Deaths of Prep Athletes Leads to Scrutiny of Safety Precautions

A broken neck suffered by a Maryland high school wrestler last month and the deaths of two Virginia high school football players this past season have increased the attention focused on the safety precautions taken to protect teen-age athletes.

Doctors, school health and athletic administrators and coaches agree that the proximity in time and geography among the incidents was coincidental and that they were handled correctly by emergency medical personnel. However, there is disagreement concerning the avoidability of these and other potentially catastrophic injuries.

As in most other parts of the country, Washington-area schools have been able to improve the safety of athletes, football players in particular, by:

--Mandating pre-participation physical examinations.

--Adopting National Federation of State High School Assn. rules changes.

--Employing better-trained coaches who are conducting sensible practices and teaching safer techniques.

--Using better equipment that meets stringent national standards.

--Using better-trained medical personnel at more events.

But questions remain as to whether more should be done and whether what already is being done, particularly with respect to the physical examinations, can be achieved in a more complete, cost-effective manner.

In interviews with members of the medical community, attorneys, insurance experts, equipment manufacturers, school athletic and health administrators and coaches, The Washington Post has learned that most area school systems do not:

--Conduct pre-participation physical examinations in the most complete and cost-effective way.

--Employ certified athletic trainers.

--Require coaches to gain and maintain emergency first aid certification.

--Require the attendance of medical personnel at most events.

--Have a viable system for attracting voluntary doctors or registered nurses at games.

Dick Schindler, football coordinator for the NFSHSA, said that considering what “you know about the game and all the collisions involved, you try by rules, equipment and education to make it as safe as you can.

“But you recognize there were deaths this past season and there will be some next year. I can say that right now, and I’ll be right because 50 years of experience and figures tell you there aren’t going to be any zeroes.”

According to the NFSHSA, which in conjunction with the National Center for Catastrophic Sports Injury Research at the University of North Carolina has compiled such statistics since 1931, the number of deaths in high school football has decreased in recent years.

An all-time high of 34 U.S. high school athletes died as a result of direct causes (a blow or contact situation) or indirect causes (a condition complicated by or secondary to football) while playing football in 1968. In 1985, an all-time low of five students died while playing football. In 1986, though, that figure was exceeded, Schindler said.

“I don’t even want to speculate as to what the final totals will be,” said Schindler, who had not received a final report. “But from what I’ve got, we may hit the highest direct total in 10 years.”

Schindler estimated that the total number of football deaths may reach 15 and the number of deaths directly related to football may reach double figures, which hasn’t happened since 1976.

“I don’t know if that’s the start of a trend again,” Schindler said. “Hopefully it’s just an odd year.”

Schindler and Ned Sparks, executive secretary of the Maryland Public Secondary Schools Athletic Assn., said they had not heard of schools planning to drop football because of injuries and deaths.

“Deaths could occur while running in a cross country meet, playing in a pickup game or while tying your shoes,” Sparks said. “I think every jurisdiction does everything possible to ensure the safety of the students participating in athletics. Perhaps if sports got to the point where the injury level was uncontrollable, maybe then something would have to be done.”

The death of Brandon Kelly Dawson, 16, of Stonewall Jackson High School in Mount Jackson, Va., of a ruptured spleen suffered while playing football Oct. 4, was the first football-related death in the state in at least eight years, according to Earl Gillespie, executive director of the Virginia High School League.

Eight weeks later, Chuck Coles, 16, a junior at Potomac High School in Dumfries, Va., collapsed and died. An autopsy revealed that Coles died of hypertrophic cardiomyopathy, a disease of the heart muscle that usually presents no symptoms. It is the leading cause of sudden heart attacks of athletes under 35, according to Dr. Barry Moran, who has studied sudden death in athletes at the National Heart, Lung, and Blood Institute in Bethesda.

On Dec. 19, Jonathan Young, a 5-6, 112-pound wrestler at Walt Whitman High School in Bethesda, Md., suffered a broken neck when he fell forward on his head trying to escape a hold during a match. He fractured the sixth and seventh vertebrae and has undergone surgery. Young has limited use of his arms, hands and legs.

According to the medical reports, both of the deaths could have occurred even had the youths not been playing football. Young’s accident was termed a “freak” by his attending physician, Michael Dennis, a neurologist at the Washington Hospital Center.

As is the case with thousands of athletes in the nation, the three youths in Maryland and Virginia passed the pre-participation physical examinations required annually by their states.

“We give a very complete examination--the cardiovascular test, a modified stress test, check the blood pressure and look for irregular rhythm or murmurs in the heart,” said Dr. Mary Ellen Bradshaw, the chief of the Bureau of the School Health Services for the D.C. Public Schools. “We’ve developed a long detailed form that asks for the student’s history, the family history, etc. We see maybe 1,000 boys and girls across the city and, at times, we are able to detect certain abnormalities that require further examinations.”

Most metropolitan area youths are given physicals by a health service or a group of physicians paid by a school, the athletes or the jurisdiction. Other athletes are examined by family doctors or at health facilities selected by parents.

“There is that freedom of choice as to whom a student can go to for an exam,” Bradshaw said. “That is the one change I would like to see implemented. If the students could receive their exams at one local facility, we would be able to monitor them better.”

Questions remain as to the completeness and cost-effectiveness of exams. The history section of the Virginia league’s high school athletic examination, for example, has been criticized for not being extensive enough and currently is under review.

In addition to the problem of having students examined by different physicians at different sites, some physicians also are concerned with the students’ early history of illness or injuries that might not be addressed on the physical form. Many physicians also would like to see follow-up examinations after a student has been out with an illness or injury.

“If the students were examined at one central location, we would know exactly what tests were given and by whom,” Bradshaw said. “Also, another desirable addition would be to give a follow-up exam to any student who had been out because of an illness or injury.”

There also is the question of care given to the athletes during an emergency, at practice or during a game.

All of those involved agree it would be ideal if a doctor could be present at each game. And indeed, there are doctors who offer their services on a volunteer basis and others who attend games for a nominal fee. However, many doctors refuse to attend events voluntarily for liability reasons.