depends on the location of the person with the device.

“I think it would be tough to have it on every field,” said Jim Rodriguez, supervisor of athletics for Carroll County schools. He said that when one does "the math," it would mean “multiple” AEDs.

In Howard County, AEDs cost $2,000 each, which included the cabinets in which they were stored, said spokeswoman Patti Caplan. The district has 36 total at a cost of $64,000 for the AEDs alone, she said.

Officials at Montogomery and Prince George's County schools said they have AEDs at every school athletic event.

School officials in Montgomery County, which has 120 AEDs between its 25 high schools, said the location of the device depends on the layout of the fields.

In some cases, it may be shared at practices between fields located next to each other. In other cases, it might be located in a fixed cabinet in the concession stand at a football game, school officials said.

Similarly in Prince George's county, which has 85 AEDs in its district, the layout of the athletic fields, which are close together, makes it easier to have AEDs at every school event, said school athletic director Earl Hawkins.

“If we had soccer practice and football and cross country, that AED must be with one of the coaches out there, and they would have it at their disposal if something would happen," Hawkins said.

John Blenko, an associate professor of the Department of Anesthesiology at the University of Maryland Medical Center, said there are two types of cardiac arrest, but only one type can be helped by the use of an AED -- ventricular fibrillation, which is considered an immediate medical emergency.

Blenko said that while not every incident of cardiac arrest is ventricular fibrillation, every person who is in cardiac arrest needs CPR.

Once an AED is hooked up to a person, it can determine what type of cardiac arrest he or she is in and distribute an electric shock to the heart, he said.