Ex­perts ques­tion heat­stroke prac­tices

McNair’s in­ci­dent fol­lowed two oth­ers at Md. col­leges

Baltimore Sun - - FRONT PAGE - By Talia Rich­man

The two foot­ball prac­tices un­folded roughly four years and 40 miles apart.

At each one, a teenage foot­ball player ran drills out­side, the tem­per­a­ture hov­er­ing in the 80s. When each started show­ing signs of ex­er­tional heat­stroke, train­ing staff ap­plied cool­ing packs to the player’s armpits and groins. But the train­ers stopped short of best prac­tices: tak­ing the ath­lete’s rec­tal tem­per­a­ture and im­mers­ing him in cold wa­ter.

About two weeks later, both stu­den­tath­letes were dead.

Jor­dan McNair, a 19-year-old of­fen­sive line­man at the Uni­ver­sity of Mary­land, Col­lege Park, died of heat­stroke in June.

Mar­quese Meadow, an18-year-old de­fen­sive line­man at Mor­gan State Uni­ver­sity, died of heat­stroke in Au­gust 2014.

A year be­fore that, a third foot­ball player in the state suf­fered heat­stroke dur­ing prac­tice. Af­ter a long hos­pi­tal­iza­tion, Tow­son Uni­ver­sity’s Gavin Class sur­vived, which he at­tributes to the train­ers’ quick ac­tion in treat­ing him with cold-wa­ter im­mer­sion.

Ex­perts ques­tion why other ma­jor heat­stroke in­ci­dents in Mary­land col­lege foot-

ball didn’t serve as a wake-up call be­fore McNair’s death — and they won­der what could be dif­fer­ent now.

Af­ter Min­nesota Vik­ings of­fen­sive tackle Korey Stringer died of heat­stroke fol­low­ing a 2001 train­ing camp prac­tice, the NFL took a hard look at its pro­to­cols. No pro­fes­sional foot­ball player has died of heat­stroke since. Mean­while, ac­cord­ing to the re­search in­sti­tute named for Stringer, more than a dozen col­lege foot­ball play­ers have died of heat­stroke since 2000.

“Re­ac­tive change is a prob­lem. We need peo­ple to be proac­tive,” said Robert Hug­gins, pres­i­dent of re­search and ath­lete per­for­mance and safety at the Korey Stringer In­sti­tute, a Uni­ver­sity of Con­necti­cut-based non­profit that stud­ies sud­den deaths in sports. “We’ve had enough heat­stroke cases, enough deaths, enough near-deaths to learn from and to serve as ex­am­ples.

“Heat­stroke is 100 per­cent pre­ventable. We scream that from the moun­tain­tops.”

McNair’s story — which took place at Mary­land’s flag­ship, a Power 5 con­fer­ence school — has gen­er­ated more sus­tained na­tional in­ter­est than the previous two se­ri­ous heat­stroke in­ci­dents in Mary­land. Uni­ver­sity Pres­i­dent Wal­lace Loh also pub­licly said the school took “le­gal and mo­ral re­spon­si­bil­ity for mis­takes the train­ing staff made” and brought in an out­side con­sul­tant to re­view what hap­pened that day

McNair was at­tempt­ing 10 rep­e­ti­tions of a 110-yard run dur­ing a May 29 prac­tice when he started show­ing signs of ex­haus­tion. Train­ers even­tu­ally moved him to the foot­ball field house for treat­ment, about 30 min­utes af­ter the on­set of symp­toms. An­other half-hour would pass be­fore any­one called 911, records show. The train­ers did not take his rec­tal tem­per­a­ture or use cold-wa­ter im­mer­sion treat­ment, which ex­perts say are the two steps that could have saved his life. He died June 13.

Af­ter McNair’s death, me­dia re­ports la­bel­ing the flag­ship’s foot­ball cul­ture “toxic” brought more na­tional scru­tiny to cam­pus, lead­ing to a sec­ond in­ves­ti­ga­tion into al­le­ga­tions of bul­ly­ing and abuse.

“I do feel the pub­lic eye is on the McNair case quite closely,” Hug­gins said. “I hope peo­ple re­ally start to pay at­ten­tion.”

The Uni­ver­sity Sys­tem of Mary­land’s gov­ern­ing body has been ac­tively in­volved in over­see­ing the two in­ves­ti­ga­tions into the Terps’ foot­ball pro­gram. Board of Re­gents Chair James Brady spoke at a news con­fer­ence last month, dur­ing which sports medicine con­sul­tant Dr. Rod Wal­ters pre­sented the find­ings from his re­view of the ath­letic de­part­ment’s safety pro­to­cols.

