What is the purpose of the new sudden cardiac arrest (SCA) law, also known as Lindsay's Law, in Ohio?
Ohio Senate Bill 252 promotes the protection of athletes related to SCA who are involved in sports activities at the youth, middle school and high school levels. The law has three main components:
- Education on the risk factors, signs and symptoms of SCA for participants, parents and coaches in interscholastic and youth sports
- Identification of a protocol for assessment and written clearance for return to athletic activity if the student is known to exhibit specific risk factors, including fainting or syncope, during or following an athletic activity
- Definition of authorized licensed health care providers who can evaluate and make medical clearance decisions related to SCA
When did the law go into effect?
March 14, 2017
To whom does the law apply?
Any public or private school operated by a school district board of education, chartered and non-chartered non-public schools, and youth sports organizations (YSOs). The specific definitions of these entities can be found in the legislation for Ohio Senate Bill 252. Ohio law includes the following in its definition of athletic activity:
- Interscholastic athletics
- Club-sponsored sports activities
- Sports activities sponsored by school-affiliated organizations
What is SCA?
SCA occurs when the heart suddenly and unexpectedly stops pumping blood, stopping blood flow to the brain and other vital organs. It is unlikely that the heart will regain normal activity on its own and, therefore, must be treated with urgency. SCA is fatal if not treated immediately. The presence of an automatic external defibrillator (AED) is essential for the survival of someone experiencing SCA. Many times, SCA is caused by underlying issues or known risk factors, but it can occur in an otherwise healthy, physically active individual of any age, including child and adolescent athletes.
What risk factors should a coach look for related to SCA?
Determining risk factors for SCA requires an evaluation of the athlete's personal history and a detailed family medical history, as seen on the Pre-Participation Exam Questionnaire along with a physical evaluation conducted by a health care provider. Further evaluation and testing for a possible heart condition may be critical if any of the risk factors below are observed or occur during or after activity:
- Chest pain or discomfort with exercise/activity
- Fainting or passing out related to exercise/activity
- Excessive or unexplained shortness of breath related to exercise/activity
- Unusual or unexplained fatigue or dizziness related to exercise/activity
- Palpitations associated with exercise, including a racing heart
- Prior history of a heart murmur, prior heart evaluation or prior restrictions from competitive sports due to a heart condition
- High blood pressure
- Family history identifying one or more relatives with unexpected death, before the age of 50 because of known heart disease or a sudden or unexplained death (such as a single car accident or drowning)
- Special knowledge of family history of certain heart conditions including hypertrophic or dilated cardiomyopathy, long QT syndrome, Brugada syndrome, Marfan's syndrome or significant rhythm problems
The athlete who faints should be removed from activity until an evaluation is completed and a written clearance note has been provided to the coach indicatingsafereturn to activity from an authorized health care provider.
Despite the best efforts to educate, screen and identify those with risk factors, sudden cardiac arrest and sudden cardiac death do occur in the general population, including youth athletes. In some cases, the underlying cause is not able to be determined prior to the SCA event. Being educated and prepared to respond with an AED can help produce the best outcomes for the child.
What are the signs and symptoms that increase the risk of SCA?
Signs and symptoms commonly occur prior to SCA. Do not ignore symptoms. Youth athletes and those supervising them must be educated and instructed to immediately report any suspicious symptoms to parents so an appropriate evaluation for an underlying heart condition can occur. If an athlete faints or has a known episode of fainting, the coach is required by law to remove the athlete from activity. Be educated to recognize the following signs and symptoms that increase the risk of SCA:
- Chest pain or discomfort during exercise/activity
- Fainting during or after exercise/activity
- Excessive fatigue or dizziness related to exercise/activity
- Excessive shortness of breath related to exercise/activity
- Palpitations or a racing heart related to exercise/activity
What if an athlete exhibits the signs and symptoms of heart disease that can cause cardiac arrest?
The legislation states that if an athlete exhibits fainting (syncope) related to sport/activity, the athlete will be removed from participation by his/her coach. Additionally, the athlete cannot return to play untilBOTHof the following conditions are met:
- The athlete is evaluated by a physician or authorized health care provider as defined by Ohio state law.
- The athlete provides written clearance from the medical professional that an appropriate evaluation has occurred and the authorized health care provider has determined it is safe to return to sport/activity and competition.
All other worrisome signs and symptoms observed by a coach (chest pain or discomfort during exercise, excessive fatigue or dizziness related to exercise, excessive shortness of breath during exercise, palpitations or a racing heart during exercise) should be reported immediately to the parents to allow for review by their chosen health care provider to determine the risk of SCA.
When should an athlete be held from athletic participation for evaluation for diseases that cause SCA?
According to Ohio law, an athlete shall not be allowed to participate in an athletic activity in the case of the following:
- The athlete's biological parent, biological sibling, or biological child has previously experienced SCA, and the athlete has not been evaluated and cleared for participation in an athletic activity by an authorized physician.
- The athlete is known to have exhibited fainting (syncope) at any time before, during or following an athletic activity and has not been evaluated and cleared for return by an authorized health care provider. This includes during or after activity, physical education, weight lifting, conditioning, practice, competition or other school-affiliated activity or recreational physical activity.
The parent, assistant coaches, school nurse, physical education teacher, any other individuals supervising physical activity and the licensed athletic trainer should be informed of the athlete's removal from activity and be advised when the athlete has been cleared with a written note to return to activity by an authorized health care provider.
Who can make medical decisions related to return-to-play?
