The NFL on March 27, 2023, hosted an in-person kickoff press conference for The Smart Heart Sports Coalition, a partnership among the country's major sports leagues and medical advocacy institutions that is pushing for all 50 sates to adopt evidence-based policies that will prevent fatal outcomes from Sudden Cardiac Arrest (SCA) among high school students.
- Jeff Miller, NFL Executive Vice President of Communications, Public Affairs & Policy
- Anna Isaacson, NFL Senior Vice President of Social Responsibility
- Dr. Comilla Sasson, American Heart Association Vice President for Science & Innovation for Emergency Cardiovascular Care
- David Gallegos, National Athletic Trainers Association Board of Directors
- Jack McMaster, American Red Cross President of Red Cross Training Services
- Doug Casa, Korey Stringer Institute CEO
Jeff Miller: Good afternoon, everybody. Thank you for being here. We are really excited about the initiative that we're going to share with you today and with the partners with whom we're going to share it. A conversation around health and safety at the NFL and this past season must begin with a conversation around Damar Hamlin and the heroic work that was done by the medical professionals, the trainers and the doctors on the sidelines. Not an accident that those people were there – practiced, trained with the right equipment and the right process to ensure the best possible outcome in a really challenging situation. And for that, the NFL is grateful. I know, of course, Damar and his family are grateful. And watching the aftermath of that conversation around that incident on field, the country was grateful for their incredible heroic work. We've thought a lot about, in the meanwhile since that incident, what could be done for other levels of our sport, or other sports around Sudden Cardiac Arrest, and whether the benefits that we're able to bring at the NFL can be shared with other levels so that we could prevent more preventable tragedies.
There are up to 23,000 Sudden Cardiac Arrests among young people aged 18 and younger in this country every year. Forty percent of them happen when kids are participating in athletics. And yet, there aren't a lot of policies in place at schools around the country to have the foundational elements that we're able to have at the NFL to prevent what are otherwise preventable tragedies. They don't necessarily have Emergency Action Plans. They're not mandated to have CPR education. They don't have AEDs. Some of the people behind me with the American Heart Association, the American Red Cross, the Korey Stringer Institute and others have spent countless hours working on exactly these sorts of challenges, to bring the lessons that we've been able to integrate into our coverage at the NFL level, and to other levels of the sport. And so what we're here to announce today, as a group, is an effort, The Smart Heart Sports Coalition, a mission to make sure that all 50 states have those three elements in place for all kids who participate in sports. Namely, an Emergency Action Plan, CPR education for all coaches, and AEDs available, should they be needed, within one to three minutes of a Sudden Cardiac Arrest.
At this point, seven states around the country have those three elements in place, and a variety of more have some of those elements, and many have none at all. So over the next three years, this coalition, which I'll get to in a moment, is going to endeavor to make sure that every state has all three elements in place and to prevent many of the tragedies that we believe are preventable.
We're joined by the other major sports leagues, let me give them a shout out real quick. The NBA, Major League Baseball, the National Hockey League, and Major League Soccer, as well as the NCAA, are joining us in this coalition. And public health partners – who have been leading this work for many years and we're proud to join them – are also here today, the American Heart Association, the American Red Cross, the Korey Stringer Institute, and the National Athletic Trainers Association, all essential partners to making sports safer for those who play them, as well as beyond sports. So I will stop with that, and introduce my colleague, Anna Isaacson, who leads our Community Relations and Social Responsibility work at the NFL, to talk about some of the NFL's efforts in this area.
Anna Isaacson: Hi, everyone. So thrilled and proud to be here today. I think we at the NFL understand that we have a role to play in society, and it is an honor to be able to use the NFL platform to help people and to give back. We have a history when we face challenges, when our country is facing challenges, when society is in trouble – we have a history of leaning into those challenges and not running away. And I think this coalition, this work that we're going to do, is really going to help save lives, and we're going to do that together with the great people around us.
