Legislation eyes cardiac emergency plans

Legislation eyes cardiac emergency plans

When it comes to responding to a cardiac arrest, Bristol resident Payton Jones knows firsthand how having the right people and resources nearby can mean the difference between life and death.

Jones, 24, suffered a cardiac arrest during a swim meet when she was 11-years-old due to an undiagnosed heart condition — Catecholaminergic Polymorphic Ventricular Tachycardia, which is characterized by an abnormal heart rhythm that often occurs during exercise or emotional stress.

Jones was in the middle of a swimming race when she suffered the cardiac arrest.

“Luckily there was a doctor already there that was a parent of one of the teammates, and the lifeguard was there,” Jones recalled. “We were in Essex, which was fortunate because we were right by (the University of Vermont Medical Center).”

The teammate’s father began CPR to revive Jones, and first responders with the Essex Fire Department and Essex Rescue quickly arrived on the scene and continued CPR. The first responders shocked Jones with an automated external defibrillator, or AED, four times during transport to the hospital.

Jones says she’s lucky to be alive.

She’s among a group of Vermonters advocating for legislation that would require cardiac emergency response plans to be in place at Vermont schools and athletic venues, ensuring a trained team and necessary equipment are on hand in the case of a cardiac arrest or similar emergency.

That legislation is expected to be introduced this legislative session by Sen. Ginny Lyons. During the 2023-2024 session, the Williston Democrat introduced S.280, a bill that would require Vermont school districts and independent schools to develop cardiac emergency response plans — a written document that outlines specific steps to reduce death from cardiac arrest in schools, community organizations and sports facilities.

The bill was referred to the Senate Education Committee but did not progress further.

The legislation expected to be introduced this session would largely resemble S.280, aside from some language changes to reflect how athletic departments use Emergency Action Plans to respond to emergencies.

PREPARE TO TAKE ACTION

Tina Zuk is the Government Relations Director at the American Heart Association Vermont, which is promoting the legislation. She noted that the survival rate for cardiac arrests is around 10%, butcan double when a cardiac emergency response plan (CERP) is in place.

Cardiac arrest occurs when the heart malfunctions and unexpectedly stops beating, according to the American Heart Association. Cardiac arrests are triggered by an electrical problem in the heart that causes an abnormal heartbeat. This isn’t the same as a heart attack, but heart attacks can be a cause of cardiac arrest.

It’s estimated that around 24 cardiac arrests have occurred at Vermont schools in the past decade, including earlier this month when a Milton High School sophomore went into cardiac arrest during a basketball game at Spauling High School.

“The reason we’re pursuing this legislation is we want to just make sure that there’s the best possible chance of survival should a cardiac arrest happen either at a school or a sporting event,” Zuk explained. “It could be a youth, it could be a visitor, it could be a sports official, it could be an athlete, but no matter who it is, that we’re prepared in schools and sporting events to take action.”

The legislation would require schools to develop a CERP and outlines several requirements for those plans, including establishing a cardiac emergency response team of CPR-trained individuals ready to spring into action, guidelines for when that team is activated in response to a cardiac event, a plan for placing and maintaining AEDs, and conducting practice drills.

The legislation would also require school officials to be in communication with local emergency responders about the plans.

“We think it’s a really good piece of legislation because it allows schools that have lay responders to be trained and take action when there’s a crisis,” Zuk said. “What better reward than having a student, or an official or an athlete or whoever it is, has a cardiac arrest at your school and you can save them versus the other handwringing that you’ve lost a life.”

The legislation would require certain school staff, as identified in the CERP, to be trained in first aid, CPR and AED use. AEDs can detect an irregular heart rhythm and, if necessary, deliver an electric shock to the heart to return it to a normal rhythm.

Zuk noted that around 211 Vermont schools or school districts have AEDs. Fewer schools have CERPs in place. Zuk referenced a survey conducted by a class at the University of Vermont Robert Larner College of Medicine this past fall, which found that 84 out of the 160 schools that responded had a plan to address cardiac emergencies.

IN ADDISON COUNTY

School officials around Addison County are in the process of developing and implementing such plans. Middlebury Union High School Lead Nurse Kelly McGovern said she and other nurses in the Addison Central School District have been working on CERPs for the district’s schools with the goal of having them in place by this spring.

“We wanted to preemptively start working on a cardiac emergency response plan knowing that this legislation was coming through the pipeline and hoping that it will certainly pass, because it just makes a lot of sense to have this in schools,” she told the Independent. “All of our nurses in the Addison Central School District have met and talked about what this will look, and we’re working individually in our schools to create this plan, determine who that team will be.”

McGovern noted that school officials have worked over the past several years to ensure all ACSD schools are equipped with AEDs.

