Video: Approach to the Unresponsive Athlete in Cardiac Arrest
In youth sports, sudden cardiac arrest and other medical emergencies can happen in unpredictable ways, such as during collisions or other high-impact scenarios. While CPR and BLS follow standard guidelines, real-world situations often require quick thinking and adaptations to ensure the best possible outcome.
Please take a moment listen to Ev Sugarbaker, medical student at Baylor College of Medicine, discuss essential techniques and considerations for performing CPR in youth sports settings.
CPR and Defibrillation in Youth Athletes with Suspected Spinal Injuries
In youth sports, the risk of sudden cardiac arrest (SCA) is rare but critical to address. Another concern in the athletic community is spinal injuries, which require careful handling to prevent further harm. When these emergencies overlap—as in the case of a youth athlete suspected of having a spinal injury during cardiac arrest—it is essential to adapt CPR and defibrillation techniques to ensure both the safety of the athlete and the efficacy of life-saving measures.
Below, we summarize key recommendations based on existing guidelines and research, including information from two cornerstone articles (Drezner et al., Kleiner et al.), to help coaches, athletic trainers, and bystanders provide effective care under these special circumstances.
Understanding the Challenges
Spinal injuries can occur during high-impact sports or activities involving falls or collisions. When an athlete with a potential spinal injury experiences cardiac arrest, the urgency of CPR and defibrillation must be balanced with the need to protect the spinal cord from further damage. Improper movement of the spine could lead to catastrophic neurological outcomes, including permanent paralysis.
Key Guidelines for CPR and Defibrillation in Suspected Spinal Injuries
1. Initial Assessment and Airway Management
According to Kleiner et al., airway management is a priority in suspected spinal injuries, but the neck and spine must be immobilized.
Use a jaw-thrust maneuver to open the airway without extending the neck. Avoid head tilt unless absolutely necessary to secure ventilation.
Ensure that cervical spine stabilization is maintained throughout the resuscitation process. If available, a second rescuer should manually stabilize the head and neck while CPR is performed.
2. Positioning for CPR
As highlighted in both articles, chest compressions should be initiated immediately if the athlete is unresponsive and has no pulse, even when a spinal injury is suspected.
If the athlete is prone (face down), and spinal injury is suspected, repositioning them to a supine (face-up) position is necessary for CPR. This should be done using a log-roll technique with the assistance of multiple rescuers to minimize spinal movement.
Face masks should be removed (leaving the helmet in place) as soon as possible to establish access to the airway
Shoulder pads should be opened or cut away (but not removed) to provide access to the chest for CPR and defibrillation
3. Defibrillation
Defibrillation remains a priority in cases of SCA. If an automated external defibrillator (AED) is available, apply it as soon as possible.
The presence of a suspected spinal injury does not delay defibrillation. Pads should be placed as directed, ensuring that the process does not exacerbate spinal instability.
Resume CPR immediately after delivering a shock, per standard resuscitation guidelines.
4. Team Coordination
Successful resuscitation in this scenario requires clear communication and teamwork. Assign roles to ensure one rescuer focuses on spinal immobilization while others perform CPR and defibrillation.
If possible, a trained medical professional or athletic trainer should take the lead in managing spinal precautions.
Special Considerations for Youth Athletes
Youth athletes may have smaller body frames, so rescuers should adjust chest compression depth and defibrillator pad placement accordingly.
Trainers and bystanders should also be aware of equipment considerations, such as removing football helmets and shoulder pads to access the chest for CPR and defibrillation while maintaining spinal immobilization. The technique for equipment removal is detailed in guidelines and should be practiced in advance.
Conclusion
CPR and defibrillation are life-saving interventions that should not be delayed, even in athletes with suspected spinal injuries. By following these specialized recommendations, bystanders and medical personnel can provide effective care while minimizing the risk of further harm. Preparation and training are key—we encourage youth sports programs to incorporate these scenarios into CPR and AED training sessions.
