Blog Post

Collapse and Confusion: The Death of a Juco Football Player (SI)

Nearly a year after Braeden Bradforth’s death following his first day of junior college practice, his family is still dealing with the loss of its “gentle giant.” Meanwhile, his mother has fought for answers about the day she lost a son, not knowing how hard that fight would be.

NEPTUNE, N.J — Braeden Bradforth called home on his first day at junior college in high spirits, gushing about meeting a fellow student who looked just like him, down to the dreadlocks. After his last-minute acceptance to play football at Garden City Community College (GCCC), Bradforth had begun the process of getting accustomed to life in western Kansas, making friends by playing video games in his dorm. The 6’4″, 300-pound defensive lineman was happy to hear that the care package his mother Joanne Atkins-Ingram was putting together back in New Jersey included Golden Oreos, gum and Oodles of Noodles.

On Aug. 1, as his third day on campus settled into a humid, 84° evening, Bradforth went to a conditioning test on GCCC’s first day of preseason practice. Players were expected to complete 36 sprints of 50 yards at speeds that varied by position group. To two coaches and one trainer looking on, nothing seemed off about how Bradforth completed the drill, but as players moved from the field to a team meeting, the freshman wandered off, hardly acknowledging a coach who called out to him. Less than an hour after practice ended, he was found lying barely conscious with his head against a brick wall in an alley near the dorms. A coach said Bradforth was moaning when he arrived at the scene, and he began to choke and vomit as he was moved to an ambulance. About two hours after practice had ended, Bradforth was pronounced dead at St. Catherine Hospital.

What happened from the start of that workout until the end of Bradforth’s life? His grieving mother thought it was a reasonable question, but it proved to be extremely difficult to answer as the days turned into months and a school halfway across the country that appeared to be a lifeline for his college football career instead became a source of conflicting stories and an obstacle to his family’s search for answers.

Head coach Jeff Sims initially told the media that Bradforth had likely died from a blood clotting disorder, but months later, an autopsy found the cause of death to be exertional heat stroke. As Atkins-Ingram dug deeper, players told her they had had no water breaks during that conditioning test, that Bradforth was struggling and that Sims taunted Bradforth during the workout that pushed him to heat stroke.

In December, a notice of claim was filed on her behalf that named coaches, the school, two juco football governing bodies and several other parties as possible defendants in a wrongful death lawsuit. The school conducted an internal review of the circumstances that led to Bradforth’s death but elected not to release its findings in full. Only on April 18, eight and a half months after Bradforth’s death, did the family receive a summary of the review—which Atkins-Ingram called “full of crap”—that provided a basic timeline of what happened but was silent on crucial controversial details. GCCC’s lawyer notified the family that no “formal report” laying out the entirety of the review’s findings was forthcoming.

In May, GCCC retained outside counsel for the purpose of conducting an independent, external investigation, with the help of Dr. Rod Walters, whose firm was hired last summer by the University of Maryland to conduct a similar safety review into the case of Jordan McNair after the second-year offensive lineman died in the hospital days after collapsing at a May 2018 workout. Walters’s team found that the Maryland training staff did not follow protocol in treating McNair’s symptoms, revelations that led to the resignation (under pressure from the school) of head strength and conditioning coach Rick Court, and the firing of Terps head coach D.J. Durkin.

Atkins-Ingram doesn’t understand why McNair’s death generated so much attention while her son’s did not. With the one-year anniversary of McNair’s death on June 13 and Braeden’s approaching fast, another summer season is upon thousands of football players, coaches, athletic programs and parents across the country. Atkins-Ingram wants to make sure no other parent has to endure the tremendous loss she suffered, or replicate the campaign she launched to get answers from a school that gave her few until nearly 10 months after her son’s death.

“What’s so disgusting is the fact that every bit of information that we have gotten, we’ve had to fight for it,” Atkins-Ingram says. “It just didn’t come naturally. Like, if there wasn’t a problem, it should just be able to roll off your tongue.”

According to the school’s internal review, present along with Sims at the practice were nine other football coaches, head athletic trainer TJ Horton, eight student helpers and three certified trainers. Horton reported in the summary that there were 60 gallons of water on site, and student helpers had water bottles in their carriers. Yet those resources seem to belie the conditions under which Bradforth and his teammates completed their workout.

Five players told SI there was barely a break between each sprint, even though the summary says they were allowed 30 seconds of rest. Six players said that players were not allowed to drink water until the end of the workout and that anyone who stopped running would need to redo the entire workout the next morning. A Garden City spokesperson said water was “readily available” for players during practice, and former defensive line coach Ben Bradley said water was available during the sprints, but since he was busy helping run the drill, he couldn’t confirm whether players were drinking. The coroner’s report, citing GCCC coaches and trainers, states that Bradforth “participated without issue in football practice and was behaving normally.”

After practice ended at approximately 9:05 p.m., safeties coach Caleb Young noticed Bradforth stumbling before regaining his balance as he was trying to speed up within the final group of players walking off the field. In an email sent to school administrators on Aug. 31, 2018 and obtained by the Associated Press through an open records request, Young said he told Bradforth, “Hey, you’re good. Let’s go,” to which Bradforth responded, “Yeah, I’m good. I’m good.” But instead of following the group to a team meeting, Bradforth broke away from the group, leading Young to ask him if he was quitting the team. “He did not respond with words, instead, he shook his head in what looked like to me disappointment and continued to walk away,” Young wrote.

Bradforth was found at around 9:45 p.m., after the team meeting broke up. The EMS report states one coach turned a hose on Bradforth to “see if they could get him to respond and he would not so that is when they contacted EMS.” According to the same report, when emergency personnel arrived, several coaches were around Bradforth, and he was wet and moaning. Young wrote to administrators that he ran to the area where Bradforth was when he was alerted a player was down, and that Bradforth was in “visible distress at this time however still breathing and making a stressful moan.” Instead of immediately calling 911, Young wrote that he called Sims in search of guidance, and the head coach directed him to call the trainer. Young adds that while he was on the phone, “a few of the players were assisting with filling their water jugs and bottles with water from the drinking fountains as we attempted to pour it over him and to get him to drink it.”

Horton had left campus and needed to be called back by the coaches. Horton returned to campus at 9:53 p.m. and was the one to call 911 at 10 p.m. (However, Young wrote in his letter to school officials that he was the one who called 911.) An ambulance reached Bradforth within 10 minutes and arrived back at the hospital at 10:33 p.m. after coaches helped move Bradforth to the ambulance from the alley. Young wrote that as EMTs put him on a stretcher to get to the ambulance, he noticed Bradforth “begin to choke; he then opened his eyes and threw up what looked like dirty motor oil.” Bradforth was pronounced dead at 11:06 p.m. GCCC did not answer follow-up questions about why it took 15 minutes for those who had found Bradforth to call 911, or why 911 was not immediately called if the lead trainer was away from campus.

Sims, who is now the head coach at Missouri Southern State University, told Sports Illustrated two days later that an emergency room doctor had told him a test was indicative of a blood clot that had broken free and caused a heart attack. Sims told SI it was “something that could have happened anytime or anywhere.”

Back on the East Coast, around 1 a.m., Atkins-Ingram got an incoherent, tearful phone call from her other son, Bryce Bradforth. She couldn’t understand what he was saying, so she called her husband Robert Ingram Jr., Braeden’s stepfather. Taking time to find the right words, Ingram Jr. called Atkins-Ingram back and told her that Braeden was gone. All she could do was let out a scream. After that, everything went black.

ince that day, Atkins-Ingram has fought to learn why the place that was entrusted with caring for her son failed to do so. Excluding a conversation with school president Ryan Ruda, campus police chief Rodney Dozier and interim athletic director Colin Lamb before the completion of her son’s autopsy, Atkins-Ingram says not one coach has reached out to her. After a few weeks, Atkins-Ingram recruited her longtime friend Jill Greene, a lawyer, to help her find out more about Bradforth’s death.

When Atkins-Ingram heard the results of the autopsy, she became frustrated with Sims’s private and public handling of Bradforth’s death as something that could have happened at any time. “That act-of-God business, God has him now,” she says. “But you kind of helped push him there.”

After months of getting nowhere with the school, Atkins-Ingram and Greene took a trip to Garden City in January. There, they spoke with players, trying to learn more about the practice and Bradforth’s final moments. What they discovered disturbed Atkins-Ingram.

In the internal summary, Sims and Horton said Bradforth didn’t complain or drop a knee to the ground during the test, and Bradley told SI he “dominated,” but six players told SI that Bradforth struggled while completing his sprints. Donte Morris, a former Garden City player serving as an unpaid assistant while he finished his classes, told SI that Bradforth seemed short of breath and was wheezing. Defensive lineman Olajuwon Lewis, who said he ran with Bradforth, recalled his white lips and dry mouth: “It was something you’re never going to forget.” Still, Bradforth kept running.

“You couldn’t drink water during running ’cause Sims said and a lot of other coaches said that water during workouts does nothing for you,” defensive back Kirby Grigsby told SI. “It’s how you hydrate before and after. That’s basically their motto about that kind of thing.” When asked about this interpretation of team policy, Bradley said coaches wouldn’t tell kids not to drink water. Morris told SI that although Sims preached the importance of hydration to his players, due to the pace of this particular conditioning drill players didn’t receive water unless they dropped out entirely. When reached for comment, Sims told SI he wasn’t allowed to speak on the matter and instead referred questions to lawyers.

