Month: August 2018

The Woes of Training for a Marathon in New Orleans’ Summer Heat (SELF)

Here’s how I’ve finally been making it work.

I had just returned from my first long training run and instead of giving myself a high-five, I felt more like I was on the losing end of a MMA fight. I just had my ass kicked by the steaming heat of summertime. To be honest: It’s my own fault. I jogged out the door hungry and thirsty (from the previous night’s happy hour) at 9 A.M. I wore black leggings and forgot water. Basically, I was completely unprepared.

I’m training for my first-ever marathon—I’ll be running the TCS New York City Marathon thanks to getting a free slot on the New Balance team. And sure, it will land on a (hopefully) crisp November day in New York, but my training has started in the middle of summer and I nearly passed out on my first long run. Oh, and did I mention that I live in New Orleans?

After that run, I wondered: Is it possible to train for a marathon in one of the most hot and humid cities in the U.S.?

First, I decided talk to an expert on athletic performance in hot environments, who could help me understand why my run felt so unbearable.

I reached out to Rebecca L. Stearns, Ph.D., the chief operating officer at Korey Stringer Institutewithin the department of kinesiology at the University of Connecticut, who told me that the reason heat and humidity impact us so much during exercise is because our bodies already produce a lot of heat while working out as a result of the mechanical processes happening inside our muscles and body when we use energy. (They call it “burning” energy for a reason.) Stearns explained that sweat—specifically, the evaporation of sweat off the surface of our skin—is the release of this heat and the main way the body cools itself during exercise.

When the environment around us is also very hot, it makes it harder for our bodies to cool off through this process. “[Environmental] heat becomes dangerous because it can result in a scenario that we refer to as uncompensable heat stress, where your body is gaining heat faster than it is being dissipated,” said Stearns. So even if your cooling mechanisms are working, the external heat can throw you over the edge and be too much for your body to handle.

To make matters worse, humidity in the air makes it harder for sweat to evaporate. “The more saturated (with humidity) the air is, the less availability there is for evaporation, meaning it will just drip off the skin, which doesn’t allow the body to cool,” Stearns said.

Being in New Orleans, I’m faced with both heat and debilitating humidity. In August, most locals retreat to air-conditioning or spend the day in a swimming pool. How would I ever manage to prep for a marathon?

I’d just have to get my body used to training in the heat. But how?

Luckily, New Balance hooked me up with a remote running coach, John Honerkamp, founder and CEO of J. R. Honerkamp Consulting & Coaching, who I immediately reached out to after that first run. Honerkamp said that while your body can acclimate to running in the heat over time, it can be difficult when you first start. “I always say I am pretty good at running in the heat eventually, but out of the gates I struggle,” he said. This made me feel a little bit better.

So then, how could I get my body acclimated enough that my runs feel more bearable? Stearns said that generally, it takes most people approximately 10 to 14 days of being active in the heat to get adjusted to it. Of course, this all varies by person and the intensity and frequency of activity, and different adaptations—like changes in perceived exertion, sweat rate, blood volume, and heart rate—happen at different points during that rough time frame.

Honerkamp also suggested that I start by slowing down my pace. Considering that I run a 13-minute mile, I tell him I’m wondering if I should speed walk. But he assured me that not having a time goal for my first marathon is a good thing, and that it’s more important to focus on the effort than speed.

So, for the next two weeks, I focused on slower and shorter runs. I also shopped for a new running wardrobe.

Honerkamp told me that less clothing is better in the heat, but that I should add a hat specifically for running (to protect myself from the sun) and wear sunscreen. Stearns said that comfortable and loose, light-fitting clothes will allow air movement across my skin which helps sweat evaporate.

Armed with new information, I purchased a pair of ’80s-style biker shorts and a breathable white hat, and applied broad-spectrum SPF. It’s true, clothing (or lack thereof) made a difference and after a few short runs, the heat actually started to feel less oppressive.

Before my next long run, I asked Stearns what precautions I should take to stay safe.

Longer duration exercise can provide a greater opportunity for your body’s temperature to rise to an unsafe level, Stearns said. She suggested I give myself opportunities to rest, rehydrate, and adjust the intensity depending on how I feel. These things are “all important to avoid potentially dangerous body temperature elevations.”

I asked Stearns about what warning signs may signal I’m starting to overheat. “You might start to feel hot, unusually tired, irritated, or your mental functioning might decrease (feeling confused or disoriented),” she said. The symptoms of severe dehydration are similar, so it’s important to listen to your body and take a break and rehydrate if you start to notice any of these signs.

In one of my daily training emails from Honerkamp, I got a tip to weigh myself (naked) before and immediately after the run to calculate my sweat rate. The goal is to lose no more than 0-2 percent of my initial body weight, he said. So, if I were to lose more than 2 percent of my initial body weight, that means I’m not taking in enough fluid during the run. Quick note: You don’t have toweigh yourself to make sure you’re hydrating enough. It’s just a tool that some experts suggest, and that comes in handy when you’re training for long periods of time in the heat.

But you probably don’t need to overthink it. Most experts (including Stearns) say, quite simply, that healthy adults can usually stay hydrated by listening to their bodies and drinking water when they feel thirsty. “Generally, if you have readily available fluid, drinking to thirst will keep you at a safe hydration status,” Stearns told me. It may not be the best solution, though, if you’re running in a race and only have limited scheduled breaks for water. That’s because when you’re forced to delay your fluid intake, you may end up not drinking as much as you truly need once fluid is available. A simple solution is to just bring water with you on a training run or during the race, Stearns said, so that you are able to drink whenever you feel thirsty. If that’s not possible, though, Stearns said that calculating your sweat rate like Honerkamp suggested (here’s an online tool you can use) is actually the best way to make sure you’re drinking enough when you’re working out hard in the heat with infrequent access to water.

