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From a regional team of on-field trainers to increased deployment of electronic defibrillators, coaches say more steps than ever are being taken to keep high-school athletes healthy and safe.
But increasing nationwide discussions of how undiagnosed illness and other risks can lead to injury and death on the field – and ways to prevent such tragedies – beg questions of whether more must be done.
Public awareness has been raised on the issue of traumatic head injuries, with protocols locally and across the nation now well in place.
But medical experts say sudden cardiac death, rather than brain injury, is the biggest killer of young athletes.
The American Heart Association says that among the more than 7 million U.S. high school athletes, one out of every 30,000 to 50,000 dies annually from out-of-hospital sudden cardiac arrest. Another generally accepted statistic is that one high school or college athlete dies from a sudden cardiac emergency every three days in the U.S.
While the raw numbers of such deaths are low, medical experts and athlete advocates say one death is too many if it could have been prevented.
“A young person at the peak of physical prowess, dying without any warning. It’s a shocking, tragic and potentially preventable death,” said Nicolas Madsen, lead researcher and pediatric cardiology fellow at Seattle Children’s Hospital and the University of Washington School of Medicine.
More thorough screening of young athletes with mandatory electrocardiograms, some medical experts say, could save lives.
That approach is not without its critics, who cite issues with cost and reliability. Safety advocates, however, say there are less expensive measures that can go a long way toward increasing player safety, but which are not as widely used as they would prefer.
Employment of electrical defibrillators is seen universally as a viable safety measure. Many Tri-parish schools have them but, in some cases, they have no trained staff to use them, nor protocols that make the equipment readily available in an emergency.
The American Heart Association has a 12-step list of checkpoints for doctors to use in athlete screenings, but their own research shows that few doctors employ them.
The Louisiana High School Athletic Association, whose standards are used by area schools, has a medical history checklist for screenings, but it seeks less thorough information than other checklists schools could employ.
Awareness of the risk to athletes from heat exhaustion is growing, and this year is a big focus of the LHSAA. But best practices cited by safety advocates go further than some of the protocols local schools use.
The most pronounced debate in terms of athlete safety is the international discussion regarding EKG screenings, and while not anywhere near a standard in this country, support is vocal and growing.
A study paid for by the NCAA released last month supports use of the tests.
Docs Weigh In
School administrators and many doctors are not sold. Greater use of the tests when family history or other issues suggest a problem exists is supported. The NCAA, however, does not yet mandate the tests for routine screenings.
“Right now a routine EKG is not recommended for screening young athletes,” said Dr. Zehra Jaffery, a cardiologist at Ochsner-St. Anne General Hospital in Raceland. “The cost-benefit makes it routinely not of value. However, if the student has a family history or a murmur or something else it would be of value. If a parent finds out their cousin or brother has had a problem, they should go to their general doctor. There is a big debate, there are sides that say screen, but so far there is no substantial evidence that it helps. Symptoms, signs and family history take precedence.”
Dr. Vinod Nair, an interventional cardiologist at the Cardiovascular Institute of the South in Houma, recognizes the cost-benefit issue, but would not be averse to seeing EKGs as a requirement.
“These instances are rare, very rare,” Nair said. “But when sudden cardiac death happens, it is devastating. … Even though it is rare, if it happens to my son, it makes all the difference in the world.”
“I think it would be a good idea,” Nair said of routine EKG screenings for young athletes. “The problem is that most patients are asymptomatic. The EKG is non-invasive and on an individual basis fairly cheap. That is the number one thing I would do after a routine screening.”
A detailed history of the athlete and family, the cardiologist said, is essential in any event.
“Any strong family history of deaths at a young age or symptoms the patient has is important,” he said. “Or symptoms the patient has. Even a single history of passing out may point to the fact that you may have a problem.”
Congenital long QT syndrome, a hereditary cardiac disease that occurs in 1 of 2,500 live births, is one condition Nair said is easily caught by an EKG.
Brugada Syndrome, another cardiac condition that is rarely diagnosed but can cause sudden death, is another. Nair said an EKG can easily detect both.
Hitting Close to Home
There were no known signs of problems for De’Vante Alexander, a Hahnville High School basketball player, when the 17-year-old died of cardiac arrest during a team practice in 2010. A coach trained in CPR tried to revive the student to no avail.
The St. Charles Parish Coroner, Dr. Brian Brogle, said in published reports that the problem was likely an undetected congenital heart defect, noting that an EKG might have picked up the abnormality.
