A thousand-dollar expenditure for an automated external defibrillator (AED) could mean the difference between life and death for some young athletes, a cost that one Little Rock, Arkansas high school knows too well.

A heart abnormality caused 16-year-old Antony Hobbs to collapse during his Parkview High basketball game in 2008. Hobbs was unaware of his condition, likely present since birth. Though an ambulance responded, he died about an hour after an otherwise ordinary game tip-off.

The outcome differed starkly two years later when another Parkview player, Chris Winston, collapsed on court with the same condition. A new state law, named for Hobbs, had required that AEDs be placed in schools, and AED use led to Winston’s survival.

While Arkansas’ policy followed tragedy, the National Athletic Trainers’ Association (NATA) and the American Medical Society for Sports Medicine are asking schools to proactively take measures to protect kids before summer training for fall sports.

“We’ve mostly been reactionary in terms of our preparations,” said Jonathan Drezner, a University of Washington sports medicine physician and co-author of an editorial in the Journal of Athletic Training that calls for emergency practice implementation in schools. “It shouldn’t be that a kid has to die for the school to be prepared,” he said.

In 2014, 11 high school football players died during practice or competition, according to the National Center for Catastrophic Sports Injury Research. Five deaths were a result of brain injury or cervical fracture. Six were the result of heart conditions, heat stroke or water intoxication.

“AEDs are a relatively inexpensive way of saving a life,” said Doug Casa, CEO of the University of Connecticut’s Korey Stringer Institute, which works to prevent sudden deaths in sports. Casa authored NATA’s “best practice” guidelines in 2012 for school sporting events.

In addition to calling for AEDs onsite, the guidelines advise schools to develop heat acclimatization programs, with phase-ins of equipment, along with gradual increases in intensity and duration of exercise. Football practice in early August is the most dangerous time for heat strokes in young athletes, according to the organization.

Concerning the danger of heat exhaustion and stroke local coaching staffs are trained to prepare and adapt their preseason workouts to late summer heat conditions.

“There is a state mandate that we follow dealing with a heat index chart and so we check with that chart frequently during practice sessions to make sure that our players are not being over exposed to the intense summer heat that we have in Kansas,” said GBHS head football coach Tony Crough. “As far as our August workouts we try to stay out of the heat of the day as often as we can. If it’s going to be a really hot day we’ll move practice up to the evening or practice early in the morning.”

Crough says hydration is a key element in taking proper safety measures. “We always make sure our kids are hydrated,” said Crough. “In addition to water we use ice towells which we place in ice buckets then members of our training staff will apply those towells to the back of the players’ necks to help regulate body temperature.”


The recommendations also call for schools to coordinate their emergency plans with local emergency services.

Nationwide adoption of the guidelines has proven slow, however. Only 14 of 50 states, for example, meet NATA “best-practices” regarding heat.

“There are two AEDs at the high school,” said USD 428 athletic trainer Ryan Zink. “One is located in the Panther Activity Center and the other in the commons in the main bulding so they’re readily available for most home events on campus.”

Zink said there are currently no state AED requirements for school campuses. “The high school has had the AEDs for as long as I’ve been here which is four years,” he said.

While no state AED requirements exist campuses that possess an AED are required to register their units.

According to marc.org Missouri and Kansas both require owners of AEDs to register with local emergency medical services so that emergency communications and medical services personnel may be aware of an AED placement within their jurisdiction.

In Kansas, “an automated defibrillator may be used by any qualified person ... who (1) has completed a course in cardiopulmonary resuscitation or a basic first aid course that includes cardiopulmonary resuscitation training and (2) has completed a course of training in the use of automated external defibrillators and (3) has demonstrated proficiency in the use of an automated external defibrillator.” -- KSA 65-6149a

According to the Sudden Cardiac Arrest Foundation, only 19 states have laws mandating AEDs in at least some schools.

Jason Cates, an athletic trainer for Cabot Public Schools in Cabot, Arkansas, was among those who worked for changes after Hobbs’ death to ensure the safety of Arkansas’ student-athletes. For districts with limited budgets, he suggests enlisting support from local booster clubs and parent-teacher organizations, and holding fundraisers during games.

To schools that install new turf or expensive video screens instead of safety measures, Cates says, “If you can afford to do that stuff, you can afford athletic health care.”