Proposed Amendment of Section 135.5 and Addition of Section 136.9 to the Regulations of the Commissioner of Education Relating to Implementing the Dominic Murray Sudden Cardiac Arrest Prevention Act

Revised Proposed Amendment

In response to public comment, the proposed rule has been revised to differentiate between the terms “athletic activities” and “physical activities” as follows:

• The definition for the term “athletic activities” is revised to mean “participation in sessions for instruction and practice in skills, attitudes, and knowledge through participation in individual, group and team activities organized on an intramural, extramural, interschool athletic or inclusive athletic activities basis to supplement regular physical education class instruction, otherwise known as extra-class periods in physical education or extra-class activities.”

• A new definition for “physical activities” is added, which is defined as “participation in physical education classes and recess, or similar activities during the school day.”

Further, the proposed rule has been revised to clarify that, regarding athletic activities, any student who displays signs or symptoms of pending or increased risk of sudden cardiac arrest must be immediately removed from such activities and cannot return until they receive clearance from a physician. Regarding physical activities, any person who displays signs or symptoms of pending sudden cardiac arrest must be immediately removed from such activities and cannot return until they receive clearance from a health care provider, which may be either a physician, nurse practitioner (NP), or physician assistant (PA). Many students use school-based health clinics or other walk-in clinics to access health care services. Such clinics are primarily staffed by NPs and PAs. NPs and PAs can diagnose and determine if a student needs to be seen by a physician. While Chapter 500 requires a student be cleared by a physician for athletic activities, the revisions provide flexibility for clearance to resume physical activities. Limiting students to see a physician only for physical activities is not medically necessary and may amount to a barrier to students who may not have ready access to a physician and could result in students never receiving clearance to resume physical activities in school.

The revisions also clarify that the need to assess increased risk applies only to athletic activities. Increased risk is determined by a thorough individual health history that includes family history. Currently, such histories are completed as part of mandated health examinations for school attendance and prior to each sports season for student-athletes. It is not feasible to obtain such detailed health histories for the grade levels a health examination is not required and would place an inordinate burden on school health professionals, who must review each health history.

Q: What does the Dominic Murray Sudden Cardiac Arrest Prevention Act require schools to do?
A: The Dominic Murray Sudden Cardiac Arrest (SCA) Prevention Act applies to all schools in NYS. Commissioner's Regulation §136.9 was revised on 9/12/22 and includes the following:
For school athletic activities:

• • • • Requires that the school include information on the signs and symptoms of pending or increased risk of sudden cardiac arrest on the parent/guardian consent form for the student to participate in athletics (the definition of athletics is not limited to interscholastic sports and also includes intramurals, extramurals, and individual, group and team activities organized to supplement PE class). This may be done by listing the signs and symptoms of SCA and increased risk on the consent form or by referring them to either the NYSDOH Sudden Cardiac Arrest in Youth website, the NYSED School Health Services website or the school website where that information is posted.
      • Public schools were already required to obtain an interval health history prior to each sports season unless a student had a health exam within 30 days before the start of the season. The interval health history form was revised to elicit questions on the risk of SCA. Unless a nonpublic school competes in a public school athletic league, they are not required to use the form and may choose how they will assess the risk of SCA in their student-athletes.
      • Requires that any student displaying signs and symptoms of pending or increased risk of SCA is immediately removed from athletic activity and may not resume athletic activity until seen and received written clearance from a physician, which is either an MD or DO.
      • Requires that coaches of extra-class athletic activities in both public and nonpublic schools complete a course in first aid knowledge and skills from a nationally recognized organization, as defined in paragraph (D) of section 3000-B of Public Health Law. Such a course must include instruction in recognizing signs and symptoms of cardiac arrest or sudden cardiac arrest. NYSED Courses Accepted as Meeting the Coaches' First Aid Requirement are approved courses for coaches and include this mandatory content.

