In the wake of four area fatalities, UIL is considering whether devices will be mandatory
By Sam Khan Jr., Leigh Hopper, Adam Ariganello, and John McCloskey
The Houston Chronicle
Copyright 2006 The Houston Chronicle Publishing Company
All Rights Reserved
Matt Nader’s heart was strong.
He had tested it himself repeatedly with years of two-a-day practices on the football field as an offensive lineman for Austin Westlake High School. His doctors said there was nothing wrong with it.
But on a hot, muggy night last month, after a long scoring drive against A&M Consolidated, as the 6-foot-6, 300-pound senior sat spent on the bench, it failed him.
His parents, both doctors, were on the sidelines. They leaped to his aid. Also on the sideline, however, was an automated external defibrillator, a device that shocks distressed hearts back to life.
Nader, 17, was one of the lucky ones, thanks in no small part to the fact that it has been Austin Westlake’s policy for four years to have an AED on hand for every game.
Since 2001, the University Interscholastic League has merely encouraged Houston-area high schools to have the device available for emergencies. But during a two-day meeting beginning Oct. 15, the UIL will decide whether schools should be required to have at least one AED on hand by the start of the 2007-08 school year.
3 deaths in 10 days
Without the AED, Nader likely would have become another statistic — a young, healthy athlete whose life ends because of a heart-related complication.
The UIL’s action follows the deaths of three Houston teenage football players in a 10-day span in September. Another athlete — Katy Taylor’s Jhonathan Bruda, 17 — died Friday while running at the school track about 6:30 a.m. The cause of death for three of the four athletes remains undetermined.
According to Jose A. Joglar, an expert in sudden cardiac death at the University of Texas Southwestern Medical Center in Dallas, 80 such deaths occur annually among 25 million athletes college-age or younger.
Nader, who has fully recovered but whose football-playing days are over, has no doubt about what the UIL should do.
“I believe all schools should have AEDs,” Nader said. “I’m walking proof that they work.”
Collapse on the track
An AED might have saved another life Sept. 18, the day a 14-year-old junior varsity football player from Booker T. Washington collapsed after a run on the high school’s track.
Christopher Pichon II was alive but unable to speak when a student trainer rushed to his side carrying bottled water. He died later at a hospital.
Washington, like 19 other high schools in the Houston area that compete in the UIL, did not have an AED on its campus. It has one now, which it received two days after Pichon’s death.
At least one grieving parent thinks the UIL should act now, not next fall.
“This can’t be done fast enough,” said Laura Friend, vice president of Parent Heart Watch, an organization that campaigns for schools to obtain AEDs. “They can talk policy and statistics all they want. In Houston, it has been a horrific nightmare.”
Friend lost her 12-year-old daughter, Sarah, on July 14, 2004, to hypertrophic cardiomyopathy, a thickening of the heart muscle. Friend appeared before the UIL’s Medical Advisory Committee on Oct. 1. She implored the body to make AEDs mandatory. The topic consumed nearly two hours of the three-hour meeting.
“I don’t think the schools are acting fast enough,” Friend said. “It scares me. It makes me cry. I’m thinking, another year? How many more children are going to die during that time?”
UIL athletic director Charles Breithaupt said he expects the policy to take effect Aug. 1, 2007, which would be the deadline for all schools to be in compliance. In an emergency situation the measure could be approved to go into effect immediately, but it wouldn’t be financially practical.
“We understand the plea and the need, but you have to have a practical application to this and the resources to use it,” Breithaupt said. "(AEDs) are not free. They’re not given away.”
AEDs cost an average of $2,300 each, according to the American Red Cross, but are available for nearly $1,000 less. On Aug. 10, the Houston ISD board approved a donation of about 300 AEDs from the Texas Arrhythmia Institute - enough for every HISD school.
According to HISD, the donation made Houston the largest American city with full deployment of defibrillators in its school system.
But 5 1/2 weeks after the donation was approved, Washington still had no AED.
As of Friday, only eight of 24 high schools in HISD (competing in the UIL) had the devices on their campuses.
Training required
HISD spokesman Norm Uhl said the delivery of 80 defibrillators began Aug. 11, but they were not officially in use until at least two people from the school were trained to use them. Schools that had nurses or other personnel already trained to use an AED received them immediately.
The remaining 220 AEDs were delivered two weeks ago. Two more training sessions are planned for HISD personnel, with the last one scheduled for Nov. 4.
Uhl also said all the district’s athletic facilities have had AEDs in place for several years.
Prior to the donation, two HISD high schools (Lamar and Westside) and two middle schools (Lanier and West Briar) had purchased AEDs.
Friend understands the limitations — financial and logistical — schools face, but she doesn’t understand why defibrillators have not been a priority.
“Had they had the equipment,” she said of Washington, "(the victims) might also have been like Matt Nader.”
In medical terms, Nader was suffering from ventricular fibrillation, a form of arrhythmia in which the heart’s electrical activity becomes disordered, the heart’s lower chambers contract in a rapid, unsynchronized way and the heart pumps little or no blood into the body or brain.