At Lusher Charter School in New Orleans last year a student athlete named Evan Blackstone collapsed after “conditioning exercises.” Fast-acting coaches saved the 17-year-old’s life using CPR. Although the school had a defibrillator it was not in a place that was easily accessible, according to them.
“I am totally grateful to the coaches because without them he wouldn’t be here,” said Evan’s mother, Janelle Blackstone. She supports the idea of EKG screenings but also recognizes that cost makes them prohibitive.
Even before Alexander’s death, St. Charles Parish administrators were equipping schools with defibrillators.
Schools spokeswoman Regina McMillan said last week that multiple defibrillators are at all of the parish’s schools at multiple locations within campuses. Coaches in Terrebonne and Lafourche now point to the St. Charles system – particularly Destrehan High School – as the gold standard for athlete safety practices in the region.
“We are very fortunate that our school board decided to take a proactive action with this,” said Destrehan football coach Clarence Dupepe. “We have a trainer who is here also as a teacher at school, an athletics training class, and he is there for all out practices.”
The St. Charles schools give concussion tests to athletes, creating a baseline brain function file for each of them. These are compared to readings taken if there is a head injury, to determine how far off the brain function might be from that student’s norm.
Guardian Angels
Brain function baselines are routinely done in Lafourche and Terrebonne with the help of Thibodaux Regional Medical Center’s Sports Medicine Center.
The hospital, in conjunction with the Nicholls State University Allied Health Department, supplies trainers on site for the schools, whose primary duty is to help athletes when an injury occurs as well as to coach them in preventative skills. Coaches see the trainers as guardian angels for their players.
“We are very fortunate we have an accredited medical facility providing assistance,” said Terrebonne Parish Superintendent of Schools Philip Martin. “The prevention and proper training procedures to prevent injuries are equally important, and they provide us with help on both of those.”
Certified trainer Larry D’Antoni is one of the architects of Thibodaux Regional’s outreach program.
“Terrebonne had no athletic training services,” D’Antoni said. “Nobody was on staff, the coaches had to do it all themselves. Lafourche already had an athletic trainer at each school. I just traveled around to the different schools in Terrebonne and stopped at the practices each day.”
D’Antoni and his staff of five full-time trainers, as well as some part-time trainers recruited from Nicholls, go to workouts at schools throughout Terrebonne and Lafourche, including private institutions.
All are certified to use defibrillators and in administering CPR. They also teach CPR to coaches.
The trainers, along with school-based coaches, are bullish on seeing that athletes take in an adequate amount of fluids during training. Heat stroke is another risk for players that can result in death or debilitating injury.
The athletic associations of some states require that an ice bath be at the ready for players who might succumb to heat stroke during practice or at games. Louisiana does not require them.
While D’Antoni is cognizant of the value, he maintains that prevention is the better route.
“An ice bath is a good practice,” he said. “Physiologically, it brings muscles back to life and rejuvenates you, but in my opinion, if you have to put somebody in an ice bath for heat exhaustion, it is almost too late.”
D’Antoni is proud of the progress that he and his team have made since 2011, as well as the steps schools have taken to keep athletes safer. But he also recognizes that more can be done.
“As the organization grows we will better be able to offer some of the initiatives we would like to move forward with,” he said. “There are things we can do to help improve the atmosphere.”
Parents Are Key
Parents and grandparents of local athletes interviewed last week had varying degrees of awareness concerning the risks involved for those with undiagnosed heart problems. The names of some are not disclosed here to protect the privacy of their children and their medical histories.
One Thibodaux mother said that while screening for football did not raise a red flag for her son, a history of heart problems experienced by some cousins caused her to have the boy see a doctor for an echocardiogram, a test similar to sonograms used to track the development of babies in the womb but for heart function.
She was glad she did. The boy had a heart abnormality that might have gone undetected, and after consultation with the doctor it was decided baseball would be a safer choice.
A Houma woman whose grandson is currently a Terrebonne High School player said that to her knowledge he never had more than a routine physical. But she is aware that his grandfather was a candidate for sudden cardiac death due to a condition not detected until he was 65-years-old.
“He had a genetic defect,” she said, adding that compulsory EKG’s would be a good idea.
Trudy Luke, of Houma, said her 16-year-old, Tate, has never experienced medical problems and has been an athlete almost all of his life, just like his siblings.
