Partnering to prevent sudden cardiac arrest in youth

State: FL Type: Promising Practice Year: 2016

St. Lucie County is located on the Central East Coast of Florida and has a diverse and growing population of nearly 300,000 people (24% Black/African American, 76% White, and 18% Hispanic).    Over a third of residents (33.7%) have incomes below 200% of the Federal Poverty Level which limits their ability to afford health care and transportation (  The target population for the Annual Know Your Heart Screenings is youth ages 5 – 20.  Marketing is sent to schools to encourage students, especially athletes to participate.  The public health issues addressed by this program include:  clinical preventive services for children, access to health care services, and screening for undiagnosed heart conditions that can result in sudden cardiac arrest.  The goal of the Know Your Heart Event is to reduce the risk that a child will die from an undiagnosed heart condition.  Objectives for the event: 1.    Increase awareness of the risk of Sudden Cardiac Arrest in youth 2.    Increase awareness of A.E.D.s (Automated External Defibrillators) and the value of early screenings 3.    Increase the percentage of students that are screened for heart defects with EKGs, Blood Pressure, and Echocardiogram testing  The Florida Department of Health in St. Lucie County partners with the Jessica Clinton Foundation to hold a one-day Know Your Heart Screening for youth age 5-20.  The Foundation organizes the event, recruits volunteer health providers, and manages appointments.  The Health Department provides clinical space, clinical supplies, logistical support, and health education during the event.  The Foundation markets the event through their website and community networks.  The Health Department supports this by printing flyers and facilitating distribution of information through the school district.  .  As member agency of the Roundtable of St. Lucie County – a coalition of executive level community leaders from the school system, law enforcement, government, social service agencies - the Health Department is able to disseminate information on the event to all Roundtable members and their agencies.   Parents register their children in advance and at the event.  The screening includes a healthy history, blood pressure, and an EKG.  EKGs are read by a Pediatric Cardiologist who performs an Echocardiogram on any child with an abnormal finding.  The event is held on a Saturday from 8:30am to 4:30 pm.  Three annual screenings have been held at the Health Department location and 600+ students have been screened over the three annual events.  The following results were found at the 2014 screening.  The early diagnosis will increase the likelihood of a positive outcome and may result in saving a life.                                      TOTAL SCREENED 210MALES 111FEMALES 99FAMILY HISTORY 42HIGH BLOOD PRESSURE 3%ABNORMAL EKG'S (AFTER READ) 13%MURMORS DETECTED 6%ECHO'S PERFORMED 33%ABNORMAL ECHO'S 7%REFERRED FOR FOLLOW-UP (PEDIATRIC CARDIOLOGIST) 11%NO PRIOR KNOWLEDGE 10%MARFANS INDICATORS 2%MITRAL VALVE PROLAPSE 2%REFERRED FOR FOLLOW UP (GENERAL Pediatrician) 4% The Health Department strives to increase access to health care services and increase life expectancy among our population.  The Know Your Heart Screening provides a service that many would not be able to obtain otherwise. The financial impact of this one day event can be seen below.  Many people in St. Lucie County are uninsured or underinsured, so these services may not have been obtained without this clinic.  The estimated value of the services provided is as follows: Physical performed:  210 @ $ 75.00 each = $ 15,750.00 EKG:  210 @ $1,500.00 each = $ 315,000.00 Echocardiograms with interpretation:  69 @ $2,250.00 = $155,250.00 Total value of services provided = $ 486,000.00  REFFERENCE:   Website for your program, or LHD.  
Students, especially young athletes can have serious but undiagnosed cardiac conditions that put them at risk for sudden cardiac arrest.  The Academy of Pediatrics reports that 2,000 patients younger than 25 die from Sudden Cardiac Arrest (SCA) each year.  This number may be low however as there is no centralized registry for pediatric SCA.  What is known is that the sudden death of a seemingly healthy athlete leaves families and communities devastated.  Jessica Clinton was a local high school cheerleader who collapsed after practice.  Her parents had no way of knowing she was at risk and her high school did not have an automated external defibrillator (AED) on site.  She died before emergency personnel could reach her.  Jessica’s family has devoted their energies to ensuring that other families don’t go through a similar tragedy.  There are approximately 50,000 students ages 5-20 in St. Lucie County.  The Know Your Heart Screening Day has provided over 600 screens at no charge to families.  Each year the event grows and helps spread the word about AEDs and sudden cardiac arrest.  Though tragic, sudden cardiac arrest affects a small number of youth each year.  Because of the cost of screenings and AED equipment little has been done in the past to prevent these tragedies.  A Health Department would not be able to provide this type of screening without the partnership of a dedicated non-profit group.  The Jessica Clinton Foundation is committed to providing CPR/AED training and Automated External Defibrillators to schools, parks, playgrounds and recreational facilities throughout the state of Florida. They have also created an awareness campaign to educate the public about often undiagnosed heart condition and to encourage electrocardiogram screening for people of all ages.   A shared use agreement allows community members to use a public space or building during off hours.  Allowing the Jessica Clinton Foundation to use the clinic and auditorium in the Health Department on a Saturday benefits both organizations.  The Foundation continues its mission to provide screening and the Health Department facilitates access to a health service without a major output of resources. This model could work for any number of non-profit groups seeking to increase their impact.  Health Departments around the country are struggling with limited budgets and often must make difficult decisions about providing services.  Sudden Cardiac Arrest is tragic, but it is not something that most Health Departments could devote resources to – it affects too few people and screening costs are too high.  By partnering with a committed, passionate non-profit the Health Department can provide the services with limited staff involvement.  Nearly every community has foundations working on health issues that could align with Health Department priorities – benefitting both groups.    