Stearns added that while the best amount of fluid to drink will be different for everyone, generally the stomach will handle small doses of fluid at greater intervals better than lots of liquid all at once.

Also, I’d be remiss to not mention that properly hydrating also means drinking before and after a run, not just loading up on it once you’re unbearably thirsty. So, I decided to skip Friday happy hour and, instead, pre-hydrate leading up to my long Saturday run.

On the first day of August, I set out on a 10-mile run, during which I felt much more comfortable in the heat—and with the idea of slowing down and taking breaks.

I left my house at 6 A.M., and stopped at the park’s water fountains along the way for small sips of water. There were times when I felt like I was jogging in cement, but my body didn’t hate me. In fact, I had a reserve of energy and sprinted the last block home. Did I mention that the heat index was at 109 degrees?

Post-run, I celebrated with lunch beers. Of course, less alcohol is better when you’re trying to keep yourself fully hydrated, but I figure that that doesn’t mean I can’t enjoy a drink or two when I really want it. (Keep in mind that I’m not a doctor or a dietitian and I’m only making choices for myself. If you’re wondering if you can drink after you have a tough workout, check with your doctor.)

By my third or fourth long run, I was way more comfortable in the heat and kept my hydration in check. (I’m sure that my improving cardiovascular fitness also plays a part in making my runs feel less miserable.)

I’ll be honest, after most long runs, I still want nothing more than to dunk my body into a cold pool of pamplemousse La Croix and sleep for an hour—but the long distance feels doable and occasionally enjoyable. Plus, there’s always happy hour at the finish line.

Source: SELF

As Temperatures Soar, High School Football Coaches Are Cracking Down On Safety (Hartford Courant)

With temperatures surpassing 90 degrees and potentially reaching record levels this week, many high school football coaches are taking precautions to ensure player safety.

“My attitude is, don’t put any kid in danger,” said Harry Bellucci, the coach at HartfordPublic. “If there’s some shade in the area, do some work in the shade. It’s not worth anybody’s health to be out here when it’s like this.”

Hartford Public, as well as teams across the state, will need more than just shade this week with temperatures expected soar. Gary Lessor, assistant director of the weather center at Western Connecticut State University, said air quality could also being an issue. Lessor said actual air temperatures in the area around Hartford and Enfield could reach 96 degrees with a heat index close to 105 on Tuesday. Wednesday might be even warmer, Lessor said.

To avoid the extreme heat, Bellucci, who has coached for more than 38 years, said he starts practice in the early evening instead of midday. If necessary, the team will practice indoors to avoid the sun. Bellucci said players are allowed to stop practicing for water breaks whenever needed and that conditioning is done without pads and helmets if temperatures are too high.

While heat is often a concern, there is increased awareness following the death of University of Maryland football player Jordan McNair. The offensive lineman died in June, two weeks after collapsing during a team workout. McNair suffered a heatstroke during the workout. Members of the Maryland athletics staff are on administrative leave during an external review.

“When that happens, it makes me even more aware of those circumstances of the heat, of making sure that you’re watching kids,” Bellucci said. “Making sure that you’re watching for signs of heat exhaustion or heatstroke. It raises your awareness level after you see something like that.”

Glastonbury coach Scott Daniels is taking similar precautions. He’s giving players longer breaks between reps, and he’s advising players to hydrate and to dump water on their heads to cool off.

The Tomahawks practice on both turf and grass. Daniels said that he and his staff will test the turf before players go on it. If it’s too hot to touch, he’ll have the players work out on grass.

In Southington, coach Mike Drury has been in contact with the athletic trainers before the potential heat wave. The Blue Knights wore full pads Monday. On Tuesday, they’re likely to go just uppers.

“Whatever the trainers, the professional staff say we should do, we’re going to do,” Drury said. “We’re out here to win and get better, but also, we want to be safe in the meantime.”

The Korey Stringer Institute, which is on UConn’s campus, provides research and education on safety and sudden death prevention to athletes and coaches around the country and is named after the former NFL player who died after an exertional heatstroke following a Minnesota Vikings practice. The institute’s CEO, Doug Casa, said there are preventative measures teams should take from staying hydrated to avoiding practicing during the highest temperatures. Casa added that more can be done, including having cold water immersion tubs and instituting an emergency action plan. Maryland did not have cold water immersion tubs available.

Casa has been critical of the Connecticut Interscholastic Athletic Conference, which governs high school athletics in the state, because it does not require either.

The CIAC, which could not be reached Monday, previously told The Courant it allows school districts to impose requirements.

“We’re not an association that imposes requirements such as trainers at every single event, or requires certain [weather] measurement systems, because frankly we think that districts are best able to decide what’s appropriate for them and, truthfully, what they can afford,” then-CIAC executive director Karissa Niehoff said, adding that the CIAC requires education for parents and student-athletes on concussions and cardiac arrest.

According to Daniels, Glastonbury has taken matters into its own hands. All preseason, a cold water immersion tub was up in the locker room for players. He, the athletic director and principal are constantly in contact and checking the heat index level. Casa said some other schools have followed suit.

Bellucci said when he was a player in the early 1970s, water breaks weren’t a thing, and they’d be running around in the upper 90s with full pads and helmets on. Even then, he thought something wasn’t right. Daniels echoed Bellucci’s thoughts on the way the game used to be played.