Brady said the uni­ver­sity sys­tem was “anx­ious” to learn from McNair’s death. He said Wal­ters’ rec­om­men­da­tions would be im­ple­mented not just in Col­lege Park, but at all other sys­tem in­sti­tu­tions with foot­ball pro­grams.

“We can and must learn from what hap­pened," he said, “and make any ap­pro­pri­ate and nec­es­sary changes to make sure it never hap­pens again."

AUniver­sity Sys­tem of Mary­land spokesman pro­vided an emailed state­ment Wed­nes­day, but it did not di­rectly address ques­tions about whether the heat­stroke in­ci­dents in­volv­ing Class and Meadow sounded alarms at uni­ver­si­ties across the state. Tow­son is part of the uni­ver­sity sys­tem. Mor­gan State, though a Bal­ti­more­based pub­lic in­sti­tu­tion, is not.

“The sys­tem has al­ready shared the Wal­ters re­port with ev­ery cam­pus, ask­ing them to re­view the rec­om­men­da­tions and im­ple­ment any nec­es­sary changes to their pro­ce­dures and pro­to­cols,” the state­ment read.

A Uni­ver­sity of Mary­land spokes­woman was not im­me­di­ately avail­able to com­ment for this ar­ti­cle.

Tow­son ath­letic di­rec­tor Tim Leonard said Wal­ters was also hired to re­view Tow­son’s pro­to­cols af­ter Class’ hos­pi­tal­iza­tion in 2013. While the Board of Re­gents was pro­vided with those find­ings, Leonard said, the sys­tem never as­sumed con­trol of the in­ves­ti­ga­tion, nor were there at­tempts to broaden the scope be­yond his school.

Class said he was dis­ap­pointed other state in­sti­tu­tions didn’t dou­ble down on heat­stroke preven­tion and treat­ment aware­ness af­ter his har­row­ing med­i­cal saga. He col­lapsed dur­ing an Aug. 12, 2013, foot­ball prac­tice, and his body tem­per­a­ture reached an es­ti­mated111 de­grees. He ar­rived at the hos­pi­tal in a coma, with sig­nif­i­cant or­gan fail­ure. He was later trans­ferred to the Mary­land Shock Trauma Cen­ter, where his heart stopped and doc­tors re­sus­ci­tated him. Af­ter he was sta­bi­lized, he re­quired a liver trans­plant.

“It didn’t shake any­body un­til Jor­dan,” said Class, now an as­sis­tant strength and con­di­tion­ing coach at Johns Hop­kins Uni­ver­sity. “You’d think af­ter Mar­quese dy­ing, too, that things would’ve been shaken up, but nope.”

The law firm rep­re­sent­ing McNair’s par­ents wrote a let­ter to Brady last month de­mand­ing to know what the uni­ver­sity sys­tem had gleaned from what hap­pened to Class and Meadow.

“The facts that need to be dis­closed now in­volve. the sys­temic fail­ures through­out the Uni­ver­sity Sys­tem that pre­ceded Jor­dan’s death, de­spite hav­ing ac­tual knowl­edge that an in­ci­dent like this had oc­curred be­fore,” lawyer Billy Mur­phy wrote.

Much of the Board of Re­gents has turned over since 2014.

Dr. David Chao, who served as the head team physi­cian for the San Diego Charg­ers for 17 years, said col­lege foot­ball pro­grams should’ve learned their lessons af­ter Stringer died — and even more so when a heat­stroke in­ci­dent hit closer to home.

“One death of a child or adult from heat­stroke play­ing foot­ball is one too many,” he said.

Since McNair’s death, a num­ber of changes have been made within the Mary­land foot­ball pro­gram.

The Terps added more on-site cool­ing sta­tions and boosted the amount of med­i­cal staff on hand dur­ing prac­tices and games. Stu­dent-ath­letes use a new tool that helps them mon­i­tor hy­dra­tion lev­els and they have ex­panded ac­cess to cold-wa­ter im­mer­sion ther­apy. Wal­ters led in-ser­vice train­ing for ath­letic de­part­ment staff on im­ple­ment­ing emer­gency plans.

Wal­ters’ re­view found the flag­ship’s pro­to­cols on ex­er­tional heat ill­ness meet stan­dards, but proper steps were not fol­lowed in McNair’s case. The foot­ball team’s prac­tice site was moved at the last minute, so the cold-wa­ter im­mer­sion tanks that are usu­ally part of the field setup were not there on the day McNair fell ill. The uni­ver­sity also didn’t mon­i­tor weather sta­tis­tics in the rec­om­mended man­ner.