Currently, the responsibility of coordinating a response to a cardiac emergency falls on the school nurse. That can be tricky as not all district schools have a fulltime nurse, McGovern noted, and in the absence of a school nurse, a healthcare designee (usually an administrative assistant or paraeducator) would take those responsibilities.

She pointed out that, in the case of MUHS, there are several staff members with ties to local fire departments and emergency medical services that could jump into action in the case of a cardiac emergency.

“What’s nice about having a cardiac emergency response plan is that it’s really comprehensive and having a team … and having a way to alert folks if there’s a cardiac emergency and make sure people come together, that’s the part that’s missing,” McGovern said. “Having that plan in place will help ensure the best outcome for people and get them the help they need.”

McGovern noted that any student could suffer a cardiac arrest, though some students have cardiac histories or conditions that make them more susceptible to such events. Having a CERP in place could provide peace of mind to those pupils and their families.

McGovern is president of the Vermont State School Nurses Association, one of several organizations that supports the legislation.

“I do think it’s a great bill. I do hope that it gets passed and ensuring schools at a minimum do have AEDs in place, and that there’s a team to respond to these emergencies,” she said. “These things do happen at schools. They don’t happen often, but obviously if there’s a cardiac emergency the timing of the response and having the right equipment is crucial to ensuring the best outcome.”

AN APP FOR EMERGENCIES

School officials in other parts of the county have also taken steps to make sure plans are in place. At Bristol’s Mount Abraham Union High School, Athletic Director & Activities Coordinator Devin Wendel and Athletic Trainer Meg Quiet have developed an app that compiles Emergency Action Plans for each of the school’s sports venues, from the football field to the wrestling room.

Quiet explained that an Emergency Action Plan (EAP) is a predetermined plan that gets posted at each of the school’s sports venues and outlines the steps that should unfold in an emergency.

“They are broad in the sense that it’s something that the coach and the kids can carry out with or without medical staff being present,” she said. “If I’m not here they can still access this; they can look at this and know what the steps are, which are call 911, any needed medical equipment that they need and where it’s located … where to tell EMS to enter the building, so it includes steps for all of that stuff.”

In addition to having EAPs posted in each sports venue, Mt. Abe coaches are trained in the plans and prepared to take action whether or not Wendel and Quiet are around. Plans are also rehearsed with local emergency responders.

Wendel noted that the school had fairly comprehensive EAPs in place when he and Quiet began working at Mount Abe in 2016.

He later stumbled upon Glide, software for building apps. Using that program, Wendel and Quiet developed an app that acts as an all-in-one EAP platform that coaches can easily access on their phones. Coaches are trained on how to use the app — in addition to CPR and AED training — every two years, and the app is shared with coaches during informational meetings each season.

In addition to the Emergency Action Plans, the app includes maps and contact information for Wendel and Quiet, as well as for each of the school’s coaches and local first responders.

When it comes to responding to cardiac emergencies, Wendel noted Vermont Principals Association-member schools have been required since 2016 to have coaches trained in hands-only CPR and AED use every two years.

“I think that on the athletic side of things, at least as far as schools go, we are ahead of the curve right now, and we fully support anything that can help to push that along and make sure that schools are equipped and outfitted and trained and rehearsed in providing that emergency care,” he said.

Another requirement of the CERPs established under the legislation would include ensuring AEDs are accessible and available, Zuk said.

“God forbid a school has an AED, but they lock their doors at night, and sports are going on afterwards and the sports don’t have an AED and can’t get into the building,” she said. “There really is a short window of opportunity because every minute that passes without CPR or defibrillation your chance of survival decreases by 10%, so you really have to act fast, and that’s why it’s so important for these schools to have plans.”

The potential to ensure schools are prepared to act in the case of a cardiac arrest is part of why Jones supports the legislation.

“I think it’s very important to get more people involved and educated on the issue,” she said. “That way when things do happen there’s more people with the education and skills to provide the care that these people need.”

Jones highlighted drills and ensuring AEDs are readily available as other key parts of the legislation.

“I think it would be really important that all schools and other public buildings should have AEDs available, and maybe more than one on hand,” she said. “I know some schools only have one or two, so it would be handy to have more available.”

The legislation has gained support from several organizations around the state, including the Vermont Association of Athletic Trainers, the Society of Health and Physical Educators of Vermont, the Vermont Medical Society and the University of Vermont Health Network.

The American Heart Association Vermont plans to further promote the legislation during a lobby day on Feb. 7. The association was also planning to offer a hands-only CPR training for lawmakers outside the Statehouse cafeteria on Jan. 24.

“Anyone can learn that, and we’ll have mannequins there, so lawmakers can take a minute or two to try it so that they’re prepared and won’t be in that situation where if something happens, they would be too fearful to act,” Zuk said.