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| June 28, 2007 |
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SPORTS AND SUDDEN DEATH
Triathlete should have been given CPR
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THE death of a healthy, young aspiring triathlete recently is truly sad. Sudden cardiac arrest is the leading cause of death among athletes worldwide. It is a well-documented phenomenon, not a medical mystery.
Sudden cardiac arrest risks are unfortunately extremely difficult to screen for, even with ECGs and chest X-rays. Thus medical examination of young, fit athletes is unlikely to identify individuals at risk.
In responding to the sudden collapse of the triathlete, several issues arose:
The first responders at the scene described him as having a weak pulse and therefore they did not begin car-diopulmonary resuscitation (CPR). On arrival at hospital, medical professionals described him as having no pulse.
A pulse check is known to be a very inaccurate way of ascertaining circulation. CPR training teaches individuals to look for 'signs of life' and this involves checking for breathing and movement. Lack of breathing is indication enough to start CPR. In a state of anxiety and panic, non-medical first responders often feel the bounding pulse in their own fingers and attribute it to the victim.
In the event of sudden collapse and an absence of medical personnel, the initial response should not have been to bundle the victim into a van and drive to hospital. A call to 995 should have been made immediately. An emergency ambulance staffed by trained paramedics and with a defibrillator would have been dispatched.
First responders should have initiated CPR on-site while waiting for the ambulance. When the paramedics arrive, they will deliver life-saving shocks at the scene, if indicated.
Despite several officials on-site being trained in CPR, errors occurred. The issue here thus becomes that of the competency of these individuals to render medical first response.
The lack of an on-site automated defibrillator (AED) and trained personnel to use it was an ill-fated oversight. To cite budgetary concerns as a reason is truly regrettable.
Just having an ambulance at sports events may not be the solution in itself. There are no regulations in Singapore governing the equipping of private/standby ambulances. Sadly, only one in 10 of non-SCDF ambulances has life-saving AEDs on board.
In summary, sports governing bodies must re-examine guidelines on the provision of event medical coverage. Personnel equipped, trained and competent in emergency medical first response must be present.
Only then can we say this life lost was not in vain.
Dr Charles Johnson
Emergency Physician
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