Sudden death during exercise: How we fall short protecting young athletes

Lenny Bernstein
Blogger July 26, 2011

Perhaps I shouldn’t have read the new book “Preventing Sudden Death in Sport and Physical Activity” on vacation, when I tend to get more exercise than usual. As a middle-aged runner, my fleeting fears of unexpected demise usually begin and end with heart attacks and heatstroke.

But wow, are there a lot of ways to die working out. The book has three chapters on sudden cardiac death — one for young athletes, one for older athletes and one on commotio cordis, death from an otherwise innocuous blow to the sternum. There are chapters on exertional heatstroke, brain injuries, asthma, cervical spine injury and even lightning.

Lenny Bernstein writes the To Your Health blog. He started as an editor on the Post’s National Desk in 2000 and has worked in Metro and Sports. View Archive

All morbid humor aside, this text — aimed mostly at athletic trainers, first responders and other officials — highlights the deficiencies in our systems for keeping athletes safe during practices and competition, and offers extensive instruction on how to improve conditions.

For example, only about half of all high schools have athletic trainers on staff, usually because of budgetary constraints, according to Douglas Casa, who edited the book, though many schools somehow find the money to pay several football coaches.

As high school football players head back to the fields this August, “that should scare . . . any parent in America,” Casa said.

Only one state, New Jersey, is meeting the guidelines set by Casa’s organization, the Korey Stringer Institute, for acclimating high school athletes after a summer off.

At the college level, the NCAA only recently began testing forexertional sickling,” an inherited condition that affects red blood cells and was the leading cause of death among Division I college football players over the past decade. The condition can be linked to exertional rhabdomyolysis, a dangerous breakdown of skeletal muscle tissue found in 13 University of Iowa football players who were hospitalized in January after a strenuous offseason workout.

Last July, I wrote about how to protect yourself from summer heat while exercising, the mission of the Stringer Institute, named for the Minnesota Vikings offensive lineman who collapsed and died of heat stroke in 2001. And a few months ago, I looked at the dangers of rushing high school athletes, especially girls, back into athletics too quickly.

But when you consider the 756 deaths from all causes among high school and college athletes between 1982 and 2009, the magnitude of the problem comes into sharper focus. The vast majority were high school athletes, many of them football players.

So many of the fatalities were preventable — if adequate preparations had been made and responders reacted appropriately in the first few minutes. That includes figuring out what went wrong, even though symptoms of various conditions appear similar.

“In nearly all circumstances,” the book notes, “it is what happens before the ambulance arrives that will dictate whether the outcome is life or death.”

At a minimum, Casa said, every school should have an athletic trainer on site during practices and games; emergency plans specific to each site (athletes on the football field may have different needs than those on the soccer field); and an automatic external defibrillator immediately available to all athletes. That means the device needs to be at the field, not a two-minute sprint away inside the school, said Casa, the Stringer Institute’s chief operating officer.

With heat illnesses accounting for such a large portion of deaths among high school athletes, no football field should be without a tub of water and bags of ice for emergency cooling this summer, Casa said.

As for people like me, who are simply trying to stay fit in the summer heat, the dangers are fewer, but the lessons essentially the same, said Pete McCall, exercise physiologist for the American Council on Exercise: Be prepared and use your head.

“It depends on what you’re going to do and when you’re going to do it,” he said.

If you’ve been working out in 85 degree temperatures and the thermometer suddenly tops 100, you won’t be acclimated and should back off, McCall said. Equally important is knowing your family history of certain diseases, especially coronary artery disease, which account for “about 80% of sudden deaths during physical exertion in exercising adults and in adult athletes,” according to Casa’s book. Simply being 45 and male, or 55 and female, is now considered a risk factor for heart problems, McCall said.

Casa, who nearly died of heat stroke while competing in a 1985 high school track championship, offers this broad guideline: “When something feels different, when something feels strange, when something feels out of the ordinary, back down on your intensity.”

Don’t count on someone being nearby with the expertise to respond appropriately. At least not yet.

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