Time was his greatest enemy, an AED his best friend.
“If you can get someone with cardiac arrest de-fibbed in less than five minutes, which is possible if an AED is on-site, not only can you save their life but you can have a good shot of having a positive neurological outcome,” said Austin cardiologist Paul Tucker, a parent of one of Nader’s teammates who played a role in helping to save Nader.
"(The chances of surviving) are increased substantially (with an AED).”
Tucker also feels a sense of urgency is needed by the UIL.
“I don’t see any real benefit in waiting a year,” he said. “Just do it. It may be (statistically rare), but it happens every year in Texas.”
Size of a laptop
An AED is about the size of a laptop computer. It analyzes a heart’s rhythm for any abnormalities and, if necessary, directs the user to deliver an electrical shock to the victim. This shock, called defibrillation, may help the heart re-establish an effective rhythm on its own.
According to the Red Cross, defibrillation is widely recognized as the most critical step in restoring cardiac rhythm and resuscitating a victim of sudden cardiac arrest.
In some cases, like that of Pichon, who had an enlarged heart, it is unclear whether an AED would have increased the chances of survival.
But Mehdi Razavi, a research scientist at the Texas Heart Institute and a clinical assistant professor of medicine at Baylor College of Medicine, said it could have made a big difference.
“If there isn’t an AED on-site, the chances of survival are probably less than 5 percent,” Razavi said. “By the time the EMT arrives, it’s way too late. But if it’s on-site and you defibrillate the victim within the first minute of collapse, your chances of bringing (the person) back (are) upwards of 80 to 85 percent.”
Though having a defibrillator is vital, so is knowing how to respond to an emergency.
911 is the priority
The first step is to call 911 immediately after discovering a nonresponsive person. Next, begin administering CPR by opening the victim’s airway, determining whether the person is breathing and checking for a pulse. If there is no pulse, use an AED or continue with CPR (mouth-to-mouth resuscitation and chest compressions).
“It’s very easy to use,” Tucker said. “It’s designed for use by nonmedical people. It talks to you while you’re using it.”
If the victim needs to be shocked, a light will come on indicating so. Tucker said that for some, it’s just not that easy.
“You have to push the button,” he said. “Some are intimidated by that. People are sometimes afraid that they might shock the victim and be wrong. "(An AED) is clearly the key. CPR is good, but it’s effective for only so long. But I don’t want to de-emphasize the importance of how crucial the reaction time is.”
...
BY THE NUMBERS
4 Athletes college-age or younger who have died in the Houston area in the past three weeks.
. . .
80 *Estimated annual fatalities among the 25 million college-age or younger athletes in the U.S.
. . .
19 High schools in the Houston area that compete in University Interscholastic League activities and are not equipped with automated external defibrillators.
. . .
16As of Friday, 16 of 24 high schools in HISD (that compete in UIL activities) did not have AEDs on their campus.
. . .
600-650 The UIL estimates approximately half (between 600-650 out of nearly 1,300 high schools statewide) are not equipped with AEDs.
*Source: Jose A. Joglar, an expert in sudden cardiac death at the University of Texas Southwestern Medical Center in Dallas.
. . .
AEDs IN AREA HIGH SCHOOLS
District...High schools with AEDs...AEDs per high school....Year obtained
Aldine ISD...4/4...1...2003
Alief ISD...3/3...2...2003
Alvin ISD...1/21...0-2 1...2003
Barbers Hill ISD...1/1...2...2002
Brenham ISD...1/1...3...2003
Channelview ISD...1/1...7...NA
Clear Creek ISD...3/3...2...2003
Conroe ISD...4/4...1...2004
Crosby ISD...1/1...2...2004
Cy-Fair ISD...7/7...1...NA
Deer Park ISD...1/1...3...2003
Dickinson ISD...1/1...3...2003
Fort Bend ISD...10/10...2...2003
Friendswood ISD...1/1...2...2002
Galena Park ISD...2/2...2...2001
Galveston ISD...1/1...3...2003
Goose Creek ISD...2/2...2...2005
Houston ISD...8/24 2...0-1 2...2006
Huffman ISD...1/1...2...2003
Humble ISD...3/3...1...2003
Katy ISD...6/6...2...2002
Klein ISD...5/5...2...2003
La Marque ISD...1/1...2...2002
Lamar Consolidated ISD...3/3...3...2005
North Forest ISD...0/2 3...0 3...2006 3
Pasadena ISD...5/5...3...2002
Pearland ISD...1/1...14...2001
Sheldon ISD...2/2...3...2005
Spring Branch ISD...4/4...1...2003
Spring ISD...2/2...4...2002
Texas City ISD...1/1...1...2003
Tomball ISD...1/1...2...2001
...
1 - Alvin has two AEDs; Manvel, which opened this year, remains without one.
2 - On Aug. 10, 300 AEDs were donated to Houston ISD, but 16 UIL schools in the district remain without them.
3 - One AED was placed at Cowart (football) Stadium this year, but there is not one on either the Smiley or Forest Brook campus.