A new state law is adding a requirement for student-athletes in Florida, and for families across Okaloosa County, the clock is ticking to get it done before the upcoming school year.

• Under the Second Chance Act (SB 1070), all incoming ninth-grade student-athletes and students in grades 10 through 12 who have never participated in an FHSAA-sanctioned sport will be required to obtain an electrocardiogram — commonly known as an ECG or EKG — prior to athletic participation beginning with the 2026-27 school year.

Dr. Lynn Keefe, a pediatrician in Niceville and a member of the FHSAA Sports Medicine Advisory Committee that helped develop the guidelines, said the new screening addresses a gap that traditional sports physicals alone cannot fill.

“The standard sports physical might get about 1% of catching the heart issues, but doing the ECG can detect up to 95% of the conditions that can cause sudden cardiac arrest,” Keefe said.

An ECG records the electrical activity of the heart over a brief period and can identify abnormal signals between the upper and lower chambers — the atria and ventricles — that may be linked to sudden cardiac arrest during physical activity. 

• “It’s a 10-second screening,” Keefe said. “Kids shouldn’t be nervous.”

Keefe described the process as quick and non-invasive. In her office, a strip with electrodes is placed on the patient’s chest, with one sticker on each shoulder and one near the left hip bone. The patient lies down, the recording is taken, and results are sent off — typically returned within 24 to 36 hours.

“There’s no exposure of their bodies that would be uncomfortable,” Keefe said. “It’s not painful. I’ve had parents and children being quite happy about the whole production, and they say it’s very worthwhile.”

Returning student-athletes who have previously participated in an FHSAA-sanctioned sport are not required to obtain an ECG, though they are strongly encouraged to do so.

“It all comes down to time and money, and what a family can afford,” Keefe said. “I think it’s reassuring when you have a normal ECG, that your child’s not at risk.”

Keefe said she is already screening rising eighth graders in her practice, noting that an ECG performed on or after July 1, 2024, satisfies the requirement. However, she cautioned that an early screening may not catch all conditions.

• “One of the concerns is a very rare cardiac condition called IHSS, where the heart muscle of the ventricles is thickened, which can develop slowly over time in a young adolescent,” she said. “So an ECG in eighth grade may not detect this, and it could be picked up later in 11th or 12th grade.”

She said she weighs a family’s risk factors alongside the child’s age and exam results when recommending whether to repeat the screening.

Where to get screened

To support families and increase access, the Okaloosa County School District has partnered with Who We Play For, a nonprofit dedicated to preventing sudden cardiac death in young athletes through heart screenings, education and advocacy.

The cost through Who We Play For is $20 per student. Families may also choose to obtain an ECG through any medical provider, as long as the required documentation is submitted and meets FHSAA and district guidelines. Keefe noted that insurance does not cover the screening.

The district has set up screening dates at multiple schools. Students may attend at any location:

• Choctawhatchee High School, May 30, 8 a.m. to noon
• Fort Walton Beach High School, June 3, 9 a.m. to 1 p.m.
• Crestview High School, June 4, 9 a.m. to 1 p.m.
• Baker School, June 16, 9 a.m. to noon
• Niceville High School, May 26, 4 p.m. to 7:30 p.m.

Registration for each screening is available through the district’s ECG webpage at okaloosaschools.com or through WhoWePlayFor.org, where families can search by county for additional screening opportunities.

Keefe encouraged families not to wait.

“My advice to all those is jump on it sooner than later,” she said. “If there is an abnormality, the beautiful thing is that there are pediatric cardiologists in Pensacola — namely Nemours — that have gotten their cardiologists to agree to see these kids on a more urgent basis.”

Exemptions and paperwork

The FHSAA has released several new and updated forms in connection with the requirement. The EL1 form is the standardized one-page ECG screening form that confirms completion, including parent or guardian attestation, clinician verification and referral information if needed. A follow-up form, the EL1/2s, is required if additional evaluation is recommended by a medical professional.

A medical exemption form, the ME1, allows a physician to exempt a student from the ECG requirement. Keefe said the only scenario where that would apply is if the student has already undergone equivalent cardiac testing — such as a recent EKG for another medical reason or an echocardiogram that showed a normal heart.

• “None of the physicians on the committee could think of any reason why a child could not get an ECG,” Keefe said.

A parental exemption option also exists under the law. Keefe said she respects families’ privacy but sees little reason to opt out.

“I can’t think of any reason I would exempt a child from that, or my child, if a screening is offered and I can make sure there’s one less thing to worry about in a child’s health and welfare,” she said.

An important distinction

Keefe raised a point about where families get the screening done. She said ECGs performed at urgent care clinics or by non-pediatric providers may use standard adult interpretation criteria, which could produce false positives in athletes.

“A student-athlete that has a heart rate of 48 will still be considered normal, but if you and I as an adult had a 48 heartbeat, it would be labeled abnormal,” Keefe said. The FHSAA requires clinicians to use the most current International Criteria for Electrocardiographic Interpretation in Athletes to ensure accuracy and minimize false positives.

Keefe, who initially worried the new law would be difficult to implement, said her experience has been the opposite.

• “Once the law was written, we just did everything we could working with Who We Play For, and I have found in working with them, it’s just been amazingly easy, much easier than I thought,” she said. “I think the parents have been thankful for it.”

She added that the screening fits into a broader pattern of Florida leading on student-athlete safety.

“We’ve done a great job in preventing a lot of illnesses and concussion recovery and heat illness prevention, and now this — sudden cardiac arrest,” Keefe said. “It’s a good thing. I’m very happy.”