“Our player safety is our No. 1 concern, period,” Daniels said. “The old school days of running through doubles and all that stuff — those days are over.”

Source: Hartford Courant

‘His Entire Body Was Shutting Down.’ New State Rankings Show Gaps in High School Athlete Safety (TIME)

By mid-afternoon on August 1, 2017, the temperature in Stockton, Calif. was at least 105 degrees. Thirteen-year-old Jayden Galbert complained to his mother, Shynelle Jones, about the heat, but didn’t want to skip preseason football practice and hurt his chances of making the freshman football team. Instead, he showed up, pushed himself to participate, and then collapsed on the field. “He started vomiting and he was shaking,” Jones says. “He couldn’t see. He was trying to focus, but he couldn’t.” Jayden was eventually airlifted to UC Davis Medical Center, where he was diagnosed with exertional heat stroke, which in turn led to rhabdomyolysis, a dangerous condition in which muscle breakdown can cause kidney damage. “His entire body was shutting down and I almost lost him,” Jones wrote on Facebook shortly afterwards.

At the time, California’s high schools were not required to follow national best practice standards for preventing and treating heat stroke — guidelines that include having cold water tubs on hand in case players overheat, among other cooling treatments. And they’re still not, according to a new study conducted by the Korey Stringer Institute at the University of Connecticut that ranks all 50 states and the District of Columbia on whether they’ve implemented key sports safety policies that can prevent serious injuries and deaths of high school athletes. California ranks nearly last on the list and hasn’t implemented any of the best practice policies for preventing heat stroke, but many other states also fared poorly.

The policies included in the study cover “the four Hs: head, heart, heat and hemoglobin,” which together account for 90% of all sport-related deaths, says Samantha Scarneo, vice president for sport safety at the Korey Stringer Institute. But these policies aren’t uniformly implemented, which leaves many of the nation’s high school athletes at risk as students head back to school. No one knows just how many student athletes have been hurt or died in each state due to the lack of implementation, because those numbers are not tracked.

“They’re not sitting back and waiting for a kid to die to make these changes.”

In California alone, there were more than 808,000 high school sports participants during the 2017-2018 school year, according to information released earlier this month by the California Interscholastic Federation. The state has several important measures in place, like requiring automated external defibrillators (AEDs) for cases of sudden cardiac arrest, and detailed return-to-play policies for players who are diagnosed with a concussionBut California also has the dubious distinction of being the only state that doesn’t regulate athletics trainers in any way. Trainers are often the ones to make calls about pulling a kid off the field or prescribing treatment. Despite several past legislative attempts, “the biggest concern in California is that the state does not require athletics trainers to be licensed,” Scarneo says. “Without any type of knowledge of who they are and what their training is, it makes it really difficult to actually trust that they know what they’re doing.”

States can look to New Jersey as a role model, which ranked No. 1 in the study and which Scarneo called “one of the most proactive states in the nation.” New policies enacted in New Jersey in the past year require cold-water immersion tubs, detailed steps for return to play, and strength and conditioning limits throughout the year. “They’re not sitting back and waiting for a kid to die to make these changes,” Scarneo says.

Overall, 21 states have made improvements since 2017 on policies in the key areas of sudden cardiac arrest, traumatic head injuries, exertional heat stroke, appropriate medical presence at games and practices, and emergency preparedness, Scarneo says. However, no state has a perfect score: even New Jersey only received 79.03% (by comparison, California scored 26%).

One reason states vary so widely on student-athlete safety policies is that there isn’t one overall group that can require them. Unlike at the college level, where the National Collegiate Athletic Association oversees policies for its member schools, the National Federation of State High School Associations (the umbrella organization for the state high school associations) has no such authority. (Though there are still problems in college sports — the recent heat stroke death of Maryland offensive lineman Jordan McNair is under ongoing investigation. Five Division I football players have died of heat stroke since 2000.)

But at the high school level, adoption of the best practice guidelines is left to each individual state. Some policies are enacted by the state’s high school association and some by its legislature, with the decentralization of oversight leading to tremendous variation that often leaves out important best practices.

There is some hope: since concussions have become a focus of public concern, lawmakers jumped to action, and it’s making a difference. Every state now has some type of a concussion law, which generally requires concussion education, immediate removal from play if it’s suspected that a player has a concussion, and medical clearance before that athlete can play again. A study last fall found a significant drop in the number of repeat concussions after the laws had been in effect for a period of time.

There’s also research showing that state heat acclimatization policies work. A study released by the National Athletic Trainers’ Association in June found that high-school football players were 55 percent less likely to be diagnosed with exertional heat illness (which includes heat stroke as well as heat exhaustion and heat cramps) during the preseason in states with guidelines for this timeframe.

To evaluate each state’s sport safety policies, the Korey Stringer Institute used the best practice guidelines established in 2013 by a task force representing the nation’s leading medical and sports safety experts. The institute, named for the Minnesota Vikings player who died of heat stroke during training camp in 2001, was one; others included the National Athletic Trainers’ Association, American College of Sports Medicine, American College of Emergency Physicians, and the National Federation of State High School Associations.

“It is unacceptable to me that there are still high schools in the United States that don’t have AEDs and also unacceptable to me that there are high schools that don’t have a comprehensive emergency response plan for cardiac arrest on their campus,” says Dr. Jonathan Drezner, a co-author of the 2013 recommendations on behalf of the American Medical Society for Sports Medicine, who also directs the Center for Sports Cardiology and is a professor of family and sports medicine at the University of Washington.

