Orlando Sentinel | by Leslie Postal | May 4, 2021
Teenagers who want to play sports for Orange County Public Schools will need to get electrocardiograms before they are cleared for athletic participation under a new rule that seeks to identify students at risk of sudden cardiac arrest.
The Orange school district will require ECGs, also known as EKGs, starting with the upcoming fall high school sports season. It follows the Brevard and Osceola county school districts, the first in Florida to adopt such policies when they enacted them in 2019. The Volusia County school district will make ECGs mandatory in 2022.
“It saves lives. It’s that simple,” said Orange County School Board member Pam Gould.
The board made the decision after hearing from one Osceola County parent who said it did exactly that.
The test will cost $20 during sports physical events at OCPS high schools, with financial assistance available if families cannot pay and for those without health insurance who might need follow-up care. Parents can also contact their child’s pediatrician or other private health care providers to arrange an ECG, just as they can have the required sports physicals privately done.
The school events in Orange, as in Brevard and Osceola, are being run by the non-profit Who We Play For. The group’s mission is to provide low-cost heart screenings and stop sudden cardiac arrest from being the leading cause of death in student athletes. It was started by friends of a Cocoa Beach High soccer player who collapsed from severe cardiac arrest during a 2007 practice and died a day later.
Though rare, undiagnosed heart problems kill children every year with little warning in part because they are not picked up by traditional physical exams done by pediatricians or those required for athletic participation. An ECG, however, will detect many of those heart abnormalities.
The Orange school board voted unanimously last week to adopt the new policy for any would-be athlete. Students taking part in marching band and ROTC military programs will be encouraged to get EGCs, too, and could be required to by next year.
The district has about 15,000 students who play sports each year. Students will need the ECG screening just once during their four years of high school, and screening events will be held ahead of each sports season.
In Brevard, nearly 6,000 students were screened the first year of its program, with 97% cleared to play based on a normal ECG, according to information presented to the Brevard County School Board in December by Dr. Gul Dadlani, chief of cardiology at Nemours Children’s Hospital, who helped do a study of the screenings.
The 199, or 3%, who had abnormal ECGs were referred for follow-up tests with cardiologists. Eight were determined to have “critical heart disease” that could put them at risk of sudden cardiac arrest.
When Shauna Scarborough learned last year that her 14-year-old would need the test to play sports at Harmony High School in Osceola, she admits she didn’t quite get why.
“This is kind of silly,” she thought. “She’s an athlete. She’s fine.”
Then she got a call that her daughter Ashlyn’s ECG wasn’t normal. She still doubted anything was really wrong, but she followed up with a cardiologist as recommended. There she learned her daughter had Wolff-Parkinson-White syndrome, a rare but serious condition that leads to extra electrical pathways in the heart and, sometimes, a dangerously rapid heartbeat.
Her daughter, who has been playing flag football since she was 8, was at “severe risk” of cardiac arrest, especially during strenuous athletic activity.
A hospital procedure last summer eliminated the extra pathways in Ashlyn’s heart — and the problem. The teenager, now 15, was cleared to play on Harmony’s team this spring and made the varsity squad.
“I couldn’t be more thankful, of course,” her mother said. “We wouldn’t have known until the unthinkable happened.”
Scarborough spoke at a recent Orange school board meeting, urging adoption of the new ECG policy. “A five-minute ECG done at a school physical saved her life,” she told the board, tearing up as she spoke.
Martha Lopez-Anderson, an Orange mother whose 10-year-old son died of sudden cardiac arrest while rollerblading in 2004, also spoke in favor of mandatory ECGs. Her son Sean had had a check-up about a month before he died, said Lopez-Anderson, who after her son’s death helped found Parent Heart Watch, which calls itself the national voice to protect children from sudden cardiac arrest.
“They look like the picture of health, my son included,” she said. “Your child may look fine, but there could be a silent killer lurking in their hearts.”
ECGs are quick and painless, experts say, with a dozen stickers attached to the patient’s chest, connecting electrodes to the machine that records the heart’s electrical signals. The results are read later by a cardiologist. As in Brevard, typically, about 97% of those screened show normal results.
Some students with abnormal results may need nothing more than monitoring. Others may need medication or surgical procedures and a few may not be able to take part in sports.
“Why wouldn’t you want your child screened?” Dadlani said. “The test is simple, non-invasive and low cost, and it can save your child’s life.”
Dadlani, who has volunteers with Who We Play For to read ECGs administered in Brevard and Osceola schools, commended OCPS for taking the same step.
Some countries, including Italy and Japan, do ECG screenings routinely on children, and they are required for many collegiate athletes in the United States.
But across the state and nation, there has been resistance to such screening programs for school sports. A bill filed this year by an Osceola lawmaker would have required electrocardiograms for all students playing sports governed through the Florida High School Athletic Association. That part of the bill by Rep. Fred Hawkins, R-Saint Cloud, however, was stripped out, leaving just a new requirement for CPR instruction, before it was approved by the Florida Legislature.
ECGs for all student athletes is part of a “growing conversation” nationwide, House staff wrote in an analysis of the bill. But requiring ECGs raises questions about cost — the full price of the tests can range from $50 to $1,200 depending on insurance and facilities — and access, the staff analysis said. Some researchers worry the tests “may carry a high false-positive rate for abnormalities compared to the relatively low rate of cardiac arrest.”
Evan Ernst, executive director of Who We Play For, however, said that when the international standards for ECGs are followed only a tiny percentage end up with false positive results. He also said that his group’s fundraising and work by Advent Health, which will be offering free ECGs to Volusia students, and Nemours, among others, have helped make ECGs affordable and available in Central Florida.
Ernst was a childhood friend and teammate of Rafe Maccarone and was on the field when the Cocoa Beach student collapsed. It was later determined the 15-year-old had a heart abnormality that likely could have been spotted by an ECG. Ernst’s group hopes that eventually all children will get such screenings before they start to play.
“It should be the standard of care for all kids,” he said.
Image: Ashlyn Scarborough, 15, is a student at Harmony High School in Osceola County. A required ECG before she was cleared to play flag football for the school showed a heart abnormality. It was corrected in a hospital procedure in July, 2020, and the ninth grader was able to play football for Harmony’s spring season. – Original Credit: Scarborough family (Courtesy photo)