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Stakeholder Education of Pediatric |
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Authors: Sara B. Stephens, MPH, Santiago O. Valdes, MD, Jennifer Bard, Brittany Hainesworth, MBA Out-of-hospital sudden cardiac arrest is a catastrophic event that is associated with significant mortality in children. Nontraumatic, nonviolent, and unexpected in nature, out-of-hospital arrest is caused by lethal heart rhythms (or arrhythmias) like ventricular fibrillation. Subsequent death from sudden cardiac arrest is known as sudden cardiac death (SCD). The Centers for Disease Control and Prevention (CDC) estimates that approximately 1,500 individuals under the age of 25 years die from SCD every year. Incidence of pediatric cardiac arrest is between 8-10 cases per 100,000 children, with more than 90% of episodes being fatal. Further, among survivors, out-of-hospital cardiac arrest can result in profound neurologic deficits, limiting children from leading a normal life. Given the unexpected nature of and high mortality associated with these events, children who appear otherwise healthy and asymptomatic can experience SCD. Therefore, early detection and prevention of SCD in children remains a challenge. SCD advocacy often focuses on partnering with community stakeholders to educate partners on the use of automatic external defibrillators (AEDs) and cardiopulmonary resuscitation (CPR) in the case a child has an out-of-hospital sudden cardiac arrest. One such organization, Project ADAM, is a nationwide nonprofit that partners with local schools to educate personnel on out-of-hospital cardiac arrest and implement a coordinated response in the event of an arrest, including CPR and AED training. Project ADAM is one public health success story exemplifying the importance of academic engagement with communities and stakeholders, as well as community-based programs focused on prevention as the science of SCD’s causes continuously evolves. Project ADAM was initially created in 1999 after the death of Adam Lemel (below), a 17-year-old high school student from Wisconsin who suffered from SCD while playing basketball. At the time, his heart was found to be in ventricular fibrillation, a fatal arrhythmia that prevents the cardiac ventricles from effectively pumping blood to the rest of the body. If an AED had been available, it could have saved his life.
In partnership with Children’s Wisconsin, his parents Patty and Joe Lemel created Project ADAM (AEDs in Adam’s Memory) to make sure AEDs are available in schools and help the respond in case of a cardiac arrest. In concordance with the ADAM Act signed by President George W. Bush in July 2001, Project ADAM has maintained a Public Access Defibrillator program. Through this program, schools work with Project ADAM to design an emergency response plan in the case of SCD in a student or staff member, get connected with their local emergency medical services, and receive CPR and AED training. Since the creation of Project ADAM the organization has expanded into 31 states with 41 hospitals, and over 200 lives have been saved through Project ADAM affiliate programs. Since its initial inception, nearly 25 years ago, there have been more than 28 affiliated chapters, partnerships in more than 800 schools, established in 22 states. This growth has ultimately resulted in lives of students and personnel saved as schools develop a systematic, schoolwide response to appropriate respond to a cardiac arrest, delivering timely response where every second counts. One recent example of this is Jeremiah (right), a Houston-based elementary school student who suffered from a cardiac arrest in 2022. When Jeremiah had his event, school staff was able to appropriately perform CPR and administer an AED to help stabilize him until emergency medical services arrived to transfer him to a children’s hospital for specialized cardiac care. Since his cardiac arrest, both Jeremiah and his twin brother, Jayden, were diagnosed with hypertrophic cardiomyopathy, one of the conditions often responsible for out-of-hospital arrests when undiagnosed or untreated.
Organizations like Project ADAM have been instrumental for community education and establishing public access defibrillator programs throughout the US. Given the aim of these organizations is preventing the devastating effects of out-of-hospital cardiac arrest, SCD advocacy has been fundamental for tertiary prevention.
Within the academic community, however, efforts have
often focused on primary and secondary prevention, such as identifying
genetic causes of conditions increasing risk of lethal arrhythmias or
heart enlargement (i.e. cardiomyopathy).
Epidemiologists can be particularly instrumental as
they have the statistical expertise to robustly evaluate the
effectiveness of Project ADAM training within schools. Prior adult
literature identifies stark
racial and ethnic disparities,
citing that more predominantly Black neighborhoods had lower rates of
AED usage and more predominantly Hispanic neighborhoods had lower CPR
administration. Among children, however, more rigorous data
identifying disparities within populations is needed. Understanding
where these disparities lie can be particularly informative for
school-based interventions designed to reduce adverse outcomes
associated with pediatric out-of-hospital cardiac arrest are needed.
Additional resources can be found at: https://www.projectadam.com/ |
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