April 12, 2010
Quick action saved referee's life
by Ian B. Murphy/
Referee John Clifford died on the field but was saved by quick action and the use of an automated external defibrilator.
June 28 was one of the few sunny days last year in a historically rainy month, a perfect day for a 125-team lacrosse tournament — the Bulldog Classic — at Bryant University in Smithfield, R.I.
It was another happy, carefree day on the field for John Clifford, a 52-year-old lifetime referee, who had worked the opening rounds of the girls’ tournament, and two games on Sunday leading up to the Under-15 girls’ championship game at 2 p.m.
There was nothing out of the ordinary as Clifford was the trailing official following play down the field. But after a turnover near the net, when play turned back upfield and the players began to run, they found Clifford prone on the ground.
A player screamed, “The referee fell down!”
Clifford wasn’t moving. He was turning blue.
His heart had stopped.
Clifford dropped in front of the stands, where a cardiologist and an anesthesiologist both happened to be watching their daughters play in the game. They were the first people to get to him.
Across the field, Bryant’s head trainer Patrick O’Sullivan saw the referee on the field, and sprinted 40 yards to get to him, bringing with him the automated external defibrillator (AED) that would save Clifford’s life.
Clifford didn’t respond to CPR. O’Sullivan followed the cardiologist’s instruction and hooked the AED’s pads to the prone umpire’s chest. The light turned green, and O’Sullivan pushed the button. Nothing happened. He pushed it again. Clifford spluttered and came back to life.
“I remember waking up, seeing eight people over me and saying, “What the hell happened?” Clifford said.
Clifford had a ventricular tachycardia arrhythmia, which is an electrical disturbance in his heart that causes an irregular beat, which caused sudden cardiac arrest (SCA). Clifford said he didn’t have a medical condition at the time; he’d never had heart problems in his life.
“I wasn’t even breathing hard or panting,” said Clifford. “I was just light jogging, and I went down. I got hit with a rogue wave.”
Jim Tighe, the referee coordinator for the event, was one of the eight people John saw standing over him when he came back. Tighe has been working with John for years; he knows just how close he was to losing a friend.
“If Bryant didn’t have the forethought to get that machine, John would have died,” Tighe said. “No matter what the doctors did, he would have died. Because they had the machine, it saved his life.”
More than 350,000 people die a year in the United States from sudden cardiac arrest, which is different from a heart attack. That’s more than lung cancer, breast cancer, and AIDS combined, according to Cardiac Science, a national manufacturer of AEDs that has teamed with US Lacrosse to raise awareness of the condition and make AEDs more affordable.
Cardiac Science also asserts that 25 to 33 percent of cases occur during sporting events. Clifford’s case — an arrhythmia — is one of the more common causes of SCA. His heart stopped on its own with no previous history of trouble.
Lacrosse players, however, are at risk for a much rarer occurrence that can lead to SCA, called commotio cordis. Commotio cordis happens when there is a blunt impact directly over the heart during a precise moment of the heart’s cycle, which stops the heart.
It’s extremely rare, but there have been a few high-profile cases when a lacrosse player has died from commotio cordis. In 1999, University of Massachusetts defenseman Eric Sopracasa died during practice after taking a shot in the chest. In 2004, Cornell defenseman George Boiardi died during a game, also after blocking a shot with his chest.
It’s a terrifying possibility, and it’s why the King Phillip Youth Lacrosse (KPYL) program in Wrentham, Mass., now has AEDs at every one of its events — both practices and games. The program bought its first AED three years ago — it currently owns two — and plans to buy two more this year.
“We had some parents get some interest into the idea,” said Greg Klim, president of King Phillip Lacrosse. “One thing led to another and I ended up speaking to some friends of mine who are paramedics. There was always talk about it, so we decided to take a lead.”
KPYL has 27 youth teams, both boys and girls, so it needs as many as eight AEDs. Units vary in price, but King Phillip’s units cost between $1,700 and $1,800. The program rented additional units from Life Support Systems in Dedham, Mass., using six units at a total cost of $3,500 for the five-month season, Klim said.
To pay for the AEDs, Klim said the program holds a series of dedicated fundraising events, like raffles and an end-of-the-season picnic. Klim said a piece of every player’s registration fees also goes towards the AEDs.
KPYL is a large, well-established program, and Klim recognizes the units are expensive. So Klim is trying to establish a network to ensure coverage of every game and practice.
“The cost is prohibitive, and not everyone can afford it,” said Klim. “For the younger programs, it’s very tough, so what we’re doing as a league is trying to find out what towns have them. We’re trying to get a network going between the surrounding towns.
“We realized as the program grew, you’ve got to cover everybody, and you’ve got to cover home and away games,” Klim said. “It’s a preventative thing that we’ve done. I think it’s a really good program, and with all the kids playing sports today, it’s a really worthwhile thing to go after.”
Bret Smith, vice president of Life Support Systems, said interest in the machines has taken off in the last few years.
“Selling and renting them has dramatically increased, and so has the request for training,” Smith said. “I think it’s just an awareness of people of what they can do.”
Using the unit requires minimal training, but it’s become a common part of most CPR courses. The machines are easy to use — Smith said anyone, young or old, can do it — and there’s no hazard of an accidental lethal shock. AEDs do require maintenance, but most suppliers include that in the sales or rental agreement.
Last year, US Lacrosse started a grant program for AEDs with Cardiac Science, matching funds with the grant winners for the purchase of machines and for training classes.
“This year, we awarded seven grants, and then we’re going to reopen the process in the fall,” said Sarah Newman, US Lacrosse’s manager of programs and grants. “Our goal is to award 12. We’re accepting applications now.”
Newman said US Lacrosse members also can qualify for a discount when they purchase AEDs through Cardiac Science.
Bryant University has had its AEDs for seven years, O’Sullivan said. Clifford was the first time he had to use one. O’Sullivan downplays his role in saving Clifford’s life; he just followed the instructions on the machine and pressed the button.
But as Tighe said, without Bryant’s AED and O’Sullivan’s quick response Clifford would be dead.
Instead, Clifford was out of Miriam Memorial Hospital in three days.
He has an internal defibrillator, called a cardio inverter, in his chest just in case, and Clifford said his doctors have told him his heart is safer than 99 percent of the population.
Clifford officiated a full season of field hockey last fall, and 20 plus games of basketball over the winter. He’s umpiring girls lacrosse again this season, and will be back at the Bulldog Classic in June.
For Clifford, there is no doubt what has allowed him to continue doing the things he loves.
“I give the credit to Bryant for being thoroughly prepared for that type of event, having the defibrillators there,” he said. “I’m alive today because of a defibrillator.”
Said Bryant’s O’Sullivan: “There was a lot involved, but when you see the guy laughing and waving as he’s getting put in the back of the truck, it really is a miracle. ... Being able to hear that … he is back refereeing, that’s unbelievable. That’s that type of event that sticks with you.”
