BILL ANALYSIS
ACR 125
Page 1
Date of Hearing: May 4, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
ACR 125 (Villines) - As Amended: April 5, 2010
SUBJECT : Health facilities: youth athlete heart screenings.
SUMMARY : Encourages all local hospitals, health facilities and
health care providers with the ability to perform
electrocardiogram (EKG) and echocardiogram (cardiac ECHO)
screenings to partner with high schools in their geographic area
to provide free screenings for young athletes to reduce the
incidence of sudden cardiac arrest and death.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS RESOLUTION . According to the author, the
incidence of sudden cardiac arrest in people between 15 and 34
years of age has increased by 10% in the last decade. The
author maintains that, while still relatively rare, sudden
cardiac arrest, if a person is susceptible to it, more often
occurs in younger, high school-aged athletes than in older,
college- and professional-age athletes. Some local hospitals,
health facilities, and health care providers have started
programs in conjunction with high schools in surrounding areas
to provide free cardiac screenings to young athletes to reduce
the incidence of sudden cardiac arrest and death. The author
maintains that the success of such events should inspire and
encourage other hospitals and schools across California to
form partnerships to provide these vital screenings to their
local athletes.
Seventeen-year-old Los Gatos football player Michael Halpin
collapsed at school on December 2, 2008, and later died of a
previously undetected heart defect. This resolution,
according to the author, is a tribute to and in remembrance of
Michael Halpin and other young athletes who have fallen to
sudden cardiac arrest and is an effort to prevent future
tragedies.
2)BACKGROUND . Sudden cardiac arrest is an abrupt loss of the
heart's ability to pump blood. It differs from a heart
ACR 125
Page 2
attack, which is caused by a loss of blood that causes heart
tissue to die. In sudden cardiac arrest the body's electrical
system becomes defective and the heart is not able to form an
organized beat and plunges into rapid or chaotic activity. If
not treated, a sudden cardiac arrest can lead to death within
minutes. Sudden cardiac arrest has often been blamed on
cardiovascular disorders that are inherited or acquired. The
most common cause is hypertrophic cardiomyopathy, an inherited
condition which causes the heart's main pumping chamber, the
left ventricle, to be abnormally thick.
There are over 350,000 cases of death due to sudden cardiac
arrest in the United States (U.S.) each year, and over 20% of
these cases involve people with no outward signs of serious
heart disease. According to a recent Stanford University
School of Medicine study published in the Annals of Internal
Medicine, nearly 100 competitive young U.S. athletes die
suddenly and unexpectedly each year. The study reports that
the risk for death due to sudden cardiac arrest is at least
2.5-fold higher for the young competitive-athlete population
than for the age-matched nonathlete population. The study
further states that the risk for death due to sudden cardiac
arrest increases with increasing peak intensity of exercise
and increasing level of competition.
Current practice for youth athlete screenings includes a
physical exam and a medical history before participating in
sports. The Stanford study found that death due to sudden
cardiac arrest can be reduced simply by screening young
athletes for heart abnormalities with an EKG. Italy
introduced mandatory screenings of all athletes in the early
1980's and since then sudden cardiac deaths have dropped
ten-fold. In Italy, when a cardiologist discovers a potential
problem in the EKG, the doctor goes on to do a cardiac ECHO.
If there is serious heart disease, the athlete may be
disqualified from sports other than low-intensity disciplines
such as golf. And in Japan, all children get an EKG when they
enter grade school and then are retested before high school.
3)EKG AND CARDIAC ECHO . EKG is an interpretation of the
electrical activity of the heart captured over time and
externally recorded by skin electrodes. The EKG display
indicates the overall rhythm of the heart and weaknesses in
different parts of the heart muscle. It is the best way to
measure and diagnose abnormal rhythms of the heart,
ACR 125
Page 3
particularly abnormal rhythms caused by the conductive tissue
that carry electrical signals or those caused by electrolyte
imbalances. For decades, researchers have been attempting to
come up with methods of identifying EKG patterns that reliably
precede dangerous arrhythmias. As these methods are found,
devices are being created that monitor the heart in order to
detect the onset of dangerous rhythms and to correct them
before they cause death. The EKG cannot, however, reliably
measure the pumping ability of the heart, for which ultrasound
cardiac ECHO tests are used. EKGs are conducted by fully
trained technologists and the results are interpreted by a
qualified physician, usually a cardiologist.
A cardiac ECHO is a sonogram of the heart using standard
ultrasound techniques to image two-dimensional slices of the
heart. The latest ultrasound systems now employ 3D real-time
imaging. Cardiac ECHO is one of the most widely used
diagnostic tests for heart disease. It can provide
information regarding the size and shape of the heart, its
pumping capacity and the location and extent of any damage to
its tissues. The biggest advantage of cardiac ECHO is that it
is noninvasive and has no known risks or side effects.
Cardiac ECHOs are either performed by doctors trained in
cardiology or cardiac sonographers.
4)GOOD SAMARITAN HOSPITAL PROGRAM . Working in partnership with
the Los Gatos High School, the Good Samaritan Hospital in San
Jose coordinated the "Wildcat Heart Day for Mikey" in honor of
Michael Halpin, the 17-year-old high school football player
who collapsed in the hallway at school and died of sudden
cardiac arrest. The largest of its kind in Northern
California, the event screened several hundred student
athletes, boys and girls, from all athletic, cheer, and dance
teams. In addition to the screenings, the event provided
Cardiopulminary Resuscitation and automated external
defibrillator training. According to the Good Samaritan
Hospital, the screening event could not have taken place
without the over 300 volunteers including cardiologists,
registered nurses, EKG techs, emergency room technicians,
paramedics, and the Santa Clara Fire Department.
5)SUPPORT . According to the California School Nurses
Association (CSNA) and the California Athletic Trainers'
Association, it is tragic when a student athlete is lost to
previously undetected heart disease. CSNA maintains that the
ACR 125
Page 4
current physician's authorization and exam in order to play
team sports is usually very basic and does not provide the
added screening methods necessary to determine heart disease,
nor can school districts afford to provide those screenings.
CSNA argues that it is vital that school districts develop
partnerships with hospitals in their geographic region to
provide the strongest educational opportunities possible and
to save lives.
6)COMMENTS . While health facilities may have the equipment to
conduct EKGs and cardiac ECHOs, conducting these screenings
for sudden cardiac arrest in youth athletes requires trained
personnel including cardiologists to interpret the results.
Because health facilities do not employ physicians and can not
compel them to participate in such screenings, perhaps the
resolution should also encourage cardiologists to participate
in the partnership with high schools and health facilities to
provide free screenings for youth athletes in their geographic
area.
7)PREVIOUS AND RELATED LEGISLATION .
a) ACR 159 (Haynes), Resolution Chapter 146, Statutes of
2006, proclaims September 12th as Sudden Cardiac Arrest
Awareness Day in honor of those who have died from sudden
cardiac arrest and requests public schools and public
agencies to observe Sudden Cardiac Arrest Awareness Day.
b) ACR 45 (Vargas) of 2003, would have designated February
2003 as American Heart Month and would have urged all
citizens to recognize the critical importance of tools and
skills that increase survival rates from cardiac arrest.
ACR 45 was adopted in the Assembly. The Senate did not
take action.
REGISTERED SUPPORT / OPPOSITION :
Support
California Athletic Trainers' Association
California School Nurses Organization
Opposition
None on file.
ACR 125
Page 5
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097