In the Novosibirsk region on October 10, during a physical education lesson during a warm-up, a second-grader became ill, fell and reportedly died on the way to the hospital. Earlier, on October 4, a 14-year-old teenager died in Bashkiria during a karate training session. Why do children die under such circumstances, how often does it happen, and most importantly, how to prevent it? aif.ru talks about this with a leading specialist in this field, pediatric cardiologist, doctor of medical sciences, professor, chairman of the scientific council of the public organization «Crystal Heart» Leonid Makarov.

Alexander Melnikov, aif.ru: — Leonid Mikhailovich, I know from previous cases that now everyone will actively discuss this, and then they will forget until the next incidents. How to solve the problem realistically?

Leonid Makarov: “Unfortunately, that is what happens. But in fact, this is a big social problem, and its solution must be approached not only emotionally, as it is now, but also rationally. Children die much more often, only those cases that have been reported in the media fall into our field of view. In my time Minister of Education Olga Vasilyeva reported that in Russia in 2018, 211 schoolchildren died in physical education classes. And almost all of these deaths are due to sudden cardiac arrest caused by arrhythmia — a violation of the rhythm of the heart. This is the so-called arrhythmogenic death. It is easy to calculate that such deaths occur more often than once every two days. And this means that seven full large classes suddenly die in the lessons of physical education every year.

— That’s a lot.

“Half the children could have been saved. This is evidenced by world experience. In those countries where this problem is being addressed, the frequency of deaths under such circumstances is 0.56 children per 100,000 schoolchildren. This is despite the fact that cardiac arrest occurs twice as often there — in 1.1 children per 100 thousand. That is, half of the children are saved.

Almost all of us die. We calculated that 211 sudden deaths in physical education are 1.4 deaths per 100,000 schoolchildren. That is, we die 2.5 times more often.

Who is guilty?

— Who is to blame for this?

— They blame the system, the collapse of school medicine, the reduction of nurses. But most often physical education teachers are blamed, arguing that they give increased loads. It is often said that because of them, any child can die in a physical education class. My answer: not any, a healthy heart will never stop, only children with undiagnosed pathology die. And it’s not about the intensity of the load. So in the last case in the Novosibirsk region, death occurred during a warm-up, and not during some hard exercises.

In support of his words, Leonid Mikhailovich shows a lot of videos on which school tragedies are recorded. Thanks to the ubiquitous cameras, they now routinely come into view. The sight is not for the faint of heart.

The lesson of fizra begins, the children easily run in a circle, warm up, one boy falls and dies in front of everyone.

Another video on the outdoor sports ground. It can be seen that the teenager does simple exercises for himself on the horizontal bar, jumps off, takes a few steps, falls face down, twitches his legs. Classmates do not even pay attention at first, maybe they think they are fooling around. Then the student calms down, everyone comes up to him …

The girls play volleyball, one falls, her friends gather around her, the teacher comes up, someone runs to call an ambulance.

“In all these cases, the load was small, if not minimal, and this happens very often,” says Professor Makarov. — After a cardiac arrest, there is no more than 10 minutes to start it again. If more time passes, the person dies. The ambulance arrived about 20 minutes later, and everything ended tragically.

And here is a similar video filmed in the USA.

Teenage girls, just like ours, play volleyball. One of them falls, friends and the teacher rush to her — everything is like ours. One woman runs away, maybe call an ambulance? And teachers begin to do closed heart massage. A minute later the woman returns with some kind of box. Turns out it’s a defibrillator. With his help, the girl is brought back to life.

Gap in medical knowledge

— But on the other hand, a defibrillator is still a complex device.

— I am often given this as a counterargument not to equip schools with them. Here is one such opinion published on a medical website: “Give a defibrillator to a physical education teacher?!!! Do you remember the IQ of your PE teachers, or do you think something has changed there? And if the child just fainted (hungry, didn’t have breakfast, for example) — and here is a physical education teacher with a defibrillator … Can you imagine the consequences?

I represent. To do this, there are not ordinary defibrillators used by doctors, but automatic ones. Their artificial IQ is enough not to harm the child. One electrode is simply placed under the back, the other is attached to the chest, the device itself immediately begins to record the electrocardiogram, and if it does not have such a heart rhythm disorder that requires defibrillation, there will never be an electric discharge — it is blocked, no matter how much you press the start button . The device is very smart and does not require any particularly high intelligence of those who use it.

— What to do?

“It is necessary to amend the legislation so that, firstly, schools regulate the use of automatic external defibrillators and, secondly, determine the circle of persons who have the right and are obliged to provide first aid and conduct cardiopulmonary resuscitation,” Leonid Mikhailovich continues. — This is also a problem, people are afraid to do chest compressions (the so-called chest compressions) because of the consequences, there have been incidents when they were held accountable for breaking their ribs. Unfortunately, this happens, but heart massage often saves lives, and ribs heal quickly.

Standard clinical examinations do not always show serious problems with the human motor.

— And what is the price of the issue, defibrillators are probably very expensive?

— Vice versa. I think if they were more expensive, many would be interested in them and take the initiative as a more cost-effective project. Automated external defibrillators are rarely more than $1,500, and domestic ones are much cheaper. Thanks to this price, they are bought even for personal use if there is a person in the family with a high risk of developing cardiac arrest and sudden death. Schools already have them in many countries. Of the states of the former USSR, such defibrillators have already begun to be installed in schools in Kazakhstan. They are located in an accessible place, usually near the gym. Only this measure will significantly reduce the mortality among schoolchildren — this is the first thing to do right now.