Wal­ters said the fail­ure of train­ers to rec­og­nize McNair’s signs of heat ill­ness was “a con­cern.”

Uni­ver­si­ties not only have to put the right pro­to­cols in place, Hug­gins said, but un­der­stand how to ex­e­cute them prop­erly.

In Jan­uary 2012 — more than a year be­fore Class was hos­pi­tal­ized — a group of lead­ing ath­lete safety ex­perts drafted a se­ries of 10 rec­om­men­da­tions for pre­vent­ing sud­den deaths in col­lege sports.

They rec­om­mended con­di­tion­ing peri- ods be phased in grad­u­ally “to en­cour­age proper ex­er­cise ac­clima­ti­za­tion and to min­i­mize the risk of ad­verse ef­fects on health.” McNair’s fi­nal work­out was his first team ac­tiv­ity in more than a month.

And they rec­om­mended that ex­er­cise and con­di­tion­ing ac­tiv­i­ties should not be used as pun­ish­ment. Meadow fell ill while run­ning dur­ing a “pun­ish­ment prac­tice,” ac­cord­ing to a law­suit filed by his mother.

The law­suit, which ended in a set­tle­ment, states that Meadow at­tended a prac­tice on Aug. 10, 2014, that was “sched­uled to pun­ish cer­tain in­di­vid­u­als on the team for team rule vi­o­la­tions.” About an hour in, Meadow be­gan stum­bling and be­came disori­ented — his tem­per­a­ture even­tu­ally reach­ing 106 de­grees. At the hos­pi­tal, he went into liver and kid­ney fail­ure and suf­fered a brain in­jury be­cause of the loss of oxy­gen. He re­mained in the in­ten­sive care unit on a ven­ti­la­tor for two weeks, be­fore he died sur­rounded by fam­ily.

His mother, Benita Meadow, said when she saw McNair’s death re­ported in the news, it took her right back to the day her son fell ill.

“I couldn’t believe it was hap­pen­ing again,” she said in an in­ter­view. “The Uni­ver­sity of Mary­land and Mor­gan State are like sis­ter schools. It scared me and it made me an­gry — how is this still hap­pen­ing, so close and in the same way?

“This can’t be swept un­der the rug. … There has to be a change now.”

The Mor­gan State foot­ball team has since im­ple­mented new pro­to­cols, The Sun re­ported in Au­gust. Be­fore prac­tice, each ath­lete re­ceives a 1-gal­lon jug of wa­ter. The play­ers take two manda­tory wa­ter breaks, with­out their hel­mets on. At the end of each work­out, the play­ers pile into ice tubs on the side­lines for a re­quired 20-minute cool-down. Mor­gan State of­fi­cials did not re­spond to re­quests for com­ment for this ar­ti­cle.

Af­ter Class’ heat­stroke, Tow­son also re-em­pha­sized pre­ven­ta­tive mea­sures, Leonard said. Manda­tory breaks are writ­ten into the prac­tice sched­ule. Coaches and train­ers preach the im­por­tance of hy­dra­tion. Of­fi­cials are al­ways mon­i­tor­ing for new ev­i­dence-based rec­om­men­da­tions on avoid­ing heat­stroke.

It re­mains to be seen what im­pact McNair’s death will have on other ath­let­ics de­part­ment prac­tices across the state.

But his griev­ing par­ents are hop­ing for change. They’ve launched a foun­da­tion in their son’s honor, aimed at pro­mot­ing aware­ness of heat-re­lated ill­nesses, im­prov­ing player safety and re­duc­ing heat­stroke in­ci­dents among stu­dent-ath­letes. They say they don’t want any other par­ents go­ing through what they are.

“While Jor­dan is not with us to build his legacy, as a fam­ily we are do­ing it for him,” his fa­ther, Marty, wrote in an open let­ter on the foun­da­tion’s web­site. “This is his legacy.”

Benita Meadow be­friended McNair’s par­ents af­ter their twin tragedies. She never imag­ined a friend­ship could stem from her grief, but she said their con­nec­tion gives her re­newed strength to talk about her son, whom she re­mem­bers for his drive, his big per­son­al­ity and his de­sire to be a hu­man­i­tar­ian.

For years, it was too hard to tell her story. Now that heat­stroke has struck an­other Mary­land col­lege ath­lete, it’s dif­fer­ent.

“Mar­quese is telling me to help,” she said.

“I couldn’t believe it was hap­pen­ing again.”

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