The results of a recent study Drezner co-authored show that there were about 50 cases per year of sudden cardiac arrest in high school athletes between July 2014 and June 2016, although Drezner believes the actual number is likely higher. “School staff and coaches need regular (at least annual) reminders on where the AEDs are located, when to use them, and how to recognize sudden cardiac arrest,” he wrote in an email.

“It is unacceptable to me that there are still high schools in the United States that don’t have AEDs.”

But another author of the 2013 best practices questioned whether ranking the states will be effective. Dr. Joel Brenner, medical director of the sports medicine program at Children’s Hospital of The King’s Daughters and an associate professor of pediatrics at Eastern Virginia Medical School, who co-authored the guidelines on behalf of the American Academy of Pediatrics, thinks it would be far better for each state to evaluate its own progress, given that circumstances and resources vary, instead of being rated and compared. “If the purpose is to see what’s being done and what’s not being done and help the states, I’m not sure a public ranking is going to be helpful,” says Brenner.

Also, he points out, there may be state policies that help protect players but aren’t reflected in the rankings, if they weren’t explicitly part of the 2013 best practice recommendations. For example, California has in-season limits on the number of full-contact football practices and a ban during the off-season, but didn’t receive points for these in KSI’s study.

Even though the rankings don’t represent the whole picture of what’s being done in each state, Drezner believes that requiring these policies at the state level is ultimately the right approach. “When we just raise awareness and we provide help and we do all of these other things, it doesn’t impact change enough,” he says. “For the state associations that have the authority to be decision makers, I think the ranking is working,” he says. “It’s pushing people to do more and come closer to the policy guidelines. We’re all working toward the same goal.”

In the meantime, there are often long-term impacts for athletes like Jayden. A year later, he still regularly goes to therapy for PTSD from the ordeal. And although he’s largely physically recovered, he still walks with a limp and has residual pain in his legs from the rhabdomyolysis he suffered. “Some days are better than others,” his mother says.

Jayden stopped playing football for the first time since he was 6 after the injury, but still hopes to play again at some point in high school. But after what he went through — and the environment Shynelle knows he’d be going back to — his mom has already made up her mind that the answer is no.

Source: TIME

Researching Heatstroke In Athletes (NPR)

The death of a University of Maryland player is among a number of training deaths in college football recently. Melissa Block speaks with Douglas Casa who has researched the causes.


In June, a 19-year-old freshman on the University of Maryland football team died in a hospital of heatstroke. Jordan McNair had collapsed two weeks earlier after running long sprints during training. His body temperature when he arrived at the hospital was 106 degrees. The university has opened an investigation, and head coach D.J. Durkin has been put on administrative leave. Many blame an abusive, toxic coaching culture at the university for McNair’s death. And it’s not just Maryland. According to the National Center for Catastrophic Sport Injury Research, a dozen college football players in addition to Jordan McNair have died just from heatstroke since 1995. That figure is higher if you include things like sudden cardiac arrest and asthma attacks. Douglas Casa studies heat illness and sudden death in sport at the Korey Stringer Institute at the University of Connecticut. And he joins me now. Mr. Casa, welcome to the program.

DOUGLAS CASA: Yeah. Thank you very much for having me.

BLOCK: And what do you make of the case of Jordan McNair? This was an offseason practice. This was not during a game.

CASA: Yeah. That is correct. It is during a collegiate conditioning session, which is really the place where we’re having the most problems right now dealing with sudden death in sport.

BLOCK: According to reports that have come out, when Jordan McNair had trouble standing after these long sprints, one of the trainers reportedly yelled, drag his ass across the field. Is that – does that speak to a culture that you find very common in college football?

CASA: Thank God that’s not common. But, you know, did that potentially delay the appropriate care? It may have. And we know in the world of exertional heatstroke that when you cool somebody down to under 104 degrees within 30 minutes, survivability is 100 percent in all the people that have ever been studied. So it’s a complete shame when you don’t have the correct, you know, treatment being done for the person on the field at that time.

BLOCK: The institute where you work is named for Korey Stringer. He’s the NFL lineman. He died of heatstroke in 2001 in a workout. And since then, as I understand it, there has been no NFL player that’s died of heatstroke. So what is the NFL doing that college football apparently isn’t?

CASA: There’s probably a few things to consider that I would say are things to consider to model. One is the NFL, after the death of Korey Stringer, thankfully, made sure that the best practices were being utilized by all 32 teams with the prevention, recognition and treatment of exertional heatstroke. So that’s obviously helpful. Second, the players, in conjunction with the NFL, have developed appropriate policies to make sure that they stay safe. So in a sense, the players have rights in the NFL. And the players have no voice and no rights in college football. College conditioning coaches and college football coaches can literally do anything they want, you know, during a conditioning session. But in pro football, the players and the teams, you know, work together in unison, I think, a lot better.

BLOCK: I’ve seen the term used in terms of how these workouts are conducted at the college level – this term irrational intensity workouts – in other words, pushing people well past the point of anything being helpful or useful in their training.

CASA: That’s correct. Back in 2012, we convened a task force. And all the top sports medicine organizations in the country attended and endorsed the document that was called “Preventing Sudden Death In Collegiate Conditioning Sessions.” But the NCAA did not endorse that document. If they had endorsed it, I’m sure we would not be having this conversation right now. And we wouldn’t have had a lot of those deaths that we’ve had in the last six years. But they have not done enough to make collegiate conditioning sessions of more a controlled environment. Right now, it’s the Wild West.

BLOCK: I’m thinking about a column that Sally Jenkins wrote in The Washington Post in which she essentially accused college coaches of working these kids to death on the field. Do you agree?

