Sudden cardiac arrest a concern for Hawaii’s student athletes

It was a day that shook up the sports world — Jan. 2, 2023, the day Buffalo Bills defensive back Damar Hamlin went into cardiac arrest after a seemingly innocuous tackle and almost died on the field during a nationally televised NFL game.

Only after weeks of recovery and his release from the hospital were well-wishers able to take a collective sigh of anxiety relief.

The frightening incident, however, had such a resonating effect that it hit home, raising questions about health and safety measures for our own athletes, especially those on the high school level, where resources usually are more limited than for colleges.

With more than 32,000 student-athletes participating in Hawaii high school sports, including 32,881 during the 2021-22 academic year, it behooves us to ask such questions as:

>> How vulnerable are young high school athletes?

>> How much training do Hawaii high school coaches, trainers and staff have in dealing with such medical emergencies?

>> And most importantly, are Hawaii high schools equipped with automated external defibrillators, portable devices that deliver an electric shock through the chest to the heart? That apparatus was used to help resuscitate Hamlin.

Alarming statistic

You might be surprised, but young athletes might be the most at risk.

According to a national high school federation, “Sudden cardiac arrest is the No. 1 cause of death in the United States for student-athletes during exercise.”

Based on that study, the National Federation of State High School Associations launched a “Sudden Cardiac Arrest” online course in May 2015.

Since that time, the NFHS has delivered nearly 2.2 million sudden cardiac arrest courses, with nearly 11,000 in Hawaii, facts provided by Dan Schuster, a Certified Master Athletic Administrator and director of educational services for the NFHS.

In Hawaii, the Hawaii High School Athletic Association made such training, along with other NFHS courses, mandatory.

“We’ve been requiring (coaches) for several years now to take this course,” said Natalie Iwamoto, director of information for the HHSAA, which is a member of NFHS.

Iwamoto said the HHSAA actually requires coaches “across the board” to take four courses provided on the NFHS website, nfhslearn.com.

“There’s a NFHS fundamentals of coaching (course), there’s a concussion, there’s a heat illness prevention and there’s a sudden cardiac arrest. The three of the four courses — the concussion, heat illness and cardiac arrest — need to be done yearly,” she said.

Iwamoto added that Hawaii was “one of the first (states) to have athletic trainers at every high school (circa 1990). We were at the forefront of that.”

AEDs in high schools

Iwamoto said that every member school of the HHSAA, public and private, is equipped with AEDs.

The HHSAA, which oversees all high school state championships, has actually been ahead of its mainland counterparts in providing lifesaving equipment and training.

In November 2006 — months after a Castle assistant baseball coach was revived on the field during a state tournament game on Maui — the HHSAA and the Hawaii Medical Service Association teamed to provide 95 defibrillators to member schools in a campaign spearheaded by then-­HHSAA executive director Keith Amemiya.

“I saw a need because there had been incidents on the mainland and even here, where if an AED was available, a life might have been saved,” said Amemiya, who was HHSAA executive director from 1998 to 2010.

“It’s always better to be proactive than reactive, especially when it comes to saving lives. We saw a need for AEDs at our athletic events and (I) didn’t want to wait for a mandate to have them available.”

Twelve years later, the NFHS made its initial distribution of 400 AEDs to member associations.

A year after that — in 2019 — the HHSAA and HMSA collaborated on a second round of distributions, with 320 AEDs going to 95 HHSAA public and private high schools statewide.

“We were able to catch all these other schools and were able to give them multiple AEDs, because schools have multiple trainers,” Iwamoto said.

“The second batch (HMSA donation), we could get 3 to 4 to a school, especially if they were a bigger school size, more geographic distance. There’s a formula, when a school is a certain size, they need to have an AED within seven minutes of each other.”

According to HMSA, the company contributed about $300,000 to fund the cost of the 320 AED devices with waterproof cases, training materials, supplies, wall cabinets and shipping expenses.

“While everyone involved prioritizes the safety of our athletes, accidents and injuries can and do occur,” Dr. Mark M. Mugiishi, president and chief executive officer of HMSA, wrote in an email statement to the Star-­Advertiser. “We saw this most recently on a national stage when Buffalo Bills safety Damar Hamlin went into cardiac arrest during a game. Thankfully, Damar recovered, in large part due to the immediate medical response and use of an AED. Having resources like AEDs can make a big difference during an emergency and we hope they offer peace of mind to our athletes and their families, teammates, coaches, and support staff.”

The Hamlin incident actually started a recent surge of donations to schools and organizations from pro teams.

According to a Jan. 18 news report, the Green Bay Packers teamed with Bellin Health in the Wisconsin area to purchase and donate AEDs to local organizations with a $100,000 donation. The New Orleans Saints and Pelicans also made AED donations.