Players also said Sims taunted Bradforth during the practice. According to Bradley, Sims had given Bradforth a loaner pair of shoes to use, and wide receiver CJ Anthony heard Sims yell that he wanted his shoes back, which Anthony took as a motivational tactic to make Bradforth run faster. Three players recalled Sims telling them he spoke with Braeden’s biological father Sean Bradforth, who does not live with Atkins-Ingram and was in and out of Braeden’s teenage life. One player remembers Sims mentioning that Sean Bradforth had told Sims that Braeden was a hard worker in practice. (Sean Bradforth confirmed to SI that he had recently called Sims.) One player said Sims “was up in Bradforth’s face” while running and that he was a “hard-nosed coach,” but that’s how he was with all of his players. Other players corroborated this, saying Sims cussed Bradforth out and screamed at him. Bradley denies this, saying Sims is a “good coach,” though he conceded Sims’s “competitiveness makes him out to be crazy because he’s willing to do whatever.” The school’s summary made no note of any comments made by Sims during practice.

What Bradforth did after walking away from his teammates after practice remains a mystery to his family. The summary of Garden City’s internal report and Young’s letter to his superiors offered no answers on those missing minutes.

Young, who did not return calls made to him for this story, appears to have been the first coach at the scene, according to the internal report summary and his letter to administrators. The few players present had trouble remembering who else was there because it was only the first day of conditioning. Among those present, there appears to have been confusion about how best to immediately help Bradforth. Bradley said he got there after someone had already poured water on Bradforth, and he wasn’t sure what was going on: “I didn’t know he was overheated. I thought he was passed out.” Morris said a trainer poured water on Bradforth. Grigsby said he was asked if he had any water when he arrived, then poured some on Bradforth because he thought he might have been dehydrated. Grigsby says he left after Young assured him that Bradforth would be O.K.

Soon the ambulance came, and Bradley rode with Bradforth to the hospital. In their timelines, school and medical records don’t make any note of Bradforth’s rectal temperature having been taken, a measure the National Athletic Trainers’ Association lists prominently in its instructions for assessing exertional heat stroke.

In New Jersey, on the second floor of Atkins-Ingram’s home, past a hole in the wall that Braeden tripped and crashed into as a teenager, sits a clean bedroom that would be messy if he were still alive. Only Atkins-Ingram and her husband go in now. Duke, the family dog who used to sleep on Braeden’s bed, will only go as far as the door’s threshold. The bedroom has become a shrine of sorts, featuring all of his life’s most important moments. On the bed is a blanket covered in photos, including a close-up of Braeden that Atkins-Ingram strokes daily, as if she were still touching her son’s face. There are stuffed animals, jerseys, letters and an old luggage tag carefully arranged. There are also the towels, sized to fit Bradforth’s hulking frame, that were sent with him as he left for GCCC. Under the TV where Bradforth used to play Xbox sits an inconspicuous white box containing his remains. Atkins-Ingram and her husband take turns opening a blue mason jar to reveal some of Bradforth’s dreadlocks, which they say still smell like him.

Since Bradforth’s death, Atkins-Ingram has seen her life altered in so many ways. On a table in their living room sit the books God Help Me I’m Grieving and Grief is a Journey. The family hasn’t been able to watch a football game, and she’s worried about Bryce, who has avoided talking about his brother’s death. Atkins-Ingram wakes up thinking it was all a dream—then she realizes Braeden is gone, and the nightmare begins again.

“I carry such guilt with me every day just knowing that I ultimately signed off on my son to go to school to follow his dream,” Atkins-Ingram said in February. “My mind knows yes, I did the right thing, but my heart, every single day I just can’t get over the fact that he’s really not here, and it was because he was deprived of the simplest thing: water.”

When the family finally received the autopsy, Greene shared it with Dr. Randy Eichner, a heat stroke expert who has been consulting with the family. After examining documents and seeing news reports on the practice, Eichner called the drill “reckless” and noted that Bradforth had just arrived in Garden City and had experienced a jump in altitude of 2,800 feet from the East Coast to western Kansas, into slightly less oxygen-rich air than he was accustomed to.

“It looks to me very bad judgment on the part of coach Jeff Sims because it’s a clear-cut heat stroke death,” Eichner says. “It’s a tragedy, but it’s a preventable tragedy. Fatal heat stroke should never occur in college football.”

Dr. Douglas J. Casa, who is the CEO of the Korey Stringer Institute at the University of Connecticut, echoed Eichner’s statement. According to Casa, patients whose temperature gets under 104° through cold water immersion within 30 minutes have survived in all known previous cases. From 2000 to ’09, there were 30 heat stroke deaths in high school and college sports. Casa estimates there have been around 35 deaths in the decade since, with one more summer season to go. While those numbers include athletes from all sports, football and cross-country account for about 90% of the fatalities.

Based on the school’s handling of the situation since the notice of claim was filed in early December, Greene said GCCC is giving them no choice with their next move. “It feels as though they want litigation,” Greene said. “To me, that really makes no sense.” She has partnered up with Kansas City lawyer Chris Dove, and Dove said they haven’t made a decision yet in terms of litigation following GCCC’s decision to launch an external review.

Atkins-Ingram said she spoke with someone at the Garden City Police Department in the fall who said that the department wouldn’t be conducting an investigation. Grisell, whose law firm also represents the city of Garden City and thus the GCPD, told SI he didn’t know “that there was any indication that there was any criminal conduct involved in the matter.” He also referred SI to the notice of claim that was filed against the city and the police department. The GCPD released a statement saying it does not comment on cases pending civil litigation.

But Atkins-Ingram has made headway through her representatives. On March 22, U.S. Congressman Chris Smith sent a letter to Ruda requesting an independent investigation after he met with Atkins-Ingram. Grisell wrote back on March 27 that the “college is satisfied with the review that was undertaken.” Ruda told Smith he would meet with Atkins-Ingram, but Grisell indicated details of the internal review would not be discussed at the meeting, and the meeting was subsequently postponed. All 12 members of the U.S. House of Representatives from New Jersey called for an independent investigation on April 30.

Finally, the school released its internal review summary—to the family on April 18 and then to the media on May 2. Atkins-Ingram said she was excited to read the school’s report, but she soon realized its limits. “Whoever wrote this, they just threw it together and they tried to piece together a summary of what I think they have read in all the different articles ’cause that’s what it looks like to me,” she says. When Greene followed up asking for more information on the internal review, Grisell wrote back that he had directed all work be done for him “in advance of, and preparation for litigation.” Grisell described how Lamb, the school’s interim AD who had not yet been elevated to the role on the day of Bradforth’s death and was replaced by a full-time AD in late May, was “primarily responsible for compiling information” regarding the events and that witness interviews and statements, medical records and athletic practices were collected and reviewed. Lamb prepared a basic outline and presented it to Grisell, which the lawyer then prepared into the summary. Grisell called the summary an “accurate representation of what occurred and what the college knows regarding the matter involving Braeden.”

In addition to describing the events of the day of Bradforth’s death, the summary also touts several improvements the school has made since the review’s completion. GCCC has hired an additional athletic trainer and strength and conditioning coach, and CPR and first aid training will now be required for all coaches. The school will also follow up with players for welfare checks and will develop a policy specifically for recognizing and treating heat-related illnesses to build off of standing protocol for “having the necessary water, equipment and training staff at each practice.” The school also plans to increase campus police personnel and develop an athletic training handbook, but there is no timetable for those changes yet.

“They immediately listed all these changes that they put in place, but at the same time you said you did nothing wrong, but therefore you also needed all these changes,” Atkins-Ingram says. “Why is that?”

Dr. Kathleen Bachynski, a postdoctoral fellow in the Department of Medicine at NYU Langone Health, read about the release of Garden City’s findings and questioned the logic of adding another trainer and coach when the summary stated there were already 10 coaches and four certified trainers on site. “To me, the fundamental question doesn’t seem to be the quantity of personnel that were there but the actual level of oversight and safety that they provided and whether safety was actually prioritized,” she says.

The move that Atkins-Ingram and Greene had been waiting for finally came on May 14, when the school authorized an external review of Bradforth’s death. Atkins-Ingram said she was “overwhelmed” by the news. GCCC said in a statement that while the “internal review served its intended purpose” at the beginning of the process, the authorization of an external review is the “most logical sequential step in the process.” The statement also said, “The GCCC Board and Administration are aware of the misconception that the college is unwilling to give answers to the family or has interfered with information about the events that transpired on the day of Braeden’s death. An external investigation may be able to provide the answers that are still sought by Braeden’s family and others, and it may also serve to confirm the findings of the GCCC internal review.”

Congressman Smith said in a statement that he hopes the announcement “will prove to be a very important step towards true transparency,” and said they are “cautiously optimistic” the decision will “finally reveal what happened during Bradforth’s last day and what can be done to prevent others from suffering the same fate.”

As Atkins-Ingram has fought to learn what happened to Bradforth, she has passed along updates to the family’s advocates and supporters. In April, her “village” gathered for a community meeting about Bradforth at a church in Asbury Park.

Atkins-Ingram called herself an “accidental activist” as she nervously prepared for people to arrive. She greeted supporters with hugs while family members placed T-shirts featuring her son’s face in some pews. A slideshow with photos looped, while someone made sure it wasn’t sacrilegious to hang a #Justice4Braeden banner on the pulpit. As the night went on, Congressman Smith and other guests delivered case updates and spoke on heat stroke as more people filed in. Atkins-Ingram watched with her husband’s arm around her.

As sunlight faded through the stained glass windows, Atkins-Ingram rose to speak last. Thanking everyone for their support, she started to choke up as she talked about Braeden, lifting her glasses in an effort to fight the tears. From across the room, Ingram Jr. whispered, “You all right.” Atkins-Ingram carried on, every so often pausing to compose herself with only the sounds of ceiling fans and the occasional restless child breaking the silence.