CASA: Yeah. In lot of cases, that’s true because you’re doing workouts that are not intuitive for what you need at that time. I’ll give you a great example. In 2013, the University of Iowa – in the first day back in January when they were doing a workout, they had the football team do 100 squats. And they had 13 people hospitalized within a day. Those players could have done 100 squats if they had trained for it properly over a few weeks but not on the first day back. So that happens across the country all the time. But the NCAA needs to make the big steps to make some big policy changes so that we can protect all of these college athletes in football and in every sport.

BLOCK: That’s Douglas Casa. He’s CEO of the Korey Stringer Institute at the University of Connecticut. Thanks so much for speaking with us.

CASA: Thank you – pleasure to be on.

Source: NPR

Prehistoric college football coaches are killing players. It’s past time to stop them (Washington Post)

“They get to dictate these things, and we get to keep burying athletes until we make definitive changes to the culture,” said Dr. Douglas Casa, a kinesiologist who serves as CEO of the Korey Stringer Institute at the University of Connecticut.

Since 2000, there have been 40 athlete fatalities in conditioning sessions in multiple sports across the NCAA, yet not a single death on the field, according to Casa. This despite the fact that schools have all the education and tools to prevent it: Heatstroke exertion is 100-percent survivable with a thermometer and some ice. The NFL has eliminated it altogether and to its credit continues to consult with the Stringer Institute on research and best practices to prevent sudden deaths. The NCAA, on the other hand, has remained lethally antiquated. Unlike NFL players, collegians have “no voice, and no rights,” Casa pointed out. McNair was forced to run 10 sprints of 110 yards, until his body temperature was 106. It was a nonsensical workout that had zero football relevance and demonstrated nothing about his character except that he was willing to work himself into a coma for fear of punishment from an all-powerful authority figure. “It’s a totally unregulated environment,” Casa said.

New Jersey boasts nation’s top health and safety policies for student-athletes (USA Today)

As student-athletes across New Jersey resume practice for fall sports this week, they can do so with confidence knowing the statewide athletic association of which their high schools are a member boasts the country’s most comprehensive health and safety policies.

The New Jersey State Interscholastic Athletic Association is the best in the nation in the area of managing injury risk to high school student-athletes, according to the Korey Stringer Institute’s second annual national ranking of statewide athletic associations.

Korey Stringer Institute researchers found many states are not fully implementing safety guidelines intended to protect student-athletes from heat stroke, sudden cardiac arrest and other potentially life-threatening conditions that may be prevented with proper policies. The institute, housed at the University of Connecticut, ranked states according to the extent to which they met a series of evidence-based best practice guidelines.

The NJSIAA, which has long been a leader in implementing and adopting safety protocols, improved its ranking from fourth to first out of 51 statewide athletic associations, according to the institute’s 2018 High School Sports Safety Policy Rankings.

New Jersey wrested the top spot from North Carolina, whose state university runs the National Center for Catastrophic Sports Injury Research. Last year, the Korey Stringer Institute determined the North Carolina High School Athletic Association had the most comprehensive health and safety polices in place for secondary school athletics.

Among the statewide athletic associations governing the nation’s 7.8 million student-athletes, North Carolina was ranked second this year, followed by Massachusetts (third), Kentucky (fourth) and Florida (fifth).

“We are very encouraged by the positive changes that have occurred across the nation,” said Douglas Casa, CEO of the Korey Stringer Institute and a professor of Kinesiology at the University of Connecticut who is one of the nation’s foremost authorities on the prevention of exertional heat stroke and other serious injury in sport. “However, we need to continue to be vigilant. We are fully committed to working with individual states on adopting these important guidelines.”

Source: USA Today

D.J. Durkin’s Program Under Scrutiny as Maryland Parts Ways With Strength Coach (The New York Times)

The president of the University of Maryland made a startling admission Tuesday, saying basic medical procedures had not been followed when a football player collapsed in the heat during a conditioning workout in May and died two weeks later.

The president, Wallace D. Loh, said that Maryland accepted “legal and moral responsibility” for the death of the player, Jordan McNair, a 19-year-old offensive lineman.

D.J. Durkin, Maryland’s head coach, remained on administrative leave in the wake of a blistering report by ESPN last week that he had created a verbally abusive and humiliating atmosphere at the university’s football program.

But the university said the team’s strength and conditioning coach, Rick Court, was no longer working there. Hours after the university’s statement on Tuesday, Court said on Twitter that he had resigned a day earlier and posted what he said was his resignation letter.

Loh said that a preliminary investigation faulted the training staff, not the coaching staff, for failing to treat McNair properly. But he said he had appointed a four-person commission to investigate the practices and culture of the football program.
McNair’s death has forced the insular, hypermasculine and scandal-ridden world of college football to reckon with itself once again about whether it is sufficiently protecting its players. Universities and the N.C.A.A. have come under criticism for not sufficiently monitoring conditioning workouts, especially in the off-season.

The university acknowledged that McNair’s temperature and other vital signs were not taken and that he was not immersed in a cooling bath — standard procedures — after being overcome while running sprints during the May workout.

“The athletic training staff, not the coaching staff — they basically misdiagnosed the situation,” Loh said at a news conference at the university in College Park, Md.

Earlier in the day, Loh and Damon Evans, Maryland’s athletic director, said they had visited McNair’s parents in Baltimore and apologized to them. Loh repeated to reporters what he said he told McNair’s parents: “The university accepts legal and moral responsibility for the mistakes that our training staff made on that fateful workout day of May 29, which of course led subsequently to his death on June 13.”

