Combatting commotio cordis

WHEN INJURIES OCCUR to young boys and girls in athletics, parents usually think of knees, ankles, or shoulders--not the heart. Commotio cordis, which can strike suddenly in sports such as baseball, softball, lacrosse, and ice hockey, now is being recognized as a cause of death among athletes between ages 4-21. Since 1998, close to 150 youngsters have died from this condition, according to the Commotio Cordis Registry.

A medical term for a rare disruption of the heart's electrical system, commotio cordis is caused by a blow to the chest directly over the heart, which occurs between heart contractions, leading to sudden cardiac arrest. It most often strikes healthy young athletes, due to the pliability of their chest walls. For commotio cordis to take place, the blunt force must strike the heart at a specific point between beats. This causes the heart to go into an abnormal rhythm, such as ventricular fibrillation, and then into arrest. Ventricular fibrillation is a useless quivering of the heart, which results in complete cessation of circulation and deprives the brain and other organs of oxygen. Death can occur within minutes if proper help is not administered by a trained, qualified individual.

There are many ways to help prevent commotio cordis, suggests the National Athletic Trainers' Association, a not-for-profit organization representing 30,000 members of the athletic training profession. Its Age-Specific Task Force offers proactive suggestions to parents and coaches on how to protect young athletes who participate in various contact sports. They include:

* Encourage coaches and officials to become trained in cardiopulmonary resuscitation (CPR), automatic external defibrillator (AED) use, and first aid. It is imperative that commotio cordis is recognized and treated within the first minute of onset. Anything done after this time can diminish the chances of survival. Once the condition is recognized, a trainer or other on-site medical professional should begin CPR or employ an AED--a device that shocks the heart to restore a normal heartbeat--until an EMS technician arrives.

The survival rate of an individual declines approximately 10% for every minute that passes without defibrillation. After 12 minutes, the usual time it takes local EMS to arrive, it usually is too late to revive the victim. When defibrillation is delivered within one minute, the reported survival rate can be as high as 90%. For defibrillation within five minutes, the survival rate can be as high as 50%. AEDs are safe for children as young as one year old. Furthermore, coaches and parents can take a CPR course through hospitals, EMS, or American Heart Association chapters. It takes four to six hours of training, and certification usually is good for one to two years.

* Establish an emergency action plan at all athletic venues. It is important that a trainer or other emergency medical professional be on-site in the event of injury. Develop a communication system that includes local EMS phone numbers (and directions to the venue), names and numbers of the nearest hospitals, and parent/coach contact information. Make sure it readily is available and posted in high-visibility areas.

In addition, youngsters should receive a complete physical exam before participating in sports activities. This will clarify whether the child has any predisposing factors that may present a health risk and if he or she is physically fit. Parents should provide coaches and associations with a comprehensive medical history, listing any medications their children are taking, and notification of allergies or any other type of health risk they may have. Parents also should fill out an Emergency Medical Authorization Card, giving permission for emergency medical care for their offspring. These types of records may help a coach save a life. A perfect example would be a young athlete with an allergic reaction to bee stings.

* Ensure all protective equipment fits properly and is used as the manufacturer intended. Have kids try on everything prior to purchase. This includes helmets, masks, chest protectors, shin guards, and shoes. Ill-fitting gear may subject the child to injury. Follow the manufacturers' guidelines. Moreover, equipment designed for a particular sport should be used for that sport only.

* Use all-purpose chest protectors and safety baseballs during practice games. These measures still are being researched to determine their efficacy in reducing the risk of commotio cordis, and should not be counted on as a total preventative. The baseballs currently used in youth associations are called RIF (reduction in force) balls, which have a lighter core and softer covering. When the ball strikes a player, it does so with less force. Youth ice hockey associations may start employing lighter pucks in the younger divisions.

* Teach athletes how to protect themselves against chest injuries. Coaches and parents should work with kids on proper playing and position techniques through controlled practice sessions. This includes demonstrating how to protect themselves from balls and pucks in the chest area by properly turning away or holding up a glove or mitt. Previously, coaches had instructed players to stop a ball or puck with any part of the body (other than the head), including the chest/torso area. This now is frowned upon by medical professionals as a means of defense. Coaches currently are encouraged to teach basic and fundamental defensive techniques. These should be taught during preseason training and repeated at every practice. Providing these guidelines when an athlete is young encourages proper technique for life.