It’s clear that moment in April won’t be the last time Atkins-Ingram speaks out, and she’s determined to make others aware of heat stroke with plans to start a foundation once she retires in June. The release of the internal summary in early May came at a difficult time for her: This year, Bradforth’s birthday and Mother’s Day fell two days apart. She went to Miami that weekend to avoid any painful reminders at home, but on the flight back, she sat behind a man with a similar build to her son, who even had the same dreads as him. She says she spent the entire flight leaning up toward him, smelling his hair like she still does from time to time with Braeden’s. She remembered the first flight they took together, not long before Braeden left for Garden City, and she spent the rest of her trip home playing a tortuous game of what-if: Would Braeden have had kids? Would he have played in the NFL? What would his life have been?

“It’s a good day,” Atkins-Ingram said in mid-May, as the wheels were put in motion for an external review—but even good days will never be the same.

“Even now, I’m about to cry,” she said. “I’m feeling so good, but it’s just still so sad cause at the end of the day none of this is going to bring Braeden back.”


By: Charlotte Carroll

Sports Illustrated

Soccer and Extreme Heat: US-France World Cup Match (GMA)

Soccer and Extreme Heat: a Potentially Dangerous Mix for US-France World Cup Match

Good Morning America, ABC News

The U.S. Women’s National Team faces France on Friday night in Paris in probably the most-anticipated match so far in the FIFA Women’s World Cup.

The energy on the pitch and in the stands is expected to be electric despite a scorching heatwave in Europe this week. Temperatures are expected to top 100 degrees Fahrenheit during the day and may still be hovering around 90 when the match kicks off at 9 p.m. local time.

The dangers of heat-related illnesses, like heat cramps, heat exhaustion and heatstroke, are real and potentially life threatening, but they are preventable.

“We’ve put a lot of time and effort into sourcing the world’s experts, the leaders in all kinds of conditions of performance,” James Bunce, director of High Performance for USA Soccer, said in an interview with ABC News. “Specifically, in this environment, we’re obviously making sure that we can cool them quick enough.”

Providing cool drinks that replace electrolytes and salts sweated out during playing is important, Bunce added. So it giving cooling towels to players and having them take cold baths after matches.

The Centers for Disease Control and Prevention considers athletes a vulnerable group when playing in hot weather, and heatstroke, the most severe form of heat illness, is a leading cause of death on the field among young athletes.

Heatstroke happens when the body overheats to over 104 degrees Fahrenheit. Early symptoms include dizziness, fatigue and dry mouth. Those can progress into confusion, a racing heart rate and vomiting. If untreated, heatstroke can damage vital organs including the kidneys and heart.

Dr. Clifford Stark, medical director of Sports Medicine at Chelsea in New York City, and not affiliated with USA Soccer, told ABC News that “drinking water constantly is key. Once you’re behind on hydration, it’s hard to catch up. The body can only absorb about a one liter of water per hour.”

“We prompt our players to drink regularly and often,” Bunce said. “If you feel thirsty, it’s too late. Dehydration has snuck in.”

For elite athletes like those on the USWNT, their fluid intakes are monitored and customized, and “each player is getting a different drink filled with different fluids, different electrolytes,” Bunce added.

Heatstroke is a medical emergency.

Treatments focus on cooling the body to prevent further damage. Experts at the University of Connecticut’s Korey Stringer Institute — named in honor of an NFL player who died from heatstroke during training camp — emphasize the importance of initiating cooling in affected athletes while they’re still on the field awaiting emergency personnel.

“When you have a heatstroke it’s very important to cool the core by using ice packs under the armpits and in the groin,” Stark said.

The CDC also recommends sponging with cool water and spraying with a garden hose but warns against giving the ill person fluids because of possible electrolyte imbalances.

Even coaches and fans can be at risk for heat-induced illnesses, depending on conditions.

“The players will be fine, the weather in the evening will be nicer,” Bunce added. “It’s the fans I’m concerned about — the ones who are out in the sun all day, drinking all day, in the heat of the day.”

Steering clear of alcohol and caffeinated substances is important to maintain hydration, as is staying covered up and reapplying sunscreen to prevent sunburn, which can also cause dehydration.

Detecting signs and symptoms of heat-related illnesses early can save lives, Stark said.

“If you catch it in time,” Stark added, “there’s a high probability that you’re going to survive.”

As the USWNT heads into the quarterfinals, Bunce feels confident in the team’s plan for coping with the heatwave.

“We have 23 world class pros who have completely dedicated their lives to doing what’s right to perform at the highest level,” he said. “We have plans in place.”

Vanessa Cutler, MD is a resident physician in Psychiatry at Rush University Medical Center working with the ABC News Medical Unit.

ABC News’ Henderson Hewes contributed to this report.

What It Feels Like to Die From Heat Stroke (Outside Magazine)

What It Feels Like to Die From Heat Stroke

By:Amy Ragsdale and Peter Stark 

End of the dirt road. You brake to a stop, swing your leg over the scooter, and kick the stand into place.

The effort makes your head throb. The scooter wobbles. Your sunglasses slide down the mixture of sweat and sunscreen on your nose. You adjust them, look up tentatively at the fiery orb in the deep blue sky, and flinch. You chide yourself for staying out so late the night before, for not getting an earlier start this morning. The sun already feels too hot. But this is your only chance to surf Emerald Cove. It’s gonna be OK, you tell yourself. You’re in good shape. You’ve got the stamina to hike the five miles over the ridge and down to the beach before the tide comes in.

That glaring sun, of course, is essential for life on this planet. But its thermal energy, which we feel as heat, is a force both benevolent and cruel. The human body employs a spectrum of physiological tricks to maintain the steady internal temperature—98.6 Fahrenheit—at which it thrives. There is about eight degrees of difference between an optimal level of internal heat and the limit the body can endure. This threshold is referred to as the critical thermal maximum. Exactly when one reaches it depends on individual physiology, exertion, hydration, acclimation, and other factors. Estimates place it at an internal temperature between 105 and 107 degrees. Heat is a giver of life, but when the human body gets this hot—or hotter—­terrible things occur.

Emerald Cove is on an island off the coast of South America. You’d flown over a couple of days ago, after a trek in the mainland’s cool interior highlands. You wanted to take in those thousand-year-old stone statues you’d heard so much about, plus you figured you could cap off your vacation with a couple days of surfing. You’re just a beginner, and already you’re hooked, but it’s hard being a newbie. The locals are reluctant to let you into the lineup. What you need is that perfect undiscovered break, no people, no pressure.

Last night you walked into a popular surf bar and pulled up a stool next to two guys you’d seen in the water that day. If you wanted to find a secret spot along this spectacular wave-battered coast, you figured these guys would be the ones to know. They gave you a cursory nod and continued their conversation.

“Huevón,” one was saying to his pal (or at least that’s what you think he said). Your Spanish is OK, but you’re not catching all the slang. He was talking about a point break.

“Qué bacán!” Rad! “And there’s nobody there. Nobody. You have to try it.”

“Nobody where?” you asked quietly, leaning in.

“La Cala Esmeralda.” He barely turned his head to look at you.

“Emerald Cove?” you repeated.

It had taken a long time, a lot of patience, and too many piscolaspisco and Cokes—to pry out where it was, but the effort was worth it. It’d be the perfect end to a perfect trip, something to talk about to your well-traveled friends back home. “Seriously, you’ve never been there?” you’ll say to them, acting surprised. “You should definitely check it out. But it’s kinda hard to get to, and the trail’s a secret.”

You had to ask the surfers to repeat themselves, just to be sure you understood. They’d finally turned and looked at you full on.

“Dude,” one said, “I’m not sure I’d try it if I were you.”

Heat-related illnesses in the U.S. claim more lives annually than hurricanes, lightning, earthquakes, tornadoes, and floods; there were over 9,000 heat-related deaths between 1979 and 2014. The fatalities tend to peak during heat waves and hotter-than-average years, and they’re expected to rise as climate change affects global temperatures. One of the deadliest heat waves in modern times swept Europe in 2003, killing over 30,000 people as temperatures soared to 100 degrees for days on end.

The human body is much less tolerant of rises in internal temperature than drops. The lowest body temperature a human has been known to survive is 56.7 degrees, nearly 42 degrees below normal. Anna Bagenholm, a 29-year-old Swedish woman, was backcountry skiing when she broke through eight inches of ice into a frozen stream. Her upper body was sucked down, leaving only her feet and skis visible, but she managed to find an air pocket and was able to breathe. After 80 minutes, she was finally rescued. Bagenholm remained in a coma for about ten days and was in intensive care for two months but ultimately suffered only minor nerve damage. On the other end of the spectrum, the highest body temperature measured was only 17 degrees above normal. Willie Jones, a 52-year-old Atlanta man, was rescued from his apartment during a heat wave in 1980. His internal temperature was 115.7. He spent 24 days in the hospital before being released.

While there is some debate, studies on women in the military have shown that they may be more susceptible to heat illness than men due to their higher body-fat content and lower sweat output. Whether the heatstroke victim is male or female, the odds of surviving depend on the duration of overheating and, once their condition is discovered, how quickly they can be cooled down—most effectively by immersion in ice water within 30 minutes. Survival, moreover, doesn’t guarantee full recovery. A powerful heat wave in Chicago in 1995 caused 739 deaths and 3,300 emergency-room visits. A study reviewing 58 of the severe heatstroke victims found that 21 percent died in the hospital soon after admission, 28 percent died within a year, and all the remaining subjects experienced organ dysfunction and neurological impairments.

