The $600,000 Vacation

Why was it on this family vacation, swimming in that pool, a nine year old went into sudden cardiac arrest? What caused it? Could it have been prevented? Could the near drowning been avoided?
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This vacation was out of control. Their room was $5,900 a night. The helicopter ride cost $36,347. They spent more than $1,000 a day on drugs. It was like nothing I'd ever heard of before.

Last summer, my friends took their family to Virginia. They rented a nice house with a pool - a prerequisite for three kids under the age of ten. One beautiful day hanging out around the pool, they turned around and found one of their children at the bottom of it . . . unconscious.

For twenty-six minutes, they performed CPR and waited for the paramedics to arrive. For twenty-six minutes, he didn't breath and his heart didn't pump. When the first responders arrived, they shocked his heart with an AED device.

Why was it on this family vacation, swimming in that pool, a nine year old went into sudden cardiac arrest? What caused it? Could it have been prevented? Could the near drowning been avoided?

Sudden cardiac arrest may be sudden, as the name suggests, in which case, there is little that can be done to prevent it. However, some studies suggest that the majority of children who experience sudden cardiac arrest have at least one warning sign. Sudden cardiac arrest is caused by an underlying heart condition. Most of these conditions can be detected with an electrocardiogram (EKG).

What began as an idyllic family vacation turned into a nightmare. Every day was touch and go. According to the statistics on sudden cardiac arrest, drownings and resuscitation, Timmy had absolutely no chance of survival.

Timmy was in a coma for six days. He spent fourteen days in intensive care. He didn't eat for eight days. During his stay, he was diagnosed with a heart condition called Long QT Syndrome, a potentially-fatal arrhythmia that disrupts the heartbeat. Before his discharge, he received an implantable cardioverter-defibrillator (ICD).

In 2005, my son, Simon, died from this condition. Following his death, I was diagnosed with the same condition. It is responsible for up to 15% of all SIDS deaths. It is one of a handful of conditions that makes cardiac arrest the leading cause of death of student athletes.

Like me, Timmy's family didn't know about their son's heart condition because children don't get EKG exams. The American Heart Association and American College of Cardiology, the two organizations that dictate which tests are offered in the world of heart health, decided three decades ago that asking students twelve questions about their hearts and family history was good enough. Timmy is nine. He's had that exam and was asked those questions at least three times. In fact, it is safe to assume that most children who collapse and die from sudden cardiac arrest have passed this AHA/ACC exam. In the medical world, that is called a false negative.

One of the major arguments against screening kids' hearts is the cost. For a minute, put aside the fact that a very small group of physicians from these two organizations are claiming that your child is not worth the cost of the exam. Instead, let's looks at Timmy's experience and explore the economics.

Timmy's eighteen-day cardiac arrest episode cost $596,806. Put another way, it cost a over a half a million dollars to save the life of one nine year old.

Alternatively, Timmy could have gotten a $25 EKG exam before his vacation, at which point he could have discovered his heart condition, gone on a beta blocker, which costs about $5 per month, and enjoyed his Virginia family vacation. What sounds more appealing to you?

Proponents of heart screenings suggest that the cost can be as low as $15. The opponents of heart screenings suggest that it is as high as $263. Let's ignore both sides of the argument since they each have their own biases, and look at some medical institutions that are actually providing this service.

Peace Health charges $50 for a youth cardiac screening. Beaumont Hospital has offered the screening for as low as $10 per student. By way of reference, Italy, who mandated heart screenings for all children puts the cost at around $60 per child. By the way, Italy reduced the incidents of sudden cardiac arrest by 89%.

Since Providence seems to have found a sustainable and scalable way to screen our youth, let's use their number.

Take Timmy's medical bills of $597,000 and divide them by the cost of one youth heart screening ($50). The result is 11,940. In other words, for the amount of money used to save one Timmy from sudden cardiac arrest, we could have screened 11,940 students at these two institutions.

This doesn't solve our problem, though. There are more than 11,940 students in this country. So, let's start with the highest-risk population - student athletes. We do this all the time in medicine. It is a way to protect the most vulnerable and learn in the process.

There are eight million student athletes in the United States. To screen this population (at $50 per athlete), we would need $400 million. That seems like a whole lot of money . . . . until you think about Timmy.

Every year in this country, almost 400,000 people die from sudden cardiac arrest. This is more than breast cancer, lung cancer and AIDS combined. Isn't it likely that out of that number, 670 would be kids like Timmy? If so, we just spent $400,000,000. The truth is, we spend way more than that because nationally, we only save about 11% of people who experience sudden cardiac arrest. That means we are trying to save way more than 400,000 people a year and spending much more money.

Shouldn't we opt for the alternative? Shouldn't we screen our children to get a baseline of their heart; discover conditions that could be life-threatening in the short term; discover conditions that could be life shortening in the long term; or prevent cardiovascular disease? Doesn't it behoove us to know as much about our hearts as early as possible? It is the #1 cause of death, remember?

Timmy checked back into the hospital a few weeks ago. He stayed there for sixteen days. Two surgeries later, he got a new ICD. This "vacation" cost hundreds of thousands of dollars. This puts Timmy's experience closer to $1,000,000. We could have screened a few more kids, probably.

My son was worth everything to me. He saved my life. I discovered my heart condition because we didn't discover his. Four years ago, at one of our screenings, Whitney Jones discovered that she had Long QT Syndrome. Soon thereafter, her mother, Rayna, was diagnosed with it too. No one had to die. That's how it should work.

I can't change my story or the ending, but if we get smarter about prevention and the way that we spend our money, I may be able to help change yours. Assuming, you think it's worth it.

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