This case involves a 14-year-old boy with a history of a heart murmur who collapsed at football practice. According to the nurse, the boy was practicing football at his high school where he was witnessed to collapse. The decedent arrived at the emergency department by medic transport. His pulse was lost en route to the hospital and CPR was performed. The physician noted that there was blood around the boy’s mouth and indicated difficult intubation. The only test the doctor was able to run prior to the boy’s demise was an ultrasound. The doctor observed on ultrasound an abnormally thick myocardium and diagnosed the boy with hypertrophic cardiomyopathy. An AED was never used in the hospital or medical transport. An expert in sports risk management was sought to review the case and opine on best practices in the prevention and emergency management of these kinds of situations.
Question(s) For Expert Witness
- 1. Please describe your work with athletes, athletic departments, and/or schools on the prevention and management of sports emergencies?
- 2. What protocols should be in place to prevent and/or manage situations like this?
Expert Witness Response E-073379
I have worked with school athletic departments as a sports safety and risk management consultant since 1986. This work has included large-scale safety and risk management assessments in school districts of various sizes, the largest being 10 high schools. I have written and lectured extensively on the subject of sports safety and sports risk management. I have reviewed several cases involving catastrophic sports injuries including quadriplegia, brain injury, and lightning strikes. I am also familiar with the condition from which this athlete suffered and with the literature pertaining to addressing the concerns related thereto.
The best approach is to address safety and risk management concerns pertaining to program policies and procedures, staff education/competency, facilities, protective equipment, athlete instruction, athlete supervision, risk warning/ informed consent, and sports medicine. In this scenario, the most important protocol to have in place is for the program to employ a full-time athletic trainer who is nationally certified and state licensed if applicable. Every state besides California has a statutory mandate for athletic trainers to be licensed. Athletic trainers function under the direction of an MD or DO. The second required protocol is for every athlete to undergo a comprehensive preparticipation physical evaluation (PPE) in conformity with accepted best practices in sports medicine, including personal and family history of cardiac issues as well as routine cardiac evaluation, and a recommendation to parents of any athlete with a personal or family history of cardiac issues or indications of pathology during the routine evaluation, that the athlete undergo more comprehensive cardiac evaluation by a specialist. The third required protocol is a detailed medical emergency plan (MEP) which addresses every type of injury sustained in sports, every venue in which the school’s teams practice or compete, and detailed recitation of the functions to be undertaken and the person assigned to that function. There should be a standard assignment list prepared prior to each active session. The fourth required protocol is to have a functioning AED readily accessible within 100 yards of each activity venue, and for those charged with supervising to activity to know that location, have immediate access thereto, and be trained in CPR including AED administration. The fifth required protocol is for all coaches to be currently certified in CPR including AED administration, and first aid, and also be familiar with and qualified to implement the MEP.