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Overexertion found to cause non-traumatic fatalities in football players
BOSTON — Most non-traumatic fatalities that occur in high school and collegiate football players are due to overexertion exercises from coaches, according to findings presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.
This study examined the number of non-traumatic football fatalities reported in a 20-year period from 1998 to 2018. Barry P. Boden, MD, and colleagues obtained data through a literature review and extensive internet searches. They reviewed more than 1,500 reports, including depositions, investigative, autopsy, media, and freedom of information reports. In addition, the efficacy of the NCAA 2003 heat acclimatization policies and 2010 sickle-cell trait screening policy were assessed in their study.
“Most non-traumatic fatalities occur during coach-supervised conditioning sessions with the primary cause being excessively intense workouts. These workouts lack any exercise science that accounts for body habitus and are often associated with an inadequate medical response,” Boden said in his presentation at the meeting.
A total of 187 non-traumatic fatalities (150 high school, 37 college) were reported during this 20-year period. Although 82% of the reported fatalities occurred in high school athletes, the risk was four-times greater for collegiate athletes due to lower participation rates. Irrational overexertion was a primary cause of non-traumatic fatalities, especially during coach-supervised sessions in which athletes had to complete punishment drills.
“The teams were exercising as a unit, with no precautions for body habitus. A common scenario was a coach who was angry at his players for a perceived lack of effort and decides to run punishment drills, such as 36 sprints from sideline to sideline,” Boden said. “During the drills the coach is screaming, ‘We’re going to run until somebody quits!’ One or more of the athletes starts to struggle or collapse and instead of activating the emergency action plan, the coach curses at the player and forces his teammates to help the teammate up to continue.”
After implementation of the 2003 NCAA acclimatization rule, the risk of a heat fatality did not decline. Also, during the same time period, the risk of a heat fatality in high school athletes did not change. However, the average number of fatalities each year in college football declined by 58% after the sickle-cell trait screening policies were implemented. For high school football athletes, the number of sickle-cell trait fatalities increased 400% since 2010. This was in part due to there being no sickle-cell trait guidelines at the high school level, researchers noted.
“The 2003 NCAA acclimatization guidelines have failed at significantly reducing heat fatalities, and we believe that the focus needs to be on the amount of exertion — in particular, the work-to-rest ratio — as opposed to acclimatization. The 2010 NCAA sickle-cell trait screening guidelines have been effective and should be implemented at all levels,” Boden said.– by Alexandria Brooks
Disclosures: The authors report no relevant financial disclosures.