We're going to use our position, the NFL's platform, to really help – and I steal this from the AHA a lot – to help create a nation of lifesavers, where people understand CPR and they know how to step in and save a life if it's necessary. We're going to do that in a few ways. The NFL Foundation is committing more than $1 million dollars to this effort. That's going to include $20,000 to every NFL club. Each NFL club will be able to use that money, how they see fit locally, to fund CPR education and AED access in their communities. And then we will also partner with the organizations behind us to help promote this effort, and it's really to blanket the country. So not only will club markets get access to this important critical information and education, but we will make sure that the rest of the country has this as well. And so not only will clubs get access to dollars, but we'll fund more money to make sure that the entire nation has these resources. So we are thrilled to partner. This is a really exciting day for us, and we spent the last couple of months really figuring out how we can best use our platform to make an impact here. So thank you.
Jeff Miller: Thanks, Anna. One quick point here is that these groups – and I will introduce everybody momentarily – this is the foundational, the introductory members. We would invite other public health professionals and organizations and sports leagues to join us. We will go to every state, we will send letters to every governor – which will be released today – asking for whether it be legislative or regulatory approval for these elements in the next couple of years, and we will have any conversation necessary to prove out that these are simple cost effective, easily learned ways to save people's lives. And that's what the goal of this is over the next three years. So with that, let me introduce each of the people here in turn, invite them to the podium to speak for a moment. Let me start with Dr. Comilla Sasson, who is the Vice President for Science and Innovation for Emergency Cardiovascular Care at the American Heart Association.
Dr. Comilla Sasson: Hi there. Very proud to be able to stand up here in front of you guys today and talk on behalf of the American Heart Association. The American Heart Association has been at the forefront of resuscitation research, science, training, advocacy – we train millions of people every year in community and health care providers, and CPR resuscitation best practices, and we're the official publisher of the CPR guidelines that really helps set the standards for resuscitation best practices across the world.
So when we get to stand up here with this great group of people, I think we have an opportunity not just to save lives, but to make an impact and to really equalize the opportunity to have everyone be able to survive a cardiac arrest event. We know right now survival from cardiac arrest event outside of the hospital is about 1 out of every 10 people. So only one person will survive who has an out of hospital cardiac arrest event. I know I'm an ER doctor, and the vast majority of patients never come to the emergency department because they don't ever make it there. And that's because the first links in that chain of survival – that we all watched when we were watching Damar Hamlin have his cardiac arrest event on the field – worked. And I remember sitting there with my husband and saying, "It's working. Everything is happening like it should." And that was because there was early recognition of a cardiac arrest event, calling 911 right away, early CPR and access to an AED or defibrillator. If everybody had that same opportunity, just like Damar Hamlin did, we would have numbers that would be much higher in terms of survival.
So I'm excited to say, as both an ER doctor as well as a mom of two kids who are in sports right now, that the work that we're going to do together to have medical emergency plans in place at every athletic field, at every high school, at every facility where we know people are going to be playing sports, having access to AEDs, having the ability to teach coaches, teachers, parents, families about cardiac arrest and CPR and activating those first three steps in the chain of survival – that's what's going to make a difference. We're so proud as the American Heart Association to be able to partner with you guys at the NFL, we really appreciate it, as well as all of the other organizations who are here today as well.
Jeff Miller: We started this conversation with Damar Hamlin as our inspiration, and I'm not sure whether I mentioned the fact that his foundation, the Chasing M's Foundation is a founding partner to this. He's not just our inspiration, but our partner in working on this. That would be a terrible omission if I didn't say that at the outset. So let me make sure that we know that we're doing a lot of this both to honor him and in conjunction with Damar and the work that he's doing to take advantage of his situation and to give back to these communities. Secondly, let me introduce David Gallegos, who's on the board of directors of the National Athletic Trainers Association.
