The new state mandate requires coaches, parents and children to learn about the dangers of sudden cardiac arrest. Already, some are pushing for modifications.

When father and coach Jeff Knupp starting learning about sudden cardiac arrest, what he learned scared him. “It takes one child … for something to happen,” he said.

Knupp has two sons who play sports, and he's also on the council for the 21-team Olentangy Stix travel baseball program. It's his role as a coach, though, that makes him nervous about the prospect of dealing with sudden cardiac arrest. When he coaches Olentangy Orange Pioneers travel basketball, he knows where the AEDS (automated external defibrillators, which are portable electronic devices used to treat sudden cardiac arrest) are located. But playing at different schools, or on outdoor fields—where AEDs are rare—is a different story. “Nobody tells you that stuff,” Knupp said.

As Knupp and other parents learn about sudden cardiac arrest as part of Ohio's new Lindsay's Law mandate, quick access to AEDs is one of the concerns they've had. Sudden cardiac arrest, also known as SCA, occurs when the heart unexpectedly stops beating, cutting off blood to the brain and organs. About 356,000 people of all ages experience out-of-hospital, nontraumatic sudden cardiac arrest each year, and 90 percent of those cases are fatal, according to the Sudden Cardiac Arrest Foundation. Access to an AED can mean the difference between life and death.

Lindsay's Law, which took effect last year as Senate Bill 52, requires parents and coaches to watch a video and read about the symptoms and dangers of SCA in youth sports. The law is named for Lindsay Davis, a Cleveland-area teenager who collapsed after a dance class and was diagnosed with hypertrophic cardiomyopathy, a genetic heart condition. She had to stop dancing but went on to become Miss Ohio as well as an actress, model and advocate for SCA awareness.

Schools operated by a public board of education have to comply with Lindsay's Law, as do nonpublic schools that are subject to rules of an interscholastic conference, or an organization that regulates interscholastic conferences or events, according to the Ohio Department of Health. Any teams participating in athletic competitions within the state have to comply, regardless of where the children live.

The legislation also requires that any child who faints before, during or after an athletic activity has to be cleared in writing by a medical professional. That same provision applies if a participant's biological parent, sibling or child has experienced SCA.

Purpose of the Law

Lindsay's Law aims to prevent SCA by identifying children with diseases that could cause it, said Dr. Naomi Kertesz, director of electrophysiology and pacing at The Heart Center at Nationwide Children's Hospital. The most common of these is Davis' condition: hypertrophic cardiomyopathy, which causes heart muscle to thicken. Congenital coronary abnormalities also could trigger SCA.

Shortness of breath, fainting, chest pain or an unusually fast or racing heartbeat could be symptoms of a disease that puts someone at risk of SCA, Kertesz said. Children also might be at risk if they have a relative who unexpectedly dies before age 50 or a family history of cardiomyopathy, long QT syndrome (a heart-rhythm condition) or other heart-rhythm problems.

If someone is suffering from cardiac arrest, he or she might be collapsed and unresponsive, gasping, snorting, moaning or breathing in a labored way, Kertesz said. Responding quickly is critical. An AED must be used within three to five minutes to correct the heart's rhythm to prevent any long-term damage, she said, which is why providing AEDs at sports practices and games is vital.

Project ADAM, offered locally by Nationwide Children's, provides free needs assessments to help schools create written emergency medical drills, Kertesz said. Many school staff members don't even know where their building's AED is, she said, and typically say they would get a nurse if a student faints. Instead, Kertesz said, they should begin CPR, call 911 and get an AED if SCA is suspected.

To be effective, however, AEDs must be maintained to ensure the batteries and pads haven't expired, Kertesz said. “You wouldn't buy an EpiPen, put it in a drawer and hope it works in 15 years, but that's what people do with AEDs.”

Amy Sheppard, a Delaware resident, has two sons, Trey, 12, and Robbie, 11, who play travel baseball. Sheppard said she wouldn't know where to find an AED at their games, though she doesn't think that's a reflection on coaches or the athletic association since SCA education just began with the advent of Lindsay's Law. “I'm not poking blame at anyone,” she said.

Karen Davis, a Lewis Center resident, would like to know which schools have AEDs and how parents can locate them in emergencies. Like Sheppard, Davis said she wouldn't know whether an AED was available at her son Kyle's baseball games. “Chances are somebody there might know how to use it,” she said. “Maybe.”

While Davis said reading about SCA to comply with Lindsay's Law was a bit scary, the information was important so she knows what to do in the event of an emergency. Though she has to sign a Lindsay's Law form for each of the sports her two children, Kyle, 11, and Karlie, 13, participate in, she isn't bothered by the redundancy. Knupp, however, said he's had to meet requirements for Lindsay's Law more times than he can count, and he believes the repetition seems excessive.

Compliance Complaints

Douglas Hare, president of the Central Ohio Youth Baseball League, said he's working with state Sen. Jay Hottinger (R-Newark) to streamline the portion of the law that requires parents of children who play more than one sport to fill out the form multiple times. Hare's league has about 3,900 families and 1,000 coaches.

Hare said he's received a couple positive comments since the law took effect, and a few complaints from parents and coaches, the latter of whom have to collect the forms. One parent reportedly told a coach that requiring an 8-year-old to sign a form was ridiculous. “In my mind, it's teaching him responsibility,” Hare countered.

The Ohio High School Athletic Association's position is that its coaches already are qualified to deal with SCA through CPR and first-aid certifications, the latter of which must be fulfilled every three years, said Deborah Moore, OHSAA's senior director of compliance and sports medicine. For this reason, the association lobbied against Lindsay's Law in 2016, she said, though after the law passed, it helped design the video and reading material with the Ohio Department of Health.

High schools ultimately are responsible for ensuring coaches have complied with the law and also making sure every parent and student has done so as well, Moore said. “Most everybody just accepts it.”

Still, some contend that requiring coaches to go through the process on an annual basis is too frequent, Moore said. In comparison, the association requires concussion training every three years, and some CPR training is required every other year.

OHSAA's suggestion to incorporate a mandate into Lindsay's Law requiring all high schools to have AEDs was rejected, Moore said. Nonetheless, she estimates nearly all high schools within the state have AEDs in indoor and outdoor sports facilities. “We believe very strongly that the percentage is quite high,” she said.