For more resources or to schedule a training session, visit our website at nysapaed.com. Together, we can create safer environments for young athletes and ensure prompt, effective responses to emergencies on the field.
References:
Drezner JA, Courson RW, Roberts WO, Mosesso VN Jr, Link MS, Maron BJ; Inter-Association Task Force. Inter-association task force recommendations on emergency preparedness and management of sudden cardiac arrest in high school and college athletic programs: a consensus statement. Heart Rhythm. 2007 Apr;4(4):549-65. doi: 10.1016/j.hrthm.2007.02.019. Epub 2007 Mar 1. PMID: 17399652.
Kleiner DM; Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete. Prehospital care of the spine-injured athlete: monograph summary. Clin J Sport Med. 2003 Jan;13(1):59-61. doi: 10.1097/00042752-200301000-00014. PMID: 12544168.
Cody’s Law: Protecting Youth Athletes and the Role of CPR Training
The sudden loss of a young life is a tragedy that no family should ever face. For Cody Stephens, a Texas high school football player, his untimely death from sudden cardiac arrest (SCA) became a catalyst for change. Cody’s death, caused by an undiagnosed heart condition, led to the creation of Cody’s Law in 2013, a legislative step that has improved youth sports safety in Texas. As the founder of a nonprofit dedicated to training youth sports coaches in CPR, I believe that while Cody’s Law was a critical first step, more must be done to ensure the safety of young athletes. This post explores the impact of Cody’s Law and the vital role CPR training plays in protecting future generations.
The Story Behind Cody’s Law
In 2012, Cody Stephens collapsed during a football game, and despite efforts to revive him, he passed away. His death was caused by hypertrophic cardiomyopathy (HCM), a condition where the heart muscle thickens, increasing the risk of sudden cardiac arrest. The condition was never detected through a routine physical exam.
In response, Cody’s family pushed for Cody’s Law, which requires student-athletes in Texas to undergo thorough heart screenings before participating in sports. This includes pre-participation physical exams (PPEs) that focus on identifying undiagnosed heart conditions that could lead to sudden cardiac arrest. The law also encourages electrocardiograms (ECGs) a diagnostic test that can screen for issues like HCM.
How Cody’s Law Has Impacted Policy
Cody’s Law has brought about critical changes in how youth sports address heart health:
Heart Screenings for Athletes: The law mandates thorough physical exams, ensuring heart conditions are identified before athletes hit the field.
Encouragement of ECGs: Although ECGs are not required by law, they’re strongly encouraged, allowing for early detection of conditions that might otherwise go unnoticed.
Emergency Preparedness: Schools and sports organizations are urged to have emergency action plans in place, including access to AEDs and CPR-trained staff.
While Cody’s Law has been a vital step forward, there’s still more to be done to protect youth athletes from the dangers of sudden cardiac arrest.
Why CPR Training for Coaches Is Crucial
The success of Cody’s Law hinges not only on heart screenings but also on how quickly an emergency is managed when it occurs. CPR training for coaches is critical because, in the event of sudden cardiac arrest, every second counts. Without immediate intervention, the survival rate for cardiac arrest decreases with each passing minute.
Coaches are often the first responders during an emergency, and with proper CPR training, they can save a life before emergency services arrive. Offering CPR courses to coaches ensures they are prepared to act confidently in a crisis, protecting young athletes in ways that go beyond just heart screenings.
Continuing Cody’s Legacy: CPR Training for Youth Coaches
As part of our nonprofit mission, we provide CPR training for youth sports coaches, schools, and organizations. By building on the foundation laid by Cody’s Law, we aim to ensure that coaches are not only knowledgeable about heart health but also trained in life-saving CPR techniques.
Conclusion: A Safer Future for Young Athletes
Cody’s Law has changed the landscape of youth sports safety in Texas, but it’s only part of the solution. By adding CPR training to the equation, we can create a safer environment for athletes. Together, we can protect future generations of athletes—because when it comes to saving lives, every second counts.
