Every year, sudden cardiac arrest (SCA) claims the lives of thousands of students and student-athletes in the United States, making it one of the leading causes of death. The condition is particularly insidious as it often strikes without warning, leaving schools and communities grappling with preventable tragedies. While student-athletes are at a higher risk due to the physical demands of sports, SCA can affect any student, highlighting the urgent need for systemic preparedness in schools.

Fast facts about SCA

Annual burden: Around 7,000 children and adolescents under the age of 18 experience SCA in the U.S.

SCA in athletes: SCA is a leading cause of death in young athletes, especially those involved in high-intensity sports like basketball, football, and soccer. The risk of SCA is higher in male student-athletes, especially during competitive sports.

Importance of quick intervention: Without immediate intervention such as cardiopulmonary resuscitation (CPR) or automated external defibrillator (AED), survival rates for SCA outside of hospitals are less than 10 percent. Timely CPR can double or triple the chances of survival. If AEDs are utilized within 3 to 5 minutes of an SCA, survival rates can exceed 40 to 70 percent.

Time sensitivity: It is important to stress that survival rates decrease by 7 to 10 percent for every minute defibrillation is delayed during an SCA event.

Disparities: African American and Hispanic populations are less likely to receive bystander CPR, and schools in low-income areas often lack adequate access to AEDs.

Training students in CPR and AED is a community-wide investment.

Training students in CPR and AED application is not just a strategy to save their peers but a community-wide investment in public health. Schools are where students spend the majority of their waking hours, making them the logical hubs for training and preparedness. By equipping students with life-saving skills, we empower them to assist in emergencies, including adults: teachers, parents, or even grandparents. Around 20 percent of the U.S. population is at schools daily, making these institutions viable places to enforce CPR and AED training.

Background on the HEARTS Act (H.R. 6829)

Recognizing the urgent need to train students and engage schools in CPR and AED training, Congressman Frank Pallone (D-NJ) introduced the Cardiomyopathy Health Education, Awareness, Research, and Training in Schools (HEARTS) Act (H.R. 6829). This bipartisan legislation passed the U.S. House in September 2024 and the Senate unanimously on December 10, 2024. The president recently signed the HEARTS Act into law.

The key components of the HEARTS Act include:

• Establishing a federal grant program to fund the purchase of AEDs for all schools.
• Providing educational and awareness resources for CPR and AED training for students, staff, and faculty.
• Mandating schools to develop and implement comprehensive cardiac emergency response plans (CERP): Develop a core response team, AED access (including maintenance of AEDs and strategic location), training with regular refresher courses, and outline clear steps of resuscitation.
• Raising awareness about cardiomyopathy and other cardiac conditions that increase SCA risk.
• Engage communities, local health care providers, and emergency services to improve response times.

Inspired, in part, by the widely publicized cardiac arrest of NFL player Damar Hamlin during a game in January 2023, the HEARTS Act underscores the critical need for immediate intervention during SCA events. With bipartisan support, the Act reflects a collective commitment to safeguarding the country’s youth and adults.

Addressing school funding gaps and potential solutions

The HEARTS Act offers promising solutions, but its implementation might be hindered by longstanding budgetary inequities in U.S. public schools. According to the 2024 Adequacy and Fairness of State School Finance Systems report, 39 states allocate less of their economic shares to K-12 public schools than in 2006, costing schools over $360 billion (between 2006-2021) – states like Hawaii, Arizona, and Indiana saw funding cuts of 20 to 28 percent, underscoring the challenge of bridging this financial gap. This chronic underfunding hits low-income districts hardest, disproportionately impacting African American and Hispanic communities. African American students are twice as likely as white students to attend underfunded schools, while Hispanic students also face significant inequities, leaving these districts with fewer resources for AED and CPR training. Affluent districts, supported by strong funding, will meet CPR and AED mandates, while underfunded schools will continue to struggle without targeted and data-driven federal support. Prioritizing high-poverty and underserved schools is crucial to closing the preparedness gap and ensuring all students, regardless of location and socioeconomic status, have access to CPR and AEDs. Integrating CPR and AED training into physical education or health education curricula ensures universal access while leveraging technology like virtual modules, which enhances student engagement across all school districts. Additionally, training student volunteers and offering free CPR and AED training at public libraries, places of worship, and community gathering places are practical solutions to ground-level implementation of the HEARTS Act.

Start early and build partnerships.

Expanding the HEARTS Act to include elementary students is another vital step for fostering a culture of preparedness from an early age, making CPR and AED skills second nature by high school. Early exposure increases the chances of skill retention and amplifies the overall long-term impact on communities. Partnering with organizations like the American Heart Association, local fire departments, and community businesses can provide critical funds and resources for effective implementation and training.

Conclusion

The HEARTS Act represents a transformative opportunity to save lives and promote equity in cardiac emergency preparedness. By addressing the gaps in CPR and AED training and ensuring that every school – regardless of socioeconomic status – is equipped to handle cardiac emergencies, we can create safer, healthier communities. Federal funding, expanded training programs, equitable education funding, and the HEARTS Act are essential to making this vision a reality. As schools strive to meet the educational and safety needs of their students, the HEARTS Act provides a roadmap for turning tragedy into action and inequity into opportunity. Expanding its reach, addressing systemic funding gaps, and fostering collaboration at every level will ensure that every student, teacher, and family member is prepared to face cardiac emergencies head-on, building a more resilient and prepared society.

Jay Tamirisa is a high school student. Ashwini Chowdhury is an internal medicine physician.