Sports RSS Feed
Print Story
E-mail StoryIs enough being done to screen student athletes?
| Friday, Feb 29 2008 4:35 PM
Last Updated: Saturday, Mar 1 2008 10:52 PM
Cal State Bakersfield swimmer Alexey Belyy seemed to be the epitome of health.
Our readers recommend:
Loading Stories
Photos:
Former CSUB swimmer Alexey Belyy
Related Stories:
The 26-year-old Russian drank plenty of water and Gatorade during practice, friends say. He knew his body, trained correctly. His medical examinations never uncovered any red flags.
Then Belyy died last month after complaining of chest pain in his apartment following practice.
It seems inconceivable that young men and women who appear to be in the peak of health and conditioning would die in their prime. But as Belyy’s tragic death proves, a weak heart can cut down even the strongest athlete.
Some local and national sports medicine experts wonder if more can be done to suss out athletes at risk before it’s too late.
The American Heart Association, among other health advocates, is pushing teams to include in-depth questions about heart health into the initial medical history and physical exams. Some advocates want schools to have written emergency plans for sports venues.
Other experts and physicians are even looking to incorporate more intensive testing, such as echocardiograms, along with placing defibrillators on the sidelines.
While rare, sudden cardiac arrest is the leading cause of death among athletes in the United States. It kills one in 100,000-200,000 high school athletes and one in 65,000-69,000 college athletes every year, according to studies from University of California San Diego and the Minneapolis Heart Institute Foundation.
“We need to do everything we can to identify people at risk,” said Dr. William Baker, director of the California Clinical Thrombosis Center and team doctor for Bakersfield College. “But we will not always be able to diagnose these people ahead of time.”
ROUTINE PHYSICALS
Before taking the field, the pool or the court, athletes must undergo a medical screening, one of the best tools to flag potential problems early. But what the screening entails varies depending on the school. Kern High School District’s form is roughly half a page compared to Cal State Bakersfield’s form, which, for new athletes, is 14 pages long.
“When you have a little brief form, it’s so easy for kids to get lazy,” said Andrew Paulin, National Athletic Trainers’ Association board member and Mount San Antonio College co-head athletic trainer in Walnut.
“The first start would be a very extensive health history.”
The California Interscholastic Federation, the governing body of California high school sports, has a two-page form schools are encouraged to use with 49 questions devoted to medical history. KHSD’s form has two lines on half a page for history.
At KHSD, students must be evaluated by their physician every calendar year and submit a form signed by the physician, certifying that they’re ready to participate, said Mark Wyatt, KHSD’s director of school support services/athletics.
“There are red flags from time to time. Some kids are required to have additional screening,” Wyatt said. “I don’t recall us ever having an athlete who suddenly died at any one of our events.”
The colleges have a more in-depth process.
“It’s kind of a mass screening, much like as is done in the military,” BC’s Baker said. “There’s usually a line out the door and one or more physicians in the room.”
If the physician hears an irregular heart murmur or other worrisome signs pop up, the student is evaluated in more detail, he said.
“In my 30 years, I have never found a problem that prevented a person from participating,” he said. At CSUB, athletes are physically evaluated every year, said Dr. Larry Yokoyama, the team physician. This goes beyond the National College Athletic Association’s recommendations.
Twelve questions alone deal with cardiovascular health and family history on CSUB’s form. The trick, though, is getting accurate health history answers.
“Here’s this kid sitting on the table with scars on his knees, and then he says he’s had no surgeries,” Paulin said. “We tend to see more discrepancies with the new kids, whether they are enthusiastic about playing or just don’t know their histories.”
A PLAN
When a student collapses or is injured, schools need specific, written plans on how to get medical care to the athlete, some say.
“Who calls the ambulance? How does it get in there?” asks Tim Terrio, certified athletic trainer and founder of Terrio Therapy-Fitness. “Heaven forbid something happens after school. Then you have an ambulance driving around a school trying to get in, and people running around there trying to get the gates unlocked.”