An average-size male at rest generates about as much heat as a 100-watt light bulb simply through metabolism. During moderate exercise, temperature increases nearly ten degrees every hour unless you cool yourself by sweating or some other means. You risk a variety of illnesses, starting with heat edema, which entails swelling of the hands and feet and can begin at body temperatures close to normal. No precise temperature marks the onset of the various other heat illnesses, and the order of symptoms varies between individuals, but they may include heat syncope (dizziness and fainting from the dilation of blood vessels), heat cramps (muscular clenching due to low salt), and heat exhaustion (identified by muscular weakness, rapid heartbeat, nausea, headache, and possible vomiting and diarrhea). Finally, an internal temperature of 105 marks the lower boundary of heatstroke territory, with outward symptoms of extreme irritability, delirium, and convulsion. Because of individual variation in how these symptoms appear, and because some may not appear at all, athletes in particular can be overcome quickly and with little warning.

There are two kinds of heatstroke: classic and exertional. Classic heatstroke hits the very young, the elderly, the overweight, and people suffering from chronic conditions like uncontrolled diabetes, hypertension, and cardiovascular disease. Alcohol and certain medications (diuretics, tricyclic antidepressants, antipsychotics, and some cold and allergy remedies) can increase susceptibility as well. Classic heatstroke can strike in the quiet of upper-floor apartments with no air-conditioning.

Exertional heatstroke, on the other hand, pounces on the young and fit. Exercise drastically accelerates temperature rise. Marathon runners, cyclists, and other athletes sometimes push into what used to be known as the fever of exercise and is now called exercise-induced hyperthermia, where internal temperatures typically hit 100 to 104 degrees. Usually, there’s no lasting damage. But as body temperature climbs higher, the physiological response becomes more dramatic and the complications more profound. The higher temperature can ultimately trigger a cascading disaster of events as the metabolism, like a runaway nuclear reactor, races so fast and so hot that the body can’t cool itself down. A person careens toward organ failure, brain damage, and death.

It’s February, the height of summer in the Southern Hemisphere. You’d planned to get up early but didn’t hear your alarm after the late night at the bar. Now the sun is well into its arc. The temperature is supposed to hit 93 degrees by midday.

Pulling the keys from your scooter, you sling your rented surfboard onto your back, thread your arms through your chest pack, and hear the reassuring slosh of the water bottle inside. You have a seat on the twice-weekly plane that leaves tomorrow, returning you to the mainland. If you’re going to do this, the moment is now. You launch up the trail, a faint unmarked path on the gentle, grassy slope. You’re not surprised you’re the only one around. The surfers said to follow the volcano’s right flank until you gain the ridge, then drop down a cleft in the rocks to the sea. Good luck finding the cleft, they seemed to say. Maybe they were just trying to deter you. You see the slope steepen as it rises toward the sharp crest, where chunks of volcanic rock protrude like broken dinosaur scales through velvety green nap. No trees, not a wisp of wind. Ancient cultures deforested this island centuries ago and mysteriously disappeared, leaving not a sliver of shade under the tropical sun.

You feel the quick flex of your quads, the push of your glutes, the spring of your calves propelling you up the winding path, and hear the steady mantra of your breathing. You have to make time. The guys at the bar said the shore bristles with stone dientes, teeth—get there at low tide. That gives you just under two hours.

Within only a few steps, your body begins to respond to the sun’s radiation, the moist air pressing against your skin, and the heat generated by your own rising metabolism. Blood coursing through your arteries begins to grow warmer. At less than one degree Fahrenheit above your normal internal temperature, receptors in your brain’s hypothalamus start to fire, signaling the circulatory system to shunt more blood toward your skin’s surface for cooling. Other messages tell peripheral blood vessels to dilate, opening up to allow greater blood flow. Still other signals activate millions of tiny coils and tubes embedded in your skin—your sweat glands. Concentrated within your head, palms, soles, and trunk, the glands pump water from a tiny reservoir at the base, pushing the salty liquid up a long tube through layers of skin to erupt in a miniature gusher at the surface.

Several hundred yards up the grassy slope, sweat is popping onto your face. You feel the slick, dark blue fabric of your shirt sticking to your back, despite its breathability. You wish it was looser, and a lighter color that didn’t so readily absorb the sun’s rays. A trickle of sweat runs down your forehead and into one eye, stinging with dissolved salts, blurring your vision.

The air is smothering, thick with moisture, like a greenhouse. The dripping sweat should bring some relief. Usually, the body’s cooling system operates remarkably efficiently; blood rushes to carry the excess heat from your core out to your sweat glands, which squeeze warm fluids to the surface, where air moving past your skin evaporates the moisture. Your excess heat literally blows away in the wind. But for this to work properly, the sweat must evaporate. When the air lies close and unmoving, heavy with humidity, sweat evaporates more slowly. If the air is saturated enough, or if impermeable fabric—or, in your case, a surfboard and a chest pack—trap the sweat against your skin, the moisture won’t evaporate at all.

High school athletes are often afflicted by heatstroke, which ranks as one of the top three leading causes of death among that demographic. And according to an investigation done by the HBO show Real Sports with Bryant Gumbel, since the year 2000, at least 30 college football players have died of heatstroke during practice, when remedies as simple as immersing the overheated player in ice water were available. Minnesota Vikings offensive lineman Korey Stringer died of heatstroke during a preseason practice in 2001, and now the University of Connecticut’s Korey Stringer Institute, established in 2010, specializes in sudden-death prevention in athletes, soldiers, and laborers.

Runners, cyclists, and hikers routinely succumb to heatstroke. If properly acclimated, trained, and managed carefully, the human body can endure grueling events in high temperatures, like the Badwater—a 135-mile running race in California that begins in Death Valley, traverses three mountain ranges, and ends at Mount Whitney—and the six-day Marathon des Sables in the Sahara. However, experts say that due to the high intensity of the pace on shorter courses, heatstroke is more common in races of 30 to 90 minutes than in longer events. Three years ago at the annual Falmouth Road Race, a 12K running event in Massachusetts in August, 48 out of more than 10,000 finishers suffered from heatstroke and another 55 from heat exhaustion. (All of them survived without incident due to the extensive cooling procedures available at the race’s finish.)

The National Weather Service now issues warnings when excessive temperatures are expected and gives predictions of the heat index, which takes into account both temperature and humidity as experienced by a five-foot-seven, 147-pound person walking at a speed of about three miles per hour in a six-mile-per-hour breeze. Like the windchill index, the heat index conveys what it feels like outside. For instance, at the Hot Trot Half Marathon, which is held in Dallas in August, the day is often 97 degrees but can have a heat index of 116 degrees because of the 60 percent humidity.

You pull your water bottle from your pack—a full liter shimmering inside a translucent blue Nalgene—take a warm swig, and strike upward again toward the broken scales of the ridge. For the next hour you push at a fast walk, pausing only occasionally to drink. You know the importance of hydration. What you don’t know is how remarkably fast the human body can expel water to cool itself—one and a half liters or more per hour. (Highly efficient, heat-acclimated marathoners can lose close to four liters per hour while they run.) The human gut, however, can absorb only a little over one liter of water per hour. That means that during maximum rates of water loss, it’s possible to drink steadily and still become dehydrated.

Your core temperature has now climbed to 101.5—three degrees above normal—but you’re still in the exercise-induced hyperthermia zone. Your head throbs. You wish you hadn’t drunk quite so many piscolas last night. In doing so, you unwittingly tricked your body’s water controls. Alcohol is a small molecule that slides easily through the walls of the gut, into the bloodstream, and up into the brain, where it suppresses the release of antidiuretic hormone, or ADH. This is the hormone that inhibits urination, in effect closing your dam’s spillway in order to keep your reservoir full. Typically, when you become dehydrated, the percentage of salt in your blood rises, triggering your pituitary gland to release ADH. But under the sabotaging influence of alcohol, your body may sense that your water stores are being depleted but blithely ignore the warning. Thanks to those piscolas, rather than prehydrating for today’s climb, you started the day in the red.

The incline grows steeper. The grass gives way to a light, loose volcanic rock called tuff. The scrappy path has now completely disappeared, but still you labor toward the ridgetop—two steps up, slide, one step down. You’re panting now. The rocks crunch under your feet. Each footstep produces a gritty dust that crusts your bare legs, which are coated in a paste of sweat and sunscreen. The arteries protruding on your forearms look like grapevines wrapped around a post. Your blood vessels are dilating, trying to move as much overheated blood to the surface as possible. Your heart pumps madly, trying to keep the vessels full, but it can’t keep up. Not enough blood—and the oxygen it carries—reaches your brain. You pause to rest. You feel lightheaded and faint. Your vision dims and narrows. You feel wobbly and strange—the onset of heat syncope (or orthostatic hypotension), a temporary loss of consciousness from falling blood pressure.

Fainting from orthostatic hypotension poses a distinct problem for those whose sworn duty requires standing still for hours in the sun, as it does for Britain’s royal guards. In their bearskin hats and thickly layered uniforms, which are designed to hide sweat, they topple with surprising regularity flat onto their faces, breaking teeth and smashing noses, fainting at full attention with their arms and rifles still rigidly glued to their sides.

But you decide to sit on the rocks, and so you do not topple. You finish your water. You feel limp, like a wrung-out rag. You have a single thought: make it to the ridge and descend to the cool of Emerald Cove. Thirty minutes to go.

At one hundred three degrees internally, you’re pushing into the upper limits of exercise-induced hyperthermia and into heat exhaustion. Your brain is no longer able to deal with large numbers.

One hundred four. Get over the ridge, you tell yourself. Get over the ridge.

