Florida Becomes First State to Mandate EKG Screening for High School Athletes, Sparking Debate Over Benefits and Harms
核心洞察
Florida's Second Chance Act, effective July 1 ahead of the 2026-2027 school year, requires students in grades 9-12 to undergo at least one ECG screening before participating in interscholastic athletics.
A mandatory ECG screening identified an asymptomatic atrial septal defect (搜索) in sophomore athlete Cameron Crider, who is scheduled for surgery in October and expected to return to sports next season.
Experts note that up to 80% of young athletes who suffer sudden cardiac arrest (搜索) have no warning symptoms, and an ECG can detect about 80% of at-risk conditions versus 80-90% missed by standard sports physicals alone.
Florida has become the first and only state in the nation to require electrocardiogram (ECG/EKG) screening for all high school athletes, a policy that has already identified a life-threatening heart defect in an asymptomatic student while simultaneously drawing sharp criticism from medical experts and public health advocates.
The state's Second Chance Act went into effect July 1 ahead of the 2026-2027 school year and requires students in grades 9 through 12 to undergo at least one ECG screening the first time they participate in or try out for interscholastic athletics, with certain exceptions. An ECG, also called an EKG, is a simple, noninvasive test that measures the heart's electrical signals and can help identify irregular rhythms or other signs of heart trouble.
A Life-Saving Discovery for One Student
For Cameron Crider, a sophomore football and basketball player at Calvary Christian High School in Clearwater, the screening led doctors to discover an atrial septal defect (搜索) (ASD), a congenital heart defect involving an opening in the wall between the heart's two upper chambers. If a significant ASD is left untreated, the extra blood flow can strain the heart and lungs over time and may lead to complications such as pulmonary hypertension (搜索), heart failure (搜索) and, in some cases, stroke.
"I've been playing [sports] my whole life and didn't notice anything, so I was surprised because I haven't felt anything," Cameron told FOX 13.
"[Cam was] going to a three-hour football practice and then a two-hour basketball practice back-to-back and never having fatigue or shortness of breath, or, you know, anything that you would think would be a warning sign," his mother, Laura Crider, told the station. "So, we were completely shocked."
Crider is scheduled for surgery to fix the ASD in October and is expected to be able to play sports again next season. His mother described the mandatory ECG as "a gift from God that has been given to us, truly," adding that "we were able to find this out in a doctor's office with an explanation and a clear plan that says we can help you, and so many of these other parents who are advocating for these screenings, they had to find out through a tragedy."
The Case for Screening
Up to 80% of young athletes who suffer sudden cardiac arrest (搜索) (SCA), the leading cause of death during exercise, don't have any warning symptoms prior to their arrest, according to Dr. Jonathan Drezner, director of the University of Washington Medicine Center for Sports Cardiology.
Because intense physical activity places additional stress on the heart, undetected heart conditions can become dangerous during sports, the American Heart Association (AHA) told Fox News Digital. "Sudden cardiac arrest (搜索) is not the only concern," the AHA said. "These conditions can also lead to other serious heart-related complications and may require monitoring, treatment or restrictions on athletic participation to keep students safe."
According to Drezner, an ECG screening, when interpreted properly, is one of the best screening tools in medicine. "An ECG greatly increases our ability to detect conditions associated with SCA in the young," he said. "A standard sports physical by history and physical alone will miss 80-90% of kids with at-risk heart conditions. An ECG can suggest or detect about 80% of the conditions that put young persons at risk. It is not perfect, but it is far better than the standard sports physical."
Concerns About Cost, False Positives, and Access
Despite the potential benefits, the mandate has drawn significant criticism. Katherine Hofmann, a fourth-year medical student in the M.D./M.P.H. dual degree program at the University of Miami Miller School of Medicine, wrote in STAT News that the policy is "costly and ultimately more harmful than helpful."
In healthy adolescents with no personal or family history of heart disease, EKG screening can produce false-positive results in up to 15% of students, with even higher rates among Black athletes. "That means for every 20 students screened, as many as three may be told something is wrong when nothing actually is," Hofmann wrote. Those students are then sent for additional testing, including cardiology visits, echocardiograms, stress tests, and monitors, which the law does not address. These tests can cost up to thousands of dollars and are not always fully covered by insurance.
"These burdens don't fall evenly," Hofmann noted. "Students from lower-resource backgrounds are more likely to face delays in care, difficulty accessing specialists, or financial barriers to completing follow-up testing. Some families may decide not to pursue further evaluation at all, or may keep their child out of sports entirely."
The law says school districts are responsible for finding "partnerships to provide low-cost EKGs to each student," and students are exempt if the school district cannot obtain them for less than $50 per student. But Hofmann argues that "the real issue isn't the cost of the EKG. It's everything that comes after."
Expert Guidance and the Path Forward
The Second Chance Act is named for Chance Gainer, a Port St. Joe High School football player who collapsed on the field and died during an away game in September 2024. Sudden cardiac death in young athletes, while devastating, is rare, occurring in roughly 1 in 70,000 adolescent athletes.
Importantly, universal EKG screening is not what leading experts recommend. The American Heart Association and American College of Cardiology (搜索), two leading cardiovascular guideline organizations in the U.S., do not support routine EKG screening for all adolescent athletes. Instead, they recommend targeted screening based on personal and family history and physical exam.
"A heart assessment that includes a review of a student's personal and family history along with a physical examination is the best way to identify serious heart conditions that can lead to cardiac events in student athletes," the AHA said. "If the comprehensive heart assessment raises concerns, health care professionals can order appropriate follow-up testing, such as an ECG, echocardiogram, heart monitor or other advanced imaging based on the suspected diagnosis."
The AHA and American College of Cardiology (搜索) support what they describe as an "evidence-based, layered approach to identify heart issues so they can be diagnosed, monitored and treated as early as possible."
Hofmann pointed to alternative measures that schools could adopt, including "strong pre-participation evaluations, better access to automated external defibrillators at practices and games, and CPR training for coaches and staff." She cautioned that "for many students, the difference between playing and not playing won't be the EKG itself. It will be the appointments, the costs, the delays."
Drezner advised that while healthy athletes and young people can have a potentially lethal heart condition and not know it, chest pain, passing out and a racing heart are symptoms that should not be ignored. "Make sure your child feels well when they exercise," he said. "If you have a family history of genetic heart conditions or SCA, you should bring this up with your child's doctor. And get your child a proper heart screen with an ECG."