Cardiac Screening
October 31, 2014
Sudden death among 12 to 25-year-olds is “a low event rate occurrence.”
“There is insufficient information to support the view that ECGs in asymptomatic young people for cardiac disease is appropriate or possible on a national basis for the United States, in competitive athletics or in the general population.”
“At present, there is no mechanism available in the United States to effectively create national programs of such magnitude, whether limited to athletics or including the wider population of all young people.”
“There is insufficient evidence that particularly large-scale/mass screening initiatives are feasible or cost effective within the current US healthcare infrastructure . . .”
“The ECG . . . cannot be regarded as an ideal or effective test when applied to large healthy populations.”
“An additional, but unresolved, ethical issue concerns whether students who voluntarily engage in competitive athletic programs should have advantage of cardiovascular screening, while others who choose not to be involved in such activities (but may be at the same or similar risk) are in effect excluded from the same opportunity.”
The AHA’s Sept. 14 AHA writing group “does not believe the available data support significant public health benefit from using the 12-lead ECG as a universal screening tool. The writing group, however, does endorse the widespread dissemination of automated external defibrillators which are effective in saving young lives on the athletic field and elsewhere.”
The Limitation of Rules – Part 1
September 2, 2016
From the age of 10 to 20, my position as a baseball player was catcher. Sometime during that decade I was taught to return the ball to the pitcher with authority, with a snap throw from my ear, targeting the glove-side shoulder of the pitcher.
I caught every inning of every game, including doubleheaders. In those years, there was less concern than today for protecting the arms of pitchers, and there was no thought given to the throwing arms of catchers.
Today, the shoulder of my throwing arm is shot; I cannot throw a ball overhand with any force.
But here’s the thing. I didn’t ruin my throwing arm in youth and school baseball; I wrecked it as an adult doing silly things with a tennis ball on the beach with my teenage son. We had a blast for a summer afternoon, and I’ve paid for it the rest of my life.
The point of this brief baseball bio is to demonstrate an example of the limitations of rules.
We can identify dozens of risks to student-athletes and we can promulgate an equal number of rules to help them avoid injuries in our programs; but we cannot protect them against a lack of common sense in our programs or accidents in other aspects of their lives.
Even if we implement new rules to limit the number of pitches by a player, what good is that if, after reaching the limit, the pitcher and catcher switch positions? Do we need a rule to address that coaching decision too?
Do we need rules that prohibit large students from practicing against small, or experienced players from competing against inexperienced? How would we ever monitor or enforce such rules? Where do rules leave off and common sense take over?
Even if we put players in bubble wrap for sports, what do we do about their decisions away from sports, perhaps in vehicles, with their friends and their cell phones? Where do laws and rules stop, and personal responsibility start?