David Gallegos: Hello. I appreciate the participation, to be part of the coalition. I'm excited for the NATA to be part of the public health effort to improve the safety and wellness of our athletes across the nation. NATA is a proud partner with the NFL to raise the awareness of the need for updated policies on Sudden Cardiac Arrest, AEDs and Emergency Action Plans. We, obviously, have a goal of keeping our students playing the sports that they love and healthy and active. Additionally, it is imperative that students have access to licensed medical professionals on site, such as an athletic trainer. As part of their comprehensive athlete safety plan, ATs have the education, knowledge and experience to treat Sudden Cardiac Arrest. However, almost one-third of high schools currently do not have access to an athletic trainer on staff. So we're excited to be part of the initiative and the collaboration, and we hope to share the message to support these policies and provide additional medical coverage.
Jeff Miller: Thank you, David. Our next speaker, Jack McMaster, President of the Red Cross Training Services with the American Red Cross, and a longtime partner and friend to the National Football League.
Jack McMaster: Thank you. The American Red Cross is just delighted to be part of this effort. When you think about it, it's quite audacious, right? It's every sideline on every field in the country. And it needs to happen. As Dr. Sasson said, the survival rates of out-of-hospital cardiac arrest is about 9%. So if you are going to be saved, much as Damar was, you're going to need someone to respond immediately. Waiting for EMS is too late. If everybody can get trained in CPR, if there are AEDs within an arm's reach, we're going to be able to save many, many more lives. And as part of our mission, at the Red Cross we've always tried to bring our training to the community in such a way that whenever there is an emergency, there's someone standing nearby who not only knows what to do, but is willing to do it. And we learned that, as was already said on the platform here, with Damar, and we think that this could be the next big start of something where essentially cardiac resuscitation rates go up all over the country. We're delighted about this work, glad to be part of the effort.
Jeff Miller: It is an important point that while we've focused on Sudden Cardiac Arrest in athletes, specifically in high school athletes, for those of us who have kids in high school, we know that the high school community is oftentimes the focal point of the entire community. Adults passing through there, visitors passing through, they would benefit, obviously, from more people knowing CPR, benefit from an AED within arm's length. And some of the cardiac arrests may not have something to do with sports, it may just be better for the community as a whole. So thank you for raising that point. Lastly, but certainly not least, one of my most favorite people in the entire world. It's my pleasure to introduce Doug Casa, who is the CEO of the Korey Stringer Institute and a true leader in public health. The benefits that the league has been able to give back in a number of our communities and through our clubs in different areas, whether it be concussion management, or heat and hydration, or understanding whatever the next thing is that needs to be done to advance sports safety, come from this man's brain. So I am honored that I can introduce Doug here and continue to work with him and call him a friend.
Doug Casa: Thank you, Jeff, and thank you to the NFL. The Korey Stringer Institute is a not-for-profit housed at the University of Connecticut that was founded 13 years ago. We've worked very closely with the NFL on a lot of initiatives, but we also work to try to enhance health and safety for warfighters and laborers, as well as athletes. And I think it's just really important to understand these efforts have been ongoing, but this could be the catalyst for us that we need, what happened with Damar Hamlin.
We have visited, in a program called Team Up For Sports Safety – the acronyms is TUFSS – working with the NFL and the NATA in over 30 states in the last three years to try to enhance health and safety policies for high school sports. The stuff you see on the map when that slide flashes up, we've worked to help overhaul health and safety policies. States like New Hampshire, Georgia, New Jersey, Florida, Louisiana have literally added 40 to 50 policies, some of those states just from the state meeting that we had working with the state high school athletic association and the sports medicine advisory committee. But you have to understand that to change policies in America, you have to do them state by state at the high school level. They cannot be done – like the NFL sets a policy all 32 teams will follow it, or the NCAA sets a policy and all their teams, all their schools follow it – but it's very different at the high school level. You have to get in the trenches, work with the state high school athletic associations or the state legislators to try to make some of these changes take place.
