Cardiac events in athletes: An Athletic Therapist’s perspective

There is nothing like a traumatic event, such as what happened to Damar Hamlin of the Buffalo Bills, to make everyone sit back and reevaluate things in their life. As Athletic Therapists (AT), we train and prepare to deal with such traumatic situations in sports, although hoping we never have to deal with one.

A cardiac event in a young, healthy athlete is something most people can’t imagine, but it, unfortunately, happens more than one would think. Research has shown this happens in between 1 in 40,000 and 1 in 80,000 athletes per year¹.  Most of the time, a previously undiagnosed heart condition is deemed the cause, but that doesn’t make it easier for people to accept. Although the focus is often on youth, it is more common in older adults, with an estimated incidence of around 21 per 1 million participants per year¹. As the population ages and an increasing number of older athletes participate in sport this becomes more significant.

When you watch an NFL, NHL, or CFL game, the first person to hit the field is usually an AT, you would easily recognize them from their fanny packs! In most high-level organized community sports, teams will have an Athletic Therapist on their sidelines or bench. ATs are often the first line of defence for most teams, for both major events like cardiac arrests and minor events like a sprained ankle. When working with professional teams, ATs will be part of a sports medicine team, which includes sports medicine physicians, other specialist physicians, and sometimes EMTs. They spend a significant amount of time practicing and coordinating their teamwork.

Athletic therapy has been around for a long time, but most people don’t know what we do or recognize us when they see us by the professional designation. We often get called “Trainers” but we are much more skilled than that. Our national association was formed in 1965 by therapists working with professional hockey and football teams. We are trained in pre-hospital emergency management, taping, concussion recognition, return-to-play decisions for athletes, and immediate care and rehabilitation of injuries.

Although highly essential in professional sports, ATs are even more important in community sports, as they often are on their own on the sidelines or benches. A situation similar to the recent NFL incident happened in Calgary a number of years ago. This led to the city getting AEDs for each of its recreational facilities. This was a huge step towards saving the lives of athletes, coaches and spectators. The skill set of an AT makes them the most qualified professional to be on the sidelines or benches. We have the most well-rounded, comprehensive training combining the clinic and the field.

Another step that can help save lives is having trained professionals working on the sidelines with teams. Research shows that upwards of 30% of athletes who have died from a cardiac event had reported symptoms such as chest pain and shortness of breath with exertion leading up to the event¹. At the higher levels of youth collision sports, most leagues require a qualified medical person to be present at all games, due to the increased risk of serious injury. The most common collision sports are hockey, football, rugby, lacrosse, and wrestling. The differentiation between contact sports and collision sports is that the athletes deliberately hit or collide with each other or inanimate objects, including the ground, with great force. A contact sport is where players come into contact with each other, so this list would include basketball and soccer.

In community and recreational sports leagues or non-collision sports, there is often no specific trained medical person at each game. Often a coach will have basic first aid, which is better than nothing, but it is not mandated by the league. Basketball has been shown to have 10 times the risk of other sports for sudden cardiac death, where it has been shown to be as high as 1 in 3,100 athletes per year³.

For effective treatment of an athlete experiencing sudden cardiac arrest you need a sequence of responses by well-prepared providers, so that the steps, when linked together, form a “chain of survival”³. The chain of survival includes the following:

1. prompt emergency medical system (EMS) activation;
2. early cardiopulmonary resuscitation (CPR) by a first or target responder (less than 2 minutes);
3. early defibrillation (2 to 4 minutes);
4. early advanced life support (less than 8 minutes); and
5. late advanced life support.

The first 4 links must have as short a time delay as possible to significantly increase survival rates. With the wait times that we are currently experiencing, having a highly trained person on the sidelines becomes even more critical a link in the chain.

It should be acknowledged that no one step will mitigate all the risks of a sudden cardiac event in youth sports. However, I believe that any effort that can be made to reduce the risk is worth the cost and effort. For anyone with kids playing sports, it is worth it to enquire with your team or association to ask about what steps they have taken to plan for the health and welfare of their athletes. If you need more information on how to get qualified people on the sidelines of your sports events, you can check out your provincial Athletic Therapy Association (AATA) for therapists in your area.