Hardly a week has passed since the beginning of the 2015 high school football season without the tragic news that a young player has died.
Six have died already this fall. Tyrell Cameron broke his neck on a punt return. Roddrick Williams collapsed at practice. Ben Hamm and Kenny Bui both died from head trauma, and Evan Murray suffered a lacerated spleen. The latest to die, Cam’ron Matthews, told teammates he felt dizzy, then suffered a seizure.
These stories have drawn horror and headlines, but they are not out of the ordinary. In fact, 2015 is on track to meet the usual numbers of high school football-related deaths: There were 11 in 2014, and 18 in 2013. More than 100 kids have died from high school football-related injuries in the last decade, according to data from the University of North Carolina’s National Center for Catastrophic Sport Injury Research.
Those numbers used to be even higher. In the 1970s, a combination of rule changes that prohibited leading with the head on blocks and tackles, helmet safety standards and medical advances made football fields dramatically safer. More than 150 high school football players died from head, neck and spine injuries alone between 1965 and 1974. That number dropped by nearly half over the following decade.
And then, progress stopped.
Since 1980, both the average number and average rate of annual high school football-related deaths have remained relatively constant. During that time, roughly four kids have died each year due to head, neck and spine injuries the NCCSIR consider “directly” related to football. An average of seven more died from “indirect” causes -- heat stroke, underlying illnesses like asthma or sickle cell complications, or cardiac arrest, the most common killer of young athletes. In the last decade, the annual averages have actually increased to five direct and 10 to 12 indirect deaths, said NCCSIR director Dr. Kristen Kucera, though that could be because increased awareness has driven up the number of media reports, on which NCCSIR relies.
Which raises the question: Why haven't things gotten better?
There are a host of potential answers, including that high school football has come to mimic its collegiate counterpart in size and intensity, said Dr. Douglas Casa, the CEO of the University of Connecticut’s Korey Stringer Institute. The institute, named after the NFL player who died from heat stroke in 2001, promotes initiatives and research to prevent catastrophic deaths in sports.
But one reason stands out above the others: States and schools, he said, aren’t putting the right policies in place to fully protect their athletes.
“The best practices are not being followed,” Casa said. “I’m kind of mystified, but people are just not implementing evidence-based medicine and policies at the high school level. I’m not saying they’re not interested in it, but they’re just not doing it.”
The changes implemented in the 1970s primarily addressed deaths related to head and spine injuries. The number of head-, neck- and spine-related deaths reached their lowest point ever over the last decade, but they remain concerning at their current level.
Indirect fatalities, however, have continued to increase, Casa said. That is worrisome because incidents of heat stroke, heart attacks and complications with illnesses like sickle cell are “almost 100 percent survivable if they’re treated properly,” he said.
Doctors and athletic trainers who study catastrophic injuries in high school sports have a decent idea of how to prevent the vast majority of those indirect deaths. Both KSI and the National Athletic Trainers Association recommend enacting emergency action plans so that people on the ground know how to respond to life-threatening injuries. They also recommend having defibrillators on site to treat sudden cardiac arrests, immersion pools to manage heat exhaustion before it becomes fatal, and other basic medical procedures and practices in place.
Too many schools, though, don’t have those devices on hand or strategies and procedures in place, likely because too many states don’t require them to.
Maps on KSI’s website track which states meet the institute’s basic standards for safety in sports. When it comes to concussion management, emergency action plans and defibrillators, not a single state meets its minimum best practices requirements. KSI recommends two separate policies to prevent heat stroke. Just three states meet best practice recommendations for the first -- modifications to practices and games during periods of excessive heat -- while only 13 pass the test on heat acclimatization policies that call for phasing in practice activity to get the body used to hot temperatures.
The most frustrating part for football safety advocates is that they know these policies can work. The NCAA drafted heat acclimatization guidelines in 2003. The number of heat stroke deaths in August -- the most dangerous month -- dropped from and average of two per month to just one in 12 years, Casa said. States that have similar standards, he added, have also seen reductions.
Another glaring problem is the lack of certified athletic trainers on site at practices and games. Just 37 percent of high schools employ a full-time athletic trainer, according to a NATA survey released this year. More than half have a part-time trainer, and three-quarters have access to a trainer at games.
In too many instances, a coach who is untrained as a medical professional is on the front line of decision-making about an injured player’s health. When it comes to determining threat levels that different injuries pose -- from concussions and spinal problems to heat- and heart-related issues -- athletic trainers are almost indispensable.
“These are areas where the care that athletes receive in the first few minutes of recognizing they are in distress dictates, for the most part, the outcome of that athlete’s injury,” said Dr. Scott Sailor, the president of NATA.
The structure of high school sports, which are governed largely on a state-by-state basis, creates a major barrier for implementing uniform safety standards.
There are, however, signs that everyone is taking the problem more seriously. Most of the state-level changes that have taken place have come in the last five years, Casa said. In March, NATA and the American Medical Society for Sports Medicine held a conference at NFL headquarters in New York that brought together medical experts and high school athletic association officials from all 50 states. They discussed best practices to prevent catastrophic injuries, and the two organizations plan to reconvene the group next year at the NCAA’s headquarters in Indianapolis.
The National Federation of State High School Associations has recommended further changes to tackling rules in an effort to limit head injuries, NFHS executive director Bob Gardner said, and even Congress has hinted at trying to take action that could require schools to implement concussion management protocol. Newly formed advocacy groups have organized other conferences and symposiums to address the dangers of high school sports, which are hardly limited to football.
“We have the evidence now in a lot of these areas,” Casa said. “It’s just, how can we get this whole thing moving faster without having to wait for kids to die?”
UPDATE: 5:50 p.m. -- Andre Smith, a 17-year-old football player at Bogan High School in Chicago, died early Friday morning after playing in a high school football game the night before, ABC7 reported. Smith reportedly suffered an injury during the game and, according to his family, experienced brain swelling afterward. He is the seventh high school football player to die in the 2015 season.