Kimberly M. Robertello, Ph.D., ATC
             Washington State University
              Sharon K. Stoll, Ph.D.
  Univers...
Sudden cardiac arrest (SCA)

 Current practices – First Aid and CPR
  Training Recommendations
 Ethical responsibilitie...
Sudden cardiac arrest defined:

    ◦ The unexpected loss of heart function,
      breathing and consciousness (Mayo Clin...
SCA is the leading cause of death for

  young athletes (Maron, 2003).
 SCA may be caused by structural cardiac
  anomal...
SCA signs and symptoms

    ◦   Sudden collapse
    ◦   No pulse
    ◦   No breathing
    ◦   Loss of consciousness
    ◦...
Screening efforts

    ◦ “ In approximately 55-80% of cases of [sudden
      cardiac death], athletes are asymptomatic un...
The single greatest factor affecting

    survival after SCA is the time interval
    between cardiac arrest to defibrill...
To what extent are coaches responsible

    for the care of their athletes?
    ◦ National Standards for Sport Coaches, D...
National Federation of State High School

  Association (NFHS) recommends high
  school coaches are certified in First Ai...
Check the NFHS website for your state’s

  requirements:
 http://www.nfhslearn.com/StatePricingRe
  gs.aspx




Current ...
For example, Idaho DOES NOT require

  CPR or First Aid certification for coaches.
 Data from a 2004 study indicates tha...
Establishing an emergency action plan

 Ensuring public access to defibrillation




A call to action
                  ...
Based on:

    ◦ Probability of AED use within 5 years of training
    ◦ High-risk children or adults present at the
    ...
U.S. House of Representatives passed the

    Josh Miller HEARTS (Helping Everyone
    Access Responsive Treatment in Sch...
States requiring or supporting AED

    placement in schools:
    ◦ Colorado (donations), Florida, Georgia (2008),
      ...
Thomas Jefferson, “The law is socialized

    ethics.”
    ◦ This is clearly an ethical issue that should
      become la...
It is not that we think too much sport,

  rather we think too little of it.
 Many states have little expectations or
  ...
Coaching education

    ◦ Online certifications
      Idaho – ASEP – online
       ◦ Coaching principles- 5 Principles, ...
CPR + AED certification for all coaches!



    The evidence shows …

    ◦ SCA survival rates can improve from 5% to 48...
SCA Foundation’s You Can Save a Life at

    School – national awareness campaign
    aimed at implementing AEDs and
    ...
American Red Cross (www.redcross.org)

    ◦ CPR/AED – Adult $35 (review $22)
    ◦ CPR/AED – Adult, Child, and Infant $5...
American Heart Association

    (www.americanheart.org)
    ◦ You can search by zip code to find courses
      offered in...
Coaches have an ethical responsibility to

    prepare for emergency care situations
    ◦ CPR/AED certification
    ◦ Co...
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Ethical Responsibilities Of Coaches In Emergency Care Situations

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Presented at the 2009 American Alliance for Health, Physical Education, Recreation and Dance National Meeting and Symposium

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Ethical Responsibilities Of Coaches In Emergency Care Situations

