In September, Moriah Lydon, a 15-year-old cross-country runner at Rocky River High School in Cleveland, felt weak and collapsed during practice. Later that evening she died — a victim of sudden cardiac death that was a result of an unknown heart defect.
She was a young woman and an athlete — not the kind of person you think would die of a cardiac arrest. Yet she is just one of four high-school students to die of sudden cardiac arrest (SCA) in northern Ohio in the past year. In a fifth case, a young female softball player was shocked back to life by a policeman watching the game who happened to have an automated external defibrillator (AED) in his car.
SCA is the second-leading cause of death in the United States. It causes an estimated 400,000 out-of-hospital deaths a year, of which 3,000 are young adults according to the Centers for Disease Control. To combat this killer, some schools have begun to establish AED programs.
These laptop-sized devices can save the life of an SCA victim by delivering an electrical shock to restore a heartbeat to normal. However, many schools that have AEDs do not know how to use them, and those who don't have them are not sure how to even start the process of acquiring them.
For many, the need for AEDs arises within the context of athletics. There are four million competitive athletes in grades 9 through 12 nationwide, and they account for 60 percent of the young adults who die of SCA every year. Athletic directors, coaches or concerned parents may be the first to raise the issue, but most administrators are interested in a program that is broader than athletics.
Administrators are keenly aware that school buildings are being used for more than student classes. Schools are community centers. Swimming pools and gymnasiums are open for public use, and community groups use the buildings for evening and weekend meetings. The more older adults that are using facilities, the greater the risk that someone will suffer SCA while on school property. This could expose schools to greater liability.
As AEDs become more commonplace in airplanes, train stations, shopping malls and government buildings, a new standard is being established.
One public school system in Northeast Ohio is facing three lawsuits for allegedly failing to meet adequate safety standards. The suits were filed by adults who injured themselves in falls on school property. Can the first lawsuit for failing to have an AED available be far off?
One problem in pursuing AED programs is that administrators are getting conflicting information on how to establish a program. Local fire departments, nurses and parents are offering help, but there is not a universal plan for schools.
Developing a strategy
Creating a plan for putting AEDs in schools involves more than making tactical decisions — it is strategic. Putting one AED in one school commits you to an ongoing program. So what happens when you have personnel changes or the enthusiastic group of parents promoting AEDs moves on? You can't count on parents to do all the work. The responsibility for putting together a long-term program falls squarely on your shoulders.
The wisest strategy is to think districtwide and include every school building.
Let's say you put an AED in the high school and justify your decision based on athletics. You know the AED also will be available to protect the student body, employees, vendors, guests and anyone else who uses the building. What happens if someone suffers sudden cardiac arrest at an elementary school?
The situation is analogous to a corporation that puts AEDs on executive row but not on the plant floor. If a plant worker dies of sudden cardiac arrest, the question could be asked why executives apparently deemed themselves more important than plant workers.
Again, the best and safest strategy is to think districtwide. This does not mean you cannot build a program step-by-step and one school at a time.
Even in industry, when a company gets to five or more AEDs, it approaches a level of spending that requires approvals and allocated funds. Schools operating on tight budgets will need to plan months in advance, but every organization has to start somewhere.
Over the past year, many professional organizations have declared their support for AED programs, and many have issued their own protocols and guidelines.
The Building Owners and Managers Association International (BOMA), American College of Occupational and Environmental Medicine (ACOEM), and the General Services Administration (GSA) have focused on AED programs in occupational settings.
An AED program can be broken down into eight steps. These steps coincide with those procedures promoted by the GSA and most other industry and professional organizations that have weighed in on this issue. Here are the steps:
Form a planning committee that includes administrators, principals, athletic directors, coaches, teachers, and parents and students who may have expressed interest in helping you create a school AED program.
Have the committee write a statement that explains its vision and timeframe for putting AEDs in schools.
To create an AED program, begin by walking through the school halls with a stopwatch to conduct site assessments. The best AED programs place AEDs where they can be accessed easily and taken to any victim on-site within three minutes.
Ask for volunteers to be “trained responders,” and be sure to evaluate the volunteers. Are they the kind of people who will respond effectively? Are they close enough to the AEDs to respond within three minutes? Are they available when large groups of people are likely to be using the facility?
Seek medical direction and a prescription. AEDs are FDA-controlled devices and require a prescription. Make sure the physician who signs a prescription understands AED protocols and state regulations as they relate to training, equipment maintenance, reporting incidents and downloading data.
Determine who will be responsible for keeping track of all the data related to the upkeep of the equipment and the educational training. It is best if you have one place where you keep all training and maintenance information for the program.
As your schools begin to get their AED programs up and running, you should notify the public about your plan. Explain it and read your vision statement at a school board meeting, and give the information to your local media so they have the opportunity to report your plan to the community.
The most effective AED programs combine AEDs with cardiopulmonary resuscitation (CPR) and emergency oxygen, so broad emergency medical training may be required. Some states even require both. Training guidelines and protocols may differ from state to state, so be sure to research what is required in your state.
For educators and school administrators, the focus always has been on educating children. But school buildings are no longer reserved solely for education. They are becoming community resources to be used by students during the day and their parents and other community groups after hours.
Regardless of the impetus for establishing an AED program, schools and universities have every reason to take a broad and strategic approach. AEDs are rapidly becoming a standard of care. To protect students and the community from SCA, and to limit liability, schools need to be aggressive in establishing AED programs.
Moon is a national accounts manager at Complient Corporation, Cleveland, a national outsourced provider of workplace AED programs and public access defibrillation (PAD) programs for large multi-facility organizations. The Cleveland Clinic Foundation, in partnership with Complient Corporation, developed an AED-based emergency medical response program for schools that helps protect athletes, students, teachers, parents and visitors from SCA.
Number of out-of-hospital deaths caused every year by sudden cardiac arrest.
- 4 MILLION
Number of students in grades 9 through 12 nationwide involved in competitive school athletics.
Percentage of young adults who die of SCA each year that are athletes.
Number of high school students who have died of SCA in northern Ohio in the past year.