ADD and Heatstroke: What Every Coach Should Know

Heat stroke deaths are preventable.  No question.  Enough is known about the human body to identify the signs of these events.

So why do they continue to occur?

Exertional Heat Stroke, or heat stroke, occurs when a person’s internal temperature reaches levels that cause major organ failure.  At approximately 104 degrees [for most people] the human body’s first defense is to “pass out” or become unconscious.  This mechanism prevents further activity and further temperature rise.

When we ignore signs of exhaustion and push beyond our natural shut down mechanism, the extreme internal temperatures cause organs to fail and often result in death.  

So how is it possible we push beyond this internal temperature limit and why would anyone want to?

It has been discovered that amphetamines, often used to enhance athletic performance, delay the point of exhaustion and increase the upper limits internal body temperatures can reach.  While measures to discourage and prevent illicit usage should be taken by individual athletic departments, another likely culprit is an athlete's prescribed medication.

In 1991, Ritalin usage increased as ADHD diagnoses in children exploded. From 1991-2011, 52 heat stroke deaths were reported in the sport of football.  Going back to 1931 there have been 137 recorded heat stroke deaths in football.  So, just about 40% of heat stroke related deaths occurred during this Ritalin boom.  Yes, correlation isn’t causation… but consider this graph:

  

As you see, another spike in heat stroke deaths in football occurred between 1959-1973.  During this period 60 heat stroke related deaths were recorded.  This dovetails with a time period of well-documented recreational drug usage, where amphetamines were found to be “widely used by NFL players during the 1960-70s".

Combine the two time periods, where suspected amphetamine use by athletes was elevated, and these 33 yrs account for over 80% of recorded heat stroke related deaths in football.  A noteworthy parallel.  

Regardless of this connection, we know the use of Ritalin, Adderall and Concerta allows for increased body temperature.  This means coaches must know which of their athletes is taking medication that alters normal body temperature limits.  This information should be provided by the parents on a Pre-ParticipationExamination (PPE) or medical clearance form.

In 2008, Max Gilpin died from heat stroke during football practice in Kentucky, with a measured core body temperature of 107.  Head coach Jason Stinson was charged with reckless homicide.  While Mr. Stinson was later acquitted, it was discovered that Gilpin was taking Adderall at the time of the incident.

The time is now, to identify which athletes are taking the medication, and take progressive action, mindful of documented side effects.  Lives are at stake.

Founder’s notes:

At Injurefree, we believe a vigorous discussion on youth sports injuries, like most subjects, improves understanding for all, and that informed participation leads to a healthier future. In that light, we wanted to put the discussion into context.

Over the last 4-5 years, concussions have become a major concern for all sports participants.  We know why they occur, and the long-term effects are becoming clearer.  Reports of depression/suicide (due to brain damaging concussions) are becoming reason enough for parents to keep their kids off playing fields all together.

The truth is concussion risks for children aren’t limited to athletic involvement, rather they exist everywhere.  Sports provide a valuable platform to impart life lessons as well as promote physical and psychological health.  Parents weigh the risks of keeping children safe versus experiencing life and developing healthy habits.

So how do we prevent concussions? What helmet should my child wear?  What is the safest age to start contact sports?  Are teams creating the safest possible playing environment for my child?

Responsibilities lie with us all.  

Concussions (and other athletic injuries) are a serious threat to the fundamental structure of sports.  Who should be accepting the risk of playing sports is now a serious debate, as the risk of lawsuit (in the US) has some youth administrators questioning whether they should provide the opportunity at all.  "Mega-suits" have trickled down from the NFL to the NCAA to high school and now youth sports levels.  The risk of negligence (by employees or volunteers) threatens the existence of many schools and clubs.

Football participation is down.  Head injuries in lacrosse, women’s soccer, equestrian, and figure skating are steadily increasing. Knee reconstruction surgery has increased 84% between 1997 and 2009.  These are alarming trends, but we also believe by applying statistical science and epidemiological study we can better understand the core factors, and begin shifting the trends.  The data will allow us to identify and apply the best available practices and improve health outcomes.

The Agency for Student Health Research was founded on the principle that technology can help us create the safest possible environments for children.  After a four-year development project, InjureFree is now available to the public and being using by youth sports clubs, schools and school districts to document and report injuries occurring in their populations.  The web-based injury reporting system allows for parents, coaches, health care providers and administrators to create a secure "connected care" ecosystem, increasing communication and transparency.

Connected Care Ecosystem

Members of the InjureFree network are contributing to a rapidly growing database of injury information being used by internationally-renown researchers, state policy makers and governmental agencies to help identify trends occurring within specific populations.  This data is the first step to improving the educational healthcare system and providing individualized care for all students.

The case studies, information, charts and issues presented here are a representation of the developing trends and best practices regarding youth sports injury prevention.  We welcome and invite collaboration and are actively creating partnerships with sports organizations all over the world.  We hope you find the information useful and use it to develop a safer playing environment for the children in your care.