Der­mot Crowe

Cor­mac McA­nallen’s sud­den death has made us much more pre­pared for car­diac emer­gen­cies

Sunday Independent (Ireland) - Sport - - FRONT PAGE - DER­MOT CROWE

“The med­i­cal pro­fes­sion and the pub­lic are so much bet­ter in­formed and pre­pared than they were a decade ago. Pro­vi­sion of car­diac screen­ing has in­creased hugely. At­ti­tudes have changed.”

IN the first week of Septem­ber, two un­re­lated events oc­curred in Dublin which had a trace­able con­nec­tion in one fun­da­men­tal re­spect. One was the launch on the Thurs­day night of The Pur­suit of Per­fec­tion by Donal McA­nallen, chart­ing his re­la­tion­ship with his brother Cor­mac, the Ty­rone All-Ire­land win­ner who died sud­denly from an un­de­tected heart con­di­tion in 2004, aged 24. The other event pre­ceded the book launch by just three days: in a school yard in Rush in north County Dublin a nine-year-old boy al­most lost his life when he col­lapsed dur­ing the lunchtime break.

The piv­otal mo­ment in Donal McA­nallen’s beau­ti­fully told ac­count of his re­la­tion­ship with his brother comes that March morn­ing 13 years ago when tragedy be­fell their fam­ily. There had been no prior warn­ing; Cor­mac ap­peared in rude health, cap­tain of his county, a supreme ath­lete who looked af­ter him­self con­sci­en­tiously. His death had a cat­a­clysmic im­pact in terms of in­creased aware­ness of sud­den death in the young, lead­ing to a pro­lif­er­a­tion of au­to­matic ex­ter­nal de­fib­ril­la­tors (AEDs) in clubs and com­mu­ni­ties through­out Ire­land, and more wide­spread screen­ing.

Three days be­fore the book launch, Gaelscoil Ros Eo in Rush was open for its first Mon­day back af­ter the sum­mer hol­i­days. Around 8.30am a mother dropped her chil­dren off to school, in­clud­ing her nine-year-old boy, be­fore she car­ried on her reg­u­lar jour­ney to work in Swords 10 miles away. A few hours later she got the shock­ing news that her boy had suf­fered a car­diac ar­rest.

“And there was ab­so­lutely noth­ing be­fore­hand, ever . . . I don’t think he had ever even been to a GP; a very healthy boy,” she ex­plains.

That he sur­vived is due to a num­ber of for­tu­nate co­in­ci­dences and the in­ter­ven­tion of peo­ple in the school and nearby. It is also due, in a way, to the legacy and con­se­quences of Cor­mac McA­nallen’s death. In­creased aware­ness and im­proved ac­cess to AEDs have saved lives. With a wait of at least 20 min­utes for the ar­rival of emer­gency ser­vices and med­i­cal per­son­nel, this boy’s life was saved by a com­bi­na­tion of CPR and the con­ve­nient prox­im­ity of an AED lo­cated in the GAA club, St Maur’s, which is sit­u­ated next door to the school.

“It does give you an up­lift­ing feel­ing to hear these sto­ries,” Donal McA­nallen says. “You do feel a lit­tle more emo­tion­ally in­volved. It is par­tic­u­larly strong where peo­ple have been saved by (Cor­mac) Trust de­fib­ril­la­tors (the Trust set up af­ter his death), not least Kevin McCloy, who has be­come an am­bas­sador of the Trust.” McCloy, the for­mer Derry foot­baller, suf­fered car­diac ar­rest dur­ing a club match in 2014. Doc­tors at the game and an AED in the ground helped save him.

The school in Rush did not have its own AED, and the in­ci­dent has prompted im­pas­sioned calls by its prin­ci­pal Tim O Tuachaigh that the State pro­vide ev­ery school in the coun­try with one. He es­ti­mates it would cost €6m, a pit­tance, he ar­gues, if it can help save even one life.

But the episode also raises is­sues for those who al­ready have AEDs. On cer­tain days St Maur’s GAA club closes early, leav­ing the AED used in this in­stance in­ac­ces­si­ble. On this par­tic­u­lar day a wo­man was clean­ing the bar up­stairs, work­ing later than usual, when she was alerted to the emer­gency. For­tu­nately, she had been trained in first aid and CPR.

