Following two recent deaths during physical fitness testing, officials at the Navy’s Great Lakes training base are withholding people with “specific medical traits” from intense exercise pending further review.
A Great Lakes spokesman, citing privacy concerns, wouldn’t name those traits, but an administrative memo issued by the Navy suggests the focus is on sickle cell trait, a genetic blood condition that can pose a lethal danger during vigorous workouts.
The memo, released earlier this month, singles out the trait as a risk factor requiring extra vigilance. It instructs people leading fitness exercises to familiarize themselves with the condition and ask recruits about it before training. It also urges African-American personnel, who are disproportionately affected by it, to “engage with medical (staff) to determine their status and understand the risk.”
It’s not clear whether any particular medical condition was a factor in the deaths of the recruits at the north suburban base. Both collapsed at the end of a 1.5-mile timed run during their final physical readiness test of boot camp, and died while receiving treatment.
Kierra Evans, 20, from Monroe, La., died Feb. 22. Kelsey Nobles, 18, from Mobile, Ala., died April 23. Lake County Coroner Dr. Howard Cooper said the investigations into their deaths have not been completed. Neither of their families could be reached for comment.
The Navy memo said two sailors who were not at Great Lakes also died during physical training over the last year.
Sickle cell disease causes blood cells to harden, grow sticky and morph into a “C” shape. The cells can clog blood vessels, robbing tissues of oxygen and causing severe pain and the risk of sudden death.
Sickle cell trait, by contrast, is a genetic characteristic. Most who have it don’t experience the symptoms of the disease, though they can surface during hard workouts.
The Navy memo said two sailors who were not at Great Lakes also died during physical training over the last year.
Sickle cell disease causes blood cells to harden, grow sticky and morph into a “C” shape. The cells can clog blood vessels, robbing tissues of oxygen and causing severe pain and the risk of sudden death.
Sickle cell trait, by contrast, is a genetic characteristic. Most who have it don’t experience the symptoms of the disease, though they can surface during hard workouts.
The trait’s prevalence in African-Americans is well known — roughly 1 in 12 have it — but Dr. Victor Gordeuk, director of the sickle cell center at the University of Illinois Hospital in Chicago, said people with roots in Italy, Greece, Saudi Arabia, and other areas around the Mediterranean can have it, too (the trait helps people withstand malaria, he said).
He said people with the trait can have their cells deform dangerously during periods of intense exercise. Why that happens isn’t fully understood, he said. It often comes in tandem with heat illness, but not always.
“Some of the patients just have sudden collapse, loss of consciousness, loss of strength in their extremities,” he said. “Sometimes they can have painful cramps. We don’t fully understand the mechanism whereby that’s occurring.
“In some cases, on postmortem, the brain looks normal, the blood vessels look normal, but they’ve had this coma develop while they’re exercising. To a certain extent it’s a medical mystery, but we do know that people with sickle cell trait are at increased risk for this happening.”
The military has long recognized those risks. Researchers as far back as the 1960s have documented sickle cell-related deaths that occurred during the rigorous workouts of basic training. One study in the 1980s found that black Army recruits who had the trait were about 40 times more likely to suffer sudden death than recruits who were not black.
The services take varying precautions for recruits with the trait, according to military health researchers. The Navy screens everyone entering boot camp, and requires those with the trait to wear a red belt during strenuous exercise. Other branches use different identifiers or don’t screen for sickle cell at all, focusing instead on mitigating heat-related risks.
The Navy memo highlights a condition known as “exertional collapse associated with sickle cell trait,” or ECAST, that can strike some recruits.
“An ECAST victim may have been a front runner, or off to a strong start, but will be noted somewhere before the collapse as slowing down, falling behind and struggling,” it says. “They begin to lose smooth coordination, they evolve into an awkward running posture and gait, with legs that may look wooden or wobbly.
“The victim may complain of progressive weakness, pain, cramping or shortness of breath. … The ECAST victim will initially be mentally clear, before the onset of confusion and loss of consciousness.”
The memo says Navy officers should adopt a liberal “bad day” policy that allows people struggling with the physical readiness test to stop and try again after a medical evaluation.
“No one should risk their life by pushing through life-threatening conditions during a (physical test),” it says.
Great Lakes spokesman Lt. Cmdr. Frederick Martin said boot camp already follows the guidelines laid out in the memo, but that changes could come as a result of the investigation into the recruits’ deaths.
Douglas Casa of the Korey Stringer Institute at the University of Connecticut, which aims to prevent sudden death in athletes, helped craft a statement about treating sickle cell emergencies for the National Athletic Trainers’ Association. He said people with the trait can endanger themselves during high stakes physical tests, such as the 1.5-mile run Navy recruits must conquer in a set time to graduate from boot camp (women in their late teens, for example, have to finish in less than 14:45).
“If someone’s really struggling, no one should be pushing or screaming at them to continue,” he said. “They should stop and be protected. We really have to ask if (the 1.5-mile run) is the best way to evaluate the fitness of someone with sickle cell trait.”
By: John Keilman
jkeilman@chicagotribune.com
Twitter @JohnKeilman
Source: https://www.chicagotribune.com/news/ct-met-great-lakes-death-exercise-20190521-story.html