Loh and Evans said they also took seriously the accusations of intimidation and denigration of players by Durkin and the training staff described in the recent ESPN article and other news reports.

“We will not tolerate any behavior from any employee within Maryland athletics that is detrimental to the mental or physical well-being of our student-athletes,” Evans said.

Durkin, 40, has generally been portrayed as a stock football character, one who was fiercely intense but not possessing a reckless ardor.

When he was an assistant at Stanford, from 2007 to 2009, Durkin once engaged in what has been described as a ferocious game of one-on-one basketball with the equally intense head coach at the time, Jim Harbaugh.

The game is said to have lasted 90 minutes and, in Durkin’s telling on a radio show, “there was no fouls being called and there was a lot of blood on the court.”

Durkin also worked under Harbaugh as a defensive coordinator at Michigan in 2015. In a profile in The New York Times that season, a Stanford coach who had worked with both men used a pet phrase of Harbaugh’s to describe Durkin’s approach to football: “With enthusiasm unknown to mankind.”

When Durkin was hired at age 37 to become head coach at Maryland for the 2016 season, he seemed to have an impeccable résumé as a highly-regarded recruiter who had been an assistant not only under Harbaugh, but also under Urban Meyer at Florida. He had learned from the best and would now have a chance to test himself against the best in the Big 10 Conference, annually facing Harbaugh at Michigan and Meyer, now at Ohio State, along with Penn State, trying to rebuild a program that had enjoyed only sporadic success.

Harbaugh spoke extravagantly of Durkin’s driven nature on his weekly radio show in 2016, saying, “I always get a smile when I think of D.J. because I think of the foam coming out of the side of his mouth, snot bubbles percolating when he’s really intense. He’s a great competitor.”

The question is whether that passion strayed beyond the limits of propriety as Maryland lost a majority of its games under Durkin.

The ESPN report described a football culture of belittlement and intimidation, according to current and former players and staff members, who said that coaches and trainers commonly embarrassed and shamed players. Two former Maryland players spoke on the record; other accusing sources in the story were anonymous.

Among the accusations in the ESPN article: An offensive lineman considered overweight was forced to eat candy bars in front of his teammates as they worked out. Another player was forced to eat to the point of vomiting. Players’ masculinity was mocked when they were unable to complete a workout or lift a weight, and one player was belittled after passing out.

ESPN reported that on the afternoon of May 29, McNair collapsed while running 10 110-yard sprints; that nearly an hour passed before a call was made to 911 (the university disputes this); and that McNair’s body temperate was 106 degrees when he arrived at a hospital.

William H. Murphy Jr., a lawyer for the McNair family, has said that the cause of death, not yet confirmed, was heat stroke. He has called for Durkin and others to be fired, calling the behavior of the coach and other staff members “reprehensible.”

Since 2000, 31 N.C.A.A. football players have died during off-season or preseason workouts from heat stroke, cardiac issues, asthma and other factors, according to Scott Anderson, the head athletic trainer at the University of Oklahoma, who keeps a database of athletic fatalities.

Since Jan. 1, 2013, there have been eight known severe cases of heat stroke involving N.C.A.A. football players, with three deaths, Anderson said in an email message. He said he could find no similar “cluster” of deaths until decades earlier, in 1962-63.

Douglas Casa, the chief executive of the Korey Stringer Institute at the University of Connecticut, named for a Minnesota Vikings tackle who died of heat stroke in 2001, said heat stroke is readily treatable with “100 percent survivability.”

“Jordan would have survived if he was treated properly,” Casa said of McNair, the Maryland player.

The onset of heat stroke is almost always preventable, too, Casa said, criticizing what he described as “crazy, ridiculous workouts” that players are subjected to, particularly in the off-season when training sessions are not always vigorously monitored and athletes can be subjected to “needless jeopardy.”

The N.C.A.A. has been slow to adopt recommendations set forth in 2012 by sports medicine experts seeking to prevent sudden death in collegiate conditioning sessions, Casa said. “That’s where the greatest risk is because it’s the Wild Wild West,” he said. “There’s no oversight. You have a coming together of many unfortunate factors that cause these kind of catastrophic injuries.”

As Durkin awaits his fate as Maryland’s football coach, he still has his supporters. Will Muschamp, the South Carolina coach who previously promoted Durkin to defensive coordinator at Florida, told reporters, “I find it hard to believe some of the things that I read” in the ESPN article, and he criticized the use of anonymous sources.

Ben Muth, a former All-Pac-10 lineman at Stanford while Durkin coached there, wrote on Twitter, “I have a lot of respect for him as a person and a coach. I never doubted that he really cared about us as players and people, and wanted the best for us.”

In another tweet, Muth wrote, “I could go to any school in the country and find 3-12 kids to bitch about the culture/abuse. And another 2-20 people that just graduated, and another ex-staffer or 2. The only difference at Maryland is that a kid passed away. Durkin wasn’t even at that workout I imagine.”

Muth’s comment in support of Durkin might signal — correctly, if unintentionally — that football’s culture will persist unabated even after the tragedy at Maryland.

“This would seem to be a moment of necessary introspection for the sport,” David Andrews, a sports sociologist at Maryland, said in an email, “but as with the gun violence issue in this country more generally, my feeling is that Jordan McNair’s senseless death will be a brief point of discussion, largely forgotten by the general public once the football season/industry gets in full swing.”

