Gerry Bram, an NCAA Division I football referee, is alive today due to the availability of a defibrillation device and the swift actions of the sports-medicine staff from Syracuse University.

University and college athletics programs are in a unique position to raise public awareness of the life-saving capabilities of automatic external defibrillators (AEDs) just by having them available for the people they service.

Sudden cardiac arrest was responsible for about 490,000 deaths in 1999, according to the Center for Disease Control, and only about half of those victims made it to the hospital. Tomorrow, about 1,000 people will suffer a cardiac arrest in our country, and only about 50 will survive. Most of those deaths are unnecessary.

In the collegiate athletics environment, the risks of sudden cardiac arrests are present with our coaches, referees, staff members, bus drivers, fans and even student-athletes. Most cardiac arrests are caused by a disruption in the heart's normal rhythm. This rhythm disruption most often results in a condition called ventricular fibrillation, where the heart maintains an electrical charge, but it is essentially misfiring.

Defibrillation is the technique involving the administration of an electric shock that can restore the heart's normal rhythm. While this procedure historically has been available only from paramedics or in hospital settings, the development of a portable computer that can analyze a person's heart rhythm has enabled lay people, coaches and sports-medicine staff members to be trained to perform this procedure. These portable devices, about the size of a lightweight laptop computer, are increasingly more practical to have available.

Remarkable outcomes

Sudden cardiac death in young athletes is a rare but devastating occurrence. Although attempts are made to identify athletes at risk for cardiovascular disease, many have no symptoms and no physical examination findings. Structural cardiac abnormalities are the most common cause of sudden cardiac death in student-athletes. Because of the difficulty in identifying these underlying anomalies, the accessibility of an AED is important in the event of a life-threatening dysrhythmia.

Truly remarkable outcomes are seen when defibrillators are used on sudden cardiac arrest victims. The success rate of restoring normal heart rhythm through standard CPR techniques is less than 5 percent. Add defibrillation within the first minute after arrest, and it becomes an amazing 95 percent. Communities who have initiated Public Access Defibrillator (PAD) programs that place AEDs in ambulances, police cars, and other public locations are experiencing sudden cardiac arrest survival rates of as high as 43 percent, compared with large cities with no such program where the survival rate drops as low as 1 percent.

Paramedics nationwide will be the first to admit that their life-saving attempts in cases of cardiac arrest are rarely successful. The time it takes for the emergency squad to respond to a 911 call is usually greater than 10 minutes. Those precious minutes are the critical difference between life and death. As mentioned, 90 percent of sudden cardiac arrest victims who are treated with a defibrillator within the first minute of arrest can be saved. However, for every minute that defibrillation is delayed, there is about a 10 percent reduction in the chance for survival.

AED availability

The value of having these devices appears obvious. However, liability concerns, quick availability of emergency personnel, training requirements, cardiac risk of the population and the cost and maintenance of the machines are among valid concerns that have arisen regarding the need for having AEDs at athletics venues.

The liability risk of using an AED was addressed when in 2000 President Clinton initiated a bill that grants legal immunity to good Samaritans who use AEDs. Since then, most states have rewritten their own good Samaritan laws to include language about the use of AEDs.

From another angle, a plaintiff in a fitness facility received a $2.5 million award after a lawsuit charging the facility for not meeting a member's emergency-response needs when the plaintiff had a heart attack and there was no AED available (Chai versus Sports Fitness Clubs of America, Circuit Court, 17th Judicial District, Broward County, Florida). This suit may represent a shift toward requiring fitness-related facilities to have AEDs available.

All instructors of CPR through the American Heart Association and the American Red Cross are now trained in the use of AEDs. The NCAA currently recommends annual training of athletics personnel in CPR. The inclusion of AED education within that training would be practical and time efficient.

Although the cost of AEDs is dropping, most still range between $2,000 and $4,000, a hefty sum for many athletics departments. For state institutions, the U.S. Senate passed the Community Access to Emergency Defibrillation Act in 2001, which budgeted $55 million a year for five years for communities to install AEDs in public places, to train first responders, to encourage private companies to purchase AEDs, and to promote public access to defibrillation in schools. Grant applications can be sent to the Secretary of Health and Human Services. More information on the details of this act is available at www.senate.com.

Public access to AEDs is critical for successful intervention. The statistics speak for themselves and the cost of saving one life certainly justifies the purchase price of a unit.

Douglas P. Zipes, former president of the American College of Cardiology, said in a recent New York Times article, "I have a cure for sudden death: it's getting a defibrillator to the patient. The problem is getting it to them in an appropriate time interval. How can I make that happen?"

The initiation of PAD programs by colleges and universities has created results that travel like waves from campus communities all the way to state legislation. Those who have recognized the need are spreading the awareness and making a difference.

Athletic trainers promote AED use

There are countless stories of university and college medical teams using AEDs to save lives. As a result, many have impacted the awareness and availability of AEDs on their campus and also in their surrounding communities.

Stephanie Brandt, athletic trainer at Concordia College, Moorhead, was glad the school purchased its AED when it did. Less than one month afterward, a retired professor had a massive heart attack after playing a lunch-hour basketball game in the athletics building. "He is alive today, two years later, because of the training I obtained and expedient use of the AED by myself and others," Brandt said.

The medical staff at Syracuse University, including athletic trainer Tim Neal and team physician Irving Raphael, joined forces with athletic trainers from East Carolina University to save the life of a football referee during the teams' game in September.

At a University of Iowa wrestling match, the device was used after the collapse of a spectator in the bleachers. Iowa athletic trainer Dan Foster said, "The results were dramatic. The immediate success has resulted in a continued high quality of life for the patient. That one incident has resulted in an increase in AED purchases in the community, general public awareness, and changes in the AED regulations in the state."

Athletic trainers nationwide are spearheading Public Access Defibrillator programs on their campuses and in their communities. These programs market the development of phases to initiate the availability of AEDs in public places. Initially, they are made accessible on all ambulances, followed by police cars and campus security, and then in public buildings. Communities that recognize PAD as a priority are using ingenuity to make it happen.

Rochel Rittgers is the director of athletic training services at Augustana College (Illinois). She chairs the drug-education and drug-testing subcommittee of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.