It happened in Hawaii

While AEDs haven’t been used frequently in Hawaii — a 2019 survey showed that four schools used them on spectators at athletic events and five student-athletes received aid from an AED — an on-field medical emergency did occur and an AED was employed to save a life.

In 2006, Maui trainer Chris Pagdilao was credited with helping save the life of Castle assistant Brent Taniguchi with the use of an AED, which he said was purchased by athletic director Don Snyder.

Pagdilao, Maui High’s trainer since 2003, recalled that it was before a state tournament game between Castle and Maui. He was with other trainers during warmups when he heard, “Hey, someone’s down.”

“We looked over, there’s Coach Taniguchi down and people were rendering aid to him. I said to bring the AED, opened up his shirt. We gave him one shock and he came back.”

Months later, Taniguchi was one of the featured guests along with former police chief Lee Donohue to attend the 2006 HHSAA/HMSA promotional campaign to distribute AEDs to high schools.

“I was hitting balls to our kids before the game, getting ready to start. I collapsed and the next thing I remember was waking up in the hospital emergency room,” Taniguchi said in a 2006 Honolulu Advertiser article.

Taniguchi died in 2013, but his family was grateful for the extra time they got to spend with him.

“He was really appreciative. He made sure we all knew how lucky he was,” Taniguchi’s son, Boyd, told the Star-Advertiser.

“No words can ever to be able to explain how appreciative our family is for the opportunity to have my dad saved and have had him around for seven more years.”

Boyd Taniguchi said what gives him peace was that his dad could witness his “grandkids, my son. Him also being able to get back on the baseball field. Just to get back out there with the kids. And I was fortunate to coach with him again. We’ve been off and on coaching together since forever. And to be able to be on the same field, on the same coaching staff, to be able to coach with him side by side, I mean …”

His message to Pagdilao, his dad’s savior, is “thank you. Words can’t express — ever — how grateful we were. Right place, right time.”

Lifesaving knowledge

Sometimes training and knowledge can be helpful in saving your own life.

Such was the case for Pagdilao, who would recognize his own heart attack years after saving the life of Taniguchi.

“Aug. 16, 2018,” said Pagdilao. “4:45 (p.m.) when I called 911. I still remember the time.”

Pagdilao said he tried to do a “downwind foil on a light-wind day,” then went home to his parents’ house to shower and rest. He woke up with a “gnarly chest pain.”

He initiated his own emergency action plan.

“I walked out of the bedroom, (said) ‘Hey, mom and dad, (I) just called 911. … Mom, you’re going to go outside and you’re going to flag down the ambulance. Dad, I’m going to lie on the ground and if I go unconscious, you’re going to start CPR on me.”

The ambulance came and Pagdilao was able to walk out, “went into the (cardiac catheterization lab) and had to get rid of the clot. I had the widow-maker (myocardial infarction).”

He was 38 at the time.

AEDs and beyond

The AEDs that Hawaii schools received in 2019 are fairly new. The units are built to last 10 to 15 years, according to HMSA.

The cost ranges from $250 to $3,000, according to research published in the National Library of Medicine. The retail rate of the devices provided by HMSA were “about $2,000 to $3,000 per device. “However, we were very fortunate and able to work directly with a distributor, which brought costs down significantly,” Christine Hirasa, HMSA’s vice president of communications, said in an email statement.

If and when units become aged or obsolete, Hirasa said, “HMSA would be happy to evaluate any future need for AED donations and/or upgrades to Hawaii high schools.”

When asked if such distribution initiatives would affect the public’s pocketbook, Hirasa stated, “Our support does not come from health plan premiums collected from employer groups or individual members, so these community donations and grants will not affect member dues.”

Amemiya and Pagdilao feel that having AEDs should be expanded beyond high school athletics.

“I was at a Little League baseball game for my son many years ago and one of his teammate’s parents suffered a heart attack, and if they didn’t have an AED nearby he wouldn’t have survived,” Amemiya said. “It was at Manoa field and they had an AED at the pool nearby.”

“Whenever you have an event with lots of people in attendance, you’re bound to have an incident sooner or later,” said Amemiya, the executive director of the Central Pacific Bank Foundation who ran for lieutenant governor. “An AED on hand is invaluable. It just reinforces to have AED at events or at recreational facilities.”

Said Pagdilao: “The more public places that can have one, besides banks, airports, credit unions, malls and all those places, there’s gonna be a chance of increased survival to the general layperson.

“Grandma, grandpa, auntie, uncle, janitor, teacher. If you can save their lives at work, they have a chance to go back to their families in a couple days.”