Many of the teenage boys that take to the gridiron every fall were probably watching on Jan. 18 when Baltimore Ravens running back Willis McGahee was carted off the field during the AFC Championship game after a hard, but legal, hit to the helmet by the Pittsburgh Steelers safety Ryan Clark. That same move is illegal in high school football, but nonetheless every season multiple students are killed on the field because of catastrophic head injuries, heart problems and heat stroke.
In 2008, five young athletes died from head injuries during high school football games or practice, while another seven had indirect causes of death, including undetected heart problems and heat stroke, according to the National Center for Catastrophic Injury Research. Two others also died of direct blows to the chest and abdomen. Those numbers were slightly higher than 2007, when there were three fatal injuries from contact, and six indirect deaths.
“Right now we’re at that single digit number,” said Frederick Mueller, director of the National Center for Catastrophic Injury Research. “But when it creeps up, people should be concerned.”
Changes to equipment and rules have helped save lives — the number of deaths and crippling injuries is much lower than it was in the late 1960s, when dozens of high school football players died every year and nearly the same amount would be permanently paralyzed — but there is still more that can be done.
TECHNIQUE, TECHNIQUE, TECHNIQUE
McGahee checked out fine after he was carried off the field, but high school students do not have the skill to take those kinds of hits, said Dr. Albert Hergenroeder, chief of Sports Medicine Clinic at Texas Children's Hospital in Houston.
Hergenroeder, who also spends his fall Saturdays working the sidelines as a doctor for high school football games, added that it is up to the coaches to teach proper technique, but also up to the referees to call penalties on head tackles.
Mueller worries that not every school has a trained doctor on the sidelines when serious injuries do happen.
“They need someone on the sidelines that can diagnose a concussion,” Mueller said. “A kid with a concussion should never be able to go back into the game that day.”
Ryne Dougherty, a 16-year-old Montclair, N.J., linebacker, died of a brain hemorrhage in October, three weeks after sustaining a concussion during practice. A doctor cleared him to go back on the field, but teammates reportedly heard him still complaining of headaches.
Because football is a sport steeped in macho bravado, it is particularly important for coaches to talk to players about the dangers of playing with any head pain after taking a hit.
“Anyone who has any headache or neck pain should not be playing and cannot go back to contact,” Hergenroeder said.
Head injuries can be accidental, but all experts agree that heat stroke is unacceptable. Max Gilpin, 15, collapsed at a football practice on Aug. 20 in Pleasure Ridge Park, Ky., and died three days later after his body temperature had reached 107 degrees, according to news reports. Football coach David Jason Stinson has been charged with reckless homicide in connection with Gilpin’s death, marking the first time a coach has ever been charged criminally in the death of a player.
Gilpin’s parents have also filed a civil suit against Stinson and his assistant coaches.
There were no heatstroke deaths in 2002 and 2003, but that number has climbed in more recent years, with four boys dying due to heatstroke in 2008, according to the National Center for Catastrophic Injury Research.
“When kids come into summer practice the assumption is that they’ve been training,” said Hergenroeder.
But coaches should not assume that players are acclimated to the heat. And in the case of Gilpin, there have been accusations that the players were being denied water. Coaches need to not only ensure that there’s plenty of water, and provide plenty of breaks, but also take it easy for the entire first week, using the lightest equipment possible.
College football, for example, does not allow for two practice sessions on two consecutive days, but there is no similar rule in high school. Players and coaches need to be aware of the heat index, and not just the rising mercury, when they plan practice times.
“It’s ridiculous for a coach to practice at 2 p.m. when it’s 105 degrees out,” Mueller said.
A MORE CAREFUL EVALUATION
More elusive than heat stroke deaths are the deaths of those like 13-year-old Sean Fisher, who suffered a heart attack during practice in Waldwick, N.J., in August 2008. He had no symptoms of heart trouble, and a basic physical exam could have easily missed his condition. It is not a problem unique to football; athletes in any sport can die if they compete with a heart problem.
“The thing to pay attention to is the history,” Hergenroeder said.
For high school students, he said, any teen who faints while running in a game or practice should have a pediatric cardiology evaluation. Family history is also important, and parents should make sure their doctors are asking all the right questions. In some states, including Texas, standardized pre-participation forms such as this one are mandatory. Even with extensive pre-participation exams, doctors admit that short of an electrocardiogram for each patient, some deaths will be difficult to see coming.
But after analyzing data spanning decades, Mueller says there is one more key to keeping students safe during the football season.
“Have a good emergency plan,” he said. “Have it in writing and make sure everyone on the field has a copy of it.”
He also had one more unpopular nugget of advice for the players on high school fields everywhere: “Don’t watch the pros on Sunday and try to emulate what they do.”