Are schools prepared to respond if a student’s heart stops? Data shows some aren’t

A 56-year-old football official went into cardiac arrest on the sideline at Jefferson High School in Lafayette in 2006. Then, a teenager who was playing basketball during lunch at the school's Tecumseh Junior High gym went into cardiac arrest a decade later.

Both were in the Lafayette School Corporation. Both survived.

The district’s preparation for a heart emergency was a significant factor in keeping them alive. Jefferson High School in Lafayette, Ind. has 25 automated external defibrillators on its campus. An AED is a device that sends a shock to the heart to try and revive a heartbeat.

“I would not want to be in a situation where somebody went down and you didn't have an opportunity to save a life,” said the school’s athletic trainer, Jeff Clevenger.

Chances of a cardiac arrest victim surviving are higher if CPR is done and someone is able to quickly access an AED. For instance, Clevenger said there’s more than one AED in the athletic area because it would take more than three minutes to run from one gym to another. That’s why Jefferson High keeps AEDs on the walls with clearly marked signs.

“If you have one at the nurse's office, and she has to run up to the third floor with the AED, that's not not an ideal situation,” Clevenger said.
 

Classrooms also have a map of where the AEDs are located.

But not all schools are this prepared.

Side Effects Public Media found that some Indiana schools do not have enough AEDs to adequately respond if someone goes into sudden cardiac arrest on their campuses.

A sudden cardiac arrest is when someone’s heart stops pumping blood and the person is no longer conscious or breathing. It can happen if a person has a heart condition, and exercise can trigger erratic heart rhythms that cause the person to stop breathing. Cardiac arrests can also happen when someone is sitting in a classroom, walking or even while sleeping at home.

In children, 9 out of 10 times it’s deadly.

Medical professionals say schools should have multiple AEDs throughout the inside and outside of the facility so it’s easily accessible within three minutes in case of an emergency –– that’s one and a half minutes getting to the AED and another one and half minutes walking back to the victim. They say the devices should be near gyms, in hallways on each floor inside the school, near the administrative office or nurse's office and at outdoor facilities.

The Indiana Department of Education collected data last summer on the number of AEDs and emergency action plans in schools statewide as part of a law that aimed to help address sudden cardiac arrest in schools.

Only 54% of Indiana’s public, charter and private schools responded to the state survey. Of those schools, Side Effects Public Media found that 41% of schools with a maximum grade level of 12th grade had less than four AEDs. For public schools, nearly 40% had less than four AEDs.

But it can be difficult to determine exactly how many AEDs are needed per school. Lynn Nelson, president-elect of the National Association of School Nurses, says three AEDs might be enough for some small schools, but it depends. Other experts say big campuses, like many high schools, should have four or more AEDs.

“Schools differ so much in, not only size of the school, but the way campuses are laid out,” Nelson said.

There’s limited data and research on the number of AEDs in schools across the country. Indiana and Kentucky are the only Midwest states that have collected statewide data on the number of AEDs in schools. Illinois, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota and Wisconsin don’t. Oklahoma didn’t respond to requests before this story was published.

In Kentucky, all of the state’s public schools submitted data on the number of AEDs. Side Effects also found at least 70% of Kentucky high schools didn’t have access to four or more AEDs.

Schools need a response plan

The average survival rate across the country for pediatric out-of-hospital sudden cardiac arrest is roughly 11%. Jon Drezner, director of the University of Washington’s Medicine Center for Sports Cardiology, said the chance of survival declines about 10% per minute that defibrillation is delayed.

“So if you are dependent on the responding ambulance and their responding EMS — which on average is about eight to nine minutes in most communities — you already have a low survival rate,” said Drezner.

But simply having an AED doesn’t mean schools are adequately prepared to address a heart emergency. They also need an emergency action plan to respond. These plans may differ, but they typically ensure staff know where an AED is located and require someone to maintain it by changing its batteries and pads as needed.

Drezner’s research shows if schools are prepared with AEDs and a response plan, survival rates can be as high as 85% for students, 61% for adults and 89% for youth athletes.

Side Effects’ analysis of the same IDOE data — which only half of the schools responded to — also found that a quarter of those schools don’t have a response plan related to a sudden cardiac arrest. Drezner said it’s unacceptable.

