By TODD TRAUB
Leader sportswriter
It hasn’t yet been determined what killed Courtney Stone, the Arkansas Baptist player who died Aug. 14, two days after collapsing during a team meeting following practice in Little Rock.
Stone could have had an undiagnosed condition that slipped past all the routine physicals, medical histories, doctor’s releases and consent forms, and university president Fitz Hill, the former Arkansas Razorback and head coach at San Jose State, has promised a full investigation.
But, with autopsy results pending, one of the suspects in the death of Stone, an apparently healthy and fit 18-year-old, is a football player’s oldest and most insidious enemy — heat.
The University of North Carolina-based National Center for Catastrophic Sports Injury reports, since 1995, 33 football players from the sandlot level to the NFL have died from heat-related causes. Of those fatalities, 25 were high school players.
And the deaths could have been prevented, Jacksonville High School trainer Jason Cates said.
“Football is a 12-month sport now,” Cates said. “We’re seeing kids that are out and doing stuff and being acclimated and things like that, so it’s helping. But unfortunately there are still deaths.”
Heat stroke occurs when a person is exposed to high temperatures so long the brain, trying to maintain all bodily functions, becomes overtaxed and simply shuts down, rendering the victim brain dead.
While football will always hold its share of risks, trainers like Cates are banding with coaches to prevent heat stroke and provide better care for high school athletes suffering from heat-related illness.
“It is something that we are trying to research and make sure that we keep these kids safe at a secondary school level,” Cates said.
AWARENESS, PREPAREDNESS ARE KEY
At most modern football practices, water flows almost nonstop, which is a far cry from the days when hard-bitten coaches used it as a reward and withheld it as punishment.
“We got a break — if we got one — that was it,” said Harding Academy coach Roddy Mote, recalling his high school days in West Virginia. “That was the only time we got water during that break. Of course the length of practices was a lot longer and of course the length of time before you got a break was longer.”
“Water breaks, you’d get a handful of ice and get back to work,” Jacksonville coach Mark Whatley said.
Cates said water is just one facet of heat-stroke prevention. Many high school programs today keep a close watch on a player’s weight, and old ideas about two-a-day workouts and full-pad practices are being replaced with more flexible thinking.
“We make sure the kids understand,” Cates said. “And the parents understand — that’s the biggest thing — that they’re being watched through these two-a-days.”
A potential heat-stroke victim will exhibit confusion — perhaps not comprehending a simple play — and become sluggish, Cates said. Dry heaving and stomach cramps could follow.
“If you get to that level, you’re in trouble,” Cates said.
Late-level symptoms include full body cramps and the absence of sweat.
“Then you go from heat exhaustion to heat stroke pretty quick,” Cates said.
As part of a prevention plan, many programs now weigh players before and after summer workouts. Cates said that if an athlete loses more than 3 percent of his body weight, he should re-hydrate and replace that weight before he can return to practice.
Cates recalled an extreme situation at Jacksonville last year when a handful of players locked up with body cramps and were taken to the emergency room where they were given intravenous saline and kept overnight.
The players were kept out of practice for three days, and when they returned they were kept out of pads for another three days while their conditions were monitored.
Cates keeps cold towels and a whirlpool bath full of cold water handy to lower a player’s core temperature should he become overheated. He also stresses proper diet, urges players to avoid dark fluids with caffeine that act as diuretics and to bring a change of clothes.
“When clothes get saturated then the clothes are working against you,” Cates said. “Not absorbing it. Can’t evaporate.”
Coaches are urged to have more flexible practice schedules, to extend the length of breaks or make breaks more frequent during the hot months and to start summer practices later in the day.
Cabot Coach Mike Malham, who has led the Panthers since 1981, mandates his players complete all of their summer conditioning so they report in shape. He insists the players hydrate before practice, conducts the first of his two-a-days in the early morning shade, lets his players have all the water they want and holds a Gatorade and cool-down break in the air-conditioned field house during the heat of the afternoons.
If a player shows symptoms of heat exhaustion, like cramps, Malham holds him out of practice, and he said there is no substitute for a simple hand on the back of the neck to see if a player’s skin is clammy.
“I’ve been in this long enough. I haven’t lost one yet,” Malham said. “I want to knock on wood. You never know what could happen, but again, it gets down to common sense.”
TRAGEDY FOCUSES ATTENTION
On Aug. 20, 2008, 15-year-old Pleasure Ridge Park (Ky.) High School offensive lineman Max Gilpin was running sprints in a heat index of 94 degrees when he collapsed. Gilpin was rushed to the emergency room, where he was found to have a core temperature of 107 degrees. He died three days later.
On Wednesday, first-year Pleasure Ridge coach David Stinson was re-indicted on a charge of wanton endangerment after he had already pleaded not guilty to a charge of reckless homicide. His trial is scheduled to start Aug. 31.
Stinson was allegedly conducting a grueling practice and withholding water from his players.
“I mean coaches are scared to death,” Cates said. “It sent ripples across the country as to how the coaches are handling two-a-day practices.”
Cates, a Jacksonville native and president-elect of the Arkansas Athletic Trainers Association, has worked to make sure similar tragedies are avoided in Arkansas, but there is only so much that can be done.