I think the most important message that I have is that when I was watching the case with Damar Hamlin, I was watching the game that night with my wife and my three kids. It's really important we get the message out there that that was not a miracle that night. Ninety percent of athletes, if they have an AED access within two to three minutes, survive a cardiac arrest. And if you have Emergency Action Plans, access to an AED, and athletic training services – we expect that outcome. That's what should happen at the high school sports field, and that's what obviously happened at the NFL with Damar. But that's the expectation we have for the 8 million high school athletes in America, and what we're striving to work towards together.
REPORTER: It's been about 10 years since a lot of the same people here pushed for the Lystedt Law. Is that some kind of pattern that you're going to follow with the states since you got pretty much everybody on board for that one?
Jeff Miller: Great question. Yes, we got all 50 states to pass laws that govern concussions among youth athletes coming out of Zackery Lystedt's tragic situation in Washington state. It is a lot of the same people. It is a lot of the same model, and why not replicate success? We were able to raise attention to concussion, to the importance of treating concussions among youth athletes, specifically conservatively, to remove players from play should there be any concern about a concussion. And I believe that there were studies written, Doug, right, about the benefits of those state laws being passed and the public health advantages that it had. If we have a similar impact here and a similar course of action where we get 50 states on board and we get the education to the level that we need to at the community and grassroots level so that we can protect more youth athletes then were protected before, then this would be a rousing success. And that's just that – that's what our expectation is, that we will get 50 states to adopt these policies in rather short order and protect more kids.
REPORTER: Quick question, just for clarification, will it be to the clubs of the NFL or the NFL itself reaching out to athletic associations and their local governments?
Jeff Miller: It will be done in conjunction. Using again the model for the Lystedt Law, the 32 clubs worked really well and obviously have a much greater knowledge of their community, of the leaders in the community, the public health advocates as well as the legislative and regulatory environment, to make inroads and make sure that the right people are aware of these challenges. And as Anna mentioned, from the NFL Foundation perspective, also the ability to share within their community some of these resources to advance the policies, programs and even the AED machines for some of the high schools in their neighborhoods.
REPORTER: I know you mentioned Damar Hamlin, and his foundation are partnered here. What has his involvement been like and how has his insight helped out here?
Dr. Comilla Sasson: We've been very fortunate to work very closely with Damar Hamlin, as well as his organization, to be able to promote the "3 CPR" challenge as well. I'm sure many of you guys are familiar with that. That's learning CPR, it's actually sharing that knowledge with others as well. I know that that's been a big focus with us with the American Heart Association. I know he's also brought obviously a lot of attention, as well as advocacy, both on that forefront as well.
Anna Isaacson: Yeah, I would just add that from the very beginning, it was clear that he saw this moment in time as an opportunity to really do something unbelievable, and I think that's what we've heard from him and seen from his family, is this desire. He partnered with the American Heart Association, which was great, very quickly, and so it's been great to stand behind him.
Jack McMaster: And I just want to add, since you are from Buffalo, one of the backstories up in Buffalo was that Aaron Thornton, a Red Cross Trainer, had trained the Buffalo Bills staff at Canisius College about six months before the event. So it was really quite remarkable. Recertification is an important training event as well. Sometime in the next month, we're going to be actually awarding the Certificate of Merit, which is a lifesaving award that has been signed by the President of the United States since the Taft Administration. President Biden will shortly be signing that letter for those that responded and used Red Cross training to save Damar.
REPORTER: Jeff, what are the costs for the states to adopt this Smart Heart Sports Coalition's policies?
Jeff Miller: Maybe somebody who knows more about AEDs than I can speak to the hard costs there. But as far as plans and training, they're de minimis. Putting an Emergency Action Plan in place – where you can find a template somewhere, you can learn from your neighbor, you can learn from the next community, you can learn from all of those that exist – those will all be made available, certainly. CPR training, I don't want to speak again for the experts here, they can go into that. And the cost of an AED machine amortized over the life of the AED machine is really a de minimis cost. But I'll give you some more details from people who can speak to that.
