ethical responsibilities of coaches in emergency care situations kimberly m. robertello, ph.d., atc...

Ethical responsibilities of Ethical responsibilities of coaches in emergency care coaches in emergency care

situationssituations

Kimberly M. Robertello, Ph.D., ATCWashington State University

Sharon K. Stoll, Ph.D.University of Idaho, Center for ETHICS*

Justin Barnes, M.S.University of Idaho, Center for ETHICS*

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IntroductionIntroduction

Sudden cardiac arrest (SCA)Current practices – First Aid and CPR

Training RecommendationsEthical responsibilitiesRecommendations for action

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Sudden cardiac arrest (SCA)Sudden cardiac arrest (SCA)

Sudden cardiac arrest defined:◦The unexpected loss of heart function,

breathing and consciousness (Mayo Clinic, 2008)

SCA – usually arises from an electrical disturbance which disrupts the pumping action of the heart

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Sudden cardiac arrestSudden cardiac arrest

SCA is the leading cause of death for young athletes (Maron, 2003).

SCA may be caused by structural cardiac anomalies (myocarditis, Marfan’s syndrome, valvular heart disease, etc.)

20% of sudden cardiac death cases are caused by a blow to the chest which produces an arrhythmia (Drezner, Courson, Roberts, Mosesso,

Link, & Maron, 2007).

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Sudden cardiac arrestSudden cardiac arrest

SCA signs and symptoms◦Sudden collapse◦No pulse◦No breathing◦Loss of consciousness◦Preceding symptoms may include fatigue,

fainting, blackouts, dizziness, chest pain, or vomiting

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Preparedness and management of Preparedness and management of SCASCA

Screening efforts◦“ In approximately 55-80% of cases of [sudden

cardiac death], athletes are asymptomatic until the cardiac arrest …” (Drezner et al., 2007, p. 146).

Early activation of EMSEarly CPREarly defibrillation

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Survival after SCASurvival after SCA

The single greatest factor affecting survival after SCA is the time interval between cardiac arrest to defibrillation.

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First Aid & CPR standards First Aid & CPR standards

To what extent are coaches responsible for the care of their athletes?◦National Standards for Sport Coaches, Domain

2, Standard 9: “Recognize injuries and provide immediate and appropriate care.” Benchmark: “Implement an appropriate action

plan for emergency first aid and CPR in all venues. (NASPE, 2006).

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Current standards for coaches Current standards for coaches

National Federation of State High School Association (NFHS) recommends high school coaches are certified in First Aid and CPR

Some have begun to require CPR/AED training as well◦American Sport Education Program, in

conjunction with the American Safety and Health Institute (ASHI) has introduced CPR/AED for Coaches

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Current standards for coaches Current standards for coaches

Check the NFHS website for your state’s requirements:

http://www.nfhslearn.com/StatePricingRegs.aspx

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Idaho as an exampleIdaho as an example

For example, Idaho DOES NOT require CPR or First Aid certification for coaches.

Data from a 2004 study indicates that from 141 public and private high schools in the state of Idaho:◦93 schools responded (66% response rate)◦54.8% did not employ someone to handle

sports related injuries◦Only 20 respondents employed a Certified

Athletic Trainer

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A call to actionA call to action

Establishing an emergency action planEnsuring public access to defibrillation

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American Heart Association American Heart Association Recommendations for AED Recommendations for AED implementationimplementation

Based on:◦Probability of AED use within 5 years of training◦High-risk children or adults present at the

school◦EMS call to shock interval less than 5 minutes

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AED LegislationAED Legislation

U.S. House of Representatives passed the Josh Miller HEARTS (Helping Everyone Access Responsive Treatment in Schools) Act on June 9, 2008◦Establishes a national grant program through

the Dept of Education to fund AED installation and training in schools

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AED LegislationAED Legislation

States requiring or supporting AED placement in schools:◦Colorado (donations), Florida, Georgia (2008),

Illinois, Maryland, Michigan, Nevada, New York, Ohio, Pennsylvania, South Carolina (2008)  and Virginia require some schools to have portable defibrillators; actual extent varies.  Tennessee "encourages" placement in schools (2008.)

http://www.ncsl.org/programs/health/aed.htm - to check your state’s laws!

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Ethical responsibilitiesEthical responsibilities

Thomas Jefferson, “The law is socialized ethics.”◦This is clearly an ethical issue that should become

law.◦An ethical issue: any case in which harm can be

avoided, and good can be done.◦My personal experience – Lewiston, ID. District boys

basketball. Lewiston HS – certified athletic trainer on staff

◦But was not hired for event. Neither coach certified in CPR No AED in building available.

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Coaching – why so little Coaching – why so little expectation?expectation?

It is not that we think too much sport, rather we think too little of it.

Many states have little expectations or requirements for coaches. All that really is required is a heart beat.◦Why has this occurred?

Coaches no longer are teachers in school. Less individuals willing to coach – i.e., Grant

Putnam, Bowling Alone Lack of respect and belief in importance of coaching

education ????

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Education for CoachesEducation for Coaches

Coaching education ◦Online certifications

Idaho – ASEP – online◦Coaching principles- 5 Principles, 1 text, online test◦Sport first aid -16 units, 1 text, online test

Florida –NFHSAA – online◦2 hour coaching fundamental courses◦4 hour safety courses

◦Majors available General search – no majors except in NZ, UK Minors only, tied to physical education teaching Master’s degrees online - WVU

◦Master’s degrees required: South Carolina

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Recommendations Recommendations

CPR + AED certification for all coaches!

The evidence shows …◦SCA survival rates can improve from 5% to 48-

74% when AED and CPR are provided within 3-5 minutes by the first person on the scene (National Athletic Trainers Association, 2008).

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AED implementation and supportAED implementation and support

SCA Foundation’s You Can Save a Life at School – national awareness campaign aimed at implementing AEDs and advancing training for school personnel

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AED classes and feesAED classes and fees

American Red Cross (www.redcross.org)◦CPR/AED – Adult $35 (review $22)◦CPR/AED – Adult, Child, and Infant $50 (review

$30)◦Standard First Aid with CPR/AED $45 (review

$35)◦Standard First Aid with CPR/AED for Adult,

Child, and Infant $65

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AED classes and feesAED classes and fees

American Heart Association (www.americanheart.org)◦You can search by zip code to find courses

offered in your area

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RecommendationsRecommendations

Coaches have an ethical responsibility to prepare for emergency care situations◦CPR/AED certification◦Coaching certifications

Ethical issues can only be resolved if … the principle guides the process and people are willing to make changes in what and how we do things – especially coaching education.

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