Medical field responds to high school football player deaths

Speed and quickness are a vital part of all sports — particularly in football.

In light of a recent rash of death on high school gridirons throughout the land, parents, coaches and medical professionals need to move faster, say sports medicine professionals.

"I think that we're getting better in terms of getting information out and awareness," said Jonathan Drezner, a past president for the American Medical Society for Sports Medicine and current team physician for the Seattle Seahawks and University of Washington. "But when we continue to lose life, we can't move fast enough."

On Sunday, South Harrison (Lost Creek, W. Va.) senior Dylan Jeffries, 17, died after collapsing during a Sept. 27 game and being placed in a medically induced coma due to a blood clot on his brain. Surgery to remove the blood clot did not work.

On his Facebook page, the following was written: "Dylan has fought very hard through this past week, but today his battle is over. He has gone to be with our Lord and Savior."

This came just two days after West (Shawnee Mission, Kan.) wide receiver and Kansas commit Andre Maloney died after suffering a stroke and collapsing during a game Thursday. The versatile 17-year-old wide receiver and cornerback, the state's No. 2 recruit according to 247Sports.com, had led his team to the school's first state title since 1985 last season.

According to the Kansas City Star, he was taken by ambulance from the Shawnee Mission South District Stadium during a 37-34 loss to Leavenworth after he had become disoriented on the sideline following a 63-yard touchdown catch and run. At Research Medical Center, doctors discovered a blood clot in his brain, and despite three hours of surgery, the clot could not be removed, according to a family member. He was pronounced dead Friday evening.

"It's shocking to me because you never expected something like that to happen to Andre," former teammate Kez Demby told the Kansas City Star.

Jeffries and Maloney are the third and fourth high school football players to lose their lives in field-related incidents since Sept. 13, bringing the fatality total to at least six this season.

Heading into this season, there were at least 25 fatal injuries to American high school football players since 2003, according to the National Center for Catastrophic Sport Injury Research at the University of North Carolina.

Cardiac arrest, heat stroke and head trauma are the leading causes for these catastrophes, and national programs from USA Football, Gatorade and the NFHS, among others, have lobbied for and educated the public with aggressive, preventative measures and programs.

USA Football's "Heads Up Football" program has been at the forefront the last 15 months and has moved swiftly to gain massive support from the highest (NFL) and most grassroots (youth football) levels.

Nearly 2,800 youth football organizations (more than 25 percent of leagues in the country) are already registered in the "Heads Up" program, which establishes standards, educates adults and supplies coaching certificates on all facets of safety. It has also started rolling out programs at the high school level and aims to be a part of every school by the end of 2014.

"I think what USA Football is doing with its Heads Up Football program is the most important thing right now in teaching the game of football," Tampa Bay Buccaneers coach Greg Schiano said. "It's a great game, and it teaches you so much, but we must do all we can to help protect the participants."

Beating cardiac arrest
Drezner, whose specialty is sports cardiology, is one of 10 experts on USA Football's Medical Advisory Committee.

He said while much of the nation's recent attention is placed on concussion, head and neck injuries — "and for very good reason," he said — cardiac-caused sudden death on football fields trumps all others by a six-to-one ratio.

Two ways to combat this long-standing trend at the youth and high school level are: A. Better screening processes of each athlete and B. Immediate and efficient life-saving response and procedures once an athlete enters cardiac arrest.

The latter is certainly the most challenging, considering medical professionals are not often immediately present — at least at practice — when most cardiac emergencies occur.

The presence of personnel with CPR skills and most importantly, Drezner said, of on-site Automatic External Defibrillators (AEDs) is absolutely key. In more than 80 percent of cases with cardiac sudden death on athletic fields, no defibrillators were present or used, he said.

According to reports, one was used on 17-year-old LaPorte (Ind.) linebacker Jake West, who died of cardiac arrest on Sept. 25 while jogging around a track in his football gear. The AED did allow West to regain a pulse but he died at a local hospital.

