Another Reason for CPR and AEDs in Youth Sports

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Boy saved at baseball game

BOILING SPRINGS, NC: 05/08/2008 – There's a term in baseball for when a relief pitcher comes in and preserves the team's win. It's called a save.

But that term took on a dramatic new meaning at a YMCA little league game Tuesday night, when four people stepped up to save a Kings Mountain 12-year-old who had been hit by a pitch.

But not just any pitch - one whose timing and placement was a potentially deadly combination - one that made Dustin Jones' heart stop beating.

In the game's fourth inning, Jones, who plays catcher, dropped his bat and headed to first. Getting hit by a pitch earns a batter a free trip to first base.

“Before he got to first base, he collapsed,” said Brad Keller, who coaches the opposing team, the Braves. “It went deathly quiet.”

The 7-0 lead the Braves had built didn't matter anymore.

When Brad made it over to Dustin, the boy's lips were turning blue.

“Basically he was dead in your arms,” said Brad. “It's something you never want to see again.”

Brad's wife, Shannon a nurse, could see the scene unfolding from the stands.

“I thought they probably knocked the wind out of him,” she said. But her husband's look of panic told her otherwise. “I knew the kid was in trouble.”

So she and three others with medical training ran to the field.

Alan Wacaster, a critical care paramedic, had decided to watch the game after his own child's had ended.

“I wasn't even supposed to be there. But I decided to stay and watch. Both teams playing were undefeated and I knew the coaches and kids,” he said.

Once Dustin was hit, Wacaster went to the field where the boy had no pulse and wasn't breathing. “The paramedic side of me kicked in,” he said. He and Kevin Jones, who also has medical training, took over mouth-to-mouth and chest compressions where Dustin's mom, Nikki Jones, was trying to help.

“You rely on your training,” said Kevin. “Fortunately we were able to see a positive result.”

All the while, Wacaster said he knew prayers were going up from the stands and from other players.

“I didn't save anybody. I was used by God as a tool,” said Wacaster. “I shouldn't get any credit at all.

"He just used a group of Christian, caring people to take care of one of His children,” he said.

Dustin was sitting up and talking before being taken to Cleveland Regional Medical Center, where he spoke with the pitcher, and then was taken as a precaution to Carolinas Medical Center in Charlotte.

A day later, the boy is doing fine, but will have to sit out his next game.

Dustin is, however, looking forward to rejoining his team, the Reds, in the future and thanks those who helped.

“He's in the highest spirits of all,” said Nikki.

Now that it's all over, Wacaster, Shannon, Kevin and the boy's mother each give the others credit for the save. But they also give a higher power credit.

“Thankfully God had people there who knew what they were doing,” Brad said.

Cleveland County Family YMCA CEO Cameron Corder agrees. “I do feel very fortunate and feel that this was a spiritual blessing for all of us involved. I'm thankful people witnessed this miracle.”


Toddler dies after being struck with bat at T-ball

EAST-CENTRAL US – 7/24/2008: Funeral services will be tomorrow for a 2-year-old [name] County boy who died after being accidentally struck in the chest with a baseball bat during a T-ball practice Tuesday night.

[Victim] of [town] was pronounced dead at [name] Children's Hospital after the force of the bat sent his heart into arrhythmia and then cardiac arrest, said [name], a [name] County deputy coroner. “It was just a horrible, tragic accident,” [coroner] said.

The accident happened during a YMCA Youth Baseball practice at [name] Church at [address] in eastern [city]. The practice session was for 4- and 5-year-old co-ed teams, said [name], CEO of the YMCA [name].

About 6:10 p.m., emergency dispatchers got a call that a child was unconscious and not breathing after being hit with a bat. [Coroner] said [victim] was struck when he ran up to his older sister, who was taking practice swings. A nurse who was at the scene began giving [victim] CPR soon after the incident and emergency crews arrived within minutes, [coroner] said.

Several teams were practicing at the time.

Counseling services will be provided for anyone who wants them, [YMCA CEO] said. “Our total focus is prayer and support for the family,” [CEO} said. “We are putting together counseling services for players, family, and friends.”