For physical activities (physical education classes, recess):

• • • Requires that any student displaying signs and symptoms of SCA is immediately removed from physical activities and may not resume physical activities until seen and received written clearance from a healthcare provider ([physician, nurse practitioner (NP) physician assistant (PA)] before resuming physical activities.

Q: Can the NYSED Sample Parent/Guardian Letter be used to provide the required information on the signs and symptoms of SCA for the consent form?
A: Yes, the  NYSED sample letter posted on the NYSED:SSS: School Health Services webpage can be used to meet the requirement of providing parent/guardian information on the signs and symptoms of pending or increased risk of SCA.  The letter may also be used to explain to parents/guardians the importance of completing the interval health history form.

Q: Do you have a sample consent form to share?
A: No.

Q: Does this pertain to afterschool intramurals and sports clubs as well?
A: Yes, school-sponsored activities such as intramurals and sports clubs meet the definition of athletic activities in Commissioner’s Regulations 136.9(b) effective 9/12/22:

Athletic activities mean participation in sessions for instruction and practice in skills, attitudes, and knowledge through participation in individual, group, and team activities organized in an intramural, extramural, interschool athletic, or inclusive athletic activities to supplement regular physical education class instruction, otherwise known as extra class periods in physical education or extra class activities.

Physical activities mean participation in physical education classes and recess or similar activities during the school day.

Q: Does this law apply to PE, recess, etc.?
A: The law applies to PE class and recess as physical activities (see above question under School Responsibilities).

Q: The most recent email referred to all students at risk for SCA. Will this act apply to students in grades PreK-12?
A: The law applies to all PreK-12 schools. See the School Responsibilities section for information on what schools are required to do for athletic and physical activities.

Q: What is required to indicate full activity clearance related to Sudden Cardiac Arrest for a student whose health exam is within 30 days prior to participation in athletic activities?
A: The NYS Required Health Exam form, where the healthcare provider checked the box “Family Cardiac History Reviewed”

Q: What is required to indicate full activity clearance related to Sudden Cardiac Arrest for a student whose health exam is more than 30 days prior to participation in athletic activities?
A: A completed interval health history form signed by the parent/guardian indicating there are no new personal or family risk factors since the last health exam.
OR
If there are new personal or family risk factors since the last health exam, the student must obtain a signed note by a healthcare provider (MD, DO, NP, PA) indicating the student has been cleared to fully participate in athletics.

Q: Who can evaluate and clear a student for SCA?
A: The Act requires a student who is removed from athletic activities with signs/symptoms of pending SCA to receive written signed authorization to resume athletic activities from a physician. A student being evaluated prior to participation in athletic activities for signs and symptoms or increased risk factors may be evaluated by a healthcare provider (MD, DO, NP, PA).

Commissioner’s Regulation §136.9(d) requires a student who is removed from physical activities for signs and symptoms of SCA to receive written signed authorization to resume physical activities from a healthcare provider (MD, DO, NP, PA).

Q: Can a certified athletic trainer serve as the school's representative to evaluate the forms?
A: No, the information requested on this form includes health information which exceeds the statutory scope of practice of athletic trainers.

Q. What is the purpose of the Interval Health History form?
A. The Sample Interval Health History form has questions to help identify changes since the last health examination or health history was completed. School health personnel may require a student with health or history changes to see a healthcare provider before participating in athletics. The form was revised for the Dominic Murray Sudden Cardiac Arrest Prevention Act to contain questions that elicit information on signs and symptoms and risk factors of SCA.

Q: Is the Interval Health History in a format that we can put our school name on the top of the document?
A. The interval health history form is available in both PDF and fillable WORD formats on the Health Services Samples & Forms webpage under Athletics Forms | Letters | Notifications 

Q. When does a parent/guardian need to fill out an Interval Health History form?
A. In public schools, the Interval Health History for Athletics must be completed and signed by a parent/guardian before each athletic season, unless a health examination has been completed within 30 days before the start of the season.

