One critical message coaches, doctors and athletic trainers must learn from the death of Jordan McNair

I saw the news about the death of Jordan McNair, the offensive lineman at the University of Maryland a couple of months ago. I immediately thought of Korey Stringer, whose death I wrote about in my book. I waited to comment on it until specific details emerged. Last weekend, ESPN reported some of the events of the player’s collapse. While I don’t know the exact nature of the events, and I won’t take sides, I bring them up because there is an important take-home message for anyone involved with football. I explained that message in my latest newspaper column.

ESPN reports details surrounding the collapse and death of Jordan McNair

In recent days, ESPN released a series of articles detailing the circumstances surrounding the death of University of Maryland offensive lineman Jordan McNair and a “toxic culture” within the Terrapins organization. As a result, the school placed its head coach, head football athletic trainer, director of athletic training, and assistant athletics director for sports performance 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 and athletes must understand to prevent deaths like these in the future.

Athlete suffering from heat illness and at risk for heat stroke

Jordan McNair collapses at a University of Maryland football workout

On May 29, the Maryland football team started a workout at 4:15 PM. After a warmup, players ran 10 110-yard sprints. Witnesses told ESPN that McNair struggled to finish, needing teammates to complete the 10th sprint.

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.”

Timeline of McNair’s on-site treatment and core body temperature at the hospital

Murphy claims that medical records show a coach saw McNair have a seizure at 5 PM, a claim the university denies. An unidentified person from the school called 911 at 5:58 PM, according to the call recording obtained by ESPN.

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

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

Also read:
Exertional heat stroke – Prevention

Events similar to those of Minnesota Vikings lineman Korey Stringer

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.

What is exertional heat stroke?

Exertional heat stroke (EHS) involves a core body temperature greater than 104°F 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 Douglas J. Casa, PhD, 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. He explained 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.

The critical massage to learn from the heat stroke death of Jordan McNair

The importance of on-site treatment for exertional heat stroke

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°F. Then the athlete can be transported to a hospital.

Also read:
Exertional heat stroke – Treatment

Why it’s critical to bring down the athlete’s core body temperature quickly

Roughly 105.5°F 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°F 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.

The problem with waiting for an ambulance and paramedics

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.

Also read:
The importance of summer practice changes to prevent heat stroke

How quick recognition and on-site treatment can save an athlete’s life

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°F. 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 rectal 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% survivable if you get their core body temperature under 104° within 30 minutes of collapse. Over 2,000 cases of heat stroke—all have survived when this is accomplished.”

Also read:
Exertional heat stroke in high school football

Note: A modified version of this article appears as my sports medicine column in the August 13, 2018 issue of The Post and Courier.

References:
Jordan McNair family attorney wants Maryland to fire DJ Durkin. By Heather Dinich. ESPN.com. August 12, 2018.

Sources: Maryland OL Jordan McNair showed signs of extreme exhaustion. By Heather Dinich. ESPN.com. August 11, 2018.

Timeline: Everything to know about the Maryland football scandal. By Tom VanHaaren. ESPN.com. August 11, 2018.

Maryland puts trainers, strength coach on leave. By Heather Dinich and Adam Rittenberg. ESPN.com. August 11, 2018.

The inside story of a toxic culture at Maryland football. By Heather Dinich, Adam Rittenberg and Tom VanHaaren. ESPN.com. August 10, 2018.

That’s Gotta Hurt: The Injuries That Changed Sports Forever. By Dr. David Geier. ForeEdge. 2017.