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Commotio Cordis and Your Duty of Care

Rob Vito

It goes without saying: kids should not die playing sports. But they do. The good news is something has been done about it to reduce risk. But parents and coaches need to understand the risk and more importantly need to be made aware that a solution exists. This is where school districts and school board members can play a vital role. School officials are perfectly positioned to spearhead awareness and proactively get out in front of this issue. Legal experts say leadership has a duty of care to do exactly that, which at the same time can mitigate financial exposure.

Have you heard of sudden death from commotio cordis? Even if you haven’t, it’s about to be officially on your radar. It’s the #2 killer in sports and already the NFHS (The National Federation of State High School Associations) has mandated commotio cordis protection for baseball catchers, starting in January of 2020. Common sense says it is only a matter of time before other at-risk positions in baseball (pitchers), other sports (lacrosse, soccer), other schools (middle and grade school) are added to the list. Other sports leadership and governing bodies are bound to follow suit.

Staying informed about best-practice trends to keep student athletes as safe as possible, is a never-ending challenge. This article addresses multiple issues surrounding the lethal threat of commotio cordis and offers solutions to mitigate the danger players face and a straight-forward way that board members, school leadership and other organizations can address potential legal exposures.

What is commotio? It’s Latin for commotion of the heart, which is like a concussion of the heart, that kills. It’s caused by disruption of the heart’s rhythm from a blow to the chest wall area, directly over the heart, by a ball, stick, hand, or other contact that triggers cardiac fibrillation. Breathing stops, and if CPR and/or an AED are not used in the first few minutes to sustain life and correct the heart’s rhythm, the athlete usually dies. Less than 50 percent survive.

Millions of kids, generally between the ages of 6 and 18, are at risk. When it happens it is catastrophic to families, friends and sports in general. But many organizations are exposed, either through not having an operable AED appropriately placed at sports fields or not informing parents and coaches of available protection to mitigate that risk.

People say “well, it doesn’t happen that much.” But, of course, one student death is too many, which is why this article is being written and why awareness, or lack thereof, about commotion cordis needs to be addressed

It is true that probably less than 100 athletes a year succumb to this tragic occurrence, but those are just the events that are accurately reported in to the Minneapolis Heart Institute Foundation’s Commotio Cordis Registry. Experts state these events are under-reported or erroneously reported as something else. And there are often non-recorded commotio cordis events where the child is revived by an AED, and a frantic chapter in a family’s life thankfully closes with a happy ending. But what about the emotional toll? Does that child want to keep playing? Should he or she?

Up until now there has been nothing but an AED or miracle standing between a child’s survival and death. Surprisingly, many sporting events and competitions don’t have an on-site AED, nor is there a protocol in place for dealing with a heart event. Those address the reactive stance that are needed to be in place. But what about the proactive side: Are you aware that there have been advances in wearable protection that athletes can use to reduce the risk of a commotio event happening in the first place? It is big news.

A world leader in commotio cordis research is Tufts Medical Center, Boston, where for more than two decades they have sought to understand it, determine what causes it and who’s at risk of it… and if a solution exists to prevent it. They tested popular chest protectors twice over the years and found nothing was effective in preventing it. In fact, 30% of deaths from Commotio have occurred when the child was wearing a chest protector. It wasn’t until the spring of 2016, when Tufts published a paper in the Clinical Journal of Sport Medicine, that governing bodies, thought leaders and testing organizations began hearing that a significant development had taken place.

Tufts found novel materials from Unequal to be the first ever proven effective in greatly reducing risk of sudden death from commotio cordis (study is here). Within a couple weeks, NOCSAE, National Operating Committee on Standards for Safety Equipment, announced that they would be preparing a certification standard designed to mirror Tufts’ findings. As of today, only one line of chest and heart protectors is on the market containing tech proven to mitigate commotio cordis risk.

Think about it: There is good news on the protective front for student athletes to get ahead of commotio cordis and play safer with less risk. Unequal’s line of HART® protectors, for any position, any sport, with the same technology used in the Tufts study, are available now. Even the FDA has reviewed the technology and marketing materials for Unequal HART products and signed off.

But this is not a commercial for Unequal HART chest and heart protectors, seen here. This is a wake-up call that protection exists today to dramatically reduce the risk of sudden death from commotio cordis and that parents, coaches and athletes need to know. Under your duty of care, to make the sports played under your aegis as safe as possible, legal experts say you should be proactive as possible in getting this word out: Risk of commotio cordis exists and a protective solution is available to reduce that risk. If this step is taken, it goes a long way in meeting an organization’s duty of care.

Sports protection matters. Effective sports protection is paramount.

Commotio cordis needs to be on your radar, parents and coaches need to become informed, kids need to have a chance be better protected. Regulatory agencies, governing bodies, school districts, sports teams, athletic directors, even coaches that do not adapt and/or inform parents of the risk and these new technologies, could face significant liability risk, of which they may not even be aware. Failing to at least warn parents of this risk, and the availability of products to minimize it, sets up a liability in much the same way as the office building management that is found liable by the family of an executive who dies of a preventable heart attack because there were no defibrillators in a particular building.

Bottom line: There’s a risk of commotio cordis happening at any minute in any sport where a ball, stick, puck, even a hand can strike the heart are at just the wrong time. Technology exists today that credibly reduces that risk. Parents and coaches need to know. You need to do all that you can to reduce the risk of sudden death happening on your watch.

Now you know.


Rob Vito is CEO of Unequal. For more information, attend the Panel #2 Killer in Sports - Commotio Cordis. Protecting Players & Risk Mitigation for Institutions, Room 208, 8:30 to 9:45 a.m. Sunday, April 8, 2018, at the NSBA Annual Conference in San Antonio. Or contact Vito at vito@unequal.com.

This article brought to you by Unequal

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