A physician, defined as an individual authorized to practice medicine and surgery or osteopathic medicine and surgery (i.e., MD or DO, including a physician who specializes in cardiology) or other licensed health care professionals authorized by the legislation may make return-to-play decisions. The authorized licensed health care providers include:
- Certified nurse practitioner
- Clinical nurse specialist
- Certified nurse-midwife
- Licensed physician assistant
- Licensed certified athletic trainer.
Authorized licensed health care providers may consult with any other licensed or certified health care providers in order to determine whether an athlete or student is ready to return to participation. Athletes must provide a written letter of clearance from an authorized medical professional that he/she may return to activity.
A family's pediatrician or primary care physician is an invaluable resource in assessing a child's risk factors and health status. They are trained to make the appropriate referral for additional testing or further evaluation based on a 14-Element Cardiovascular Checklist for Congenital and Genetic Heart Disease. These guidelines set forth by the American Heart Association were developed by a team of leading pediatric cardiologists from around the country and will direct the child's care.
What action should a staff member take if an athlete has an SCA?
SCA should be treated immediately to save the athlete's life.
Recognize acute symptoms of SCA:
- Fainting or collapsing and unresponsive
- Gasping, moaning, labored breathing
- Seizure-like activity
- No pulse
Activate the emergency action plan (EAP)
- Call 9-1-1, report symptoms to dispatcher
- Immediately begin CPR
- Retrieve AED immediately and place AED on the athlete, following prompts as soon as possible
- Use the AED as soon as possible, ideally within 5 minutes, to have the best success in restoring proper heart rhythm and have the best outcome for the athlete
Time is precious when dealing with an SCA episode. It is crucial that coaches, assistant coaches, referees/officials, administrators and athletic trainers work as a team to communicate, collaborate and initiate use of the AED immediately in order to provide the best outcomes for the athlete. It is best to have a plan in place that is practiced and understood by all parties before an emergency occurs.
What are the requirements for school-based coaches?
Ohio law requires interscholastic coaches to complete the following:
Complete the Ohio Department of Health approved training course on the signs, symptoms and risk factors of sudden cardiac arrest. This course is available on the Ohio Department of Education's website.
Verify course completion to school official or designated school district office. Coaches are required to renew the course each calendar year.
Review and comply with ODE requirements for coaches regarding CPR/AED certification.
Verify current OHSAA Athlete Pre-participation Physical Exam is on-file prior to athlete's participation in practices or games.
What are the requirements for youth sports organization (YSO) coaches?
Ohio law requires YSO coaches complete the following:
Complete the Ohio Department of Health approved training course on the signs, symptoms and risk factors of sudden cardiac arrest. This free course is available on the Ohio Department of Health's website.
Verify course completion to the designated organization official. Coaches are required to renew the course each calendar year.
What are the requirements for parents?
Parents/guardians and athletes are required to review, sign and submit Ohio Department of Health Parent-Youth SCA Signature Form every year for each sport/activity. The form must be turned in to a designated school or YSO official before the athlete participates in ANY activity. Forms can be found on the Ohio Department of Health's website. As the law directs, no alternative forms may be signed or submitted. The Ohio Department of Health Parent-Youth SCA Signature Form can be found on the school's website or at http://www.odh.ohio.gov/landing/Lindsays-Law.aspx.
What resources will help me implement this program?
Resources from the American Heart Association, the Ohio Department of Health, OHSAA, Ohio Department of Education, American Heart Association, Nationwide Children's and Project ADAM are available:
- Ohio Department of Health documents related to Lindsey's Law
- Ohio High School Athletic Association
- CPR and AED information
- Project ADAM for a Heart Safe School
- The Heart Center at Nationwide Children's Hospital
Athletic Administrators Checklist for Sudden Cardiac Arrest (SCA)
Compliance with Ohio law, Lindsay's Law
- Parent education approved by Ohio Department of Health with signed parent/athlete forms
- Coaches education approved by Ohio Department of Health with education course verification
- Pre-participation physicals for each athlete per Ohio High School Athletic Association guidelines
- Compliance with Ohio law on athlete clearance for activity with specific risk factors:
- Removal from activity or non-clearance if the athlete's biological parent, biological sibling or biological child has previously experienced sudden cardiac arrest, and the athlete has not been evaluated and cleared for participation in an athletic activity by an authorized physician.
- Removal from activity or non-clearance if the athlete is known to have exhibited fainting (syncope) at any time before, during or following an athletic activity and has not been evaluated and cleared for return by an authorized health care provider. This includes during or after activity, physical education, weight lifting, conditioning, practice, competition, or other school affiliated activity or recreational physical activity.
- Compliance with Ohio law on athlete clearance with fainting event
- Removal from activity or non-clearance if the athlete is known to have exhibited fainting (syncope) at any time before, during or following an athletic activity and has not been evaluated and cleared for return by an authorized health care provider. This includes during or after activity, physical education, weight lifting, conditioning, practice, competition, or other school affiliated activity or recreational physical activity and has not been evaluated and cleared for participation by an authorized health care provider.
- The athlete shall be removed by the youth athlete's coach from participation in an athletic activity if the athlete exhibits fainting (syncope).
- Compliance with Return to Participation written clearance by an Ohio law authorized health care provider
- Coaches' CPR/AED certification per Ohio Department of Education
- Emergency Action Plan (EAP) for unresponsive athlete
- Coaches' Pupil Activity Permit per Ohio Department of Education
- AED accessibility ideally within 5 minutes via squad or an on-site AED