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Fatal Exertional Heat Stroke in Football: The Coaches Are the Culprits

2019; Lippincott Williams & Wilkins; Volume: 18; Issue: 7 Linguagem: Inglês

10.1249/jsr.0000000000000612

1537-8918

E. Randy Eichner,

Exercise and Physiological Responses

Introduction Exertional heat stroke (EHS) should never be fatal in sports. Yet it continues to kill athletes with alarming regularity. This is particularly true of American football. Among all high school sports, football has by far the highest incidence of exertional heat illness and fatal EHS (1). Since the year 2000, EHS has killed more than 40 high school football players, along with at least 10 college football players. Almost all of these football EHS deaths are not from the play of the game, but from conditioning or training for the game. The coaches are the culprits. I will begin by describing the first-day conditioning workout on a college baseball team. Then I will cover EHS in football. Day 1 for a College Baseball Catcher Slater Springman, a 22-year-old scholarship baseball player, a catcher, at Freed-Hardeman University (FHU) in Henderson, Tennessee, took part in the Day 1 team conditioning workout in the summer of 2018, when the ambient temperature was 94°F and the humidity was high. It was a team run in the baseball parking lot. As Slater told the media, "We were doing the '2-Mile Push;' I was about 1 ½ miles into it when I started having problems. You run the first mile on your own as fast as you can. With no rest, you then run the final mile as teammates are stationed every 100 yards and run a short distance with you to urge you to run as fast as possible." Slater remembers struggling and being helped off to the side. A coach and two teammates got him into the field house, took off his shirt, laid him on the cold concrete floor in air conditioning, and put ice on him to lower his core temperature, which was 105°F. The last thing Slater remembers from that day is lying on that cold floor. It was August 27. Slater awoke in a hospital, thinking he had been "out" for 2 h. It was September 12. Slater had been put into a medical coma because of seizures from his EHS. He also had impaired renal function and major rhabdomyolysis, with serum creatine kinase peaking at nearly 1,000,000 IU/L. He spent a month in intensive care and 109 d in hospitals. He lost more than 50 pounds of muscle and had to train just to walk again. The medical bill exceeded US $2 million. But he survived, and returned to FHU to throw the first pitch before their home opener in February 2019. He hopes to be back on the FHU baseball team by the fall of 2019. But I ask you, is this any way to train a college baseball catcher? Or any baseball player? Now let me tell you about college football. EHS in College Football Just as Slater Springman survived EHS from baseball conditioning, Gavin Class survived EHS from football conditioning. Gavin, a 20-year-old, 305-pound right guard at Towson University in Maryland, ran sprints with other linemen near the end of practice in August 2013, when the ambient temperature was 90 F. The line coach said of Gavin: "He was the role model for hard work; he faced each repetition like it was his last one." On the final sprint, Gavin became uncoordinated, "a puppet with strings," and fell to his knees. "Let me finish," he gasped, but they put him in a nearby ice-water tub and called 911. At the hospital, he was in coma, and his core temperature was 108 F. The next day, Gavin's liver began to fail, and he was rushed to Maryland Shock Trauma Center for a liver transplant. As reported by others, Gavin's mother told the surgical team: "God gave you a gift. Now use that gift to save my son." And so they did (2). Gavin spent 6 wk in the hospital — through a liver transplant, pancreatitis, pneumonia, a collapsed lung, lymphoma, chemotherapy, shingles, and 14 operations — but he survived. He lost 100 pounds and was unable to walk on his own. Over the next year, however, he trained back into shape and passed heat tolerance tests. He was disappointed when, after a long court battle, it was judged unsafe for him to return to college football. It Gets Worse Gavin Class survived EHS, but in the past 5 years, four college football players have died from EHS. The first was Marquese Meadow, an 18-year-old, 300-pound defensive lineman at Morgan State University in Maryland. He and his team endured what was called a "punishment practice" on a Sunday evening in August 2014. The drills were mostly running; ambient temperature was 82 F. After an hour, Marquese stumbled, seemed disoriented, and collapsed. The training staff applied cold water to his armpits and groin and rushed him to a hospital, where his rectal temperature was nearly 107 F. He developed renal and liver failure and died 2 wk later. The second was Tyler Heintz, a 19-year-old, nearly 300-pound offensive tackle — known as a "workout warrior" — at Kent State University in Ohio. He collapsed on a morning in June 2017, day 2 of intense team conditioning drills — including sprinting — when the ambient temperature was about 85°F, and humidity was high. Emergency responders found him "unresponsive," he was pronounced dead 2 h later. The coroner said Tyler's body temperature was "very high," and he died from EHS. The third was Jordan McNair, a 19-year-old, huge right guard at the University of Maryland. He died from EHS in June 2018. The details are widely known. The athletic trainers got most of the blame for late recognition of EHS, whereas but for the coaches, Jordan would not even have needed athletic trainers – or any medical care at all – that day in late May. On day 1 of football conditioning, after no team activities for 33 days, the coaches forced Jordan, who had gained weight to 341 pounds, to sprint 110 yards as fast as he could, 10 times, in the heat. Jordan needed help by the eighth sprint, when he was exhausted, cramping, hyperventilating, and sweating heavily. When they got Jordan to a hospital >90 min later, his core temperature was 106°F. He died 2 wk later. The fourth was Braeden Bradforth, a 19-year-old, 305-pound defensive lineman at Garden City Community College in Kansas. Braeden flew from his home in New Jersey to Garden City, a jump in elevation of > ½ mile for him. Two days later, August 1, 2018, was day 1 of football team conditioning, and, on a hot, humid evening, Braeden was forced to run 36 sprints of 50 yards each. Then the football staff let him wander away, in the wrong direction (away from a planned team meeting), stumbling and likely disoriented. After the team meeting, a teammate found Braeden outside, sitting slumped against a dormitory wall, unresponsive, moaning, vomiting, and choking. After more delay by coaches, 911 was called. Braeden arrived at the hospital in a coma and dire respiratory distress, having aspirated vomitus. Thirty minutes later, he was dead. The forensic pathologist concluded the cause of death was EHS. What to Do? Fatal EHS should never occur in college football. As I have covered before, to prevent EHS, among other commonsense precautions, you have to "bird-dog the big guys" (3). Huge linemen like this, forced to sprint hard, can build body heat very fast, much faster than they can shed it. Stay vigilant for the earliest signs of EHS: fuzzy thinking or peculiar behavior. Do not let EHS evolve into the later signs: physical decline and collapse. When in doubt, take them out and plunk them into a tub of ice water up to their neck. In ice water, they will cool fast, even with gear still on (4). When immediate cold water immersion was done during 18 years at the Falmouth Road Race, 274 runners collapsing with EHS in the homestretch, the survival rate was 100%, and most of them walked home healthy from the medical tent (5). Better safe than sorry. Better yet: End these reckless sprinting drills for massive linemen. Why must they do repeat sprints — and on day 1 of conditioning, in the heat! — for a total distance of > ½ mile or even >1 mile? How often do they sprint >10 yards in any football play? This brutal "conditioning" has been called "irrational intensity." I would say irrational insanity. It is reckless endangerment by coaches. When college football players die from EHS, is it manslaughter?