S.1297 – Student Athletes Cardiac Arrest

May 23, 2017

Hon. Catherine T. Nolan
Chair, Assembly Education Committee
Room 836 Legislative Office Building
Albany, New York 12248

Dear Assemblywoman Nolan:

The Medical Society of the State of New York wishes to express its significant concerns regarding Assembly Bill 3452 which would require cardiac screening of student athletes and Assembly Bill 6050/S. 1297, which requires the development of regulations for the treatment and monitoring of students who exhibit signs of sudden cardiac arrest.  Both of these bills were on the Assembly Education Committee agenda for May 23.  While we of course agree with the goals of these bills to prevent sudden cardiac arrest in student athletes, these bills have some flaws which we are urging be addressed.

Sudden death in young athletes is a rare but tragic event which MSSNY wants to work with all interested parties to help to prevent.  The possibility that young, well-trained athletes at the high school, college, or professional level could die suddenly seems incomprehensible.  It is a dramatic and tragic event that devastates families and the community.  Physical exertion associated with competitive sports and other physical athletic activities can exacerbate a pre-existing condition and can result in an untimely death of a student.  However, experts have concluded that to require a cardiac screening for every individual who seeks to in any school sponsored athletic activity poses a potential unnecessary emotional toll on the student athlete and could also incur a significant financial burden on the family as cardiac screenings in young people, without a family history, may not be covered under insurance.

In this regard, the Medical Society of the State of New York supports Assembly Bill 6538, sponsored by Assemblymember Michael Cusick.   A. 6538 has already passed the New York State Assembly and is on its companion measure, S. 3149, sponsored by Senator Andrew J. Lanza, is advancing in the New York State Senate.  This measure adds to the existing Health Care and Wellness Education and Outreach Program within the New York State Department of Health. The bill would require DOH to provide educational materials for students and their parents and guardians regarding sudden cardiac arrest. The materials would be developed in conjunction with the Commissioner of Education, the Medical Society of the State of New York, the New York Chapter of the American Academy of Pediatrics, and the American Heart Association.  The materials would include an explanation of sudden cardiac arrest, a description of early warning signs, and an overview of options that are presently available for screening.   The State of New Jersey currently has a similar program where brochures are sent home to parents and guardians.  We believe this is a positive legislative approach for addressing this difficult issue.

Regarding A.3452, we are concerned that experts have recommended against mandatory cardiac testing.  While competitive sports are associated with an increase in the risk of sudden cardiovascular death (SCD) in susceptible adolescents and young adults with underlying cardiovascular disorders, the United States Preventive Services Task Force does not recommend universal screening with Electrocardiography for any individual, let alone children under the age of 18.  The USPSTF recommends against screening with resting or exercise electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events.  The USPSTF ranks this as D—which means that the USPSTF recommends against this service and that there is a moderate or high certainty that the service has no benefit or that the harms may outweigh the benefits.   Additionally, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at intermediate or high risk for CHD events.  The USPSTF has concluded that the current evidence is insufficient to assess the balance of benefits and harms of the service.   Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Instead, the American Heart Association recommends that pre-participation screening of athletes include a history and physician exam and A complete and careful personal and family history and physical examination designed to identify (or raise suspicion of) those cardiovascular lesions known to cause sudden death or disease progression in young athletes is the best available and most practical approach to screening populations of competitive sports participants, regardless of age.

Regarding A. 6050/S. 1297, we agree with the concept of requiring course instruction for coaches, physical education teachers, nurses and athletic trainers on the signs and symptoms of sudden cardiac arrest.  However, we are concerned that the bill”s language does not specifically include medical personnel, such as pediatric or family physicians, cardiologists, emergency department physicians or organizations representing these groups of individuals in the development of such educational program.   Additionally, it should be noted that the most important way to effectively treat sudden cardiac arrest with student athletes is for schools to have and to have individuals trained to use an automated external defibrillator (AED). An AED is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation and pulseless ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm.  Having individuals trained within the school systems to use AEDs would be a significant step forward.

We very much want to work with you to assure that individuals who work with student athletes are properly trained in recognizing the signs and symptoms of cardiac arrest.  However, at the same time, we do not want to subject patients to what often are unnecessary tests that have been recommended against by national experts.  Moreover, we believe it is very important that physician experts be involved in the development of educational materials for families and school personnel involved in overseeing student athletes.   Working together, we can all help to prevent these tragic incidents in the future.

Thank you for your consideration of our comments.   Please do not hesitate to contact us if there are any questions.

Sincerely,
Morris Auster, Esq.
Pat Clancy
Hon.  Kemp Hannon
Hon. Carl Marcellino
Hon.  Richard Gottfried
Hon.  Jeffrion L. Aubry
Members:  Assembly Education Committee