Members of the Meade football team pause for a water break during the first official day of practice for Maryland high schools Wednesday. With a certified athletic trainer on staff, the Mustangs have an experienced professional on hand to recognize and treat heat-related illnesses. Many other area high schools do not. (Jonathan Newton/The Washington Post)

Embossed in bronze on the plaque that marks his grave, there is an image of a teenage boy on one knee with a football in his hand and a helmet at his feet. “Edwin Dekonti Oliver Miller,” the plaque reads. “My son, my prince and my partner.”

A little more than five years have passed since Miller, a wide receiver and linebacker at Northwest , arrived at the high school for a voluntary offseason conditioning workout. After missing the previous season with a fractured pelvis, he was eager to put in extra work with hopes of earning a spot on varsity. His teammates called him “Dek,” a shortened version of his middle name, which in his parents’ native Liberia means “everything has a time.”

Miller lined up alongside his teammates to complete a series of sprints. In many of the races, he was among the last to finish. But in the final sprint, he was among the first.

The 16-year-old collapsed on the track and was rushed to a local hospital, where medical reports say he was treated for severe heat exhaustion. He died four days later.

As high school football practices begin around the area this month, Miller’s death is a reminder of a persistent and often overlooked danger. In the past decade, 31 football players have died of heat-related illnesses in the United States, according to an annual study by the National Center for Catastrophic Sport Injury Research at the University of North Carolina. Fifty-two players have died since 1995. Forty-one of those deaths occurred at the high school level.

They are all especially tragic, experts say, because each one was 100 percent preventable.

The National Athletic Trainers’ Association has established a model heat acclimatization policy, and in the 13 states that have enforced that policy, there have been zero heat-related deaths in high school football. The association’s recommended treatment — immediate, aggressive cooling, usually by submerging the victim in ice water within 30 minutes of collapse — also has a 100 percent survival rate.

Yet some jurisdictions, including the District, Maryland and Virginia, still do not have heat acclimatization policies that meet the association’s minimum standards. The majority of U.S. high schools do not have a certified athletic trainer on staff. And at this time almost every year, another preventable death goes unprevented.

“It’s staggering,” said Douglas Casa, chief operating officer of the Korey Stringer Institute at the University of Connecticut. “I’m the one sitting across from the parents of the dead kids when I’m an expert witness. And I have to explain to them that with ice water and a tub, their kid would have lived.”

Members of the Meade football team run through drills on the first official day of practice for Maryland public high schools. (Jonathan Newton/The Washington Post)
Shades of Georgia

Today’s high school football players typically wake up in air-conditioned homes and ride in air-conditioned cars, spending the majority of their summers in places where cold drinks are rarely far from reach. So when they return to the field for the first few weeks of practice, a time traditionally reserved for the season’s most strenuous conditioning, their bodies are not fully acclimated to the heat.

The dangers of this transition period were first cast into the national spotlight in 2001, when Minnesota Vikings offensive lineman Korey Stringer, the institute’s namesake, died of heatstroke at training camp. Heat acclimatization policies were created to address the issue, regulating when and how a team can practice during the first seven to 14 days of the season. They typically restrict two-a-day practices, for example, and limit practice time in full pads.

The NCAA instituted heat acclimatization policies at all levels of college football in 2003, and such policies were included in the NFL’s most recent collective bargaining agreement.

State high school athletic associations have been quick to adopt policies, but slow to embrace the recommended policy. Thirty-seven, including Virginia and the District, have a policy that does not meet NATA’s minimum standards. West Virginia has no policy whatsoever.

Maryland is unique because its policy is tied to a state law. In 2012, Gov. Martin O’Malley (D) signed a bill requiring the Maryland Public Secondary Schools Athletic Association (MPSSAA) to create model heat acclimatization guidelines. However, the measure did not include any means for enforcing them. Each school district is responsible for implementing the model guidelines or choosing to adopt its own.

Other states, including Georgia and Florida, hand down $5,000 fines or postseason bans to noncompliant schools.

Ned Sparks, executive director of the MPSSAA, says the association has enforcement mechanisms at its disposal but does not enforce the heat acclimatization guidelines because they stem from a state law. They are not MPSSAA regulations.

“And given the potential for a youngster having serious issues and maybe even death, there’s no reason for us to believe that anyone is not following them,” Sparks said. “I take exception to the idea that people aren’t following these guidelines and aren’t practicing the best standards possible.”

Casa said self-regulating systems are worrisome because it reminds him of a similar situation in Georgia several years ago. The Georgia state legislature passed a bill that prevented teams from practicing when the heat index exceeded a particular mark, but the law gave each school freedom to set its own limit.