  1. 1. Kimberly M. Robertello, Ph.D., ATC Washington State University Sharon K. Stoll, Ph.D. University of Idaho, Center for ETHICS* Justin Barnes, M.S. University of Idaho, Center for ETHICS* 1
  2. 2. Sudden cardiac arrest (SCA)   Current practices – First Aid and CPR Training Recommendations  Ethical responsibilities  Recommendations for action Introduction 2
  3. 3. Sudden cardiac arrest defined:  ◦ The unexpected loss of heart function, breathing and consciousness (Mayo Clinic, 2008) SCA – usually arises from an electrical  disturbance which disrupts the pumping action of the heart Sudden cardiac arrest (SCA) 3
  4. 4. SCA is the leading cause of death for  young athletes (Maron, 2003).  SCA may be caused by structural cardiac anomalies (myocarditis, Marfan’s syndrome, valvular heart disease, etc.)  20% of sudden cardiac death cases are caused by a blow to the chest which produces an arrhythmia (Drezner, Courson, Roberts, Mosesso, Link, & Maron, 2007). Sudden cardiac arrest 4
  5. 5. SCA signs and symptoms  ◦ Sudden collapse ◦ No pulse ◦ No breathing ◦ Loss of consciousness ◦ Preceding symptoms may include fatigue, fainting, blackouts, dizziness, chest pain, or vomiting Sudden cardiac arrest 5
  6. 6. Screening efforts  ◦ “ In approximately 55-80% of cases of [sudden cardiac death], athletes are asymptomatic until the cardiac arrest …” (Drezner et al., 2007, p. 146). Early activation of EMS   Early CPR  Early defibrillation Preparedness and management of SCA 6
  7. 7. The single greatest factor affecting  survival after SCA is the time interval between cardiac arrest to defibrillation. Survival after SCA 7
  8. 8. To what extent are coaches responsible  for the care of their athletes? ◦ National Standards for Sport Coaches, Domain 2, Standard 9: “Recognize injuries and provide immediate and appropriate care.”  Benchmark: “Implement an appropriate action plan for emergency first aid and CPR in all venues. (NASPE, 2006). First Aid & CPR standards 8
  9. 9. National Federation of State High School  Association (NFHS) recommends high school coaches are certified in First Aid and CPR  Some have begun to require CPR/AED training as well ◦ American Sport Education Program, in conjunction with the American Safety and Health Institute (ASHI) has introduced CPR/AED for Coaches Current standards for coaches 9
  10. 10. Check the NFHS website for your state’s  requirements:  http://www.nfhslearn.com/StatePricingRe gs.aspx Current standards for coaches 10
  11. 11. For example, Idaho DOES NOT require  CPR or First Aid certification for coaches.  Data from a 2004 study indicates that from 141 public and private high schools in the state of Idaho: ◦ 93 schools responded (66% response rate) ◦ 54.8% did not employ someone to handle sports related injuries ◦ Only 20 respondents employed a Certified Athletic Trainer Idaho as an example 11
  12. 12. Establishing an emergency action plan   Ensuring public access to defibrillation A call to action 12
  13. 13. Based on:  ◦ Probability of AED use within 5 years of training ◦ High-risk children or adults present at the school ◦ EMS call to shock interval less than 5 minutes American Heart Association Recommendations for AED implementation 13
  14. 14. U.S. House of Representatives passed the  Josh Miller HEARTS (Helping Everyone Access Responsive Treatment in Schools) Act on June 9, 2008 ◦ Establishes a national grant program through the Dept of Education to fund AED installation and training in schools AED Legislation 14
  15. 15. States requiring or supporting AED  placement in schools: ◦ Colorado (donations), Florida, Georgia (2008), Illinois, Maryland, Michigan, Nevada, New York, Ohio, Pennsylvania, South Carolina (2008) and Virginia require some schools to have portable defibrillators; actual extent varies. Tennessee quot;encouragesquot; placement in schools (2008.) http://www.ncsl.org/programs/health/aed  .htm - to check your state’s laws! AED Legislation 15
  16. 16. Thomas Jefferson, “The law is socialized  ethics.” ◦ This is clearly an ethical issue that should become law. ◦ An ethical issue: any case in which harm can be avoided, and good can be done. ◦ My personal experience – Lewiston, ID. District boys basketball.  Lewiston HS – certified athletic trainer on staff ◦ But was not hired for event.  Neither coach certified in CPR  No AED in building available. Ethical responsibilities 16
  17. 17. It is not that we think too much sport,  rather we think too little of it.  Many states have little expectations or requirements for coaches. All that really is required is a heart beat. ◦ Why has this occurred?  Coaches no longer are teachers in school.  Less individuals willing to coach – i.e., Grant Putnam, Bowling Alone  Lack of respect and belief in importance of coaching education ???? Coaching – why so little expectation? 17
  18. 18. Coaching education  ◦ Online certifications  Idaho – ASEP – online ◦ Coaching principles- 5 Principles, 1 text, online test ◦ Sport first aid -16 units, 1 text, online test  Florida –NFHSAA – online ◦ 2 hour coaching fundamental courses ◦ 4 hour safety courses ◦ Majors available  General search – no majors except in NZ, UK  Minors only, tied to physical education teaching  Master’s degrees online - WVU ◦ Master’s degrees required:  South Carolina Education for Coaches 18
  19. 19. CPR + AED certification for all coaches!  The evidence shows …  ◦ SCA survival rates can improve from 5% to 48- 74% when AED and CPR are provided within 3- 5 minutes by the first person on the scene (National Athletic Trainers Association, 2008). Recommendations 19
  20. 20. SCA Foundation’s You Can Save a Life at  School – national awareness campaign aimed at implementing AEDs and advancing training for school personnel AED implementation and support 20
  21. 21. American Red Cross (www.redcross.org)  ◦ CPR/AED – Adult $35 (review $22) ◦ CPR/AED – Adult, Child, and Infant $50 (review $30) ◦ Standard First Aid with CPR/AED $45 (review $35) ◦ Standard First Aid with CPR/AED for Adult, Child, and Infant $65 AED classes and fees 21
  22. 22. American Heart Association  (www.americanheart.org) ◦ You can search by zip code to find courses offered in your area AED classes and fees 22
  23. 23. Coaches have an ethical responsibility to  prepare for emergency care situations ◦ CPR/AED certification ◦ Coaching certifications Ethical issues can only be resolved if …  the principle guides the process and people are willing to make changes in what and how we do things – especially coaching education. Recommendations 23

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