There are two fixed-point AEDs in the St Maur’s club. The one used in this case is lo­cated in the foyer. An­other is lo­cated in a ref­eree’s room next to the dress­ing rooms, but that room is of­ten locked. A third is used as a mo­bile de­vice that is brought to matches that teams are in­volved in away from home. The in­ci­dent has made the club re­con­sider the is­sue of ac­cess and the press­ing need to move one of the AEDs to an out­side lo­ca­tion where it is al­ways avail­able if needed. The main con­cern about out­side lo­ca­tions is the risk of van­dal­ism, but it is a risk they will have to take. This is the sec­ond time in a few years the club used an AED, al­though the first time was not as se­ri­ous and did not re­quire shocks to be ad­min­is­tered. The AED can mon­i­tor the heart’s rhythm, and based on its find­ings in­form whether shocks are re­quired or not along with com­pres­sions.

Stacey Brady was the per­son work­ing in the bar at the time the boy col­lapsed. “It was a very trau­matic ex­pe­ri­ence,” she re­calls. “When I got there some of the teach­ers were cry­ing, the boy was on the ground and Tim (prin­ci­pal) was there. They were stand­ing over him. I ap­plied the pads. At that stage Tim was do­ing the com­pres­sions and they were on the phone to a para­medic. I was grand till a half an hour af­ter it. I think it was just adren­a­line.”

When the boy col­lapsed the prin­ci­pal, who con­tacted the emer­gency ser­vices and soon be­gan CPR, dis­patched a staff mem­ber to the club know­ing it had a de­fib­ril­la­tor in the build­ing. There is a side en­trance through a gym, Evo­lu­tion Fit­ness, which oc­cu­pies part of the club prop­erty only a few me­tres away from the school. The per­sonal trainer in at­ten­dance was not trained as a first re­spon­der but she took the staff mem­ber to the AED in the re­cep­tion area, re­moved it from its box and then went up­stairs where they found Stacey Brady. “Stacey re­acted in a non-pan­icked way,” says the per­sonal trainer, who pre­ferred not to be named. “We went out and she was able to check the boy’s con­di­tion and ba­si­cally did what she had to do. She was fan­tas­tic I have to say.” To­gether with Tim O Tuachaigh, she worked on the boy un­til the paramedics ar­rived.

Donal McA­nallen’s book isn’t to­tally con­sumed with what hap­pened af­ter his brother died. Not un­til page 286 of the 332 pages do we read of the ‘af­ter­math’ and what fol­lows. Much of the book is about their lives grow­ing up to­gether and the broth­erly rap­port that forged a close bond be­tween two sib­lings di­vided by lit­tle over a year in age.

But there is no es­cap­ing how much Cor­mac’s death has taken over fam­ily life since. “Back in Fe­bru­ary 2004,” as Donal writes, “did I even know what a de­fib­ril­la­tor was?” By the end of 2006 the Cor­mac Trust, set up to in­crease aware­ness of sud­den death in the young and cam­paign­ing for bet­ter screen­ing fa­cil­i­ties, had sup­plied 80 free AEDs to a va­ri­ety of GAA, soc­cer, rugby and golf clubs, as well as com­mu­nity cen­tres, fire bri­gades and leisure fa­cil­i­ties in Ty­rone.

“So pub­lic and so mys­te­ri­ous had Cor­mac’s tragedy been, and so many peo­ple would be po­ten­tially af­fected by sim­i­lar is­sues, that we had to act,” Donal writes. “We had to learn quickly about Sud­den Adult Death Syn­drome. One of the first things we learned was that lots of young peo­ple had died sud­denly be­fore but with much less pub­lic­ity af­forded to their cases.”

He says that within days of Cor­mac’s death they were con­tacted by many par­ents who had sud­denly lost a son or daugh­ter to heart con­di­tions, mostly un­di­ag­nosed.

In 2007 the GAA set up a pro­gramme to pro­vide dis­counted AEDs to clubs and be­come ac­tive in pro­mot­ing on­go­ing aware­ness and train­ing. Donal McA­nallen is a dyed-in-the-wool GAA man but he hasn’t al­ways seen eye to eye with the GAA dur­ing the years since his brother’s death. He cites many ex­am­ples of over­whelm­ing sup­port and de­cency but also cases of bu­reau­cracy and pro­cras­ti­na­tion which proved frus­trat­ing.

“The GAA proved to he a harder nut to crack than you might think,” he writes. For sev­eral years the Trust ad­vo­cated a mo­bile screen­ing unit that would travel the coun­try and screen teams and in­di­vid­u­als for a small fee. Com­mer­cial spon­sor­ship and Trust con­tri­bu­tions would have cov­ered most of the cost. He sub­mit­ted a de­tailed pro­posal on this to the GAA, with in­put from car­di­ol­o­gists and a cam­paign group in Bri­tain de­tail­ing how it would op­er­ate. He re­ceived no re­sponse.

