Three months ago Flagler County schools and AdventHealth signed a partnership agreement that included, among other things, free health screenings for the district’s 800 to 900 athletes. Physicals are nothing new for athletes. But this is: AdventHealth next Thursday is organizing the first electrocardiogram, or ECG, screening for athletes, the five-minute procedures that records electric signals from the heart and detects abnormalities.
The free, voluntary screening event on Oct. 28 is at Flagler Palm Coast High School from 5 to 8 p.m. (You can register here, and pick a specific time.) The screenings are run by Who We Play For, a Tallahassee and Melbourne-based non-profit that specializes in heart screenings.
It’s not an excessive precaution. Rather, it’s a long-overdue response by districts like Flagler’s to what has been a small but significant risk to young athletes: sudden cardiac arrest. About 3 percent of individuals tested are flagged with an abnormal, undetectable heart rhythm that could trigger sudden cardiac arrest–commonly known as a heart attack–at any time, especially during physical activity. Undetectable but for an ECG means that the abnormality would not be picked up by a stethoscope, as in most standard physicals.
Erik Nason, AdventHealth’s sports medicine outreach coordinator and a past president of the Athletic Trainers Association of Florida, puts the importance of ECG screenings in starker terms: “We just did a physical event, our mass physicals, in Volusia County,” where the district also has a partnership with AdventHealth, he said. “We screened just over 600 athletes, and we had approximately eight or nine flagged individuals. One of them had a significant red flag condition that required immediate surgery.” The parent of that student-athlete had a sister who had died from sudden cardiac arrest when she was 17, so when she heard of the screening, she took her soon there out of concern over the family’s history. “And sure enough it was there, and it was detected.”
Or take a different case in Volusia, when there hadn’t been a screening–that of Julia Bosset, a Seabreeze High School cheerleader, basketball player and flag football player. She was conditioning in the gym during the basketball pre-season. John Rogers, the Bunnell city commissioner who happens to be the girls varsity basketball team’s head coach, had instructed the team to run warm-up laps.
Bosset, 15, collapsed after just one lap. It was sudden cardiac arrest. Rogers and his assistant coach rushed to help. The assistant provided CPR. She was taken to a hospital in Ormond Beach then up to a children’s hospital in Jacksonville. (In the interview, Nason did not refer to Bosset by name, but her case was widely reported, and Rogers spoke of it to FlaglerLive.) “She had an abnormal heart rhythm that required an ablation type procedure,” Nason said, “and all of it could have been prevented if she would have had an ECG. They could have let her know that you’re at a higher risk, and go and have it taken care of. But she recovered. She did amazing and went back to activities.”
The screenings’ intent is to prevent collapses, or worse.
The Centers for Disease Control finds that about 66 young athletes die of sudden cardiac arrest each year in the United States. The figure is based on a study that looked at athlete deaths over a 27-year period in 38 sports, ending in 2006. Another ominous finding of the study was that there were more than twice as many deaths in the second half of the period studied than in the first, and that deaths among young athletes were increasing at a rate of 6 percent a year.
Stressing the importance of screenings, another study covering 27 years of data found that unscreened athletes were five times as likely to die of sudden cardiac arrest than screened athletes. Overall deaths among athletes declined once screenings began.
“The sudden, unexpected death of a young athlete is a tragedy unparalleled in sports,” reads a study in the Journal of Athletic Training. “Aside from the grief of friends and family members, shock waves reverberate as the community, institution (high school, college, or professional organization), and sports medicine team all cope with the death. Instinctively, those involved wonder what intervention might have prevented the death.”
ECG screenings reflect the most recent standard and best practice in the field, and are “a great preventative measure,” Nason said. This year, the screening is voluntary. AdventHealth is hoping that at least half the district’s student athletes take advantage of it. Next year, the plan is to make it mandatory.
Students and parents should not expect to be told the results of their ECG at the screening event. They’ll hear back from AdventHealth. If the screening is normal, they’ll receive an email saying so.
“We have a team of pediatric cardiologists that review these screenings,” Nason said, citing both Who We Play For and AdventHealth physicians. “If there is a case that is clearly on the border, that they’re not sure, or they had questions about, we will rescreen them.” The incidence of false positives is about 1 percent. “But then there’s some that are definitely in the red, definitely a concerning factor. As cardiac pediatric cardiologists, they know what to look for in a young student athlete.”
If a student is flagged, the goal is “to create a pathway of care and treatment for that athlete along with their family,” Nason said, “making sure that our pediatric cardiologists will reach out to that family, let them know the results of that abnormal heart finding and what it means.” Typically, the next step is a pediatric cardiologist consultation, which would include an echocardiogram that would help diagnose and pinpoint the abnormality. Treatment options follow. That does not necessarily mean the athlete is sidelined.
“Sometimes it’s not surgical,” Nason said. “Most of the times it’s a procedure such as an ablation that is done to correct that abnormal rhythm. And most of the time the athlete goes back without any other complications and can return to competition, under the guidance of their physician.”
In some cases the athlete may have to abstain from strenuous activity, because of the concerns and the risks. But the aim is to identify concerns, address them and allow the athletes to resume a normal life.
“We don’t want to startle any family member, and we don’t want to startle or stress any child,” Nason said. “But we feel confident that the right thing and the best practice is to identify the risk factors ahead of time, and treat and care so that it doesn’t become an emergency later in the future. I’m a parent of a high school athlete who gets tested, and I am relieved that this is being tested or being performed, so that when there are outcomes and competing, we can allow them to compete in stressful environments, and in environments that are maybe high heat or high intensity, and they can perform safely.” He added: “Those that we’ve cared for have been so appreciative, and we’re glad that we walk through this with them as a corporation. It’s been I think very helpful to those families.”
In Volusia, ECG screenings will be mandatory starting on June 1 next year. AdventHealth will request from the Flagler County School Board that the screenings be likewise mandated in the second year of the program, at least for participation in sports, as they are in Orange and Osceola schools. Seminole and Polk counties are near adoption of the mandates as well, Nason said.
“I think it’s a wonderful program,” Rogers, the coach at Seabreeze High School, said this evening. “They did it at the race track and they found several kids with different problems. It’s a wonderful program. When you live through a moment like that, it’s unbelievable.” He was referring to the incident involving Julia Bosset. “We call her the miracle at Seabreeze. Julia took one lap and immediately fell at the baseline.” Describing what followed, he said, “We just thank God that our miracle child lived.”