The National Athletic Trainers’ Association advocates having an emergency action plan specific to each athletic venue that includes establishing emergency communication, training first responders, having the necessary life-saving equipment and determining access to the injured person.
“Where are the bolt cutters (for a locked gate)? That could be in the plan,” Paulin said.
KHSD and BC do not have written action plans.
If something were to happen at a KHSD school, the coach knows CPR, and emergency medical services would be called, Wyatt said.
BC’s action plan for cardiac problems is not well developed, Baker said.
At BC games, the athletic trainers, and sometimes the team doctor and an ambulance, are on-site, said Jan Steubbe, BC’s athletic director.
“We don’t have a written policy. We just know our procedure,” Steubbe said. “We’ve all been up here so long together.”
Action plans for most of CSUB’s facilities are posted on the school’s Web site. They include emergency numbers, the venue’s location, available emergency equipment and roles of the first responder.
“With the plan in place, there’s no confusion,” said Joel Oetker, CSUB certified athletic trainer. “That way you don’t have multiple people leaving and running to make phone calls, when it just takes one.”
HIGH-TECH TOOLS
Some athletic training experts advocate high-tech methods of screening and care.
“Every time we have an event like this happen, I think through the same thing,” Baker said. “Maybe if this young man (Belyy) had an echo (echocardiogram), it would have picked something like this up.”
Some European countries require all athletes to undergo an echo or electrocardiogram, or EKG, in the hopes it will spot abnormalities that the routine physicals miss.
There’s some interest in doing that here, but considering the high number of athletes, low number of athlete deaths and cost of the test (about $75), it probably wouldn’t be feasible, said national sports medicine expert Dr. Barry Maron, director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation.
“It certainly would be a useful thing to do on a local basis,” he said, suggesting that a local hospital or business donate the money and resources.
Screening all athletes with EKGs leads to more dilemmas, such as the logistics of doing several hundred screenings and distinguishing between a cause for alarm and a false positive, which happens from time to time, Baker said.
“Are you going to keep an athlete from participating because a test comes back positive but they are symptom free?” Terrio asked.
Another device debated among sports medicine experts is the automated external defibrillator, which senses the heart’s rhythm during cardiac arrest and, in some cases, delivers an electric shock to get the heart beating again.
The athletic trainers’ association recommends having one of these over-the-counter devices as part of a school’s emergency plan.
“They keep beating the message into us that CPR is great, but you can increase survival with the aid of them,” Paulin said. “Even for the layperson, if they have common sense, they can use it.”
Besides the ambulance standing by at KHSD football games, the district does not have defibrillators at events or practices, Wyatt said.
“Almost every year there are conversations about them,” he said. “But in the past they’ve been a little expensive and hard to operate.”
Most cost $1,500–$2,000.
BC’s sports department had defibrillators three or four years ago, but they were abandoned due to insurance reasons, Steubbe said. If something happens, a fire department, which has one of the devices, is nearby.
CSUB athletics has two defibrillators, which make the rounds at all the sporting events, said Kevin Gilmore, CSUB’s assistant athletic director/media relations.
In the few years they’ve owned them, the devices haven’t had to be used, he said. “Statistically, they are never going to be used,” Terrio said. “But when you need it, it’s too late.”
Local athletes who died suddenly
• Alexey Belyy, CSUB swimmer Died: Jan. 11 Place of collapse: his apartment following practice Age: 26 Cause: Atherosclerotic cardiovascular disease.
• Raul Ramirez, Desert High football player Died: Aug. 22, 2003 Place of collapse: football practice Age: 17 Cause: hypertrophic cardiomyopathy, a condition that thickens part of the heart
• Julian Yearwood, Bakersfield Blitz fullback/linebacker Died: July 19, 2003 Place of collapse: team bench during a game Age: 31 Cause: sudden cardiac death due to blocked arteries