Call to Action:
If you’re a coach or work with youth athletes, please contact nysap.aed@gmail.com to schedule CPR training. Help us continue the legacy of Cody’s Law by ensuring that all young athletes are protected.
Ethan Low
Heart Health for Young Athletes: Tips for Coaches and Parents
In the high-energy world of youth sports, keeping young athletes healthy and safe is a top priority for coaches and parents. While physical fitness and skill development are often the focus, the heart health of young athletes deserves equal attention. Sudden cardiac arrest (SCA) is rare but real, and knowing how to support a heart-healthy environment can save lives and enhance performance.
Here are some essential tips for promoting heart health in youth sports:
1. Know the Signs of Cardiac Issues
Parents and coaches should be aware of warning signs that may indicate potential cardiac problems, such as:
Fainting or dizziness during exercise
Chest pain or discomfort
Unusual shortness of breath
Palpitations or irregular heartbeats
If an athlete experiences any of these symptoms, it’s crucial to seek medical attention immediately.
2. Encourage Regular Health Screenings
Annual physicals and heart screenings can help detect underlying conditions early. For athletes with a family history of heart disease or sudden cardiac arrest, additional tests like an electrocardiogram (ECG) may be advisable.
3. Promote Proper Warm-Ups and Cool-Downs
Warm-ups prepare the heart for increased activity, while cool-downs help it return to a resting state gradually. Skipping these steps can place unnecessary strain on the heart.
4. Hydration Matters
Dehydration can impact heart function and lead to complications like heatstroke. Encourage athletes to drink water before, during, and after practice or games, especially in Houston’s hot and humid climate.
5. Teach Stress Management
High levels of stress, whether from competitive pressure or academic responsibilities, can affect heart health. Introduce mindfulness techniques or relaxation exercises to help young athletes manage stress effectively.
6. Provide CPR and AED Training
Coaches and parents should be trained in CPR and the use of automated external defibrillators (AEDs). Having an AED on-site at practices and games is a vital safety measure. NYSAP is dedicated to making these life-saving resources accessible to youth sports teams in Houston.
7. Advocate for Balanced Nutrition
A heart-healthy diet supports overall athletic performance. Encourage meals rich in fruits, vegetables, whole grains, lean proteins, and healthy fats while limiting processed and sugary foods.
8. Create an Open Dialogue
Foster an environment where young athletes feel comfortable discussing their physical and emotional well-being. Regular check-ins can help identify issues before they escalate.
9. Develop an Emergency Action Plan (EAP)
Every sports program should have a clear plan for responding to cardiac emergencies. Ensure all coaches, parents, and volunteers are familiar with the EAP and know their roles in an emergency.
10. Partner with Local Experts
Organizations like the National Youth Sports AED Program (NYSAP) provide resources and training to keep young athletes safe. By working together, we can create a culture of heart safety in Houston’s youth sports community.
By taking these steps, coaches and parents can empower young athletes to thrive both on and off the field. Protecting their hearts ensures they’re not only game-ready but also prepared for a lifetime of health and success.
If you’re ready to learn more about CPR and AED training or want to bring heart health resources to your team, contact NYSAP today!
Using Data to Save Lives: How Research Guides CPR Education for Youth Sports Programs
At NYSAP AED, we are passionate about equipping youth sports programs with the tools and training necessary to prevent tragic outcomes from sudden cardiac arrest (SCA). The paper, Geospatial Analysis for Targeting Out-of-Hospital Cardiac Intervention, published in the American Journal of Preventative Medicine, sheds light on critical areas where CPR training and AED placement can make the greatest impact.
The study, which focuses on Houston, Texas, examines zip codes with high rates of out-of-hospital cardiac arrest (OHCA) and low bystander CPR intervention rates. This granular approach to mapping risk is invaluable for organizations like ours, as it allows us to target resources to areas of greatest need.
