Just this once, let’s be more like Florida!

Kudos to the state of Florida for boldly going where no other state has ventured in promoting the health and safety of its school athletes.

Yes—Florida.

Take a second. Let that settle.

Now before anyone reflexively rolls their eyes or assumes I’ve lost my bearings, let me be clear: I’m not talking about lifestyle choices, climate preferences, or dinner reservations at 4:30 p.m.

I’m talking about something far more interesting—and, I would argue, far more important.

Florida has passed the “Second Chance Act,” which will require high school athletes, starting in Fall 2026, to have an electrocardiogram (ECG) before participating in interscholastic sports.

And for once, I’m looking south and thinking:

We should probably follow that.

Why This Matters

The goal of this legislation is straightforward: identify young athletes who appear completely healthy but may be at risk for sudden cardiac death.

We’ve all heard these stories.

A high school athlete collapses during practice. A college player goes down mid-game. A kid who was seemingly fine one moment is suddenly in cardiac arrest the next.

They feel random.

They aren’t.

And every single one of these events devastates a family, a team, and an entire community.

The U.S. Is Playing Catch-Up

Florida is the first state in the U.S. to mandate ECG screening for student-athletes.

But globally? We’re late to the party.

Italy has been screening competitive athletes with ECGs since 1982, prompted by a spike in sudden cardiac deaths in the 1970s. Their program has been credited with dramatically reducing these events—perhaps not quite the “90% reduction” often quoted, but unquestionably a meaningful impact.

Other countries followed:

Much of Western Europe
South America
Israel (starting in the 1990s)
Japan, which has gone even further by incorporating ECG screening into routine school health programs

Japan, in particular, deserves a moment of appreciation. They figured out a practical solution: put ECG machines in schools and have school nurses perform the tests.

School nurses! Not just for ice packs and the occasional lice check anymore.

In many of these countries, screening is part of the culture of youth sports.

In the United States? Not yet.

What We Currently Do Instead

Right now, the standard pre-participation screening for student-athletes in the U.S. follows guidelines from the American Academy of Pediatrics.

This includes:

A questionnaire about symptoms (chest pain, fainting, palpitations)
Family history of cardiac disease
A physical exam (blood pressure, listening for murmurs)

It’s thoughtful. It’s structured. It’s helpful.

But it does not include an ECG.

The Big Question: Should It?

By now, you’re probably asking two very reasonable questions:

Why should ECGs be added to screening?
Why haven’t they been added already?

Let’s start with the first.

The Case FOR ECG Screening

Most cases of sudden cardiac arrest in young athletes are not truly random. They are usually caused by underlying conditions such as:

Hypertrophic cardiomyopathy
Long QT syndrome
Wolff-Parkinson-White syndrome
Brugada syndrome

Many of these conditions can be detected on a screening ECG.

Not all—but many.

If we estimate roughly 2,000 sudden cardiac deaths per year in young people in the U.S., it’s reasonable to believe that ECG screening could prevent a significant portion of them—perhaps the majority.

Not every case. But many.

And when the outcome we’re trying to prevent is catastrophic and irreversible, even partial prevention matters.

What ECGs Don’t Catch

There are limits.

One of the more common causes of sudden cardiac death—an abnormal origin of the coronary arteries—often won’t show up on an ECG. That requires an echocardiogram, which is more complex, more expensive, and far less practical as a universal screening tool.

So no, ECG screening is not perfect.

But it’s a meaningful step.

The Case AGAINST ECG Screening

The hesitation in the U.S. comes down to one word:

Cost-effectiveness.

There’s actually a formula for this in medicine. Interventions are often evaluated based on cost per “quality year of life” saved.

Under $50,000 → considered cost-effective
Over $100,000 → generally not
In between → debated

ECG screening tends to fall around $40,000 per quality year of life saved.

Which, by that standard, is… actually pretty good.

So why the resistance?

Because the real cost isn’t just the ECG itself.

It’s everything that follows:

Follow-up testing for abnormal results
Specialist evaluations
Anxiety generated by false positives

Minimizing unnecessary downstream testing is critical.

Making ECG Screening Work

This is where experience—and nuance—matter.