Above you the jagged lava rocks begin to distort, reshaping into those ancient giant stone statues erected along the island’s shore. They face you, their enormous heads silhouetted against the blue sky, as if to say, Go back!

But you don’t.

Over millennia, people exerting themselves in hot environments, like the nomadic Maasai of Kenya, have genetically adapted, selecting for tall, slender, long-limbed body types that offer the maximum ratio of cooling surface area to heat-generating body mass. You are not Maasai.

When you finally crest the ridge, your core temperature is pushing 105. You are weak, hot, and thirsty, and you are confused but don’t know it. Gazing back down the way you came, you see the dropping sweep of green. It seems surreal, removed and stylized, like an old hand-painted postcard. Just ahead, the cliff’s edge drops away to crashing ocean far below.

The guy at the bar had said that the top of the trail was marked by a divot where the rock is worn like a V. You walk carefully along the broken ridgetop, afraid to peek over the airy drop. Where’s the guardrail? Your body feels unwieldy.

Maybe it was a mistake to come here straight from the interior highlands, with their evening breezes and cool air. You’d heard that the human body needs time to fully adjust to heat. What you didn’t know is that it generally needs about 7 to 14 days. By gradually building your exercise time outdoors in heat and humidity, your body learns to activate its cooling response at lower temperatures. It learns to increase the rate of sweat production and to trigger a mechanism to conserve sodium, which, along with potassium, is essential for fluid regulation and transmission of nerve signals. (The evolution of this mechanism was honed by our hunter-gatherer ancestors, who struggled to consume enough sodium in their diets.) Acclimation would have slowed your heartbeat but boosted the volume of blood circulated with each contraction to help maintain your blood pressure as your vessels dilated.

But you didn’t acclimate. You relied on the fact that you exercise five days a week at home—also a hot, humid place in the summer. Your heat-addled mind drifts back to those summer days. Instead of this blazing light, you see the tinted windows of your SUV. Instead of this heat smothering your skin, you remember the hair-tingling chill of your car’s air-conditioning, the dim, dank spaces of a parking garage, the cold blasts washing over the treadmill in the climate-controlled gym. It begins to dawn on you that all your life you have relied on artificial sources to keep you cool. You’ve never had to change your behavior or alter your ambitious schedule to accommodate the natural diurnal cycle. You’ve always carried your bubble with you. You’ve never had to truly confront the punishing heat of the midday sun.

And then: you’ve found it! You see a scuffed notch on the ridgetop and, far below, the glint of water. This is why you came! Delirious, you begin to scramble down. You slip, skid on your side, dragging and scraping your hands. You regain your feet and steady yourself against smooth boulders, leaving a bloody handprint. The blood stain looks like a bird, you think, in acrylic paint, textured and thick—another effect of dehydration. Suddenly you notice that a bird (does it have four wings or six?) is swooping toward you, its talons reaching for your face. You try to swat the heat-induced hallucination away, first with your hands, then with your board, but it keeps coming back. You toss aside your board and stumble downward to get out of range.

You come to a ledge. Beyond it is pure drop and yes, there’s the beach, several hundred feet below. You just need to fly, you think foggily, but sense that you have no choice but to climb back up. Your chest pack feels impossibly heavy, as if you’re hauling the 13-ton head of one of those ancient statues. Irritated, you shimmy clumsily out of the straps and watch, mesmerized, as your pack tumbles over the edge and drops into the ocean.

Free at last, you begin to crawl back up. But you feel yourself sliding down the loose tuff. It’s so much easier than climbing. You give into the sensation of increasing speed, like a plane accelerating down a runway. You always loved that. You spread your wings and topple backward down the slope. As your head hits the tuff, you feel the coarse lava grit stick to the drying saliva of your lips and mouth. The ledge stops your descent. And then you feel no more.

It could be a small measure of good fortune that confusion, semiconsciousness, or coma overcome victims as they succumb to severe heatstroke. The damage about to ensue wreaks so much havoc that almost no major organ escapes untouched. At 105, your metabolism accelerates, so your cells generate heat at a rate that is 50 percent faster than normal. In other words, as your internal temperature rises, rather than cranking your air conditioner, you fire up your furnace. The only effective remedy is to douse the fires with immediate and extensive cooling.

Each heatstroke victim responds differently to these extreme internal temperatures, but a sequence of events might go like this: at 105 to 106 degrees, your limbs and core are convulsed by seizures. From 107 to 109, you begin vomiting and your sphincter releases. At 110 to 111, your cells begin to break down. Proteins distort. Liver cells die; the tiny tubes in your kidneys are grilled. The large Purkinje neurons in your cerebellum vanish. Your muscle tissues disintegrate. The sheaths of your blood vessels begin to leak, causing hemorrhaging throughout your body, including your lungs and heart. There is now blood in your vomit. You develop holes in your intestines, and toxins from your digestive tract enter your bloodstream. In a last-ditch effort, your circulatory system responds to all the damage by clotting your blood, thinking your vessels have been severed. This triggers what physicians call a clotting cascade.

As your insides melt and disintegrate, purple hemorrhagic spots appear on your skin. Those, the bloody vomit, and your convulsions are the only external hints of total internal annihilation.

“Is that a person down there?” the surfer from the bar asks his friend, skidding to a halt in their quick descent through the rocks.

Following the line of a pointing finger, the friend peers at a dark splotch on a ledge far below and a bit to the left, off the winding path and down through the steep rocks.

“Looks like that dude from the bar last night,” he continues.

They continue scrambling down toward the cove, their wide-brimmed hats flapping, surfboards strapped to their backs. As they get closer, they see it is you. They drop their boards and clamber across the rocky slope. When they reach you, you look dead—limbs askew, eyes staring. One of them touches your bare arm. The skin is clammy. He feels for a pulse. It’s faint and quick, like the heartbeat of a bird.

“He’s still alive,” he says. “But he’s way too hot,” he adds, shaking his head. “Let’s get him to the agua dulce.”

Lifting you carefully, they drape you over the stouter surfer’s back and shoulders. You’re several pounds lighter than your normal weight due to dehydration. They scramble down the precipitous path, kicking free tuff that bounces ahead. Ignoring the shimmering water and the sculpted waves curling off the point, they haul you across the beach to a grove of palms against the foot of a cliff. A spring spills from a crevice in the rocks into a clear, quiet pool. Agua dulce. Sweet water.

It’s much cooler than the tepid ocean—­almost cold. They slide your body in and hold you there, immersed, cradling your head above the surface. Two minutes pass, five minutes, ten.

“Está muerto,” says the stouter one.

“No,” says the other, carefully scooping handfuls of cooling water over your head.

Your eyes show a flicker of movement.

You hear splashing, faint at first, from somewhere far away. It comes closer, growing louder, until you realize that it’s right around your ears. You feel the sensation of cold all over your body. When you open your eyes, you can’t make sense of what you see—two faces framed by drooping palm fronds and deep blue sky.

“Descansa,” one says. Rest.

You close your eyes again. A hand brings water to your lips. You drink. You are lucky. With an internal temperature of 106, you peaked within your critical thermal maximum. It’s not yet clear what lasting damage you may have sustained, but you are alive.

Right now, however, all you know is that you’re so very tired. You’ll have to be carried out of here, by stretcher or helicopter or boat. Your thirst feels like a cavernous hollow at your core. You don’t know where you are or where you have been. You remember leaving the scooter and starting up a long grassy slope toward a volcanic ridge. After that there was only the relentless weight of the sun overhead, the heat-blasted lava rock underfoot, and the sense that you were being crushed between them with nowhere to run or hide, a fragile creature of flesh and bone, blood and water, trying to escape the enormity of this force that gives life but, you now understand, can so easily destroy it.



How to Prevent and Treat Heat Stroke (Outside Magazine)

How to Prevent and Treat Heat Stroke

Outside Magazine

By: Peter Stark

“The key thing for people’s outcome is the number of minutes their temperature is over 105 degrees,” says Douglas Casa, CEO of the University of Connecticut’s Korey Stringer Institute, named after the Minnesota Vikings offensive lineman who died of heatstroke during an August 2001 training camp. Survival is highly likely if the core temperature is brought below 104 degrees within 30 minutes. Here are Casa’s tips on prevention and treatment.

  1. Avoid exercising in high temperatures, or choose cooler parts of the day and stay in the shade. If you do exercise in the heat, wear pale-colored, loose-fitting, lightweight clothing, and acclimate to the conditions by gradually increasing your output over 7 to 14 days.
  2. How much water to drink is the subject of some debate. For recreational athletes, Casa suggests hydrating based on thirst. High-level endurance athletes should account for other factors, such as sweat rate. Avoid drinking alcohol before and during strenuous outings.
  3. Heatstroke symptoms vary. Many victims are still conscious, and some have seizures or vomit while others do not. Suspect heatstroke if the person can no longer support their body weight, speaks irrationally, or is hyper-irritable or confused. (Casa knows of heatstroke victims who punched a police officer at the finish line of a race.) To get a true reading of core temperature, use a rectal thermometer.
  4. “Cool first, transport second” is the oper­able concept when it comes to heatstroke. With mere minutes to act, a victim should be cooled down before being taken to an emergency room. Immersing the body in a cold bath lowers temperature the fastest, dropping it one degree every three minutes if the water is circulating.
  5. Exertional heatstroke in the backcountry presents additional challenges. Anything that cools the victim is helpful, but the best options are to immerse them in a lake, river, or stream, or wrap them in fabric drenched with ice water from a cooler. It’s important to cool as much of the body’s surface area as possible. In the absence of cold water, seek shade, wet the person’s clothing with your water bottle, and fan them. (For heatstroke prevention tips aimed specifically at desert hikers, go to Ariel’s Checklist.)



