Cold-water immersion was the most effective way to treat the exertional heatstroke that McNair suffered during a team workout May 29 in College Park, but medical experts said details contained in hospital medical records and an incident report written by Prince George’s County medical responders suggest it was used far too late.
McNair never recovered, and he died June 13, an event that has rocked the program, led the school to place Coach DJ Durkin on administrative leave and prompted two external investigations.
Had football trainers and athletic staff been able to lower McNair’s temperature more quickly at the practice field, heatstroke experts interviewed by The Washington Post said, the offensive lineman likely would have survived. The experts, who are not affiliated with the University of Maryland, reviewed the details available in hospital medical records and the medical responders’ report but urged caution because the full timeline from the day has not been released and is still under investigation by the school.
“For patients with exertional heatstroke, time is of the essence,” said John Jardine, an emergency medical physician and chief medical officer of the University of Connecticut’s Korey Stringer Institute. “We know if you get a patient’s temperature down within 30 minutes, we have reported 100 percent survivability.”
Maryland officials have not discussed the events surrounding McNair’s death in detail, nor have they divulged the treatment that he received or the efforts made by staff to lower his body temperature. The afternoon’s timeline probably will serve as the crux of the school’s external investigation and a federal lawsuit planned by McNair’s family.
While medical experts said heatstroke is easily treatable, hospital medical records reviewed by The Post and the incident report written by medical responders suggest McNair’s temperature had not been sufficiently cooled by the time he was admitted to Washington Adventist Hospital, which is about four miles from campus.
The hospital records say McNair initially showed symptoms of heatstroke 45 minutes into the team’s workout, which began at 4:15 p.m. That would have been more than 90 minutes before McNair’s temperature was lowered to 102 degrees by hospital medical personnel. Maryland officials strongly dispute that timeline. “At no point before or during the external review has a student-athlete, athletic trainer or coach reported a seizure occurring at 5 p.m.,” the school said in a statement.
“I’m very confident in the personnel we have and the procedures we have in place,” Durkin said at Big Ten media day last month, the last time he addressed reporters before being placed on administrative leave Saturday. “And again we’re looking at those and making sure there’s anything we can do better or do differently, then we’ll be able to do that.”
Jardine has treated more than 350 exertional heatstroke patients and said every one of them survived because he used cold-water immersion to cool their body temperature within 30 minutes. That sentiment was echoed by Douglas Casa, the chief executive of the Korey Stringer Institute, which aims to prevent sudden death in sport. The institute was established in 2010 in honor of Stringer, a Minnesota Vikings offensive lineman who died of exertional heatstroke in 2001.
“If I were betting, they were not using cold-water immersion,” Casa said, stressing that all the details were not yet known and that he had no firsthand knowledge of the steps taken by Maryland personnel. “And if they did, they didn’t use it long enough to help him out, and something happened to stop the treatment.”
The first 911 call that day was made at 5:57 p.m., according to the incident report written by medical responders, and McNair arrived at the hospital at 6:36. His reported body temperature of 106 degrees indicates cold-water immersion was not used, according to medical experts contacted by The Post, and the window to ensure recovery had passed. Multiple medical experts said death by exertional heatstroke is 100 percent preventable if the patient is placed in a cold-water tub and the body temperature is cooled to 104 degrees or lower within 30 minutes of symptoms appearing.
“Everything is a little bit of speculation here, but if someone was struggling clearly at 5 o’clock, and then the ambulance didn’t arrive until 6:10 or 6:15, that’s a 70-minute stretch of time?” Casa said. “So in that 70 minutes, just to give you an idea, if they used cold-water immersion, you can get someone from 110 [degrees] to 102 in, like, 30 to 35 minutes. So he was still at 106 when he got to the hospital, and I’m saying 110 is a worst-case scenario from what I’ve seen in my career.”
Asked to comment for this story, a Maryland spokesman referred to the school’s previous statements on the day’s events but declined to answer further questions about the training staff’s response and the school’s policies regarding heatstroke prevention and care. School officials declined to specify whether cold tubs were present and operational at the practice fields the day McNair was hospitalized.
Maryland has not released details of the events of May 29 while it is participating in an external review of McNair’s death. The review is being conducted by Walters Inc., an athletic training consulting firm, and is expected to conclude around Sept. 15.
In the wake of newly reported details of McNair’s death, and accounts by The Post and ESPN of an abusive football culture in College Park, Maryland placed four staff members on administrative leave: Durkin, head strength and conditioning coach Rick Court, athletic trainer Wes Robinson and assistant athletic director of athletic training Steve Nordwall. The university has said that the workout was run by the strength and conditioning coaches, that athletic trainers were present throughout and that Durkin and his coaching staff were also on hand.
The NCAA’s sports medicine handbook includes a variety of recommendations for schools to protect athletes from heat-related illness, and Casa helped write the section related to heatstroke.
The handbook warns that “a delay in treatment can be fatal.” It advises an emergency action plan and “immediate cooling of the body with cold water immersion” and points to a recommendation issued by a National Athletic Trainers’ Association task force: “Cool first, transport second.”
That task force, composed of a nationwide panel of experts and physicians, came up with a list of recommendations and urged every organization to “have a policy, procedure or emergency plan established to address exertional heat illnesses.”
“Aggressive and immediate whole-body cooling is the key to optimizing treatment,” the task force noted, adding that cold-water immersion “should be initiated within minutes post-incident.”
Casa outlined the three key steps to treating exertional heatstroke, with the first being quickly recognizing the signs and symptoms. The two main signs are cognitive nervous system dysfunction — which can feature a number of symptoms, including combative behavior, disorientation, loss of consciousness or, as was the case with McNair, a seizure. The second sign is a rectal temperature above 104 degrees; rectal thermometers have been proved to give the most accurate body temperatures.
The second step is to use cold-water immersion to cool the body temperature to 104 degrees or lower. The third step is to cool the player’s body temperature to a safe level, then transport him to a hospital. A 2015 position statement released by NATA said that medical personnel should prepare to cool the patient and contact emergency responders once heatstroke is detected.
“Best practices are in the literature, and the team physicians and the team trainers are all licensed medical professionals in the state of Maryland, and they are obligated to follow best practices to care for the individuals that they are responsible for,” Casa said. “And cold-water immersion — cool first, transport second, rectal temperatures — they are all completely understood to be best practices, and they are in every document that has been released in the last 10 years.”
“Like I said, we don’t know all the details,” Casa added, referring to Maryland’s handling of McNair on May 29. “But it seems like all those things were not followed.”
Roman Stubbs and Rick Maese contributed to this report.