THE HEART OF THE MATTER

"When young children die due to a heart condition, it can be scary and seem random," said State Rep. Karyn Polito (R-Shrewsbury). "If an AED device is used it can help to save lives." The risk of a young athlete dying of a heart problem during practice or a game is a little more than one in a million; yet ever parent worries about their child playing a sport, especially when the media reports about a young girl who died during a soccer game or a high school athlete who collapsed during a practice.

While the American medical community considers "sudden cardiac death" in the "pediatric and adolescent population as an uncommon event," it does recommend children get a proper physical and heart testing, if necessary, before beginning a sport.

But one Shrewsbury legislator and a Pittsfield mom believe putting a medical device in each school could help prevent sudden cardiac deaths, too.

Amy Wolfe does not want a memorial bill named after her daughter, who suffers from multiple heart conditions. She wants to be able to make a change, so her daughter can be protected when she attends school. Her goal is to have a life saving device available to her daughter while at school and any other person who might need it.

At her routine ultrasound appointment, Wolfe thought the only surprise would be finding out the sex of her baby. The ultrasound detected a devastating heart problem. Her unborn baby daughter's heart did not have all four chambers. Allison, now 8, was later diagnosed with tetralogy of fallot, which means she was born with a congenital heart defect and four forms of heart disease.

"I couldn't let her cry when she was a baby because she would turn black," Wolfe said. "Her aorta is wrapped around her airway, so she would literally suffocate herself."

After two open heart surgeries, Allison Wolfe could not be in any public situation, due to the risk of infections.

When Allison was 4, she was well enough to attend preschool.

"At the time, we lived in Virginia Beach, and the climate was not good for her heart and lung problems," Wolfe said. "After that, we moved to Pittsfield, and fought to have an automated external defibrillator (AED) at the public school."

An AED is similar to a defibrillator used in hospitals, yet it is easier to use and is portable. The AED evaluates a sudden cardiac arrest victim's heart rhythm, determines if shock is needed, and delivers an electric shock through the chest wall to the heart. Audio and visual prompts guide the user through the process, according to the American Heart Association.

According to Wolfe, the public school was unable to spend the money to purchase an AED and train any personnel to use the defibrillator.

"I want my daughter to enjoy her school and I didn't want to have to put her back in the bubble," she said. "Without this, if my daughter had an attack at that school, no one could help her."

Wolfe said there was only one floating nurse at the elementary school she attended, so there was no one trained at the school every day to help in an emergency.

"The Red Cross offered to train people on site for free, and the school department refused to help because they couldn't require the teachers to be there because of their union obligations," Wolfe said. "And I even had a prescription from a doctor to pay for the AED, though the insurance companies wouldn't pay for it in the end."

As a result, Wolfe took her daughter out of public school at the beginning of this school year.

"It was very costly to put her in private school, but I was so worried that something might happen," she said

At the first Parent Teacher Organization meeting at her new private school, Wolfe was prepared to fight to get an AED in her child's school again.

"I was geared up for the meeting, and was pleasantly surprised," she said. As soon as she told the group her concerns, they immediately began coming up with fundraising ideas.

"The parents kept saying, 'We can raise that money in a heartbeat,'" she said. "And now if a child wants to wear street clothes to school for a day, they pay $5. They said we could raise the $1,000 for the AED in no time and the fundraiser is called, 'In a Heartbeat.'"

Need for a State Law

Wolfe is also working with local legislators and the American Heart Association to require all public schools across the state, to have at least one AED.

"When young children die due to a heart condition, it can be scary and seem random," said State Rep. Karyn Polito, RShrewsbury. "If an AED device is used it can help to save lives."

In September, a 6-year-old girl died in Belmont, where she was playing soccer on a local sports team.

"It is unclear whether or not an AED would have helped in that situation or similar situations you hear about around the country," said Dr. Darshak Sanghavi, a pediatric cardiologist and an assistant professor of pediatrics at UMass Medical School. "A large number of people can be saved using an AED and having them onsite."

Dr. Sanghavi said AEDs can be found in airports. Many sports stadiums have them and they are now required in every sports club in the state, he added.

"Schools should have AEDs readily available because every second counts when a child's heart stops," he said. "Parents worry about heart murmurs, but murmurs are just an abnormal sound."

Dr. Sanghavi said that one way to help prevent children from dying from undiagnosed heart condition is to have a thorough physical examinations and costly heart tests.