After 2 boot camp deaths at Great Lakes base, Navy urges vigilance for recruits with sickle cell trait (Chicago Tribune)

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

Twitter @JohnKeilman


National Winter Sports Traumatic Brain Injury (TBI) Awareness Month

Brad Endres, MS, ATC, CSCS

Assistant Director of Sport Safety, Korey Stringer Institute

The new year is upon us, and with the changing of the calendar comes the increased participation in our beloved winter sports. Fittingly, January is National Winter Sports Traumatic Brain Injury (TBI) Awareness Month, so before you dust off the skates or head up the ski-lift, here is a breakdown of what you need to know to stay safe out on the slopes or in the rink.

What is a traumatic brain injury (TBI)?

The types of traumatic brain injuries include sport-related concussion (SRC), diffuse brain injury, second impact syndrome, subdural hematoma, and epidural hematoma.  Although cerebral concussions rarely cause death, they can be the starting point for other deadly brain injuries.


How often does TBI occur?

Between 1.6 million-3.8 million TBIs are seen in sports each year in the United States. Athletes under the age of 15 represent the majority of TBIs. Also, in every age group males show a higher rate of TBIs than females.


What is a sport-related concussion?

According to the 5th International Conference on Concussion in Sport held in Berlin, October 2016, a SRC is defined as a TBI induced by biomechanical forces. Several common features that may be utilized in clinically defining the nature of a concussive head injury include:

  • SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
  • SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.
  • SRC may result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
  • SRC results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.


What are the signs and symptoms of a SRC?

The suspected diagnosis of SRC can include one or more of the following:

  1. Mechanism of Injury (eg, direct blow to the head)
  2. Physical signs (eg, loss of consciousness, memory loss, neurological deficit)
  3. Balance impairment (eg, unsteady gait)
  4. Behavioral changes (eg, irritability)
  5. Cognitive impairment (eg, slowed reaction times)
  6. Sleep/wake disturbance (eg, sleepiness, drowsiness)
  7. Signs and Symptoms including the following:
Signs Symptoms
  • Disorientation, confusion
  • Retrograde/anterograde amnesia
  • Loss of consciousness
  • Automatism
  • Unequal pupil size
  • Combativeness
  • Slowness to answer questions
  • Loss of balance
  • Atypical behavior/personality changes
  • Vacant stare
  • Nystagmus
  • Headache
  • Nausea
  • Balance issues/dizziness
  • Tinnitus (ringing in the ears)
  • Diplopia (double vision)
  • Blurred vision
  • Trouble sleeping
  • Trouble concentrating
  • Memory issues
  • Irritability, sadness,
  • Sensitivity to light or noise


What to do if a TBI / SRC is suspected?

Any person suspected of a SRC should be removed from the mountain or event area immediately and evaluated by a licensed healthcare professional who is trained in the evaluation and management of concussions. The injured person suspected of a SRC should not return to activity on the same day as injury. Finally, continued monitoring of an athlete evaluated of having a SRC is necessary in order to observe any deterioration of physical or mental status (which warrants transport to local healthcare facility).


How do you treat an individual with a TBI / SRC?

After being evaluated by a health professional, treatment and management of a TBI/SRC includes:

  • Physical and Cognitive Rest: Physical and Cognitive activities that result in an increase in symptoms should be avoided during the acute phase of concussion treatment
  • Medications that mask the symptoms of a concussion (NSAIDS, Aspirin, stimulants, and antidepressant) should be avoided, especially in the acute phase of the injury.
  • The use of acetaminophen (Tylenol) may be considered in treating symptoms such as headache but should be used after the acute phase of the injury
  • Athletes sustaining a concussion should have a follow-up appointment with their general practitioner to evaluate the mechanism of injury, the course of symptoms, and any previous history of concussive injuries.
  • Return-to-play following a concussion should follow a graded return-to-play protocol. This protocol should consist of 5-7 stages and take 5-7 days to complete (if there is no recurrence of symptoms). The graded return to play protocol should begin once the athlete has a cessation of symptoms for at least 24 hours. An athlete must be prohibited from returning to activity if they are still experiencing symptoms.
  • The goal of the return to play protocol is to progressively increase the duration and intensity of exercise to ensure that there is no return of symptoms with physical exertion. See the table below to see an example of a 6-stage return-to-play protocol.
Rehabilitation Stage Functional Exercise at each Stage of Rehabilitation
1.  No activity Complete physical and cognitive rest
2.  Light aerobic exercise Walking, swimming, or stationary cycling keeping intensity <70%
No resistance training
3.  Sport specific exercise Skating skills in ice hockey, slide board for skiing, general agility drills
No head impact activity
4.  Non-contact training drills Progression to more complex training drills (eg: passing drills in ice hockey, bunny slopes for skiing/snowboarding)
May begin progressive resistance training
5.  Full-contact practice Participate in normal training activities
6.  Return to play Normal game play or event competition


How do I prevent a TBI / SRC?

Based on the most updated consensus statement created by a committee of sports medicine professionals at the 5th International Conference on Concussion in Sport, the following steps were recommended for TBI prevention:

  • Protective Equipment: There is sufficient evidence in terms of reduction of overall head injury in skiing/snowboarding to support strong recommendations and policy to mandate helmet use in skiing/snowboarding. The evidence for mouthguard use in preventing SRC is mixed, but suggests a positive trend towards a protective effect in collision sports (such as hockey).
  • Rule Change/Risk Compensation: The strongest and most consistent evidence evaluating policy is related to body checking in youth ice hockey (ie, disallowing body checking under age 13), which demonstrates a consistent protective effect in reducing the risk of SRC.
  • Aggression/Violence: Appropriate competition and the aggressive nature of some sports is not discouraged, however unnecessary violence or other aspects should be evaluated based on the merit they provide in the sport.
  • Education: The ability to detect and deal with a TBI is enhanced when everyone on the slope or ice is looking out for the safety of the athletes.  Education should include the athletes themselves, coaches, administrators, and parents.  It should cover basic tools for recognition, what to do if they suspect a concussion, and the process of treatment and returning to participation.

What are the risk factors for SRC?

  • Previous concussions: A previous history of a concussion increases the risk of sustaining another concussion on the order of 2-5.8 times greater risk
  • Number, severity and duration of symptoms: Evidence has shown that those who report a greater number of symptoms, or report a greater severity of symptoms or duration, may experience a longer recovery than those who experience less severe symptoms.
  • Sex: Research has shown that females experience a higher incidence of concussion in addition to reporting a increased number/severity/duration of symptoms, and prolonged recovery.
  • Age: Young athletes may experience a prolonged recovery from a concussion and may be due to the differences in the developing brain of a child/adolescent compared to that of an adult brain
  • Sport, position, and style of play: Depending on the sport, position, and the athlete’s style of play increases the risk of concussion. In sports where there is player-to-player contact, the risk of concussion increases. The table below outlines the incidence the risk of concussion for various sport.
  • Mood Disorders: Mood disorders such as depression, anxiety, and irritability may complicate both the diagnosis and management of a concussion
  • Learning disabilities and attention disorders: Learning disabilities such as ADD/ADHD or others that result in some form of cognitive dysfunction can complicate the management of a concussion and may lead to a longer recovery time post-concussion

So bundle up, have fun, and most importantly stay safe this Winter! For further information, check out the TBI page at the Korey Stringer Institute’s website at The 5th International Conference on Concussion in Sport publication can be found at

KSI Summer 2018 Conferences









2018 ACSM National Conference

Yasuki Sekiguchi, MS, CSCS, Associate Director of Athlete Performance and Safety

The American College of Sports Medicine (ACSM) Annual Meeting was held in Minneapolis from May 29 – June 2. Most of the KSI staff attended this outstanding conference and they were honored with the opportunities to present their research. We had great discussions with other attendees and received feedback for future work via these presentations.

  • Douglas J. Casa, PhD, ATC, FACSM- Alcohol and hydration
  • Ryan M. Curtis, MS, ATC, CSCS- The effects of sleep duration on sleep quality in elite soccer athletes
  • Courteney L. Benjamin, MS, CSCS- Sleeping patterns of NCAA D1 collegiate athletes: A sex comparison
  • Gabrielle EW. Giersch, MS- Validity and reliability of a short-based integrated GPS sensor
  • Gabe also did an excellent job as a moderator of the hydration thematic poster session with Dr. Cheuvront
  • Rachel K. Katch, MS, ATC- Effects of wrist cooling on balance and cognitive performance in the heat
  • Yasuki Sekiguchi, MS, CSCS- Factors influencing hydration status during a NCAA Division 1 soccer preseason
  • William M. Adams, PhD, ATC- Hormonal, steroidal and inflammatory responses in collegiate male soccer players and female cross-country runners
  • Yuri Hosokawa, PhD, ATC- Comparison of rectal temperature responses during a modified heat tolerance test

Attending this conference allows the KSI staff to obtain further knowledge, skills and new ideas as well as make new relationships with other professionals. This conference certainly helps to develop KSI and execute our goals to maximize performance, optimize safety and prevent sudden death for the athlete, soldier and laborer. The KSI staff members are thankful to all of the presenters and attendees for their contributions to this field as well as helping make this conference one where individuals who are passionate about similar topics can meet, collaborate, and enjoy one another.