Some schools mocked the law by moving their heat index restrictions to 150, which is higher than any recorded heat index in the state’s history. Then, in 2011, two Georgia high school football players died of heat-related causes on the same day. (Another state football player trying to avoid a similar fate accidentally drank too many liquids and died earlier this week of overhydration). The state has since reexamined its heat acclimatization policy and now has one of the best in the country.

“Almost all the time, changes have been reactive instead of proactive,” Casa said. “The motivation level never seems to cross the key threshold until there’s a tragedy.”

Meade athletic trainer Jason Hickman helps junior varsity football player AJ Williams after Williams struggled during running exercises during the Mustangs’ first day of practice. (Jonathan Newton/The Washington Post)

Anne Arundel County has full-time athletic trainers, such as Meade’s Jason Hickman, to monitor heat acclimatization and treat heat exhaustion. But many Maryland high schools do not. (Jonathan Newton/The Washington Post)
Emergency response

There is no specific punishment for Montgomery County schools that don’t follow the heat acclimatization guidelines or new heat index restrictions, county director of athletics Duke Beattie said. Punishments would be handled on a case-by-case basis, but the schools “all follow them. . . . I would say we’re 100 percent compliant.”

In the county’s four-page “Fall Heat Plan,” schools are also instructed to buy plastic tubs or other emergency materials designed to treat heatstrokes. They are not distributed or the purchases otherwise confirmed by the county.

“I know when I go to a fall practice, I’m going to see that they all have these materials out there,” Beattie said. “They all will.”

Conversations with local coaches revealed a wide range of preparedness. While multiple Montgomery County coaches said they have treatment materials — ranging from children’s swimming pools to frozen towels — one said he does not have such materials at practice, adding that the acclimatization guidelines have all but eliminated the threat of heatstroke.

Prince George’s County Director of Athletics Earl Hawkins, who said he discussed the topic in a meeting with athletic directors earlier this week, has instructed each school to provide some sort of cooling method for players. One coach said he was not given any sort of treatment equipment from the county. Another said he has only ice packs, which are used to treat a variety of injuries.

The sporadic availability of emergency treatment equipment is particularly concerning in Calvert, Charles and Prince George’s counties, where schools do not have access to athletic trainers. Six area jurisdictions (Alexandria City, Anne Arundel County, Arlington County, Fairfax County, Loudoun County and D.C. public schools) have a full-time trainer at every school. Others, including Montgomery County, use part-time trainers.

At schools without trainers, coaches take on that additional role. They are required to take a 15-hour course in athletic injury care and prevention and an online course on heat acclimatization every two years. They are also CPR and First Aid certified. But they are admittedly not health care professionals.

“You can’t teach us for two hours and expect us to know what the guy in that ambulance knows. It’s not going to happen,” Gwynn Park Coach Danny Hayes said. “And lives are on the line. So you want to talk about safety? Get some trainers on the sidelines.”

Meade’s Auston Iverson gets a drink from the cooler as the team works out during their first practice of the year. (Jonathan Newton/The Washington Post)
Empty lawsuits, empty words

When Miller collapsed at Northwest on July 2, 2009, coaches administered CPR and called an ambulance, according to documents in one of two wrongful death lawsuits filed by his family.

Emergency medical responders again performed CPR before Miller was taken to Shady Grove Adventist Hospital, where he was diagnosed with “profound metabolic acidosis, fever and heat illness,” according to the court documents.

Mark Maradei, who was the team’s head coach at the time, declined to comment for this story.

Nearly three years later, the lawsuits started coming. The first, a $4 million civil suit, charged Northwest’s former coaches and the county board of education with three counts of negligence, including one of wrongful death. Miller’s family claimed the defendants failed to provide “necessary trainers, and/or first-aid equipment, water, and/or ice, or other safety equipment, so as to treat players.”

In its response, the school district simply said Miller’s death was “caused by [his] sole or contributory negligence.” The suit was dismissed by the end of the year.

The family’s next lawsuit, which in 2013 claimed medical malpractice by the hospital and doctors first responsible for Miller’s care, also was dismissed. It is unclear whether the lawsuits were settled and, if so, for what amounts.

When reached for comment, Miller’s uncle, Alston Nah, abruptly hung up the phone.

The lawsuits were little consolation for the family’s loss. Miller would have been 22 in January, likely a taller, stronger version of the teenager in football pads pictured on his grave. Instead, his body rests beneath a sprawling grassy field at a cemetery in northern Germantown, a bitter reminder of the dangers of summer.

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