Aug. 7, 2007 Every year, Fred Mueller compiles a sports list, but unlike popular pre-season picks or a glamorous hot-recruit sheet, nobody envies him this task. Some years the list is longer than others, but, Mueller said, there's no reason any kid should be on it.
It's a list of boys who died playing or practicing football, kids whose body temperatures rose so high and so fast under the summer sun that their brains couldn't keep up, couldn't regulate their cores, and the boys died.
"When something is preventable ...," Mueller said, shaking his head. "Those kids could be alive today."
Five young athletes, from 11 to 17 years old, died of heat stroke in 2006. The trend was declining. The last time there were more than five was 1972, when there were seven. In five of the past 16 years there were none. But, Mueller said, there have been 31 since 1995, and all of them could have been avoided.
Seven other players died last year of "heart-related" deaths that might or night not have been related to heat or exertion. "And we don't know the number of kids who had heat exhaustion," Mueller said.
With summer practice about to swing into high gear, Mueller said it's time to remember these kids, and to keep in mind how heat-related deaths can be prevented.
Require each athlete to have a physical and know if an athlete has a history of heat-related illness; these kids are more susceptible to heat stroke. Overweight players are also at higher risk.
Acclimatize players to the heat slowly; North Carolina mandates that the first three days of practice be done without uniforms.
Alter practice schedules to avoid long workouts in high-humidity.
Provide cold water before, during and after practice in unlimited quantities.
Provide shaded rest areas with circulating air; remove helmets and loosen or remove jerseys; some schools have plastic outdoor pools filled with ice for cool-downs after practice.
Know the symptoms of heat illness: nausea, incoherence, fatigue, weakness, vomiting, muscle cramps, weak rapid pulse, visual disturbance. Contrary to popular belief, heat stroke victims may sweat profusely.
Have an emergency plan in place; parents should inquire about emergency plans for their kids' teams.
Heat-related deaths are compiled as part of the Annual Survey of Football Injuries, research that began in 1931; Mueller took the reins in 1980. The survey tracks major injuries and deaths in 1.8 million football players from sandlot (organized, non-school affiliated teams), middle school, high school, college and professional teams.
There were a total of 20 deaths in 2006; two sandlot players, three in college, 13 middle and high schoolers. Only one death was directly related to the game; a 17-year-old high school player who received a spinal cord injury when tackled in a practice drill.
Rules against "spearing," or leading blocks and tackles with the helmet or face mask, have drastically reduced the number of direct injuries, Mueller said.
The heat-related injuries warrant special attention because they are preventable, he said. These and other "indirect" deaths and injuries were the highest since 1936, when there were 18.
Mueller said there still exists a hard-core mentality in some football circles, where kids feel pressured from coaches or parents not to complain about feeling ill during practices or games.
But machismo doesn't affect physiology. Physical activity raises players' temperatures higher than normal, Mueller said. When body temperatures rise to 103 or 104, the brain's hypothalamus loses its ability to regulate the heat. The heart beats faster to increase blood flow to the skin to aid in evaporation, leaving less blood in the heart and other muscles. Brain death begins around 106 degrees, but death from heat stroke can be gradual, taking three or four days while organs begin to fail.
"Coaches, athletes and parents should be aware that all fall sports could lead to heat-related deaths if precautions aren't taken," Mueller said. "Every year we have to get the word out."
And every year, he has to make a list.
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