AHA recommends states require cardiac emergency response plans in schools

School systems across the United States should have a clear and concise district-wide cardiac emergency response plan that meets laws, standards and safety practices, according to an American Heart Association (AHA) policy statement.

The statement, which was released Sept. 30, noted that the goal of a cardiac emergency response plan is to increase the chance of survival after sudden cardiac arrest and decrease the incidence of sudden cardiac death.

Kathleen Rose, RN, a consulting school nurse in Cape Coral, Florida, and Monica Martin Goble, MD, a pediatric cardiologist in Ann Arbor, Michigan, were co-chairs of the committee that wrote the statement.

In 2014, approximately 360,000 people suffered a sudden cardiac arrest in community settings, including approximately 7,000 children who were 18 years old or younger. The numbers include nontraumatic sudden cardiac arrests from cardiac causes treated by emergency medical services and exclude cardiac arrests of noncardiac origin.

Approximately 10 percent of people survive after sudden cardiac arrest, but the authors mentioned that survival rates can double or triple if people are given prompt cardiopulmonary resuscitation (CPR).

Sudden cardiac arrest in younger children is typically from a noncardiac origin such as respiratory difficulties, according to the authors. For older children and adolescents, sudden cardiac arrest is more often from congenital conditions present at birth such as hypertrophic cardiomyopathy and coronary artery abnormalities. Although sudden cardiac arrest can happen anywhere, they mentioned that it often happens during athletic practices and games.

When developing a cardiac emergency response plan, the authors recommended that schools form teams that include a medical director, coordinator who oversees the program and people to respond and take the proper steps when a medical emergency occurs.

They also said that schools should have an automated external defibrillator (AED) that is accessible, so rescuers can deliver a shock within three minutes of the sudden cardiac arrest. In addition, they should deliver the plan to anyone who works at the school, have practice drills to get them familiar with the plan and train all staff members in first aid, CPR and AED use. Further, school officials should work with the local emergency medical system (EMS) and fire and police departments to integrate the cardiac emergency response plan into the community’s EMS responder protocols.

Connecticut, Indiana, Michigan and New Jersey are the only states that require a cardiac emergency response plan in schools from kindergarten through 12th grade, according to an AHA news release. In addition, 34 states require CPR training as a high school graduation requirement, but 15 states and the District of Columbia do not have laws that require schools to teach about CPR, AEDs and cardiac emergency response plans.

“The AHA recommends that state laws, regulations, and related educational standards require schools to develop and maintain a [cardiac emergency response plan] and that appropriations are made available to support the development, implementation, and evaluation of [cardiac emergency response plans] in schools,” the authors wrote. “Where related appropriations are lacking, [cardiac emergency response plans] should still be in effect, using indirect sources of community or EMS-related support.”