Dr. Comilla Sasson: I will say, I think we have, as an organization, really done a lot in terms of also advocating for CPR training as a high school graduation requirement in 40 states – that's been passed already. So we are familiar kind of with that work in terms of both the idea that training can come with a cost associated with it, but it also can be done very inexpensively as well. Part of the initiative here is going to be to try to get AEDs more publicly available, not just necessarily at an athletic field, but also more to the community as well, or even within mobile responders. The Heart Association is actually working with Damar Hamlin, we'll be introducing some legislation coming up in the next couple of days – the "Access to AED Act" – which will be corollary to this work as well to provide more broad scale funding for schools to get AEDs as well. So I think there is going to be a hard cost to AEDs, but there's also a lot of work that can be done not necessarily with just the financial aspects, but with community volunteers, etc, who can help with the training aspects as well.
Doug Casa: It's a nuance for sure, but a lot of the states actually do have policies that require AEDs at the high school itself. That's not what we're looking for with this particular policy. We want the AED to be accessible specifically to athletics and be accessible two to three minutes – not locked in the nurse's office or near the principal's office and you have to get through three locked doors from a sports field that's a half mile away, where this is very specific AED access for high school athletes during the afternoon and evenings, when practices and games are happening.
David Gallegos: I'd like to add, in New Mexico, we have legislation in the governor's office to have a bill to be signed requiring CPR for coaches, and I appreciate the TUFSS work that brought that forward. But it's a great question, because in rural state like New Mexico, it's a challenge to get some of the certifications through, and I greatly appreciate the support of the NFL, and I do think we'll come up with community initiatives to do that.
REPORTER: You guys talked about going into trenches, specifically at the high school level. What exactly is that process like? And do you guys have any plans already to kind of talk to those high school leagues?
Jeff Miller: Thanks for the question. I think that the order of operations is going to follow similar to what a lot of the organizations here have already done, which they're welcome to speak to, certainly. Korey Stringer Institute has, in that as somebody referenced earlier, we did as it regarded youth concussion laws, which would go to the governing bodies in the state, whether it be a legislative response, or a regulatory response with the Department of Education, or the state high school athletic association, or some similar body that had the ability to create a policy that made a mandate on the schools to follow those three key elements: have an Emergency Action Plan in place, make sure that it was approved; make sure that AEDs were accessible, as Doug pointed out; and make sure that there is CPR education for people responsible, then so that that could be incorporated should there be a need. So those three simple principles, again, from people who can insist upon the enactment of those at the school level, meaning that we would work with regulators or legislators to make that happen.
Dr. Comilla Sasson: I think the question that you have is really important. It's great to make policies, but how's it going to happen in the real world? And I think that's really the strength of the organizations that are standing here. With the American Heart Association, we already have a presence, like I'd mentioned, we've got 40 states that have passed CPR and AED as a mandatory high school graduation requirement. So we are already in the schools, already doing this training with folks. Many of you guys have had "Jump Rope for Heart," I'm not sure if you guys have had your kids participate in that. So we have a huge presence already from kindergarten through high school, and college as well. And so those are the letters that we have as an organization to be able to not just talk about the policies and get them pushed at the federal, state, local levels, but also then to actually enact them as well.
And then I would just mention, I think part of the strength, again, of this entire coalition is that with youth sports, we have an opportunity, I think, to really look at communities maybe where there aren't necessarily resources, right? And so I think we have an opportunity to really equalize the playing field and make sure that every single person has access to that information, not just the students themselves, but their families. And I think that's a really important piece that is really important as we start thinking about how do we make sure that survival increases. It's not just making sure that the people who have had the training continue to get certified, that's not what we're looking for here. We're looking at getting grassroots, public education and awareness to anyone and everyone who wants that information. And most of the time, that is not with cost. That is just truly education and awareness. And that's where we're going to make the biggest impact and that's how we're going to save more lives.
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