Articles

New ERASE program aims to save lives by detecting hidden cardiac risks by Senior Airman Braman, Matthew-John. “New Erase Program Aims to Save Lives through Early Cardiac Risk Detection.” 59th Medical Wing – JBSA – Lackland & Randolph AFB, 23 Apr. 2025.

ERASE is a quality improvement project to test ECG screening in recruits, mandated by Congress in the National Defense Authorization Act for Fiscal Year 2024.

The ERASE (Electrocardiogram Risk Assessment to Prevent Sudden Cardiac Events) pilot program began at U.S. Air Force Basic Military Training in 2025, screening Air Force trainees for hidden, potentially serious heart conditions. It uses a questionnaire, blood pressure check, and resting ECG.  Trainees were sent for further evaluation and an echocardiogram only if abnormalities were found. The three-year pilot program’s aim is to identify silent heart problems early, reduce the risk of sudden cardiac events, and support a rapid, safe return-to-duty process.

Benefits of this research program include: 

• Early detection: The program has the potential to save lives by identifying potentially life-threatening conditions in asymptomatic individuals before they become a problem. 

• Rapid return-to-duty: By catching issues early, the program aims to quickly return most candidates to their duties, as disqualification is rare (only about 4 out of 10,000). 

• Proactive intervention: Early detection allows for advanced interventions, such as implantable defibrillators, in high-risk cases.  

No One Left Behind: Incidence of Sudden Cardiac Arrest and 30-Day Survival in Military Members by Franzos, Marc Alaric et al. No One Left Behind: Incidence of Sudden Cardiac Arrest and 30-Day Survival in Military Members, The American Journal of Medicine, Volume 138, Issue 6, 987-993.

The authors aimed to estimate the incidence of SCA and examine 30-day survival rates among U.S. military personnel. They found that SCA incidence in active-duty military members is substantially higher than previously estimated for similar age groups in civilian athletic populations.  A total of 958 military personnel were identified with sudden cardiac arrest/ventricular arrhythmia from fiscal years 2016 to 2019—more than 200 incidences per year—with a sudden cardiac arrest rate of 10.8 per 100,000 person-years. Thirty-day survival rates were high at 73% for subjects aged <35 and 76% for those aged 35-64 years. 

A Call for Action to Prevent Sudden Cardiac Death by Thompson, Col. Amy. “A Call for Action to Prevent Sudden Cardiac Death.” NCO Journal, Oct. 2024.

Basic facts about Sudden Cardiac Arrest, revelations about how behind the Army is in being proactive, and a call to action to have AEDs on every sideline.  

Exercise at the Extremes: Toward an Understanding of Increased Cardiovascular Risk in the Tactical Athlete by Murphy, C.E. et al. Exercise at the Extremes: Toward an Understanding of Increased Cardiovascular Risk in the Tactical Athlete. Curr Treat Options Cardio Med 27, 25 (2025).

Tactical athletes—such as military members, firefighters, and law-enforcement officers—regularly face sudden, intense physical demands in dangerous situations. These conditions may increase their short- and long-term risk of heart problems. This review describes who tactical athletes are, explains what counts as extreme environments and extreme exercise, and outlines how these factors affect their health. It also discusses why cardiovascular disease may be more common in this group and identifies key areas where more research is needed. 

The Tactical Athlete: Definitions, Cardiovascular Assessment, and Management, and “Fit for Duty” Standards by Jennifer Xu, et al. The Tactical Athlete: Definitions, Cardiovascular Assessment, and Management, and “Fit for Duty” Standards, Cardiac Electrophysiology Clinics, Volume 16, Issue 1,2024, Pages 93-105.

“Military, law enforcement, firefighters, and emergency response providers, referred to as tactical athletes, have a high demand for physical fitness and must endure mentally and physically demanding occupational tasks, often in extreme conditions.” 

USU Initiative reexamines ECG screening to Reduce Sudden Cardiac Death of Service Members by Brendel, Hadiyah. “USU Initiative Reexamines ECG Screening to Reduce Sudden Cardiac Death of Service Members.” DVIDS, Jan. 2024.

Effective Cardiovascular Screening of Military Recruits Requires an Electrocardiogram by Murphy, C, et al. Effective Cardiovascular Screening of Military Recruits Requires an Electrocardiogram. JACC. 2022 Mar, 79 (9_Supplement) 1638. 

Details of the screening of all midshipmen at the US Naval Academy in 2020/21 show that the addition of an ECG allowed the diagnosis of rare, potentially life-threatening conditions among fit young candidates for a high-stress occupation.

Rapid and Precise Return-to-Duty: Reflex Echocardiography Screening of Officer Candidates at Service Academies within Project ERASE by Dr. M. Alaric Franzos, et al, presented at MHSRS, 2024. This detailed poster summarizes the background, methods, results, discussion, and conclusions, starting with the first ECG screening at the US Naval Academy in 2021 through the expansion of the screening program to the other academies (USAF and West Point) in 2024. 

Cardiovascular Screening in the U.S. Military: Time to Reconsider the Electrocardiogram by Charles Magee, Mark C Haigney, Cardiovascular Screening in the U.S. Military: Time to Reconsider the Electrocardiogram, Military Medicine, Volume 185, Issue 7-8, July-August 2020, Pages e1039–e1045.

One of the challenges to using ECGs for screening new U.S. military members is how to ensure accurate and consistent ECG interpretation. Updated interpretation guidelines and newer technology help reduce these issues. Experience from other programs shows that modern ECG screening can offer significant benefits for the highest-risk military groups.