Ac­cord­ing to Donal, some­where be­tween 500 and 1,000 young peo­ple have died of sud­den death-type ill­nesses on the is­land of Ire­land since 2004.

Much has been achieved. “The med­i­cal pro­fes­sion and the pub­lic are so much bet­ter in­formed and pre­pared than they were a decade ago,” he writes. “Pro­vi­sion of car­diac screen­ing has in­creased hugely. At­ti­tudes have changed too. The change was driven from ground level. So many county and club teams and in­di­vid­u­als were get­ting screened of their own ac­cord, not want­ing to be hostages to for­tune. In 2011, Croke Park an­nounced that all se­nior teams would be screened as a mat­ter of course. Af­ter six years, it had ar­rived at the des­ti­na­tion we had been point­ing it to­wards, only it had taken the scenic route.”

He points out that wher­ever you work, learn, play or shop the chances are that you are within “shout­ing dis­tance” of an AED. But not all is right. “Pub­lic aware­ness isn’t yet where it should be. Ire­land has one of the high­est den­si­ties of com­mu­nity-based de­fibs in the world — roughly one for ev­ery 500 peo­ple — but many peo­ple don’t know where their near­est de­fib is.”

Gearoid McDe­vitt, player wel­fare of­fi­cer with the GAA, de­scribed the in­ci­dent in Rush as a “pos­i­tive ex­am­ple of the aware­ness/as­so­ci­a­tion that peo­ple have with GAA clubs and the pro­vi­sion of these AED units. We have a scheme in part­ner­ship with Heart­safety So­lu­tions where they pro­vide AED units at a dis­counted price to GAA clubs.”

Ac­cord­ing to McDe­vitt, the num­ber of AEDs pur­chased by clubs is just un­der 1,500 dur­ing the scheme, al­though how many of these ac­tu­ally went to clubs he isn’t sure. “At the time some clubs bought sev­eral de­vices and dis­trib­uted to the com­mu­nity, schools etc. In ad­di­tion, or­gan­i­sa­tions like the Cor­mac Trust pro­vide units di­rectly to clubs which wouldn’t nec­es­sar­ily be pur­chased via the scheme.”

He says that GAA clubs who do not have an AED at their main grounds are in the mi­nor­ity. How­ever, test­ing and main­te­nance of the units can prove chal­leng­ing for clubs. “Larger clubs may not have a unit at each venue they use which we en­cour­age them to ad­dress, as if an event oc­curs away from the club­house/main pitch it may not be pos­si­ble to get the de­fib in time. We ad­vise club ex­ec­u­tives to as­sign re­spon­si­bil­ity for main­te­nance of the de­fib­ril­la­tor to a club of­fi­cer. It is now rec­om­mended that clubs also place a sticker with the Eir­code ad­dress on the unit/car­rier bag so to eas­ily no­tify the emer­gency ser­vices of its lo­ca­tion in the event it has been used.”

A de­fib­ril­la­tor ex­change pro­gramme is in op­er­a­tion with Heart­safety So­lu­tions, whereby a fur­ther €100 re­duc­tion off the al­ready dis­counted GAA club prices is avail­able when the club ‘trades in’ an old de­fib­ril­la­tor. The club, in ex­change for their old unit, gets a new de­fib­ril­la­tor with a 10-year war­ranty. This has been in place since Oc­to­ber 2015.

In the case of St Maur’s, the AEDs were do­nated by Apache Pizza, which has a busi­ness pres­ence in the re­gion, but the onus is on the club, as it is in all clubs, to en­sure that they re­main in work­ing or­der and are ac­ces­si­ble if needed in an emer­gency.

As Donal McA­nallen writes, there is a risk of fail­ing to fol­low main­te­nance pro­ce­dures. His book is about a lot more than what hap­pened af­ter Cor­mac died, yet the wider ed­u­ca­tional im­pact of that tragedy is still be­ing felt in in­cred­i­bly pos­i­tive ways. In the week he launched his book on his brother’s life and death, that legacy helped save a young boy in Dublin. The link is un­de­ni­able.

This is the sec­ond time in a few years the club used an AED

GAA clubs who do not have an AED at their main grounds are in the mi­nor­ity

Harry Ren­nicks of the St Maur’s GAA club in Rush with a mo­bile de­fib­ri­la­tor which is brought to all club games; above, Cor­mac McA­nallen af­ter Ty­rone’s vic­tory over Kerry in the 2003 All-Ire­land semi­fi­nal, just seven months be­fore his sud­den death, and who is re­mem­bered by his brother Donal in a new book, The Pur­suit of Per­fec­tion. Main photo: David Conachy

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