Let the health care professional doing the pre-participation exam make that call. There is no reason for a trainer to get into that arena. EKG is a medical exam. It is way out of the scope of practice for a trainer. Remember, trainers are not supposed to treat or diagnose disease. Even suggesting an EKG and other medical tests is treading into the realm of practicing medicine. Same thing goes for recommending a client get MRI or xrays or physical therapy. That’s getting in to a gray zone, liability-wise.