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High School Cardiac Emergency Response Plans and Sudden Cardiac Death in the Young

  • Michelle J. White (a1), Emefah C. Loccoh (a1), Monica M. Goble (a1), Sunkyung Yu (a1), Folafoluwa O. Odetola (a2) and Mark W. Russell (a1)...



Sudden cardiac death (SCD) is responsible for 5%-10% of all deaths among children 5-19 years-of-age. The incidence of SCD in youth in Michigan (USA) and nationwide is higher in racial/ethnic minorities and in certain geographic areas. School cardiac emergency response plans (CERPs) increase survival after cardiac arrest. However, school cardiac emergency preparedness remains variable. Studying population-level factors associated with school cardiac emergency preparedness and incidence of SCD in the young may improve understanding of disparities in the incidence of SCD.


The objective of this pilot study was to determine the association of elements of high school cardiac emergency preparedness, including Automated External Defibrillator (AED) distribution and the presence of CERPs with county sociodemographic characteristics and county incidence of SCD in the young.


Surveys were sent to representatives from all public high schools in 30 randomly selected Michigan counties. Counties with greater than 50% response rate were included (n=19). Association of county-level sociodemographic characteristics with incidence of SCD in the young and existence of CERPs were evaluated using Spearman correlation coefficient.


Factors related to the presence of AEDs were similar across counties. Schools in counties of lower socioeconomic status (SES; lower-median income, lower per capita income, and higher population below poverty level) were less likely to have a CERP than those with higher SES (all P<.01). Lack of a CERP was associated with a higher incidence of SCD in youth (r=-0.71; P=.001). Overall incidence of SCD in youth was higher in lower SES counties (r=-0.62 in median income and r=0.51 in population below poverty level; both P<.05).


County SES is associated with the presence of CERPs in schools, suggesting a link between school cardiac emergency preparedness and county financial resources. Additionally, counties of lower SES demonstrated higher incidence of SCD in the young. Statewide and national studies are required to further explore the factors relating to geographic and socioeconomic differences in cardiac emergency preparedness and the incidence of SCD in the young.

White MJ , Loccoh EC , Goble MM , Yu S , Odetola FO , Russell MW . High School Cardiac Emergency Response Plans and Sudden Cardiac Death in the Young. Prehosp Disaster Med. 2017;32(3):269272.


Corresponding author

Correspondence: Michelle J. White, MD Division of Hospital Medicine Department of Pediatrics Wayne State University 3901 Beaubien, Detroit, Michigan USA 48201 E-mail:


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Conflicts of interest/funding: All phases of this project were supported by internal funding from the Division of Pediatric Cardiology, University of Michigan Congenital Heart Center (Ann Arbor, Michigan USA). Members of the Division of Pediatric Cardiology at the University of Michigan participated in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors have no conflicts of interest to disclose.



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1. Vetter, V, Haley, D. Secondary prevention of sudden cardiac death. Curr Opin Cardiol. 2014;29(1):68-75.
2. Meyer, L, Stubbs, B, Fahrenbruch, C, et al. Incidence, causes, and survival trends from cardiovascular-related sudden cardiac arrest in children and young adults 0 to 35 years of age: a 30-year review. Circulation. 2012;126(11):1363-1372.
3. Michigan Department of Health and Human Services. Too Young to Die: An Update on the Impact of Sudden Cardiac Death of the Young in Michigan 1999-2011. 2012. Accessed June 8, 2015.
4. Drezner, J, Rao, A, Heistand, J, et al. Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with Automated External Defibrillators. Circulation. 2009;120(6):518-525.
5. Smith, C, Colquhoun, M. Out-of-hospital cardiac arrest in schools: a systematic review. Resuscitation. 2015;96:296-302.
6. Hazinski, M, Markenson, D, Neish, S, et al. Response to cardiac arrest and selected life-threatening medical emergencies: the medical emergency response plan for schools. A statement for health care providers, policymakers, school administrators, and community leaders. PEDIATRICS. 2003;113(1):155-168.
7. Drezner, J, Toresdahl, B, Rao, A, et al. Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED Use in Sports. Br J Sports Med. 2013;47(18):1179-1183.
8. White, M, Loccoh, E, Goble, M, et al. Availability of Automated External Defibrillators in public high schools. J Pediatr. 2016;172:142-146.
9. Weiner, SG, Kapadia, T, Fayanju, O, Goetz, JD. Socioeconomic disparities in the knowledge of basic life support techniques. Resuscitation. 2010;81(12):1652-1656.
10. Root, ED, Gonzales, L, Peresse, DE, et al. A tale of two cities: the role of neighborhood socioeconomic status in spatial clustering of bystander CPR in Austin and Houston. Resuscitation. 2013;84(6):752-759.
11. Rothmier, J, Drezner, J, Harmon, K, LeBrun, C. Automated external defibrillators in Washington State high schools. Br J Sports Med. 2007;41(5):301-305.
12. Chugh, S, Reinier, K, Teodorescu, C, et al. Epidemiology of sudden cardiac death: clinical and research implications. Prog Cardiovasc Dis. 2008;51(3):213-228.


High School Cardiac Emergency Response Plans and Sudden Cardiac Death in the Young

  • Michelle J. White (a1), Emefah C. Loccoh (a1), Monica M. Goble (a1), Sunkyung Yu (a1), Folafoluwa O. Odetola (a2) and Mark W. Russell (a1)...


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