AED and commotio cordis: What every youth sports coach should know
A 13-year-old boy took an inside pitch to the chest while attempting to bunt during a Little League game in 2011. Hayden Walton dropped the bat, took two steps toward first base and collapsed. CPR was performed, but an automated external defibrillator (AED) wasn’t available. He died the next morning at the hospital.
Thomas Adams was a 16-year-old catcher on a travel team when he was struck on the chest by a pitched ball during practice in a high school gym in 2010. He was wearing a chest protector. He collapsed. A defibrillator was used but not until paramedics arrived. He died an hour later at the hospital.
These boys died from commotio cordis, the leading cause of fatalities in youth baseball in the U.S. Pitchers, catchers and batters attempting to bunt are at the highest risk. Commotio cordis, which is the second-leading cause of sudden cardiac arrest (SCA), occurs from a blow to the chest by a blunt object, such as a baseball, precisely at the 10-30 millisecond frame of the heart beat cycle. The strike to the left chest wall over the cardiac silhouette causes erratic electrical activity within the heart muscle. It results in the failure of blood to pump through the body. The Italian word is translated as “agitation of the heart.”
After baseball, the most occurrences of commotio cordis per year are softball, hockey, football and lacrosse. It mostly occurs in children between the ages of 9 and 15. The mean age is 15, and 95 percent of the victims have been male. An AED is the only way to save someone’s life who has suffered SCA -- the No. 1 killer among young athletes.
While CPR can help with blood flow, it is necessary to deliver an electrical shock to restore a normal heart rhythm with an AED. But time is of the essence. A February 2013 study in Heart Rhythm said the intervention of medical assistance within three minutes of the event gives the victim a 40 percent chance of survival. However, after three minutes, the survival rate drops to only 5 percent. The Commotio Cordis Registry indicates mortality rates have decreased over the years because of faster response times and an increase in awareness. Survivability was only 10 percent 25 years ago.
Fast access to an AED is the only answer. Optimal AED placement allows a person to grab the AED and return to the victim within 90 seconds. In any given week during the spring baseball season up to 1,600 players ages 4-15 practice or play baseball games on five baseball fields at the Tecolote Recreation Center in San Diego, CA. Hundreds more watch. A small building located at the northern-most point of the grounds – a minimum 7-minute walk to the farthest field – has one AED. But the recreation department hours of operation do not coincide with all scheduled baseball activity. Even if an SCA event occurred while open, it would be impossible to transport the AED in a beneficially timely manner to all corners of the park.
The rate of survivability would be higher with greater awareness and public access to AEDs. Today, only 19 states require that at least some of their schools have AEDs, according to research by Scripps Howard News Service. California requires golf courses, amusement parks and health clubs have AEDs. However, there’s little to no legislation nationwide requiring public-use athletic fields or youth athletic events to have AEDs.
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Liability concerns and expense have been routinely cited. There is no liability. Virtually every state has “Good Samaritan” laws that protect coaches, administrators, parents or bystanders when using an AED to help someone. While training is advisable, the portable device instructs the user through voice and text prompts where to place the pads and when to apply the shock. In terms of expense, an AED can be purchased for as low as $1,200. And a grant program (aedgrant.com) makes them available for under $1,000. There are also organizations, like AED Mission, that provide AEDs free as loaners to groups like youth sports teams.
Protecting kids through improved sports equipment has been studied. Baseballs represent 61 percent of the sports equipment that cause commotio cordis. The Consumer Product Safety Commission recommends the use of RIF (reduction in force) or age-appropriate baseballs for children 13 and under. The lighter core and softer cover balls reduce the chance of commotio cordis but they do not eliminate it. Reportedly, 6 percent of baseball related deaths have been from RIF balls. Hockey is considering the introduction of similar age-appropriate pucks. Chest protectors do not prevent commotio cordis. The National Operating Committee on Standards for Athletic Equipment (NOCSAE) reported there are no chest protectors currently on the market that can prevent commotio cordis.
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