Precision Medicine Advocates all: F-l- Dr. Jose Raul Canlas, Ma. Rosario Sevilla, Eva Cutiongco-De la Paz, Michael Zaragoza, Maria Teresa Abola, Jonas Del Rosario, Atty. Andrei “Rebo” Saguisag Jr., Atty. Ignatius Michael Ingles, Drs. Lucky Cuenza, Lauren Kay Evangelista-Galindez
MANILA — Highly-conditioned Filipino athletes collapse on local courts and sports fields, leaving their teammates and coaches confused in recent years.
Some regard such cases as happenstances, but experts define them as harsh realities that are preventable if not for institutional and financial gaps nationwide.
"We had four known deaths last year," Philippine Olympic Committee executive board member Dr. Jose Raul Canlas said on Wednesday during a session at the Philippine Heart Association (PHA) 56th Annual Convention and Scientific Meeting.
Dr. Canlas is part of the panel of cardiologists, orthopedic surgeons, and sports law experts who call for mandatory emergency medical equipment and uniform cardiac screening protocols across all Philippine sports leagues.
"At least three of them could have been saved had there been an AED (automated external defibrillators) on that," he added.
He noted that while a disposable AED costs under P100,000—an amount manageable for major private and international institutions—securing such funding remains a critical challenge for public schools.
"A China-made disposable AED now is about, you can get one for about PHP70,000. I think that P70,000 could have saved the lives of at least three of them last year," Dr. Canlas said.
"But still, for the private schools, it might be possible, although we still have a hard time enforcing it. The problem would be in public schools," he added.
Screening by age and intensity
The panelists emphasized that early cardiac screening is critical for identifying underlying genetic conditions, such as hypertrophic cardiomyopathy (HCM), which often present no prior clinical symptoms before a sudden cardiac event.
Dr. Lucky Cuenza, a sports cardiologist and co-author of the Asian Pacific Society of Cardiology (APSC) screening guidelines, explained that the necessity of a cardiac evaluation depends heavily on the physical demands of the sport.
Under the APSC framework, low-intensity sports such as chess, esports, billiards, and bowling do not require mandatory testing.
"However, for moderate to high-intensity sports, such as endurance sports, basketball, football, they recommend the questionnaire, history, and physical examination as validated by the American Heart Association, as well as a 12-link [lead] ECG [electrocardiogram]," Dr. Cuenza said.
Regarding the appropriate age to initiate testing, University of the Philippines–Philippine General Hospital Pediatric Cardiology Division Chief and Spokesperson Dr. Jonas del Rosario said that routine screenings generally begin as students transition into junior high school.
"In my practice, or at least now, generally speaking, we do get to see patients as early as about 12 to 14 years of age," he said.
For high-performance youth competitors, doctors recommend starting the process significantly earlier.
"We have had the screening as early as about eight because, mind you, there are elite athletes who are about eight, young gymnasts, triathletes, as early as eight," he added.
However, a single negative test result during childhood does not guarantee permanent clearance.
Del Rosario described HCM as an evolving disease in many patients.
"If we do screen them early, there’s usually every two years or every three years, or some of them even every year, depending on the type of intensity that they do," he said.
Clearance as determined by coach
The panel also addressed the legal and administrative complexities of returning to play after a cardiac risk or episode is identified.
Cuenza noted that sports cardiologists are moving away from using the word “clearance” due to legal liabilities, preferring terms like “fit to play” or “eligible.”
When a medical risk is established, the final decision on whether an athlete competes rests with team management rather than the examining physician.
Legal experts on the panel confirmed that coaches and sports federations hold the ultimate authority over roster eligibility, as uncontracted athletes do not possess an inherent legal right to participate on a team.
University Athletic Association of the Philippines Executive Director Atty. Andrei Rene Saguisag Jr. disclosed that while leagues issue safety frameworks, individual member schools retain administrative accountability.
"Ultimately we lead you to the school, in this case the decision maker, pushing the PPD [head] coach,” he said.
Cuenza concluded that while doctors provide mandatory clinical risk stratifications, the final operational execution remains institutional.
"We could give our medical opinion and recommendations, but in the end, the coach, along with the best interests of the institution, will be the one to have the final say,” he said.