With 300 schools participating under the Arkansas Activities Association banner and only 192 certified or licensed trainers in the state, Cates said it would be impractical to mandate each school have a trainer.
“We are trying to stay away from any unfunded mandates because, No. 1, the schools, they just can’t afford it,” Cates said.
“And, No. 2, we don’t have enough certified athletic trainers in the state.”
Instead, Cates and his brethren have tried to work within the AAA and the state legislature to come up with acceptable guidelines for a number of sports safety and health issues.
Cates, the 2008 Arkansas Athletic Trainer of the Year, said there are few mandates in place for the prevention of heat stroke, but he is pleased with the progress that has been made when it comes to awareness.
“We’re forming position statements and trying to educate the coaches on each of these things,” Cates said. “And we’re also trying to educate them on athletic trainers and how athletic trainers can help the schools. And there are a lot of schools the last few years that have stepped up to the plate and started hiring athletic trainers.”
“I’m fortunate because of Jason,” Whatley said.
Cates is an employee of Ortho Arkansas, which donates Cates’ time to Jacksonville High. Harding Academy has a trainer on staff while Cabot, though without a full-time trainer, gets volunteer help from local physical therapist Joe Farrer.
“He comes by a couple times a week and he’s here for all the games,” Malham said.
Cates said there is an extensive medical history form on the AAA Web site that is recommended to all athletes and their parents.
“If anything comes up, whether it be a blood pressure issues, a pulse issue, maybe we hear a murmur or something like that, the kids have to go for further studies and get cleared,” Cates said. “We let their family doctor plan their course of action until we get an all-clear for athletic participation.”
Heart conditions, sickle-cell traits and other conditions that can be accelerated by exposure to heat can possibly be detected if the medical history form is properly filled out, Cates said.
Unfortunately, a player too often simply reports to practice with a family doctor’s clearance.
“But there is no blood pressure record, no allergy record,” Cates said. “By rule that paper says the kid is cleared to play, but at Jacksonville, if I get that, I have the kid go ahead and get that form off the AAA Web site and fill it out for me to know.”
Cates also advocates EKGs be included as part of routine physicals. A cardiology group in Jonesboro donates EKGs to the entire area, and it was just such a test that detected a previously undiagnosed heart condition in Arkansas State freshman receiver Alan Muse, who has since had corrective surgery and is back in practice.
“If there’s a group that’s doing it in Jonesboro we need to find a group that can do it in Little Rock,” Cates said, acknowledging the cost of the test is prohibitive. “There’s got to be somebody that has those resources here.”
Before Cates, physicians and concerned politicians can begin considering mandates for heat- stroke prevention — and how to fund them — Cates is waiting on the results of studies on the subject at the University of Georgia.
Cates is particularly interested in the study because of the similarities in climate to Arkansas.
“Then we’ll be able to form a position statement and look at what changes may be needed as far as addressing the coaches and two-a-days and things like that,” Cates said. “But we’re really not in a position to jump out there and make something because you don’t want to do it without scientific research.”
PLAYERS COME FIRST
Without the hard science to support the passing of tough laws, doctors and trainers like Cates have found the best way to prevent heat stroke is to work hand-in-hand with high school coaches as much as possible.
For the most part, the coaches have been receptive and willing, Cates said.
“Some coaches are still traditional football coaches; they’re out there from 1 to 4 o’ clock,” Cates said. “But with the lawsuit from last year I don’t think there’s a coach that is not in tune with it. There is not a coach who wants to lose an athlete.”
Close to 4,000 attended seminars on heat exposure during AAA All-Star week festivities at Fayetteville in June. Similar, well-attended seminars have been conducted in Jonesboro and Little Rock — with coaches traveling from as far away as Newport and Junction City to attend.
“I know that a lot of coaches, just from talking to coaches and athletic trainers around the state … they’re having early morning practice to avoid the heat of the day,” said Cates, who got his degree in sports medicine at Arkansas State, which had the first accredited sports-medicine program in Arkansas. “Some of them are coming in at 7 and 8 in the evening and practicing under the lights.”
Many of the guidelines people like Cates are preaching are based on rules adopted by the NCAA and recommended by the National Athletic Trainers Association: Going longer in helmets and shorts, no back-to-back two-a-days or back-to-back workouts in full pads, flexible practice and hydration break schedules.
Of course, the NCAA has the luxury of requiring one certified trainer per every 50 athletes. Cates is the only trainer for 64 football players at Jacksonville, while Cabot and many other schools have yet to hire a trainer at all.
For the time being, and maybe for always, the first line of defense against heat stroke appears to be the coaches, who can be a notoriously demanding lot when it comes to sticking to schedules and budgeting time.
But a practice timetable is trivial when compared to the health of a young man who has his whole life ahead of him. Most coaches agree, when a player bids his family goodbye and heads off to practice or a game, they should expect to see him again.
“I wouldn’t say that putting a kid’s life No. 1 would complicate anything,” Whatley said. “From that standpoint, I don’t think it handcuffs us anymore. We’re going to be more organized and make better use of our time.”