Safety Advocates Focus on Hidden Threats to Young Athletes Michael Stravato for The New York Times David Wilganowski, in the stands, was revived with an automatic external defibrillator after his heart stopped during a high school football game. In February, hundreds of youth sports safety advocates convened at a Washington hotel. They were determined to talk about something other than concussions, a counterintuitive ambition considering the rampant worry about the effects of head trauma in young athletes. But the Washington group knew something most do not: the No. 1 killer of young athletes is sudden cardiac arrest, typically brought on by a pre-existing, detectable condition that could have been treated. Another substantial yet hidden lethal threat is heat stroke, a condition considered completely preventable. Concussions are receiving attention nationwide, but death from a blow to the head is exceedingly rare. In contrast, a young athlete dies from a cardiac incident once every three days in the United States, researchers say. In hot months like August, heat stroke often causes the death of a young athlete every other day on average. "Concussion victims almost always get a second chance," said Laura Friend, an attendee at the Washington summit whose 12-year-old daughter, Sarah, died of sudden cardiac arrest while swimming at a Texas community pool in 2004. When your heart fails from something that could have been treated - which happens all the time - you don't have another chance. As someone told me, sudden cardiac arrest is not rare; surviving it is. Heat stroke, also known as exertional heat illness, has been a focus of sports safety advocates because of simple, common-sense preventive measures, like introducing gradual levels of exercise at the beginning of a sports season in hot temperatures. "When my son died, people treated it as a freak thing," said Rhonda Fincher, whose 13-year-old son, Kendrick, died in 1995 from heat stroke sustained during a season-opening football practice in northwestern Arkansas. The ignorance was unacceptable because, unfortunately, it is not infrequent. And we should all know that. No healthy child should be sent off to a routine practice and die from it. Leaders of youth sports acknowledge that concussions have long been overlooked and that the injury deserves a period of heightened awareness, especially because of the potential for long-term consequences. But as the focus of the February conference organized by the National Athletic Trainers" Association suggests, there is a mounting worry that more hazardous health concerns are being disregarded because of the intense emphasis on brain injuries. A sudden heart-related death is "so incredibly tragic and stunning that people aren't comfortable putting it into the everyday conversation," said Dr. Jonathan Drezner, the president of the American Medical Society for Sports Medicine. "I do wish, to some extent, it was something people talked more about," Drezner added, "because we are getting to a place where we could prevent many of these deaths." One factor that may be inhibiting the conversation is a widespread disagreement about the best course of action to reduce deaths from sudden cardiac arrest. The debate hinges on suitable precautionary measures for young athletes. The physical examination that virtually every athlete in the United States must pass to play a school sport includes listening to the heart, checking blood pressure and reviewing family medical history. Additional testing is typically not done unless a red flag is raised. But many doctors strongly advocate adding an electrocardiogram, or EKG, to the pre-participation exam. They say it would detect about two-thirds of the deadly, concealed heart trouble aggravated by exercise in competition. Sudden cardiac arrest in a young athlete is most commonly set off by a structural heart defect or a problem with the heart's electrical circuitry that is not usually found during a routine physical. The most frequent cause is hypertrophic cardiomyopathy, a thickening of the heart muscle. The condition has few warning signs. In other countries, most notably Italy, young athletes are required to have EKGs to play sports, but adopting the practice in the United States could cost $25 to $150 per EKG, which may not be covered by insurance. Some school districts have arranged for deeply discounted EKGs for their athletes, and several hospitals, like Cook Children's Medical Center in Fort Worth, offer to conduct an EKG on an athlete and have it read by a pediatric cardiologist for $25. Some hospitals, like Miami Children's Hospital, have begun offering free EKGs for athletes. Many colleges screen all of their athletes before every season. But even at discounted prices, the cost of giving an EKG to each of the country's 7.7 million high school athletes has led to skepticism of whether EKGs are a prudent, practical medical procedure. Because the test can produce false positives, leading to more testing, the debate can be contentious. At the Washington summit, the role of EKGs was hotly discussed. But when the conference created a national action plan for sports safety, the tests were not part of it. Many attendees felt that the focus on universal EKG screening was a distraction from more pertinent goals, like having lifesaving automatic external defibrillators, or A.E.D."s, in every school in the country and near every playing field and gymnasium. Every Minute Counts An A.E.D., properly administered, can boost the survival rate after sudden cardiac arrest by 60 percent or more, but about 30 percent of schools nationwide do not have an A.E.D. In some poorer states, half of the schools might be without an A.E.D.