The goal of the Know Your Heart Event is to reduce the risk that a child will die from an undiagnosed heart condition.  Objectives for the event: 1.    Increase awareness of the risk of Sudden Cardiac Arrest in youth 2.    Increase awareness of A.E.D.s (Automated External Defibrillators) and the value of early screenings 3.    Increase the percentage of students that are screened for heart defects with EKGs, Blood Pressure, and Echocardiogram testing  The Health Department partnered with the Jessica Clinton Foundation to host the Know Your Heart event at the LHD clinic.  This partnership provides the Foundation with an ideal venue for screening and opens the LHD up to community members on a Saturday.  The Foundation members are passionate about their cause, but lack the medical infrastructure to hold a large screening event.  The LHD provided eight exams rooms, a waiting room, registration desk, and large auditorium for education and overflow.  The LHD Medical Director and Pediatrician advised on clinical logistics and participated in screening participants.  The LHD facilitated getting the flyer designed and printed.  The LHD Public Information Officer was able to connect with the School District Public Information Officer to allow the flyer to be posted in school buildings and sent via email to all school staff.  Flyers were distributed to the St. Lucie County Roundtable and sent via email to 40+ community partner organizations.  Participants register in advance with the only eligibility factor being that they are between the ages of 5 and 20.  Many are athletes as the flyers are distributed to local athletic coaches. Participants are given appointment slots and the visits take 1-2 hours from sign-in to release depending on whether they need an echocardiogram.  Given the space and time constraints, the event is limited to approximately 250 participants though this could be increased with more volunteer health providers, especially pediatric cardiologists.  In addition to the Health Department, the Foundation has the support of Indian River State College, St. Lucie County Fire District, Mortara Instruments, Nicklous Children’s Hospital, Palm Beach Children’s Hospital, Adams Air Conditioning, Panera Bread, and Florida Orthopaedic Specialists.  Each partner contributed time, staff, and/or funding to make the event a success. Indian River State College Nursing Students and Fire District Emergency Medical Technicians provided clinical support to the physicians.   The LHD has strong partnerships with community stakeholders and holding the event at the LHD provides credibility to the screening.  The LHD contributes in-kind staff time, but no funding for the project.  Using volunteer providers and donated services keep out of pocket costs to a minimum.  The Foundation handles any required fundraising.  
The goal of the Know Your Heart Event is to reduce the risk that another child will die from an undiagnosed heart condition.  Objectives for the event:  Increase awareness of the risk of Sudden Cardiac Arrest in youth – Every year this event becomes better known in the community which increases the reach of its message.  Eight hundred and thirty-five people now follow the Foundation Facebook page.  Increase awareness of A.E.D.s (Automated External Defibrillators) and the value of early screenings. – Part of the Jessica Clinton Foundation mission is to get AEDs in public places.  They were instrumental in changing Florida law to require AEDs in all public schools with high school athletics (SB 772 2006).    By holding the annual event, the message is reinforced through all marketing materials and social media.  Increase the percentage of students that are screened for heart defects with EKGs, Blood Pressure, and Echocardiogram testing – Over the past three years, the Foundation has screened 668 children, identified over forty kids with cardiac abnormalities and approximately eight kids that required immediate attention and follow up.  Each year the number of participants has increased by approximately ten percent.  Performance measure include:  how many clients were screened, how many participants had abnormal findings, and how many were unaware of their status prior to screening. In 2014, 210 participants were screened.  Thirteen percent had an abnormal EKG, 3% had high blood pressure, and 20% had a family history of heart problems.  One third of participants needed an echocardiogram and of those, eleven percent were referred for further testing.  Ten percent of those presenting with abnormal readings were unaware of any problems.  Six percent had a heart murmur, two percent had Marfans indicators, and two percent had mitral valve prolapse (the heart condition that led to Jessica’s death in 2003). As the event grows it is hoped that more long-term evaluation of outcomes will be possible.  
The Know Your Heart Event is sustainable in its present form.  The Foundation has been very successful in recruiting volunteer health providers and out-of-pocket costs are very minimal.  The LHD has adequate resources to host the event and to help market it to the community.  The biggest threat to sustainability would be the inability to get participation from one or more pediatric cardiologists.  Lessons learned include:  Increasing participation requires recruiting more than one cardiologist to streamline the echocardiogram process; more staff is needed during and after the event to help with the process and clean-up.  Working closely with members of a non-profit is very rewarding and LHD staff members have been inspired by their dedication and passion for this cause.  An unexpected benefit is the pride that LHD staff feels in being able to bring these services to the community.   Each year the program grows and more children are screened.  The value of these services last year was $486,000.  On a strictly fiscal analysis, $486,000 of health service was provided to the community at a minimal cost to the LHD.  It is difficult however to put a value on a screening that uncovers a potentially fatal condition in an otherwise healthy young person.  As long as the Jessica Clinton Foundation remains committed to increasing heart screenings to the community, the Health Department will support their effort.   
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