"It would cost way too much money to do extensive heart testing on each child who wants to play a sport, but it is important for parents to bring up concerns to their doctors during physical examinations," Dr. Sanghavi said. "So that is why it is important to have AEDs available in areas where there are a lot of community events like schools."

Rep. Polito says the cost of an AED has dropped from $5,000 each to about $1,500 each in the past five years, since she began working on the legislation.

"A student at Shrewsbury High School came forward and wanted to get an AED for each school in her town," Polito said. "She came to me and asked me to help put together legislation that would require each public school to have at least one AED on site and allow anyone who donates the device to the school to be eligible for tax incentives."

Polito says the AED is easy to use and can help save lives.

"340,000 Americans are claimed every year from Sudden Cardiac Arrest," she said. "Additionally, the chance for survival is decreased by 7 to 10 percent each minute that passes without the use of a defibrillator."

Student Pushes For Change

"When Danielle Leary was a sophomore (in 2002), she read a story about a referee in Wellesley who had been recently saved by an AED, and the AED was just purchased in the Newton school system," said Judy DeFalco, high school nurse and nurse leader at Shrewsbury High. "Danielle went to her guidance counselor and said, 'Something like that could happen here. What can we do about it?'"

DeFalco said the guidance counselor referred Danielle to her and they researched how to get AEDs for the high school, and eventually the other schools in the district.

"She wrote grants to raise money and asked insurance companies and other community members to raise money," DeFalco said. "She sat down with the president of Fallon (Community Health Care), and he was so impressed with her. He couldn't believe she was a teenager."

As a result of Leary's hard work, there are two AEDs at the high school and 15 trained professionals at the high school alone. She also contacted Rep. Polito to put together legislation so each school in Massachusetts will have an AED.

"The Massachusetts Emergency Management Agency donated one AED, we purchased five, and now this year, all the schools have an AED," DeFalco said. "All it took was one person to have an idea and come up with a plan and implement it."

In Shrewsbury, DeFalco works to make sure the AED is accessible to the trainer at the high school, so the device can be on the sports fields, as well as one on each floor at the high school.

"We are actually behind the times - in other states across the country, AEDs are required in each public school," DeFalco said.

"This legislation is a no-brainer - an AED at a school can help save the lives of children, but also anyone attending community events at the school," said State Sen. Stephen M. Brewer, D-Barre.

Using an AED is as fundamental as knowing CPR in an emergency situation."

The American Heart Association and the American Red Cross work with local communities to help coordinate training days both on and off site after AEDs are purchased.

"And the training for using an AED can be combined with the CPR course, which takes just about four hours," said Allyson Peron, of the American Heart Association

For more information about the AED legislation, please contact your local state senator or state representatives. And to learn more about providing AEDs in schools, contact the American Heart Association at 508-620-1700 or www.americanheart.org.

Jennifer Luccarelli is a Massachusetts-based freelance writer.

Early Defibrillation is Best Treatment

Every year, more than 950,000 Americans die from cardiovascular disease, making it the number one cause of death in the Unites States and Massachusetts. Sudden cardiac arrest claims the lives of at least 250,000 of those Americans before they reach the hospital. Many of these lives could be saved if bystanders act promptly to phone 9-1-1 and begin CPR, and use an automated external defibrillator (AED) within minutes. AEDs are userfriendly, computerized defibrillators that use voice prompts to lead a rescuer through the steps of defibrillation with a minimal amount of training.

Today less that 5% of sudden cardiac arrest victims survive. If emergency treatment is provided immediately, the American Heart Association estimates that perhaps as many as 40,000 of theses lives can be saved. By increasing public access to automated external defibrillator we can save lives in our communities.

Sudden cardiac arrest is most often caused when an abnormal heart rhythm called ventricular fibrillation (VF) develops. A heart in VF quivers instead of pumping blood. The victim collapses and becomes unresponsive. Bystanders who recognize the emergency, activate the EMS system and begin CPR improve the victims chance of survival. However, bystanders, who shock the heart with an automated external defibrillator (AED), can increase rates of survival much more. In cities with public access defibrillation programs, when bystanders provide immediate CPR and deliver the first shock with 3 to 5 minutes, reported survival rates from VF sudden cardiac arrest as high as 48 to 74%.

Early defibrillation is the best way to successfully treat most cardiac arrests. Time is critical. If a normal heart rhythm isn't restored in minutes, the person will die. In fact, for every minute without defibrillation, the chances of survival drop 7-10 percent. A cardiac arrest victim who isn't defibrillated within 8-10 minutes has little chance of survival.

Source: American Heart Association