Her family has no known history of heart problems, but she said she keeps a sharp eye out.
“I look to see if they get tired easily,” she said. “If they have symptoms they should be telling their parents. I’ve noticed a lot of these kids fill their bodies up with 5-hour energy drinks and I tell them not to do that.”
For youngsters new to competitive sports, Luke said, the value of an EKG test is understandable.
“I would imagine if they are getting fresh into it that would be good,” she said. “But most athletes I know have been doing it since they are 5 or 6 years old. I know there is no reason to go on a field and die of a heart attack.”
Eric Gautreaux, whose son Jordan is a captain at Ellender High, said he is confident in the boy’s health, and that he has faith in the trainers supplied through Thibodaux Regional.
“He has never had that kind of trouble,” he said. “But I will tell you, the trainers are a big help. My daughter tore her ACL on the field and the trainers were right there.”
Screening Form Choices
One of the ways parents can help keep athletes safe, doctors said, is by providing thorough information on health screening forms.
The form used for most area schools is provided through the Louisiana High School Athletic Association. But doctors also note that more detailed information can always help.
The American Heart Association’s 12-step heart history query gets good marks from cardiologists, and goes further than others in potential identification of hidden heart problems.
Issues identified in that questionnaire could result in parents or even coaches considering that a more thorough exam – including an EKG or echocardiogram – is in order.
Where the AHA protocol differs from that in use by the Louisiana Athletic Association – and by most other state athletic governing bodies – is in the detail requested.
The AHA standard includes questions about exertional chest pain or discomfort, temporary loss of consciousness or near loss of consciousness, fatigue associated with exercise, prior heart murmur recognition and elevated blood pressure.
On the family history end there are detailed questions as well, including premature death of relatives before age 50, specific knowledge of named cardiac conditions.
A physical exam according to the AHA standard includes a check for heart murmur, check of femoral pulse and special blood pressure readings.
All of these, doctors agree, are less expensive than cardiograms.
COACHES SEE NEEDS
At local schools, coaches interviewed last week said they were generally satisfied with how their school systems screen athletes, and steps now taken to keep them safe. But they also see where improvements can be made and are open to them.
“There is always room for improvement,” said Dupepe, of Destrehan. “We don’t have all the answers and the more we can be educated the better. Some schools are better equipped than others. A lot of schools aren’t able to have a trainer at all practices. Then it is on the coaches so they have to be more educated. In the past it was one thing when we were growing up but now more things are happening, parents are becoming aware and asking questions. We have pamphlets we give them. We try to have anything they need in terms of articles. We share truth.”
Chad Callais, at Houma Christian, said he would like to see mandatory EKGs but doubts the cost will ever allow that to happen.
“Anything you can do to prevent or catch something before it happens you want to go that route,” Callais said. “Nobody wants to have someone suffer anything like that.”
Although his school – like other local institutions – does not keep an ice tub at the ready for heat stroke emergencies, Callais said it wouldn’t hurt.
“You don’t want to ever get to that point,” he said. “If we are hydrating and taking enough breaks and looking for signs of extreme fatigue you shouldn’t get to that point. But a tub of water and ice? It’s not impossible to do.”
While Terrebonne is making strides with placing defibrillators in its schools, Philip Martin said the potential for more is currently under study.
“We are working on that, we are working with a vendor,” he said. “It hasn’t happened yet but it is in the exploratory planning phases, to provide them in all schools. Without proper training, however, it is not a wise thing to do. We have limited resources. But we may have someone willing to provide them to us.”
Richard Fischer, a spokesman for Medtronic, a medical supply firm that makes the devices and also provides programs that enhance the ability of students and bystanders to help in emergencies, said placement of the defibrillators and other considerations are vital to any school’s plan.
“Does the school have a plan in place to know how to respond?” Fischer said. “If it is after school hours at a sporting event to those teens and coaches know how to retrieve it? The ideal thing is to have a plan, someone who is designated to retrieve the device. Anytime it is closer that is better.”
At Berwick High School, coach Craig Brodie said he is confident that water breaks and other precautions are enough to keep athletes safe. There are no defibrillators at Berwick but he hopes that might change.
“I would love one,” he said. “I might need one for myself.”
A Thibodaux High School football player douses himself with water during spring practices last season. High school football teams are looking to stay cool and safe this season as more student athletes across the country collapse — and sometimes die — from unexpected cardiac arrest.
