mcnair

Maryland head coach D.J. Durkin has been put on administrative leave after reports of his coaching style surfaced following the death of football player Jordan McNair, who collapsed during practice. File/AP

The death of Maryland offensive lineman Jordan McNair was followed by a disturbing series of articles from ESPN detailing the circumstances surrounding a “toxic culture” within the Terrapins organization. As a result, the school placed head coach D.J. Durkin and several members of his staff on administrative leave pending an external review.

We don’t know the exact details of the events leading up to McNair’s collapse at practice. The university disputes some of the details claimed by ESPN and the McNair family attorney, Billy Murphy. Regardless, it’s worth discussing the alleged timeline because there is one critical message that football coaches, athletic trainers, athletes and parents must understand to prevent deaths like these in the future.

On May 29, the Maryland football team performed a workout starting at 4:15 p.m. After a warmup, players ran 10 110-yard sprints. Witnesses told ESPN that McNair struggled during the workout, needing help to complete the 10th sprint.

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According to one player at the workout, “Jordan was obviously not in control of his body. He was flopping all around. There were two trainers on either side of him bearing a lot of weight. They interlocked their legs with his in order to keep him standing.”

Murphy claims that medical records show a coach saw McNair have a seizure at 5 p.m., a claim the university rejects, even though EMT personnel later reported a “male patient with a seizure.” The call from Maryland personnel to 911 was made at 5:58 p.m., according to the call recording obtained by ESPN.

Upon arrival to Washington Adventist Hospital, McNair’s core body temperature was 106 degrees. He died on June 13. ESPN reported that heat stroke is the cause of death.

Murphy argues that if the coaching and medical staff had recognized McNair’s condition and treated him immediately — namely by placing him in an ice tub — they could have prevented his death. Instead, he fears that the one-hour delay between the seizure and EMS call contributed to his death.

We won’t know the exact details until the external review is released in September. The death and the events leading up to it eerily remind me of Minnesota Vikings offensive lineman Korey Stringer that I described in my book, That's Gotta Hurt: The Injuries That Changed Sports Forever.

Exertional heat stroke (EHS) involves a core body temperature greater than 104  and altered mental status of the athlete. That abnormal mental state might manifest as confusion, disorientation, impaired judgment, or abnormal motor coordination, or it could be marked by seizures and loss of consciousness. The excessive core body temperature can quickly cause multi-system organ failure.

I interviewed Dr. Douglas J. Casa, a professor in the Department of Kinesiology at the University of Connecticut, as well as chief operating officer of the Korey Stringer Institute and a leading expert on heat stroke, about the condition for my book. He told me that even if an athlete suffers heat stroke, athletic trainers and doctors can still prevent the athlete from dying if they recognize it and start treatment immediately.

First, the athletic trainers and doctors must recognize any alterations in mental status and obtain a rectal temperature to properly determine core body temperature. Then the medical staff must treat the athlete on site first. They should use cold water immersion — namely putting him in an ice or cold bath — to get his temperature down below 104. Then the athlete can be transported to a hospital.

A temperature of 105.5 appears to be a critical threshold for permanent body system damage. If an athlete’s core body temperature falls below that level within 30 minutes, the athlete survives and has no long-term complications. If his temperature remains above 105.5 for 30 to 60 minutes, he might survive but suffer long-term complications. If he remains above 105.5 past 60 minutes, he will either die or survive but suffer permanent damage.

Medical providers must decrease the athlete’s core body temperature in that 30-minute window. If they skip cold-water immersion and instead wait for an ambulance, they could lose 10 to 15 minutes or more before it arrives. Then the paramedics might need 10 minutes to assess the athlete and load him into the ambulance. The transport to the hospital could take 10 to 15 minutes. It will take another five minutes or more for the emergency room doctors to assess him before initiating treatment. Far more than the critical 30 minutes will have passed.

It’s critical that athletic trainers, coaches, doctors and teammates start treatment on site immediately. Most athletes have a core temperature between 106 and 110 in these cases. Let’s say an athlete’s core body temperature is 108 when an athletic trainer first takes a rectal temperature. It takes about three minutes to lower an athlete’s temperature 1 degree. To get him down to a safe 104 level, it would take at least 12 minutes.

That’s 12 minutes once the medical staff starts cooling the player. Getting the athlete off the field, taking his helmet and pads off, assessing him, taking his  temperature, and preparing the cold tub add several minutes before the cooling starts. Finally, the athletic trainers and doctors must realize that the athlete’s temperature probably exceeded the critical threshold for several minutes before anyone recognized his illness.

With quick and appropriate action, doctors and athletic trainers can prevent these events.

“Deaths from EHS within controlled environments are always preventable,” Dr. Casa stressed. “Meaning, exertional heat stroke is 100 percent survivable if you get their core body temperature under 104 degrees within 30 minutes of collapse. Over 2,000 cases of heat stroke — all have survived when this is accomplished.”

Dr. David Geier is an orthopedic surgeon in Charleston and author of That’s Gotta Hurt: The Injuries That Changed Sports Forever.