Q. Do students now need a separate note for clearance from a healthcare provider if any of the conditions are checked off in the Family Heart Health History section?
A. The  Dominic Murray Sudden Cardiac Arrest Prevention Act memo states, "Any student with such signs or symptoms, family history or personnel risk factors should be evaluated by a healthcare provider before participating in athletics" Therefore, the healthcare provider evaluating the student regarding their family history and /or personal history should provide written documentation the student is cleared to participate in athletic activities. 

Q: Isn’t an annual physical sufficient to allow a student to participate in athletic activities?
A: The purpose of the Interval Health History is to determine if there have been any changes since the last health exam or health history was completed. For instance, a family member may have been diagnosed with a condition on the list after the student had a health exam that now warrants the student is evaluated for risk of SCA.

Q. Do I also need to submit a healthcare provider's note for the new law in addition to a health exam that was done within 30 days before an athletic season?
A. No, a health examination performed by a healthcare provider within 30 days before the start of the athletic season is acceptable and additional documentation is not needed.

Health exams conducted more than 30 days before the start of the athletic season will require a parent/guardian to complete an interval health history before the season.

Q: Can a school district require parents/guardians to fill out the Interval Health History form whether or not their child has had a health exam within 30 days of the start of the season?
A:  Current state policy is that an Interval Health History is only required if a health exam has not been conducted within 30 days of the start of the season.  A health history is part of a health exam.

Q. Is an Interval Health History form required in nonpublic schools?
A. It is up to nonpublic schools to determine how to assess students who are at risk for SCA and the time interval that they choose to assess that risk. However, if participating in a public school athletic league, a nonpublic school is required to follow the same requirements as public schools.

Q: A student who participates in a sport but trains for that sport outside of the season. Are they required to provide a separate Health History Form for the off-season?
A: No.

Q: If a parent/guardian answers yes to any cardiac question, does that prevent a student from trying out for the sport?
A: If there is a yes answer on the Interval Health History form unless the school has documentation that the response is known to a healthcare provider and the student is cleared, then the student will need to be referred to a healthcare provider for evaluation. 

Q: Can the student attend practice while waiting for their clearance?
A: No, they must be cleared by a healthcare provider before participating in athletics, which includes practice. They can attend practices as long as they don’t participate. 

Q: Will there be further parameters released regarding the signs and symptoms?
A: The symptoms listed are based on current research and have been vetted by pediatric cardiologists. There are no parameters or tests done at school to determine which symptoms need to be evaluated by a healthcare provider. 

Q: Can the district medical director perform an evaluation for students with signs and symptoms of or pending or increased risk for SCA?
A: No, a student being evaluated for signs and symptoms of pending or increased risk of SCA should be seen by a private healthcare provider in a healthcare setting where the provider has access to any needed healthcare resources and tests.

Q: Will the student be required to have an EKG or further cardiac testing?
A: The decision regarding what tests or further workups are necessary is at the discretion of the evaluating healthcare provider. Schools may not require what types of healthcare testing are conducted.

Q: Once a student has been evaluated, the written signed authorization is filed in the cumulative health record, does the student have to be evaluated if the same signs and symptoms reoccur?
A: No, a student who has been cleared for certain signs and symptoms or risk factors does not have to be reevaluated for the same signs and symptoms unless there has been a change. 

Q: Which cardiac arrhythmias in a student’s family history indicate the need for evaluation?
A: Only those arrhythmias listed in the NYSED  Dominic Murray Sudden Cardiac Arrest Prevention Act memo or on the NYSDOH Website indicate a need for further evaluation by a healthcare provider. For example, atrial fibrillation diagnosed in a grandparent after age 50 does not require a student to be evaluated.

Q: Other than Eric Paredes Save a Life Foundation Free Resources, are there other training’s that will be available to help educate our coaches and community on this topic?
A: For coaching certification, coaches must take the courses approved by NYSED Courses Accepted as Meeting the Coaches First Aid and CPR/AED Requirement. These courses contain the mandated instruction on SCA.