Source: The New York Times

Experts say Maryland may not have acted quickly enough to save football player (The Washington Post)

Nearly 40 minutes after a 911 call was placed, Jordan McNair arrived at Washington Adventist Hospital in Takoma Park with a body temperature of 106 degrees, according to a hospital medical report. Once admitted, the 19-year-old Maryland football player was covered with ice and cold water, a cooling method known as cold-water immersion. It took 12 minutes for his body to cool to 102 degrees, which one medical expert called “a much, much safer temperature.”

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.

Maryland football player Jordan McNair, shown in this undated photograph, died in June after collapsing during a team workout. (Photo provided by McNair family attorney)

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.

Source: The Washington Post

Cold-water immersion is ‘magic elixir’ for heatstroke — and a question in treatment of Maryland’s Jordan McNair (The Baltimore Sun)

In the University of Maryland Medical Center hospital wing where he had lain five years earlier, battling for his life, Gavin Class leaned over the bed of Jordan McNair, grasped his hand and whispered to him.

“Be strong, Jordan,” Class recalled saying in his early-June visit. “Fight every day. Be positive.”

McNair, 19, an offensive lineman for the University of Maryland football team, had by then been hospitalized at Baltimore’s Maryland Shock Trauma Center for a week. After the former McDonogh star collapsed during a late-afternoon May 29 workout, he was taken to Washington Adventist Hospital and later Shock Trauma. McNair died June 13, about a week after Class’ visit, of heatstroke.

Maryland’s timeline of the day McNair collapsed offers only a general account of what happened from the time he began “having problems recovering” to when a 911 call was placed.

But medical experts said Monday that McNair’s health could have hinged on Maryland’s adherence to medical guidelines for treating heatstroke, including cold-water immersion — a practice which doctors said likely saved Class’ life after he was stricken during a Towson University football practice in 2013.

Attorney William H. “Billy” Murphy Jr. and associate Malcolm Ruff, who are considering filing a lawsuit on behalf of McNair’s family, say the firm has corroborating evidence that suggests McNair was showing signs of exertional heatstroke as he completed a series of sprints.

When McNair was taken from the workout in College Park to nearby Washington Adventist Hospital, Ruff told The Baltimore Sun on Monday, medical records indicate his body temperature was 106 degrees, a sign of heatstroke.

Douglas Casa, CEO of the University of Connecticut’s Korey Stringer Institute, a nonprofit dedicated to preventing sudden death in sports, outlined a best-practice approach for treating possible heatstroke. The two key diagnostic criteria, he said, are central nervous system dysfunction — signs include confusion, altered consciousness and seizures — and a rectal temperature of at least 105 degrees.

If those symptoms are present, Casa said, cold-water immersion should be used.

“It’s the magic elixir,” said Casa, who said he has treated over 285 heatstrokes and studied over 2,000 such cases. In cold-water immersion, he added, body temperature can fall about a degree Fahrenheit every three minutes. “That’s the thing that’s going to allow the person to survive.”

Dr. Raj Deu, an assistant professor of orthopedic surgery at the Johns Hopkins University School of Medicine, said that the more a body is exposed to cold water, the more effective the treatment.

University officials have not said whether McNair’s treatment included cold-water immersion. Asked about that, they referred a reporter to their official timeline, which does not mention it. Ruff said Sunday that there were no ice baths present at McNair’s workout.

The fallout from McNair’s death has thrown the Terps’ program into disarray, with coach DJ Durkin and three other staff members placed on administrative leave amid reports of an abusive coaching culture. The university is awaiting the results of an external review of the protocols and procedures relating to the death of the Randallstown native. Walters Inc., a sports medicine consulting firm, is expected to conclude its investigation by Sept. 15.

According to Maryland’s timeline, the team’s practice began at 4:15 p.m. Athletic director Damon Evans has said players did a “dynamic workout” of 15 to 20 minutes of stretching before turning to 10 repetitions of 110-yard sprints.

The timeline says athletic trainers “began supporting an active recovery and providing care” when they noticed McNair having problems, but the university account does not say what time that happened. Later, the university said, he was taken to the athletic training room on a Gator utility vehicle for “further observation and continued treatment.”

Shortly before 6 p.m., according to tapes obtained through a public-records request, a 911 call was placed in which an unidentified caller described McNair as having breathing problems. McNair arrived at Washington Adventist Hospital at 6:36 p.m., according to a Prince George’s County incident report. At the hospital, Ruff said, McNair’s body temperature dropped to 102 degrees within minutes of cold-water immersion by hospital staff.

Prolonged hyperthermia can cause “large-scale” damage, Casa said. A body temperature around 105.5 degrees is a “critical threshold” for cell damage, he said, but human bodies normally can handle about a half-hour above that temperature without long-term complications.

After that time, Casa said, cells denature. This disruption of their molecular structure “obviously causes things to happen that are not optimal,” he said. Vital organs like the kidney, liver and brain can be affected.

“I would say many would die if you go up to 60 minutes [of hyperthermia],” he said.

The doctors who treated Class five years ago have said the treatment he received, including cold-water immersion, was critical to his survival.

Class went to visit McNair in the hospital in June after McNair’s family reached out to him.

For Class, the traumas of the two strapping offensive linemen seemed unbearably similar. In August 2013, Class collapsed during a Towson practice and was rushed first to the University of Maryland St. Joseph Medical Center, then to Shock Trauma with kidney failure and a dying liver. His temperature peaked at 108 degrees, and he arrived at Shock Trauma in cardiac arrest. Twice, his parents were told to brace for the worst.

As he lay comatose, awaiting surgery for a liver transplant, his mother, Danielle Class, pleaded with her son: “Keep fighting. Keep fighting. You’re strong. Don’t give up!”

