Minnesota is one of 12 states that fall short of three standards endorsed by the NCAA and major pro sports leagues this week to protect high school athletes from sudden cardiac arrest.

A coalition led by the NFL wrote Gov. Tim Walz and urged Minnesota to provide the same protection for young athletes that saved the life of Buffalo Bills safety Damar Hamlin when he suffered a cardiac arrest Jan. 2 during a nationally televised game.

"Young athletes deserve the same, and we think that is achievable," said Jeff Miller, an executive vice president for the NFL, which formed the Smart Heart Sports Coalition along with the NBA, MLB, MLS, NHL and NCAA.

Miller said there are an estimated 23,000 sudden cardiac arrests each year in the United States involving people 18 and younger, and that about 40% occur during athletic activities.

Sudden cardiac deaths during high school games and practices in Minnesota are relatively rare; a University of Minnesota study identified four from 1993 through 2012 involving two cross-country runners, a wrestler and one basketball player. Any count of high school events doesn't include fatal cases such as Patrick Schoonover, though, who died at 14 in 2014 after he collapsed during a club hockey game.

Sudden cardiac arrests, no matter the prevalence, are especially jarring in young athletes because they often occur without warning compared with those in adults with diagnosed heart problems, said Kim Harkins, program director of the U's Center for Resuscitative Medicine.

"With youth and very often with athletes, it is not until that event happens that they know there is an underlying condition," she said. "The first sign is cardiac arrest."

Minnesota has responded over the past decade, requiring one-time CPR training for public school students before they graduate. The Minnesota State High School League also used grant funding from Medtronic in 2015 to create an Anyone Can Save A Life program. It taught basic lifesaving techniques people could use in emergencies even without CPR certification.

The state league also advises schools on how to create emergency action plans to respond to sudden cardiac arrests, and credited that preparation with saving a football referee who collapsed during a game in Kimball, Minn., in 2019.

Stronger state requirements are recommended by the Korey Stringer Institute, a Connecticut sports safety group named after the Minnesota Viking who died following heatstroke at preseason training in 2001. The institute wants states to require that emergency plans be regularly reviewed and rehearsed, and spell out details such as who retrieves defibrillators in emergencies and who calls 911.

Minnesota also doesn't meet the institute's recommendations that defibrillators be placed within one to three minutes retrieval time of every high school game and practice venue, and that all coaches be certified in cardiac resuscitation. The institute is part of the new coalition, along with the American Red Cross and American Heart Association, that sent letters to 43 governors in states falling short of one or more standards.

Some Minnesota school districts meet these criteria and have detailed emergency plans on file with the high school league. A state requirement would ensure that they stay current with training and equipment for these rare emergencies, Harkins said: "It's real easy to put it on a backburner."

A proximity requirement for defibrillators also forces schools to plan for practices and games at off-site locations or far from school buildings, she said. A defibrillator inside Wayzata High School helped save football player Teddy Okerstrom after he collapsed during outdoor training in 2009; a speedy teammate sprinted the device to the field. The high school added a defibrillator in a closer location afterward.

Michael Schoonover founded Play for Patrick to improve awareness and prevention of sudden cardiac arrests after his son's death. The organization has donated 17 defibrillators to area schools, trained 4,000 people in CPR and provided 28 screening events where parents were alerted to elevated blood pressure or possible heart defects in 300 children.

Schoonover has tempered legislative calls to require heart scans for all high school athletes because of the potential cost and confusion over whether students with any concerning findings would still be allowed to play.

The state should focus on boosting its emergency response while research sorts out whether universal heart screening for athletes has merit, he said.

"That's not going to happen anytime soon," Schoonover said, "so this is the next best thing."

The NFL as part of this week's announcement committed $1 million to improving response efforts in high schools. The amount included $20,000 that the Vikings can use to support local initiatives.