In 2013, Julie West’s son, Jake, died after he collapsed and went into sudden cardiac arrest on a football field at a high school in LaPorte, Ind. from an undetected heart condition. His school had an AED, but it was in the coach’s office and not easily accessible, his mom, Julie West, said. She now advocates for schools to have proper safety protocols in place.

“You can say, ‘I have an AED,’ but do you have a plan? And most of the time we don’t,” West said. “I've seen AEDs with dead batteries, I've seen AEDs locked up, I've seen AEDs with expired pads. Because I think they were put up and like, ‘Okay, I did it.’ But you didn't do it all the way.”

Part of an emergency response plan should also include knowing how to do CPR while someone else is getting the AED, and in-between shocks from the device. Nelson of the Nurses Association said each state has different requirements for who needs to be trained to perform CPR.

“I think people would be surprised how few people actually have the full CPR training in a school district,” she said. “And that's a really important part of an emergency response plan.”

Researchers say schools should develop emergency action plans with local EMS responders so they can establish the best routes for arriving on the scene. Drezner also suggests schools review the emergency action plan and conduct a response training at least once annually for people who might respond to a sudden cardiac arrest, including coaches, administrators, nurses and athletic trainers.
 

Why it’s hard to mandate AEDs in schools

The rate of out-of-hospital pediatric sudden cardiac arrests in the United States is 8-10 per 100,000 cases annually. Many people say it’s rare, and that’s partially why it’s been difficult to require AEDs in schools.

“I don't like the word rare, because rare is a really relative term,” Drezner said. “And when you're talking about a young person, possibly dying at a very early age, like there's nothing about that, to me, that sounds rare. And the stats would tell you that there are some young athlete groups where the statistics are simply just not rare.”

The impact is also disproportionately felt among the Black community.

The rate of out-of-hospital cardiac arrest in Black children is 15.5 cases per 100,000 kids. That’s more than four times as high as White children with 3.8 cases or Hispanic children with 3.3 cases per 100,000 children.

Those outcomes could be partially attributed to how prepared those communities are to respond to cardiac arrest. In Indiana, nearly 40% of Black students went to a school with only one AED, or none at all. That’s compared to almost 33% of Hispanic students, about 30% of Asian students and 29% of White students, according to Side Effects’ analysis of the same IDOE school survey data.

Some schools are reluctant to purchase AEDs due to financial restraints (the device can cost up to a couple thousand dollars), liability concerns if an AED is there but isn’t used or if it malfunctioned, and a lack of staff to maintain the devices. But some researchers and advocates argue that schools are now more likely to be liable if they don’t have an AED since so much research shows the devices can help keep cardiac arrest victims alive.

Some schools have been able to reduce or completely eliminate the cost of AEDs by working with their local hospital, fundraising or applying for grants.

AED laws across the country are a patchwork. Some states require AEDs, but only for high schools, and some only suggest having AEDs, but don’t require them.

At least 14 states are considering legislation this year to help respond to sudden cardiac arrests — Colorado, Florida, Georgia, Hawaii, Maryland, Mississippi, Missouri, New Jersey, New York, South Carolina, Tennessee, Vermont, Virginia and West Virginia.

Lawmakers proposed federal legislation last year to provide schools with funding to purchase AEDs and create emergency response plans.

“The first step in giving [students] an opportunity to survive — not even thrive, but just survive — is getting that AED there,” said Democratic Congresswoman Sheila Cherfilus-McCormick of Florida. “We have to make sure that life-saving technology is available to every single child in the country.”

Right now, the bill is stalled in Congress.

In Indiana, lawmakers have tried to pass legislation mandating AEDs in schools for the past two years. The earlier versions of the 2023 bill required an AED be available anytime there was a physical activity, including drama and band. It also mandated school staff who were in charge of those events to review the school’s emergency response plan at the beginning of every season.

The bill became law after it was significantly watered down. It no longer mandated AEDs. Now, it only encourages schools to have these devices and an emergency response plan.

That isn’t enough for Julie West, who lost her son to sudden cardiac arrest.

“If we push this out year after year after year, there's more children that are going to die from sudden cardiac arrest because our schools are not prepared,” West said.

Contact WFYI’s health reporter Elizabeth Gabriel at egabriel@wfyi.org.

Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.

This reporting is supported by a grant from the USC Annenberg Center for Health Journalism’s 2023 Data Fellowship.