The Book on Teachers
The literature our students read may reveal what they see in us.
by David Booth
by Francis Chalifour
A Few Fears and Fantasies
The high school experience haunts a 50-year-old man's dreams.
by Linwood Barclay
What you learn about Sudden Arrhythmia Death Syndromes could save a life.
by Rosemarie Bahr
The College passes a major milestone.
An apparently healthy young athlete dies during a game or race. It's a tragedy. It makes headlines. Every adult shudders, feels sympathy for the family and regrets the lost potential.
Anyone who knew the young person will never forget what happened.
Doug Wilson, currently registrar at the Ontario College of Teachers, was watching a junior football game early in his teaching career. “I noticed a player didn't get up after a play. And then I saw staff from the school run over and pound him on the chest, you know, to start the heart. An ambulance was called and took the student away. He died before he got to the hospital. He was 15.
“You don't anticipate students dying,” says Wilson. “I remember teaching the Grade 9 geography class the next day and he'd sat in the middle of the class about two thirds of the way back, and all of us were in deep shock with the absence of John. I remember how challenging it was for me as an adult. For the students in his class, it was a great loss.”
The student had undergone a thorough medical exam before playing football. Not until his death was it discovered that his heart had been damaged since birth.
SADS (Sudden Arrhythmia Death Syndromes) is a group of heart and heart-rhythm abnormalities that can cause sudden death. Most of the abnormalities are genetic but do not show up until age 10 or later, often after puberty. If diagnosed, it's usually because someone else in the family has died unexpectedly or been diagnosed, but fainting can also be a symptom.
Fainting is common
During his class on blackouts, cardiologist Andrew Krahn asks second-year medical students how many have ever fainted. It is usually about half the class. When he asks the next question, how many went to a doctor, almost all the hands disappear.
“It's fair to say that most fainting is not serious,” says Krahn. He estimates that more than 95 per cent of fainting episodes are not cause for concern.
Krahn, who is with the University of Western Ontario and the London Health Science Centre, says that about a third of people faint at least once in their lives. About three per cent are recurrent fainters.
Most often the fainter has been standing in a hot room for a long time or the sight of blood or getting a needle has been too much. Most are out for less than a minute.
However, a faint could stem from neurological or brain causes. Krahn says, “This would be people who have obvious seizure activity or twitching, or those who lose control of bowel or bladder or bite their tongues or are confused for hours afterward. Such cases don't always turn out to be serious but they warrant a medical workup.”
A faint while doing physical activity can indicate a problem with heart structure or rhythm. “Those are pretty uncommon,” says Krahn. “They may produce a prolonged period where the patient appears to be unresponsive or turns blue.”
When is a faint a warning?
Most times, a faint is just a faint. Sometimes, however, it's a warning.
Sam is 11 and loves doing anything athletic. Earlier this year he fainted while playing with his friends in the gym during an after-school program. His parents searched the Internet and discovered that most fainting in children isn't serious, but decided to make a doctor's appointment for him anyway. The next day Sam fainted at home while getting himself a glass of juice.
His parents immediately took him to the family doctor but when they arrived the nurse told them to go straight to the local emergency room. Sam was admitted and went through three days of monitoring. Some test results were faxed to the Sick Children's Hospital. Doctors found nothing and Sam went home.
A day later Sam's parents had a call from the hospital. Doctors there had found an anomaly. Eventually, Sam was tentatively diagnosed with ARVD, arrhythmogenic right ventricular dysplasia – a progressive cardiac arrhythmia disorder.
Sam is lucky. As his mother says, “It was diagnosed. We can't cure it. But we can help him.”
Getting the story
Particularly important for diagnosis are the circumstances surrounding the faint. Krahn says, “Often when somebody faints there's a sort of widespread panic. An objective observer who can describe what they saw is invaluable in figuring out what happened.
“By definition, a faint resolves itself and so, typically, by the time a person comes to the medical establishment, the crisis is over and hasn't necessarily left any clues. The most useful tool in figuring out why a person has blacked out is the story of what happened. What was the patient doing at the time? How did they look? How long were they out for? How quickly did they recover? Did they get dizzy at other times? A careful history has been shown to be more useful than most tests ordered after a blackout.”
Schools routinely report to parents whenever a student faints. Depending on the circumstances, the school may call 911, preferring to err on the side of caution.
A teacher who observes a faint can help by writing down what happened in as much detail as possible and giving those notes to the parents.
Pam Husband, executive director of the Canadian SADS Foundation, points out, “It doesn't have to be a full-blown faint. It might be the student who is lightheaded after physical activity, who has to sit down after their turn on the basketball court because they can't cope.”
If a child is diagnosed with one of the disorders associated with SADS, the parents should tell the school staff what they need to know to keep the child safe. What that is will be unique to each child. Sam's mother reports that his teachers have been fabulous. They've learned how his implanted monitor works and which activities are forbidden (contact sports). In consultation with his parents they make sure he's included in everything else.
Husband says, “It's about kids who have not been diagnosed, not about kids who are being treated. When they're being treated their risk is virtually no greater than that of anyone else in the classroom. It's the ones we don't yet know about that are the concern.”
Because he fainted, Sam is no longer an unknown case. Because of that, he won't make the NHL – but he will make adulthood.
If the answer to any of these questions is yes, the child's heart should be checked.
Source: SADS Foundation. For more information visit www.sads.ca.
Automatic external defibrillators
Defibrillation is just one part of treatment, which must also include calling for emergency medical service assistance, cardiopulmonary resuscitation and the administration of medications and other life-support measures.
Early defibrillation, however, is the most critical of all the steps.
Advances in miniaturization and rechargeable batteries mean that an automatic external defibrillator (AED) today is lightweight and comes with step-by-step instructions. The AED analyzes the heart rhythm and automatically indicates when to shock. These developments have markedly reduced response time and minimized the need for training. In a study of mock cardiac arrest the mean time to defibrillation was 67 seconds for trained emergency service technicians and 90 seconds for untrained sixth-grade students, indicating that even the untrained can use these devices successfully. An automatic defibrillator can save lives. At O'Hare Airport in Chicago, these devices are located throughout the terminals. Untrained people used them in 11 of the first 19 instances that they were used. In nine of those 11 instances the patient survived the attack. Without use of a defibrillator within a few minutes of a heart attack, the survival rate in North America is less than five per cent. At O'Hare it was 88 per cent.
An automatic external defibrillator costs about $2,000 and lasts about 10 years.
More and more public buildings are acquiring defibrillators. Most Ontario schools do not yet have them.
Public access defibrillator program
Many programs encourage public involvement in cardiopulmonary resuscitation (CPR) and the use of public access defibrillators (PADs).
September is SADS Awareness Month
Press Release 2005 (PDF)