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 parts:
Coaches, parents and participants in school or youth sports must be educated on the signs, symptoms and risk factors of SCA.
Students who have shown specific risk factors or who have fainted during or after athletic activity are required to get written clearance from an authorized health care provider before returning to physical activity.
Authorized, licensed health care providers identified in the law can evaluate and make medical clearance relating to SCA.
When did the law go into effect?
March 14, 2017
Who does the law apply to?
Any child/athlete who plays sports in one of the following groups:
- School - public or private
- Schools operated by a school district board of education
- Chartered and non-chartered non-public schools
- Youth sports organizations (YSOs)
Specific explanations of these groups can be found in Ohio Senate Bill 252. Ohio law includes interscholastic (school-based) athletics, cheerleading, club-sponsored sports activities and sports activities sponsored by school-affiliated organizations in its definition of “athletic activity.”
What is SCA?
SCA happens when the heart suddenly and unexpectedly stops pumping blood. This stops blood flow to the brain and other vital organs. It is rare and unlikely the heart will start again on its own, so SCA must be treated immediately. SCA is fatal if not treated immediately. An automatic external defibrillator (AED) is essential for the survival of someone experiencing SCA. Many times, SCA is caused by risk factors that are already known to the family. It's important to know SCA can also happen to an otherwise healthy, physically active person of any age, including teenage athletes.
How do I know if my child is at risk?
Determining risk factors for SCA requires a detailed review of the athlete's personal health history, a detailed family medical history – as seen on the Pre-Participation Exam Questionnaire – and a physical examination conducted by a health care provider. Your health care provider may order more testing for a possible heart problem if any of the following are present:
- Chest pain or discomfort with exercise /activity
- Fainting or passing out when related to exercise/activity
- Excessive or unexplained shortness of breath with exercise/activity
- Unusual or unexplained fatigue or dizziness with exercise/activity
- Palpitations (racing heart) associated with exercise/activity
- 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 age 50 because of known heart disease or a sudden or unexplained death (such as single car accident or drowning)
- Special knowledge of a family history of certain heart conditions including hypertrophic or dilated cardiomyopathy, long QT syndrome, Brugada syndrome, Marfan's syndrome or significant rhythm problems
Despite the best efforts to identify those with risk factors and to educate people about SCA, sudden cardiac arrest and sudden cardiac death do occur in the general population, including youth athletes. In some cases, the cause is not able to be determined before an SCA event. Being informed about SCA and prepared to respond with an AED at any time can help deliver the best outcomes for the child.
What happens if my child has identified risk factors?
If risk factors are found during a well-child examination, or during a pre-participation examination (PPE), your child's doctor will decide if a referral for more cardiovascular evaluation is needed. These risk factors are found through a detailed personal history, a detailed family medical history and a thorough physical examination. It's important for parents/guardians to use great care when completing the history questions of a PPE. This helps your child's doctor complete a proper and thorough family and medical history evaluation. If your child's doctor determines the need for further evaluation or testing, he/she may refer you and your child to a cardiologist.
What are the signs and symptoms associated with increased risk for SCA?
Signs and symptoms commonly occur before an SCA event. Don't ignore symptoms! Youth athletes, parents and coaches must be taught to immediately report any symptoms suspicious for SCA. 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 related to exercise/activity
- Fainting during or after exercise/activity
- Excessive fatigue related to exercise/activity
- Excessive shortness of breath related to exercise/activity
- Palpitations or a racing heart associated with exercise/activity
What happens if my child exhibits the signs and symptoms of heart disease that can cause cardiac arrest?
Ohio law states that if an athlete exhibits fainting (syncope) related to sport/activity, the athlete will be removed from participation by his/her coach. The athlete cannot return to play until BOTH of the following conditions are met:
- The athlete is evaluated by a physician or an authorized health care provider as defined by Ohio state law.
- The athlete provides written clearance from the doctor or authorized health care provider that an appropriate evaluation has been done, and the physician or authorized health care provider has determined it is safe to return to sport/activity and competition.
Other signs and symptoms of heart disease that can cause sudden cardiac arrest observed by or reported to the parent should be discussed with a 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 the Ohio law, an athlete shall not be allowed to participate in an athletic activity if:
- 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 fainted (syncope) at any time before, during or after an athletic activity and has not been evaluated and cleared for return by an authorized health care provider. This includes during or after activity, school recess, physical education, weight lifting, conditioning, practice, games or competition, or other school affiliated activity or recreational physical activity.
- The athlete shall be removed by the youth athlete's coach from participation in an athletic activity if the athlete displays fainting (syncope).
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 professional authorized by the law can decide when an athlete may return-to-play. The list of authorized licensed health care providers described in the law includes:
- Certified nurse practitioner
- Clinical nurse specialist
- Certified nurse-midwife
- Licensed physician assistant
- Licensed certified athletic trainer
The authorized licensed health care providers listed above may consult with any other licensed or certified health care providers to decide if 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.
Your pediatrician or primary care physician is a valuable resource in assessing your child's risk factors and health status. They are trained to make a 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.
Are there any other requirements for parents?
Parents/guardians and athletes are required to review, sign and submit the Ohio Department of Health Parent-Youth SCA Signature Form every year for each sport. 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. No alternative forms may be signed or submitted. You can find the Ohio Department of Health Parent-Youth SCA Handout and Signature Form at your school's website or at http://www.odh.ohio.gov/landing/Lindsays-Law.aspx.
Are coaches educated on SCA?
Yes, all interscholastic (school) coaches and youth sports organization coaches are required to complete education on SCA. This training must be completed every year. It is important that athletes, parents, coaches and organization administrators are educated and prepared.