[Victim]'s parents, [names], declined to comment yesterday. But a family friend, [name], said they wanted to thank the community for the many prayers and support that have been offered. [Friend] said [victim] was a creative boy who loved to build things, and often played with a small woodworking set.

The YMCA will have a memorial service early next week, likely at [name] Church, [YMCA CEO] said. The funeral will be at 10 a.m. tomorrow at [different church], [address].

A memorial fund has been set up. Donations can be made to the [victim] Memorial Fund through any PNC Bank branch, said [name], a[nother] friend of the family. [First friend] said donations will help the family pay for funeral services, but any additional money would be donated to Habitat for Humanity in memory of [victim]'s love of building. “The family just feels that that would be his wish,” [first friend] said.


The Stories:

The first event related above could have been a heart-warming television drama – an everyday common event that became a nightmare by a fluke occurrence but was transposed into a miracle by involved bystanders. That it really happened is wonderful – that similar events occur with far less happy endings is tragic. Much of the time the final scenes are different and involve sudden and violent deaths, as illustrated by the second article. Instead of heart-warming it is heart-wrenching – a family goes to T-ball practice and their toddler dies after being struck by a bat swung by his four-year-old sister.

Deaths like these occur because correction of the medical disorder caused by such a trauma usually requires nearly immediate cardiopulmonary resuscitation (CPR) using a defibrillator and cardioactive drugs. Most coaches are normally not trained in CPR nor are resources like an AED and cardioactive drugs generally present at youth sporting events.


The Issue:

Medically speaking, young Dustin Jones and the toddler who died experienced commotio cordis or a sudden disturbance of heart rhythm. It was caused by the blow to the chest, in their cases a baseball and a baseball bat respectively, but it could have been caused by any blunt non-penetrating impact on the precordial region (the area directly in front of the heart – specifically located between the second and fourth ribs slightly to the left of the sternum).

More than 80% of the victims of commotio cordis are under 18. The injury most commonly involves children whose heart rate is elevated because they are actively involved in an athletic activity such as baseball or softball, but ice hockey, football, lacrosse, soccer, polo, rugby, cricket, and contact sports like boxing, karate, kung fu, and other martial arts are represented in the statistics. The impact is most frequently from a baseball that is traveling between 30 mph and 50 mph. The bad news is that such speeds are easily attained in both youth softball and baseball. A toddler’s heart rate is faster than an older child and thus this victim was susceptible even though not actually exercising.

The good news is that impact to the precordial region usually does not disrupt the heart’s rhythm and result in arrhythmia, ventricular tachycardia, or ventricular fibrillation because the cardiac cycle is such that the opportunity for an impact to cause such detrimental results presents itself only about one to three percent of the time, even during aerobic exercise.

Even though relatively rare, commotio cordis is still the leading cause of fatalities in youth baseball in the US, with two to three deaths annually. It is the second leading cause of death for all young athletes. The Commotio Cordis Registry has recorded 156 incidents since during its first seven years (which is the last data available), but it is believed that commotio cordis is vastly under-reported.


The Solution:

There are several things that can be done to combat the potential loss of life from commotio cordis.

  • Recognition is key – time is very short and for there to be a good outcome commotio cordis has to be recognized nearly immediately, thus making the training of coaches, assistant coaches, and referees extremely advantageous and desirable
  • Utilization of an AED in the very early stages of commotio cordis can be critical – within the first minute is best because every minute’s delay reduces the chance of a favorable outcome by about 10%
  • Unfortunately, an AED at every game site may not be financially feasible; thus, requiring that all coaches, assistant coaches, and referees be proficient in and prepared to give CPR is at the very least a great idea and possibly the prudent solution

  • Fortunately, many games are held adjacent to facilities where there is an AED

    • it might be possible to acquisition one to be at the sidelines (if there are multiple units or if the event is after normal operating hours)
    • possibly a protocol for rapid deployment of the AED could be developed during open hours if there is only one unit in the facility
  • The Consumer Product Safety Commission recommends the use of RIF (reduction in force) or age-appropriate baseballs for children 13 and under; these balls have a lighter core and softer cover and reduce the chance of commotio cordis (but do not eliminate it – 6% of baseball related deaths have been from RIF balls)

  • Hockey is considering the introduction of similar age-appropriate pucks

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