In June, Class echoed those words as he stood over the bed of McNair, whose family had asked Class to come.

“They were so grateful that I took time to come [to the hospital], though in my mind, there was no option,” said Class, 25, an assistant strength and conditioning coach at Johns Hopkins. “I was there to provide hope and to help any way that I could. We talked about our faiths and how God does this to people who can handle it and how it happens for a purpose.”

“My family and I prayed for Jordan every day,” Class said. When he learned McNair had died, “I was in shock; there’s no way this should happen.”

When Class collapsed at practice, Towson trainers immediately immersed his body, neck-high, in a 300-gallon Rubbermaid tub filled with cold water that they kept on the sideline, the athletic training staff said then. They kept him in the 50-degree water for seven to 10 minutes, while coaches and trainers stirred frantically by hand.

“That time in the ice bath absolutely saved me,” Class said Monday, the day after the five-year anniversary of his own heatstroke.

Source: The Baltimore Sun

Heatstroke dangers reinforced by investigation into death of college football player (USA Today)

Minnesota Vikings Pro Bowl tackle Korey Stringer’s death at practice in 2001 led to increased awareness and education on the dangers of heatstroke during summer football conditioning.

But it hasn’t come close to eliminating the threat, according to Rebecca Stearns, chief operating officer for Korey Stringer Foundation.

“We see an average of about three deaths per year from heatstroke across all levels,” Stearns told USA TODAY Sports. “But the last five years have been really telling because we have seen a gradual increase in the number of exertional heatstroke deaths.”

The issue is in the news again this weekend. Maryland put football coach DJ Durkin on leave Saturday, a day after putting other athletic department personnel on leave as an investigation continues into the death of a football player during offseason workouts earlier this summer.

Jordan McNair, a 19-year-old offensive lineman, died on May 29, two weeks after being hospitalized following an organized team workout. The cause of death was heatstroke, according to a foundation named after the player.

Late Friday, ESPN published a story in which players and former staffers talked atmosphere of “fear and humiliation” that included verbal abuse at Maryland under Durkin. Specifically cited as helping create that culture was strength and conditioning coach Rick Court.

According to the Mayo Clinic, heatstroke is caused by the body overheating, “usually as a result of prolonged exposure, or physical exertion, in high temperatures.”

The Mayo Clinic refers to it as “the most serious form of heat injury.”  It occurs if a body’s temperature rises to 104 degrees or higher. Untreated heatstroke can quickly damage a person’s brain, heart, kidneys and muscles.

Football players are vulnerable because they practice, often wearing helmets, in the August heat. Besides, McNair, defensive back Darius Minor of Maine also collapsed and died at a workout, and a state of Washington high school player also died. The high school player, according to Q13 Fox TV, was determined the King County medical examiner to be hypertrophic cardiomyopathy, an abnormal enlargement of the heart.

Football players certainly are not the only one affected. Oklahoma Fox affiliate KXII reported this week that members of the Atoka High School marching band suffered from severe dehydration and heatstroke after they took part in a practice. According to KXII, six members of the Atoka band were taken to a clinic and three were hospitalized.

According to Stearns, there were eight deaths from heatstroke across all levels of football from 2005 to 2009. From 2010 to 2014, there were 14.  Eight players have died since 2015.

Stearns said the encouraging news about heatstroke is that there’s strong data to support the belief that there “is 100 percent survival when it is treated aggressively and appropriately.”

“That is why (the death rate) is very concerning from our perspective,” Stearns said. “We have some cheap, effective interventions that can save lives and we are still seeing deaths.”

Stearns said most heatstroke cases arise during preseason conditioning, when proper medical personnel may not be readily available. “And, unfortunately a lot of policies are not in place to act aggressively enough and quickly enough to treat exertional heatstroke when it does happen,” she said.  “You need policies in place, so everyone is aware of what steps should be taken and you need a medical professional present who can identify the condition. Unfortunately, heatstroke can be confused with many other conditions.”

Stringer died of heatstroke during the Vikings’ 2001 training camp, and the Stringer Institute was created with the hope of preventing sudden deaths in sports.

No NFL players have died of heatstroke since Stringer’s death, but here are college players who have died:

2018: Jordan McNair, University of Maryland: A 19-year-old, 325-pound sophomore offensive lineman, McNair was observed struggling during a May 29 conditioning test at the school, which included multiple 110-yard sprints. He was hospitalized that night and died June 13. The Jordan McNair Foundation announced he died of heatstroke.

2017: Tyler Heintz, Kent State: A coroner confirmed Heintz, 19, a freshman 275-pound offensive lineman, died of heatstroke after completing his second day of conditioning drills at Dix Stadium

2014: Marquese Meadow, Morgan State: According to the Baltimore Sun, he became disoriented after an Aug. 10 practice, was hospitalized, slipped into a coma, and died two weeks later. Cause of death was listed as heatstroke. The high temperature on Aug. 10 was 86 degrees.

2008: Chad Wiley, North Carolina A&T: A fifth-year senior, Wiley complained of dizziness at a voluntary workout on campus. He lost consciousness when he was being treated in the trainer’s room. According to the United Press International, the autopsy showed Wiley died of heatstroke complications, resulting from a sickle cell trait.

2001: Eraste Autin, Florida: An incoming freshman, Autin, a 250-pound fullback was expected to compete for a starting job. But according to the Associated Press, he died of complications from heatstroke after collapsing while jogging back to the locker room after a voluntary conditioning session.

Source: USA Today