Automated ECG interpretations tend to overcall abnormalities. Without proper interpretation criteria, you can end up referring far too many patients for further testing.

Fortunately, we’ve gotten better at this.

Standardized interpretation guidelines—like the Seattle Criteria—help distinguish normal athletic heart changes from true pathology.

Using these criteria, I review screening ECGs from local practices and recommend further evaluation in less than 10% of cases—despite many more initially being flagged as “abnormal.”

Could I refer more? Absolutely.

Would it be good medicine? Not necessarily.

A Practical Barrier: Who Pays?

There’s another important distinction between the U.S. and countries that mandate ECG screening.

In many countries, sports are organized through federations—not schools. The cost of screening is absorbed within that system.

In the U.S., sports are tied to schools.

So adding a requirement like ECG screening effectively creates a new expense for school systems.

That complicates things.

But not impossibly so.

How Change Actually Happens

Medical policy doesn’t always move because of spreadsheets.

Sometimes, it moves because of stories.

Years ago, pulse oximetry screening for newborns—measuring oxygen levels before discharge—became standard not because of pristine cost-effectiveness data, but because of advocacy from families affected by undiagnosed heart disease.

New York was among the first states to adopt it.

Then others followed.

Now it’s universal.

Florida’s ECG legislation followed a similar path—driven by families, survivors, and advocacy groups who pushed for change after devastating losses.

This is often how meaningful progress begins.

Why Florida Being First Actually Matters

Let’s be honest—Florida is not always the state people expect to lead the way in public health policy.

Which is exactly why this matters.

When Florida takes a step like this, it gets attention.

It creates momentum.

It creates, whether we like it or not, a bit of competitive pressure.

And yes, it raises an interesting question:

Does New York really want Florida to beat us to something like this?

Closer to Home

There are already local efforts gaining traction.

On Long Island, a family who lost their child to sudden cardiac death has been advocating for broader ECG screening. Their work is building awareness—and momentum.

Florida’s legislation provides a blueprint.

And history suggests that once one state moves, others follow.

A Cardiologist’s Perspective (With a Grain of Salt)

I’ll acknowledge the obvious:

I’m a cardiologist.

So yes, this is a bit like walking into a bakery and asking the baker if you should buy bread.

But I’m not, by nature, a medical alarmist.

I believe in thoughtful, evidence-based care. I’m generally cautious about over-testing.

And yet—I’ve looked at this from enough angles, over enough years, to feel that ECG screening represents a meaningful safeguard.

Not perfect. Not comprehensive. But meaningful.

For what it’s worth, I didn’t let either of my kids head off to camp without getting an ECG.

It wasn’t about eliminating all risk—that’s impossible.

It was about reducing a very small but very real risk, just enough to sleep a little better.

Where This Is Probably Headed

In the U.S., we’ll likely start with athletes.

That’s the most practical entry point.

But the risk isn’t limited to organized sports. Kids exert themselves in many ways—recreationally, socially, unpredictably.

Over time, as systems improve and costs decrease, it’s not unreasonable to imagine broader screening.

But for now, athletes are where the conversation begins.

Final Thoughts

We don’t often look to Florida for inspiration.

But in this case?

Maybe we should.

Because at its core, this isn’t about policy or geography.

It’s about one simple question:

What is it worth to prevent even a fraction of these tragedies?

What is it worth to remove that needle from the haystack?

If Florida is willing to take that step, I’d argue it’s time for others to seriously consider following.

And yes—even New York.

One Last Thing (Because I Can’t Help Myself)

My wife’s favorite Disney attraction has always been the Carousel of Progress—a ride that somehow manages to feel both nostalgic and slightly outdated at the same time.

Every time we went, I assumed it wouldn’t be there on the next visit.

And yet—here we are, decades later, and it’s still standing. In fact, it’s getting renovated.

Which feels oddly appropriate.

Because progress doesn’t always move quickly.

It doesn’t always move perfectly.

But when it does move forward—even a little—it matters.

Here’s hoping for a “great, big, beautiful tomorrow” for our young athletes.

And yes… I probably should have stopped a paragraph ago.

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