Ethical responsibilities of coaches in emergency care situations 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

Introduction Sudden cardiac arrest (SCA) Current practices – First Aid and CPR Training Recommendations Ethical responsibilities Recommendations for action 2

Sudden cardiac arrest (SCA) 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 3

Sudden cardiac arrest 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). 4

Sudden cardiac arrest 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 5

Preparedness and management of SCA 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 6

Survival after SCA The single greatest factor affecting survival after SCA is the time interval between cardiac arrest to defibrillation. 7

First Aid & CPR standards 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). 8

Current standards for coaches 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 9

Current standards for coaches Check the NFHS website for your state’s requirements: gs.aspx gs.aspx 10

Idaho as an example 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 11

A call to action Establishing an emergency action plan Ensuring public access to defibrillation 12

American Heart Association Recommendations for AED implementation 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 13

AED Legislation 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 14

AED Legislation 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 "encourages" placement in schools (2008.) - to check your state’s laws! 15

Ethical responsibilities 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. 16

Coaching – why so little expectation? 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 ???? 17

Education for Coaches 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 18

Recommendations CPR + AED certification for all coaches! The evidence shows … ◦SCA survival rates can improve from 5% to % when AED and CPR are provided within 3- 5 minutes by the first person on the scene (National Athletic Trainers Association, 2008). 19

AED implementation and support SCA Foundation’s You Can Save a Life at School – national awareness campaign aimed at implementing AEDs and advancing training for school personnel 20

AED classes and fees American Red Cross ( ◦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 21

AED classes and fees American Heart Association ( ◦You can search by zip code to find courses offered in your area 22

Recommendations 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. 23