A study by Henry Greenberg finds only a third of U.S. states require schools to have defibrillators on hand.
Last February, Claire Crawford, a high school senior, was in the middle of a volleyball game when she collapsed to the floor of her gym in sudden cardiac arrest. A video captured by the girl’s parents shows a school administrator using an AED – automated external defibrillator – to save Claire’s life.

An estimated 1 in 25 high schools in the United States see a sudden cardiac arrest event like Claire’s each year. Yet according to a new study in the Journal of the American College of Cardiology by Henry Greenberg, a cardiologist and special lecturer in Epidemiology, and his colleagues only about of third of U.S. states require AEDs in their schools.

Greenberg and co–authors used the LexisNexis database to find state statutes and regulations on AEDs. They identified 17 states that require AEDs in schools; only one of these states, Oregon, mandates the devices for all public grade schools, private schools, and in colleges. Another four states require AEDs in public schools and colleges, but not in private grade schools.

“Nearly 35 million public elementary and secondary students attend school in states where there is no legislative requirement for a school AED,” says Greenberg. “Many states prioritize AEDs in other locations, such as state office buildings, health clubs, and gambling facilities over schools.”

Sudden cardiac arrest happens when a short circuit in the heart causes it to beat irregularly or stop beating entirely; if normal rhythm is not restored, the person will die within minutes. Portable AEDs use simple audio instructions to direct the user through the necessary steps, including applying pads to the patient’s chest and pressing a button to administer a shock. The devices are so easy to use; sixth graders have been reported to use them with success.

In schools with AEDs, approximately 70 percent of children survive sudden cardiac arrest – seven times the overall survival rate for children. The most important factor for survival is a trained responder who can start CPR and provide early defibrillation. In one study, collapse to defibrillation took a little over three minutes when administered by bystanders compared with nearly 13 minutes by EMS. Survival is estimated to decrease 10 percent every minute until a shock is applied.

So why then don’t more schools have AEDs? According to Greenberg, the main reason is cost. Of the 17 states with requirements around the devices in schools, only five fund or reimburse for them. But to equip a school with two devices plus training and maintenance is only $3,330 – a miniscule amount, he says, compared to lifetime healthcare costs for a single student with cognitive and physical disabilities related to sudden cardiac arrest.

Much of the conversation around sudden cardiac arrest in young people centers on student athletes like Claire Crawford. In fact, three states limit their school AED requirement to those that participate in interscholastic athletic programs – less than a third of public schools in those states. While vigorous exercise is a trigger for sudden cardiac arrest, Greenberg says this attention may be misplaced. “It’s shocking to see a young person who is in peak physical condition collapse in the middle of a competition. But research shows that it’s much more common in school–aged non–athletes than athletes.”

Young people aren’t the only age group who benefit from AEDs. Sudden cardiac arrest is the leading cause of death for adults over age 40 – including many teachers, administrators, coaches, and visitors.

“An estimated 64 million people or one in five Americans can be found in schools on any given week day,” says Greenberg. “AEDs are a ‘best buy’ and making them available where they’re needed is a simply a matter of