2018 NATA Clinical Symposia

Alicia Pike, MS, ATC, Director of Education

View of the Mississippi River near the Convention Center

During the last week of June, a majority of the KSI staff traveled to the “Big Easy” for the 69thannual National Athletic Trainers’ Association Clinical Symposia. New Orleans may have been ready for us, but we sure weren’t ready to face the very hot and humid days. Despite the sweltering weather, this year’s conference was filled with presentations and meetings that not only showcased the numerous projects KSI is actively engaged in, but also served as a platform to continue our mission of optimizing safety and preventing sudden death in sport.


The week kicked off with our Medical & Science Advisory Board Meeting at one of Dr. Casa’s favorite restaurants – Bubba Gump Shrimp Co. We were very thankful to have so many familiar faces in the room, and even saw a little competitiveness come out in a friendly game of Bubba Gump Trivia. Following dinner and a lot of laughs, Dr. Casa spoke to the Board regarding the recent accomplishments of KSI, especially three primary initiatives that have been the focus over the last couple years: (1) the ‘Raise Your Rank Campaign’, a state-specific approach aimed at improving mandated best practices policies to reduce catastrophic injuries in sport, (2) the Athletic Training Locations and Services (ATLAS) database, which has now officially mapped the extent of athletic trainer services provided to every public and private secondary schoolacross the United States, and (3) the Perceptions of Athletic Training study, which is currently assessing perceptions of the profession from athletic directors, principals, superintendents, legislators, coaches, and parents in order to develop educational strategies to further raise awareness of the value of the athletic training profession.

The remaining days of the conference flew by, as they always do, with various presentations by our staff members. The following presentations showcased the work of KSI at this year’s conference:

  • Rebecca Stearns & Alicia Pike- Legislators Perceptions of the Athletic Training Profession
  • Samantha Scarneo- Implementation of Emergency Action Plan Policies in Secondary School Athletics Without Previous Athletic Training Services
  • Brad Endres- Epidemiology of Sudden Death in Adult Organized Recreational Sport in the United States, 2007-2016
  • Robert Huggins:- Athletic Trainer Services in the Secondary School Setting: The ATLAS Project
  • Rebecca Stearns- Heat Tolerance Test Results from Exertional Heat Stroke Patients Receiving Cold Water Immersion Treatment
  • Sarah Attanasio- Athletic Trainer Education Level and Employment Models: The ATLAS Project

In addition to the presentations, our staff enjoyed manning the KSI booth at the NATA Expo. We love when people stop by; even if it’s to tell us a personal story, talk to us about one of our presentations they attended, or reach out to us as a resource for whatever circumstance they may be encountering in their current clinical position or state. Every year we have more attendees stop by and share with us how they’ve heard about KSI or thank us for the work we do to improve health and safety for student-athletes. It really is the biggest motivation to continue our mission day after day.

The 2018 conference was a unique one for KSI, since we also held two separate events to raise awareness and support initiatives we are currently engaged in. The first was a ‘launch event’ for the Comprehensive Safety Initiative (CSI), a collaborative effort between KSI, University of Connecticut, University of North Carolina at Chapel Hill, and Player’s Health, to help secondary school athletic trainers identify areas for improvement related to health and safety best practice adoption. A comprehensive library of resources will be accessible on the Player’s Health platform by the end of 2018. All secondary school athletic trainers are encouraged to complete the Safety Needs Assessment located at:

The second event was held for all athletic trainers currently employed at high schools who were recipients of the NFL Athletic Trainer Pilot Grant, an initiative aimed at providing secondary schools with resources to start or enhance their athletic training programs. June 2018 marked the end of year one of the pilot grant program, so we invited the athletic trainers currently employed at these schools to attend the meeting, provide them with more detailed information related to the grant program, but more importantly, debrief about their first year and offer as much support to them as possible. The meeting was a success, and not only gave us the chance to meet the athletic trainers in person, but also served as a platform to receive valuable feedback to improve the program in the next two pilot years.

Now the conference really can’t be all work and no play…when in New Orleans, do as the New Orleaners do! We were very fortunate to have our own personal tour of the city from a KSI benefactor, massive supporter, and close friend of Dr. Casa’s, Scott Chafin. Scott, along with colleagues from his law firm, brought us around NOLA for four hours of unforgettable fun. From the Garden District, to an amazing seafood dinner, followed by authentic Italian dessert, and of course, some trolley karaoke, it was a night we are forever thankful for and will never forget.



It was a very busy, yet rewarding week, and the perfect opportunity to share the work of KSI with athletic trainers across the country. Perhaps my favorite quote of all time is “Alone we can do so little; together we can do so much,” and this year’s conference truly made me realize how muchwe’ve done and how muchwe will continue to do.






2018 Hydration for Health Conference 

Gabrielle Giersch, MS, Associate Director of Research


I had the great opportunity to attend the 10th Annual Hydration for Health Conference in Evian, France. I was able to present research from a study done in collaboration with Dr. Lawrence Armstrong and Dr. Elaine Lee that investigated the role of fluid restriction on perceived sleep duration and quality. This research was presented as a part of the “Pitch Your Science” contest for the Young Researcher Award that consisted of a consolidated 3-minute presentation in a specific session of the conference. This conference is unique in that it unites several disciplines all with specific interest in hydration for health outcomes. This conference provides a great opportunity for a variety of disciplines to discuss with international colleagues on the role of hydration on overall health.







2018 NSCA National Conference

Courteney Benjamin, MS, CSCS, Director of Education & Associate Director of Athlete Performance and Safety

The 2018 NSCA National Conference was held in the beautiful city of Indianapolis, Indiana- home to the NCAA and ACSM headquarters. Members of KSI had the great opportunity to present some of our research during this July conference.

  • Yasuki Sekiguchi- Relationships between resting heart rate, heart rate variability, and sleep characteristics among female collegiate cross-country athletes
  • Ryan Curtis- Sleep Distribution and heart rate-derived autonomic nervous system responses to acute training load changes in collegiate soccer players
  • Courteney Benjamin- Effects of Early Morning Training on Sleep in NCAA Division 1 Female Cross-Country Runners

I was also awarded the opportunity to give a featured presentation titled, “What S&C coaches need to know to prevent sudden death in sports.” During this talk, I reviewed the 2012 best practices document related to collegiate strength and conditioning as well as discussed how this profession can continue to advance by ensuring the safety of athletes.

This talk could not have come at a better time as the NSCA president, Dr. Greg Hoff would announce exciting changes surrounding requirements for obtaining a CSCS certification at the opening ceremonies. According to an article released by the NSCA on July 12th, 2018 the certification process will change as follows.

There will be two principal changes to the certification process:

  1. Effective target date 2030, all CSCS exam candidates must hold a Bachelor’s degree in a strength and conditioning related field, or be enrolled as a senior in such a program.
  2. Effective target date 2030, candidates will need to obtain those degrees from a college or university that has a program accredited by an NSCA-approved accrediting agency.

This conference was a great opportunity to meet other professionals in this field as well as establish relationships for future collaborations. We look forward to attending this conference again next year!


Loudoun County Public Schools Approves EHS Protocol

Paul A. Peterson MA, LAT, ATC

Athletic Trainer, Woodgrove High School

(May 17, 2018 Virginia)-  We are proud to announce that Loudoun County Public Schools has approved an exertional heat stroke (EHS) protocol that includes the use of rectal thermometry.  We hope this decision will encourage other secondary school districts in the state of Virginia and throughout the United States, who are having difficulties convincing their administrators the vital importance of rectal thermometry, to continue their pursuit.

In the past, our school district administration was adamantly opposed to approving rectal thermometry.  They denied our athletic trainers, on numerous requests, permission to purchase and use rectal thermistors.  Ironically, this past fall, one of our student-athlete cross-country runners suffered EHS during a championship meet.  The athletic trainers and EMS volunteers immediately assessed the student-athlete’s internal body temperature at 107.7°F via rectal thermometry, placed him in an ice water immersion tub and didn’t transport him to the ER until his internal body temperature dropped to 102°F.  Fortunately, the student-athlete was released from the ER later that night with no organ damage and made a full recovery.

By following best practice guidelines in the treatment of EHS, the athletic trainers and EMS volunteers, almost certainly prevented a catastrophic outcome.  This incident, once again, brought the need for our school district administration to approve the use of rectal thermometry in the treatment of EHS to the forefront.  After an eight-month process to help educate the administration on the vital importance of rectal thermometry, we finally received consent and this policy is now officially part of our EHS protocol.

This policy implementation would not have been possible without the support of several individuals. First and foremost, we had the support of our Athletics Supervisor. Second, we received support and the go ahead from our Health Services’ Supervisors and Director.  Third, we received support and further go ahead from our Risk Management Supervisor.  Then finally, we received approval from our School Administration Director to include our EHS protocol in the LCPS policies and procedures section of the student-athlete handbook.

The key to our success was a team effort approach.  With help and support from many individuals most notably, the LCPS athletic trainers, the orthopedic physicians and staff from The National Sports Medicine Institute (NSMI), the researchers at the Korey Stringer Institute (KSI), Dr. Kevin Miller at Central Michigan University, and Darryl Conway at The University of Michigan, we were finally able to convince our administration to allow the medical professionals in the school system to make the medical decisions and act within published best practices.

With patience and perseverance, the LCPS athletic trainers were able to accomplish the goal of getting an appropriate EHS protocol approved to ensure the future health and safety of LCPS student-athletes who may suffer from EHS.

Korey Stringer Institute Announces 2018 Lifesaving Awards

KSI Perfomance/Safety Logo(May 14th, 2018) — The Korey Stringer Institute (KSI) is proud to honor three individuals for theiroutstanding contributions to preventing sudden death in sport through the KSI’s 2018 lifesaving awards.The awards were presented at NFL headquarters in New York City, NY during the KSI’s annualfundraising gala on May 10, 2018.

