Your EMS crew is dispatched to the local neigborhood park for an injured person. Upon arrival, you see kids frantically waving from the basketball court. On arrival, you find a male patient in his late teens who is unresponsive and pulseless, and CPR is in progress.

   As you start resuscitation, you ask the friends to tell you what happened. They explain they had been playing basketball for about 30 minutes when the patient was running down the court and collapsed. You ask about medications, medical history and allergies as friends try frantically to reach the boy's parents. The friends say they don't know his medical history, and they absolutely deny any drugs or alcohol.

   CPR is ongoing, the patient is defibrillated and ALS care is continued en route. Despite your aggressive treatment and the hospital's efforts, he's pronounced dead by the emergency department physician. As you clean up the truck and write your report, you tell yourself, "We deal with older patients in cardiac arrest frequently, but not a young, healthy appearing kid like this. His friends have to be lying. There has to be more to this story."

   In the United States, it is estimated that 200–300 young people die each year from cardiovascular events during physical exercise.¹ While this number is relatively low compared with other causes of death in similar age groups and considering how many athletic events take place annually, several times a year, television media report an athlete's death. These deaths are always high profile and generate community attention. But what causes a healthy appearing child, teen or young adult to suffer fatal cardiac arrest?

   The generally accepted definition of sudden death is a sudden loss of consciousness from a cardiovascular event within an hour of the onset of symptoms. Sadly, diagnosis is often made upon autopsy.² In the U.S., 90% of deaths occur during competitive sports like basketball or football. Soccer has the highest death rate in Europe. Males are nine times more likely to die than females.³