See Q&A with USA Football Medical Advisory Committee chairman Dr. Stanley Herring

More often than not, however, coaches and personnel are left with basic CPR skills while waiting for an ambulance.

"Like fire extinguishers, one or more AEDs need to be present on every campus," Drezner said. "And they should be strategically placed — somewhere within 90 seconds of where an attack would occur, most commonly a gymnasium."

A defibrillator, of course, is more costly than a fire extinguisher, at about $1,000 per item. And budgets are understandably extremely tight. That said, Drezner said, "It should be the standard of care."

Use of an AED, Drezner said, isn't complicated.

"They are made for a layperson," he said, noting a recent case test of sixth-graders with no training versus paramedics. "It took the sixth-graders 23 seconds longer on average to implement on a mock patient."

To prevent even needing AEDs, Drezner would like to see Electrocardiography (EKGs) as the first and foremost part of the screening process, which again comes at a cost — anywhere from $10 to $25 on most medical plans.

Reading EKGs, more than cost, is a barrier in that process.

"There aren't enough physicians who know how to interpret EKGs when it comes to heart disease among athletes," he said. "That's a major concern."

Using one's head
Head and neck trauma at all levels of football is also a major concern.

Dr. Gerald A. Gioia, a pediatric neuropsychologist at Children's National Medical Center in Washington, D.C., said strengthening the neck and learning to tackle correctly are two of the most vital ways head injuries can be avoided.

A former high school football player at Niskayuna (N.Y.), Gioia switched to rugby, a highly physical sport that doesn't use a helmet, in his college and adult years.

He had to relearn how to tackle with his arms and shoulder without using and leading with the helmet, which is largely what the Heads Up program is all about. It's also why he's part of the USA Football Medical Advisory Committee.

"I think it's a great start and important piece to prepare coaches and teach the kids how to protect their heads, and not lead or tackle with it," Gioia said. "To really break down tackling makes a lot of sense."

Damen Janes, a junior at Westfield/Brocton (Westfield, N.Y.), lost his life after attempting a tackle in a Sept. 13 game. According to reports, he lost consciousness from a helmet-to-helmet collision and later died at a local hospital. Westfield/Brocton later announced that it cancelled the rest of its season.

"As a human being, I'm deeply saddened to hear of a child, teen or adult to lose their life in a sport which they love and having fun," Gioia said. "It's so very important to examine all the conditions and was it something preventable."

To build the neck and shoulders can only help in football, especially while sustaining a blindside blow.

"(The neck) is the stock where the head sits and you don't want it flailing around," Gioia said. "Blindside hits utilize much more force to the head so it's critical the neck already be strong and conditioned."

More critical than tackling techniques or neck muscles are attitudes concerning head injuries, concussions and penalties.

"I'm blown away when I see angry fans and parents at referees for making calls on dangerous hits," Gioia said. "We can't have it both ways here. If we're going to err, we have to err on the side of a player's safety."

And the new measures at all levels to remove possible concussed players from the field is another major plus. Now it's a matter of getting teenage boys on board to be more safety-driven and less daring. It's a cultural change that will take time, Gioia said.

He's hoping a couple quips will catch on: Friends don't let teammates play concussed and No brain, no gain.

But catch phrases, screening or even a defibrillator likely wouldn't have saved Maloney or Jeffries.

Though strokes rank as the fourth-leading cause of death according to the Centers for Disease Control and Prevention, among youth they are the result of a congenital heart abnormality in which one is born with a hole that is supposed to close at birth.

Interventional neurologist Coleman Martin told the Star that 80 percent of the time that hole seals up. When it doesn't, blood clots pass through the hole and into the brain. Aneurysms, which frequently go undetected, are also leading causes of stroke.

“A high school physical isn’t going to give you signs of these,” Martin told the Star. “You’re not going to pick it up on a sports physical.”