Located at the University of Connecticut, the Korey Stringer Institute is a national research and advocacy organization dedicated to maximizing performance, optimizing safety, and preventing sudden death among athletes, warfighters, and laborers.

The 2018 award recipients are:

KSI Lifesaving Research Award

This award recognizes exceptional dedication and work in research aimed to advance knowledge regarding the prevention of sudden death in sport.

Scott Anderson, ATC

Head Athletic Trainer University of Oklahoma

The head athletic trainer for the University of Oklahoma since 1996, Scott Anderson is currently president of the College Athletic Trainers’ Society and the Big 12 Conference representative to the NCAA Concussion Safety Committee. He is former co-director of the Summit on Safety in College Football (2014, 2016). His prior service includes

membership on the NCAA Concussion Task Force (2014) and the Inter-Association Task Force on Safety in Football: Off-Season Conditioning (2012). He was co-chair of the National Athletic Trainers’Association Inter-Association Task Force on Sickle Cell Trait in Athletes (2007) and a member of the Inter-Association Task Force on Exertional Heat Illness (2003). He served as chair of the Big 12 Conference Medical Aspects of Sport Committee from 1999 to 2002.

Recognitions: College/University – Athletic Trainer of the Year 2006; All-American Football Foundation, Inc – Outstanding Athletic Trainer 2005; and 2000-01 Big 12 Conference Athletic Training Staff of the Year, and Oklahoma Athletic Trainers Association Hall of Fame.

KSI Lifesaving Service Award

This award recognizes exceptional service aimed to improve policies and advocate for the adoption of policies in order to reduce sudden death in sport.

Larry Cooper, MS, LAT, ATC

Teacher & Athletic Trainer Penn-Trafford High School

Larry Cooper has been a tireless advocate for secondary school athletic trainers.

He has been involved locally, regionally, and nationally on various committees, projects, and several inter-association task forces. Recently, he served as the NATA Secondary School Athletic Trainers Committee (SSATC) Chair and also the District 2 SSATC Representative. Cooper has been a teacher and certified athletic trainer for 35 years. For the last 27 years, he has served as a sports medicine, health, and physical education instructor at Penn-Trafford High School in Harrison City, Pennsylvania. Cooper has also served as a member of the National Federation of State High School Associations (NFHS) Sports Medicine Advisory Committee. In addition, he has held numerous positions within the Pennsylvania Athletic Trainers Society (PATS) including being a member of the Board of Directors and Secondary School Committee Chair. Cooper is a founding member of the Western Pennsylvania Interscholastic Athletic Leagues (WPIAL) Sports Medicine Advisory Committee. He continues to work as a master assessor for the Pennsylvania Interscholastic Athletic Association’s (PIAA) Wrestling Weight Loss rule. Cooper has been an active member in the KSI’s ATLAS Projectsince its inception. This collaborative effort between the NATA and KSI has led to new policies and policy changes that have increased secondary school athlete safety across the country.

Cooper was inducted into the Pennsylvania Athletic Trainer Hall of Fame in 2014. He received the NATA Athletic Trainer Service Award in 2014 and the NATA Most Distinguished Athletic Trainer Award in 2016. In addition, he received the School Health/ Training and Conditioning Magazine Most Valuable Athletic Trainer Award in 2015; The Micro Bio-Medics Scholastic Athletic Trainer Award in 2003; the PATS Service Award in 2005; and the PATS Distinguished Merit Award in 2011.

His favorite role has been that as loving husband to Lisa and father to their three daughters, Sara, Molly, and Delaney.

KSI Lifesaving Education Award

This award recognizes exceptional work to advance knowledge and education in the realm of preventing sudden death in sport.

Cindy Chang, MD

Professor, Primary Care Sports Medicine University of California San Francisco

Dr. Cindy Chang is a primary care sports medicine physician specializing in the prevention, diagnosis, and treatment of injuries and illnesses related to exercise and sports participation in children and adults.

She serves as chair of the California Interscholastic Federation’s SportsMedicine Advisory Committee, and also served on the Sports Medicine Advisory Committee for the National Federation of State High School Associations (NFHS). She is a board member of Racing Hearts, a non-profit organization that increases awareness of and improves access to automated external defibrillators (AEDs) in communities. After co-founding the California Concussion Coalition, Dr. Chang is now co-chair of the Sports Concussion Program at UCSF Benioff Children’s Hospital. She was an elected four-year member of the Board of Directors for the American Medical Society for Sports Medicine (AMSSM), one the largest organizations of primary care sports medicine physicians in the world, and later served as its President in 2011-2012. She is also a fellow of the American College of Sports Medicine (ACSM) and is currently an elected member of its Board of Trustees.

Dr. Chang has worked at the U.S. Olympic Training Center in Colorado Springs and was part of the USA medical team for the Winter Paralympic Games in Nagano, Japan, in 1998 and in Salt Lake City in 2002. She served as Chief Medical Officer for the USA delegation at the 2007 Parapan American Games in Rio de Janeiro, the 2008 Summer Paralympic Games in Beijing, and the 2012 Olympic Games in London.

She was the 2003 recipient of the AMSSM Founders Award, given to a sports medicine physician who demonstrates outstanding professional achievement and service to the community. She was also selected to receive the 2013 Dr. Ernst Jokl Sports Medicine Award, given annually to an individual for his/her contributions to the growth and development of sport medicine through practice and/or scholarly activity. In 2016, Dr. Chang was honored with the National Athletic Trainers’Association Jack Weakley Award of Distinction, for a lifetime of outstanding contributions that directly impact health care in the area of athletics, athletic training, or sports medicine and are of major and lasting importance.

Dr. Chang is currently a Clinical Professor at the University of California San Francisco in the Departments of Orthopaedics and Family & Community Medicine. She continues at Cal as a team physician and sports medicine consultant, and volunteers as the team physician at Berkeley High School. She is very invested in supporting her athletic trainer colleagues and advocating for their licensure inCalifornia. Chang is medical director of Emergency Education Services at UCSF Benioff Children’sHospital, and has become credentialed to train others including athletic trainers to become certified instructors in First Aid and CPR/AED. She frequently speaks to community groups, schools, club teams, and the media on a wide range of topics affecting the health and safety of our young athletes.


New Jersey Champions Sports Safety Campaign

KSI Logo

New Jersey Leads National Effort to Adopt 

Lifesaving Measures for High School Athletes


“Raise Your Rank” campaign encourages all states to adopt important safety guidelines

NEW JERSEY– Many states across the country are not fully implementing important safety guidelines intended to protect student athletes from potentially life-threatening conditions. Research has shown that nearly 90 percent of all sudden death in sports is caused by four conditions: sudden cardiac arrest, traumatic head injury, exertional heat stroke, and exertional sickling. Adopting evidence-based safety measures significantly reduces these risks. With more than 7.8 million high school students participating in sanctioned sports each year, it is vital that individual states begin taking proper steps to ensure their high school athletes are protected. The call for action came this past fall when the University of Connecticut’s Korey Stringer Institute (KSI), a national sports safety research and advocacy organization, released a comprehensive state-by-state assessment of high school sports health and safety policies. New Jersey currently ranks 4thnationally in terms of meeting all of the recommended safety guidelines with a score of 67%.



In response to the findings, New Jersey officials are collaborating with the KSI in addressing existing gaps in state policy to improve high school athlete safety. New Jersey is the first state to join the KSI’s national “Raise Your Rank” campaign, which started in 2018. The campaign aims to raise funds to support meetings with state representatives in order to improve mandated best practice policies and increase implementation of those policies.


“With support and guidance from the experts at the Korey Stringer Institute, the New Jersey State Interscholastic Athletic Association and Senator Patrick Diegnan (D-Middlesex) will convene this week to begin taking the necessary steps to improve the health and safety of our secondary school athletes,” says David Csillan (Ewing HS Athletic Trainer and NJSIAA Sports Medicine Advisory Committee). “Our goal is to be the first state to be 100% compliant with the recommended safety guidelines.”


This is not the first time New Jersey has led the way in improving the health and safety of high school athletes.  New Jersey was the first state to implement heat acclimatization policies for high school athletes in 2011. Acclimatization policies require teams to allow athletes to adjust to hot conditions in late summer by phasing in practices, participating without heavy equipment, and requiring frequent breaks to allow athletes to recover and stay hydrated. Since 2011, six states have implemented similar heat acclimatization policies with positive results; there have been no reports of exertional heat stroke deaths in states where acclimatization policies are in place and properly followed.


“A hallmark of my tenure of as a legislator, working collaboratively with the Athletic Trainers’ Society of New Jersey, is to make New Jersey high school sports safer for our children by creating researched-based state policies to address preventable sudden deaths,” says Sen. Diegnan. “My hope is that through this conscientiousness partnership, we will shine a light on the great measures this state legislature has taken to restrict cardiac arrest, exertional heat stroke, and head injury deaths in our student athletes and to develop further needed changes to ensure all athletes enjoy their high school sports experiences — and live to tell about them.”


KSI CEO Douglas Casa has been leading KSI since its inception in 2010 and has made athlete safety a focused effort of the institute. “We know that implementation of these important health and safety policies has dramatically reduced sport-related fatalities,” says Casa. “We are excited that New Jersey is taking action to continue to improve its policies and become a leader in minimizing sport-related high school deaths.”


For more information about the Raise Your Rank campaign, including how to apply for KSI support and how to donate to the cause, please visit




Media Contacts

Douglas Casa, Korey Stringer Institute, UConn                      David Csillan, NJ Sports Medicine Advisory Committee                                                           

(860) 486-0265 (office)                                                                         (609) 651-3053 (cell)