The tragic collapse of Buffalo Bills football player Damar Hamlin highlighted the need for a quick response to help cardiac arrest victims. An NFL stadium provided just that environment.
Trained emergency personnel were on the sideline and within seconds of where he fell. An automated external defibrillator (AED) was quickly available to restore Hamlin’s heartbeat. An ambulance was nearby and took him to the hospital, following steps documented – and practiced – in an emergency action plan.
This same type of care is far less common in youth and high school sports, where sudden cardiac arrest is the No. 1 death among high school athletes. Our youngest athletes are also vulnerable to other ailments – concussions, knee injuries, heat exhaustion and many more – without the same standard of medical care and protections given to professional athletes.
One in three high schools lack access to an athletic trainer, according to a 2019 study by the Korey Stringer Institute and National Athletic Trainers’ Association. The lack of appropriate sports medicine care is even greater for private schools (45% with no athletic trainer access) than public (31%).
Meanwhile, despite recommendations by health organizations like the American Heart Association that AEDs be placed in schools, state laws on AED requirements for schools vary widely. As of 2021, only 17 states required the installations of AEDs on school campuses, according to Avive, an organization devoted to increase the survival rate for cardiac arrest.
It’s not clear exactly why Hamlin went into cardiac arrest. Medical experts believe the most likely reason is he suffered from commotio cordis, a very rare but serious condition after blunt trauma to the chest. In one study of commotio cordis patients, resuscitation within three minutes resulted in a 25% survival rate. Survival dropped to 3% when resuscitation was delayed beyond three minutes.
Since 1995, 188 athletes have died from blunt force injury to the heart, according to the U.S. Commotio Cordis Registry. It’s far more common for younger athletes to die from this condition. Of those fatalities, the average age was 14.7 years and 96% were male athletes.
Among 69 well-documented sports-related cases, youth baseball (39), softball (seven) and ice hockey (seven) were the most common sports involved. Football and soccer each had three cases. Chest blows from a projectile such as a ball or puck were involved in 75% of the studied cases. Only 10% of the victims survived cardiac arrest; five of the seven survivors received CPR within one minute.
Given these facts, “it’s imperative” that youth sports administrators adopt preventive measures, wrote Washington Post columnist Leana Wen, Baltimore’s former health commissioner.
“AEDs must be placed at all athletic facilities including gyms,” Wen wrote. “Crucially, they must be accessible within one minute of cardiac arrest. Every athletic venue, including school training facilities, must have an emergency action plan. NFL games have dozens of trained medical staff present. This isn’t feasible in youth sports, but schools and youth leagues can require all coaches and officials to be up to date on CPR certification.”
Only 41% of youth sports coaches in 2021 reported being trained in CPR during the past year, down from 46% in 2020, according to the Aspen Institute’s State of Play 2022 report. In a separate National Coach Survey by The Ohio State University LiFEsports Initiative, the Aspen Institute, Susan Crown Exchange and Nike, 91% of youth sports coaches indicated they participated in CPR training at some point and 57% were interested in more CPR training.
Relying solely on coaches to care for injured athletes is risky. Only 35% of coaches “strongly agree” that they are confident in their ability to handle injuries, the National Coach Survey found. Coaches in school and travel sports settings (42%) reported more confidence than rec and developmental coaches (33%).
The Aspen Institute’s Reimagining School Sports Playbook called for athletic trainers to be required in schools that offer collision sports. Funding is the biggest challenge, along with the medical profession producing fewer athletic trainers than in years past. Hawaii is the only state with at least one athletic trainer in every high school, earmarking $4.28 million annually in the public-school budget for 74 athletic trainer positions. Hawaii is an outlier because of its small population and statewide educational model.
For schools that can’t hire a full-time athletic trainer, there are other options. Physical therapists have a board certification in sports and the profession is evolving to attempt to mimic the skills of athletic trainers. The National Athletic Trainers’ Association and American Physical Therapy Association offer databases with certified professionals. Schools can meet with their local health care organization, nutritionist or exercise physiologist to identify a medical partnership.
The challenges of providing better care to young athletes is evident In Kentucky, where 32% of high schools have no athletic trainer. The state has no law requiring an AED to be on high school sidelines. The Kentucky High School Athletic Association recommends one within three minutes of a game or practice.
Following the 2008 death of Kentucky high school football player Max Gilpin, the state passed a law requiring high schools to create and rehearse their emergency action plans. Twelve years later, Matthew Mangine Jr. died during high school soccer conditioning in Kentucky. An ongoing lawsuit over his death showed that Mangine Jr.’s school did not have an emergency action plan in place for the soccer conditioning.
Mangine’s father watched the Bills-Bengals game this week from his Northern Kentucky home, 17 miles away from the Cincinnati stadium where Hamlin went into cardiac arrest.
“(Hamlin’s collapse) is an eye-opener to the world that this is something that needs to be addressed at all levels in athletics,” the father told the Louisville Courier Journal. “This is something people don’t take seriously enough at the high school and youth sports level. Last night, you saw the culmination of a professional athlete that hopefully his life was saved due to the quick action. For our youth athletes, we’re doing them a disservice.”
Jon Solomon is editorial director of the Aspen Institute Sports & Society Program.