Cardiovascular Emergency Action Planning in the United States Military

Sudden cardiac arrest/death (SCA/D) are uncommon but potentially catastrophic events in military service members, occurring most often during physically demanding training and operational activities. Compared with similarly aged athletic populations, service members experience higher rates of SCD, highlighting the unique risks inherent in military service. Although cardiovascular (CV) screening can identify many at-risk individuals, it does not prevent all acute CV events. In athletic populations, improvements in emergency preparedness including cardiopulmonary resuscitation (CPR) training, rapid automated external defibrillator (AED) use, and rehearsed emergency action plans (EAPs) have been associated with significant improvements in survival following sports-related SCA. However, despite similar exertional demands, standardized CV-specific EAPs are inconsistently established and implemented across military settings. Existing policies emphasize physical readiness and emergency response capabilities, yet substantial variability remains regarding formalized planning for CV emergencies that occur during military activities. Importantly, military environments differ substantially from traditional athletic venues. Physical training (PT) and operational missions often occur in austere locations with limited medical resources, evacuation constraints, environmental extremes, and reliance on other service members as initial responders. Additionally, service members may be required to engage in prolonged exertion, load carriage, water-based activities, or remote operations that may delay recognition and treatment of SCA. These unique factors necessitate military-specific CV EAPs that extend beyond traditional competitive athlete frameworks and incorporate adaptable emergency response strategies for diverse tactical environments. Accordingly, the broad adoption of structured but flexible CV EAPs across the U.S. military represents a practical and meaningful opportunity to improve survival after SCA.