Sudden Death in Sports

Preventing sudden death in sports requires onsite care and split-second decisions

The health and safety of athletes in recent years has taken a sudden turn into the spotlight. Hank Gathers, Reggie Lewis, Korey Stringer and Ryan Shay are just a few well-known names that have passed away during sports participation.

Another unfortunate example is Max Gilpin, a 15-year-old football player who died in 2008 from exertional heat stroke (EHS) after an intense summer football practice in Kentucky.1

Just a few months prior, Ereck Plancher, a football player at the University of Central Florida, died from exertional sickling brought on by intense conditioning drills.

But these examples offer only a glimpse of the entire picture. In the past 30 years there has been a distinct increase in the number of indirect football fatalities across high school, college and professional levels (108 deaths from 2001-2009).2 This trend is also mirrored in the number of exertional heat stroke deaths during a five-year period.

The most recent period, from 2004-2009, had the highest number of deaths (18) for any period since the 1970s.3 In 2010 and 2011 there have already been 12 deaths from exertional heat stroke, placing us on course to reach 30 by the end of the next five-year period.4

In NCAA schools alone, 36 deaths occurred during exercise in a five-year period (January 2004 to December 2008).5 Twenty-seven of these were cardiac cases, with the remaining nine being exertional heat stroke.5 Overall, the main causes of death in athletes have been cardiac events, exertional heat stroke, brain injuries, cervical-spine injury and exertional sickling.3

Not a New Problem?

With so many advances in medicine, the common question becomes, why are we still seeing these deaths occur? And most importantly, what can we do to prevent them from occurring?

This is not the first time the sporting world has seen this issue. The 1905 college football season saw 18 deaths.6 In response to these alarming numbers, President Theodore Roosevelt called a meeting, threatening that the game be reformed or it would be outlawed.6

This brought about the creation of the NCAA to form new safety rules, which ultimately led to dramatic decreases in deaths. The NCAA has implemented many safety rules since then. In the 1970s, the NCAA introduced the no spearing rule, leading to a significant reduction in catastrophic injury in football.6,7

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In 2003, new heat acclimatization guidelines for pre-season football were implemented, and have reduced the number of heat injuries during practice and games.3,6

More recently, in 2010, the NCAA introduced sickle-cell testing.6 The NFL has also followed in these efforts and in 2011, as a result of the collective bargaining agreement, adopted heat guidelines similar to those of the NCAA.

Challenges of Youth Sports Safety

Yet despite all these initiatives, deaths continue to occur, mainly among youths. At the professional and college level, there are fewer athletes participating in sports such as football (approximately 1.5 million high school and middle school football players vs. 75,000 college football players.)3 Also, there is a greater number of staff and medical professionals, and a higher degree of athlete fitness, which may contribute to lower death rates at the older levels.

While deaths can still occur at these levels, the large waves of sports-related deaths are happening in high schools, where there is a greater number of athletes, far less medical care and a vulnerable athlete population (for example, high school athletes take longer to recover from a concussion than older athletes).7

In many cases of severe medical conditions, it's apparent that immediate recognition and treatment is vital for successful outcomes. With cardiac events, the chance of survival decreases by 10 percent with every minute that defibrillation is delayed.8,9

The likelihood of survival from exertional heat stroke drastically decreases if severe hyperthermia lasts for more than 30 minutes.10-14

In such instances, average EMS response will not arrive soon enough for optimal treatment. Immediate onsite care is required for successful outcomes. This care must be performed by a trained medical professional knowledgeable in the recognition and treatment of emergency situations. Another challenge is that only 42 percent of high schools have access to an athletic trainer.15 In the other 58 percent of high schools, coaches or other staff are left to determine the medical care of their athletes.

Onsite Care Makes a Difference

Of course, some scenarios may obstruct proper medical care, so not all emergency situations allow for the application of life-saving steps. Examples include a sudden blow to the head that causes a fast-developing epidermal hematoma, or a cardiac event that occurs on a secluded trail.

In these cases, survival may be slim. However, we do know from research and past examples that many measures can be taken to reduce incidence of sudden death.

Tommy Mallon was a high school lacrosse player who suffered a blow to the head in 2008. Unknown to anyone at the time, he fractured his C-1 vertebrae, but insisted that he could get up. An onsite athletic trainer made him stay on the ground while she stabilized his neck, spine-boarded him and sent him to the hospital.

He was able to make a full recovery. Had Tommy been allowed to get up, his story could have been drastically different.16

During a track meet at the University of Georgia last spring, a man collapsed on the infield. Ron Courson, ATC, PT, EMT, director of sports medicine and athletic trainer at the University of Georgia, and his team immediately recognized that the man had sustained cardiac arrest. They started CPR and applied an AED. The man survived. The effort put forth by the medical team and their well-written and well-rehearsed emergency action plan led to the best chance of survival. It's likely that without efficient onsite care, his story would have also been different.17

Current Initiatives      

These deaths and saves have not gone unnoticed. The National Athletic Trainers' Association (NATA) has spearheaded the Youth Sports Safety Alliance, comprising 70 sports and health organizations committed to keeping youth athletes safe.

Over the past two years, NATA has hosted a Youth Sport Safety Summit in Washington, DC. Speakers have included experts in the field of concussions, exertional heat stroke, exertional sickling and cardiac conditions, among others.

The purpose of this summit is a continued call to action to increase education, research and legislation and to raise awareness of the issues surrounding youth sports safety, and to provide comprehensive recommendations to improve the on-field safety and off-field care of young athletes.

This past February, the Journal of Athletic Training published a new position statement from the NATA: "Preventing Sudden Death in Sports."18 It's the first of its kind to comprehensively address 10 major health conditions that can lead to catastrophic outcomes during sports participation - asthma, catastrophic brain injuries, cervical spine injuries, diabetes, exertional heat stroke, exertional hyponatremia, exertional sickling, head-down contact in football, lightning and sudden cardiac arrest. This statement offers guidelines for the prevention, recognition and treatment of all included conditions (see sidebar).18

While all these points are important, perhaps the most important suggestion is having an onsite medical professional trained to implement these life-saving guidelines. With such steps, we can help to minimize and prevent the occurrence of fatal incidents in athletics. 

References are available at http://www.advanceweb.com/pt%20under the Resources tab.

Rebecca L. Stearns is vice president of operations and director of education at the Korey Stringer Institute, located within the Neag School of Education at the University of Connecticut in Storrs.


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