Bridging the Gap in High-Risk Areas
By analyzing the paper's findings, we can identify which Houston youth sports programs operate in these high-risk zip codes. This means that our efforts to teach CPR and distribute AEDs won’t just be widespread—they’ll be strategic. With data-driven planning, we can ensure that underserved communities, where bystander CPR is less likely to occur, receive focused attention.
Why Data Matters for CPR Education
Research like this highlights disparities in bystander intervention, often tied to socioeconomic factors, access to training, and community awareness. When we understand where these disparities exist, we can:
Prioritize training in communities most affected by OHCA.
Partner with local organizations already active in these areas.
Evaluate the long-term impact of our training programs using community-specific metrics.
Scaling Impact Through Research Collaboration
Houston is just one example of how we can use research to guide our mission. As we expand our reach, we aim to collaborate with other medical schools and community organizations to replicate this data-driven approach in cities nationwide. By aligning efforts with evidence-based findings, we’re not just teaching skills—we’re creating systemic change to save lives.
Get Involved
If you're in the Houston area and want to bring our training programs to your community, reach out! Together, we can make youth sports safer for every athlete, coach, and family.
Research provides the roadmap, but it’s organizations like NYSAP AED and supporters like you who take action. Let’s transform data into life-saving outcomes!
Source:
Raun LH, Jefferson LS, Persse D, Ensor KB. Geospatial analysis for targeting out-of-hospital cardiac arrest intervention. Am J Prev Med. 2013 Aug;45(2):137-42. doi: 10.1016/j.amepre.2013.03.013. PMID: 23867019.
NYSAP Begins Chapter at Baylor College of Medicine in Houston, TX
Exciting new development at NYSAP! We have created our first student chapter at Baylor College of Medicine Houston Campus. Our team of motivated medical students are excited to bring NYSAP's message of prehospital cardiac arrest preparedness to the HTX/Harris County area. Please reach out if you are a Houston/Harris County youth sports program in need of free CPR training and/or AEDs!
Commotio Cordis
It all begins with an idea.
Let’s talk about commotio cordis, a cardiac phenomenon that puts young athletes at risk for cardiac arrest and death. This can occur with a sudden blunt impact to the chest in the absence of any cardiac damage. Around 10-20 cases are added to the national Commotio Cordis registry annually, and victims are typically adolescents (mean age = 15 years) and are overwhelmingly male. Baseball is the most common sport in which commotio cordis occurs, with pitchers, catchers, and hitters at highest risk. Other common sports include hockey and softball, with a rising incidence in lacrosse due to its increasing popularity.
Currently, the outcomes of cardiopulmonary resuscitation after a commotio cordis event is very similar to that for CPR in other forms of cardiac arrest. An animal model developed at Tufts Medical Center in the 1990s has shed light on the variables critical to induction of commotio cordis. They anesthetized 20-kg male pigs and used a lacrosse or baseball to strike the left chest wall directly over the cardiac silhouette. These animal studies have found that ventricular fibrillation is the most common arrhythmia causing commotio cordis. They have also found that factors like timing, velocity, and shape of the object are critical to it’s initiation.
On an EKG, only impacts within a narrow region of the upslope of the T-wave (40 ms before the peak to the peak) will cause ventricular fibrillation. Also, impact velocities at 40 mph were most likely to to cause v-fib; impacts at 20 mph never induced v-fib; and impacts 50-70 mph showed a reduced occurrence of v-fib and an increased incidence of cardiac rupture or other major trauma. When it comes to shape, spheres with smaller radii were more likely to induce v-fib.
Commotio cordis is another reason why cardiac arrest is the number one medical killer of young athletes, and it is all the more reason to equip youth fields with AEDs and to provide coaches with CPR education.
Source: Mark S. Link, Commotio Cordis: Ventricular Fibrillation Triggered by Chest Impact-Induced Abnormalities in Repolarization, URL: https://www.ahajournals.org/doi/10.1161/circep.111.962712