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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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