Jones & Bartlett Learning Health Blog

    Expert Aims to Prevent Sudden Death in Sport

    Posted by admin on Apr 6, 2011 11:30:07 AM

    "On August 8, 1985, somewhere between 11:00 and 11:10 p.m. EST, the path of my life unfurled in front of me. I have nearly no memory of approximately 6 hours of my life, while I was in a coma, due to the severe exertional heat stroke."

    In the foreword to the groundbreaking new text, Preventing Sudden Death in Sport and Physical Activity, Doug Casa tells the amazing story behind his quest to prevent sudden death in sport.

    The Confluence of Conspiring Factors

    Kent Scriber, EdD, ATC, PT
    Professor, Department of Exercise and Sport Sciences
    Ithaca College, Ithaca, New York

    "Almost every year since the early 1980s, I have served as a volunteer athletic trainer for the New York State Empire State Games (ESG). These annual Games, generally held in late July, serve as a statewide Olympic-type event for several thousand amateur athletes. I was assigned as the head athletic trainer for Athletics (track and field) during the 1985 Empire State Games that were held in Buffalo, New York. Although this was quite some time ago, I vividly recall a frightening life-threatening scenario that has had a tremendous impact on me in many ways.

    The scholastic boys’ 10,000 meter run started in the late morning. Although I’m not certain of the exact temperature and humidity readings, it was definitely a hot and humid morning. I was positioned with a physician outside the track around the 250-meter mark or somewhere between the 3rd and 4th turns. On the final lap, we noticed the third-place runner staggering and collapse just as he was coming into the turn. He stood up, took a few more strides, and then collapsed again. He was lying unconscious not more than a hundred meters from the finish line. His coaches quickly reminded the physician and me not to touch this young athlete because he would be disqualified and lose his chance at a medal! Ignoring the coaches’ request, we were quickly able to get the athlete to the ambulance area, which was stationed very near where he happened to collapse. He was initially placed in the shade of the ambulance, and ice bags and wet towels were placed on his neck, forehead, axilla, and groin areas while the EMTs called the Emergency Room where he was to be transported. Initially, the Empire State Games physician at the site ordered the administration of IV fluids. However, the EMTs would not administer it without approval from the ER physicians. Instead, the athlete was placed in the back of the ambulance, which also was warm since it had been sitting in direct sunlight. Precious minutes passed before the ambulance left the venue. Although I do not recall the patient’s core temperature at the time, I later heard it was above 106 degrees F° (rectal) when he arrived at the ER. After several hours of concern about this young man’s health status, I was greatly relieved to learn later that afternoon that our young runner’s core temperature had quickly returned to normal and that he was conscious and alert. If memory serves me correctly, he returned to the track in two days to cheer on his teammates.

    The Empire State Games Sports Medicine Staff wanted to ensure no such recurrence of this type of heat related episode would again occur (a road cyclist also had a serious heat illness on the same day). The night of the emergency, they met to determine what precautionary measures could be implemented. They determined that athletes could have water during their races, longer endurance events would take place in the earlier part of the day, and several events would take mandatory breaks during their competitions (i.e., soccer played periods instead of halves and took rest and hydration breaks between each). Later, certain policies and procedures for the care of athletes were also changed to better care for future emergency situations. In particular a clearer “chain of command” was established to avoid confusion and discussions relating to who was responsible for whom at the time of an emergency. The 1985 Empire State Games ended with no further serious heat related incidences.

    In the years since this near catastrophic event I have discussed this scenario with my athletic training students for a number of reasons. Obviously, a major teaching point is the need to be knowledgeable and prepared ahead of time for heat related problems and other emergencies. In addition to the administration of the most appropriate treatment plan, of great importance is the establishment of a clearly communicated emergency action plan that can facilitate emergency care quickly when there is a potentially life threatening situation.

    For many years I was somewhat curious about the young man from Long Island who had collapsed on that fateful day, and whatever had happened to him. Through an interesting set of circumstances at the 2001 NATA Clinical Meeting and Symposium in Los Angeles, I found out that the young man who collapsed from exertional heat stroke that day was Douglas Casa. We have since spent time together as professional colleagues. We have been able to visit each other’s campuses, speak to each other’s students and faculty members, serve on national committees together, and collaborate on a publication. Most importantly, we have developed a wonderful friendship. I was impressed with Dr. Casa’s research long before I realized our paths had crossed years earlier. I still remain in awe of Dr. Casa’s passion for the work he does, and I am proud to know that my actions many years ago has been a catalyst for the work that he has done since then."

    Douglas Casa, PhD, ATC
    Chief Operating Officer, Korey Stringer Institute
    Department of Kinesiology
    University of Connecticut, Storrs, CT

    "The story that Kent recounts above was the seminal moment of my life.  I have nearly no memory of approximately 6 hours of my life, while I was in a coma, due to the severe exertional heat stroke.  A few lingering snapshots from those 6 hours dangle inside my mind that I occasionally see at the oddest of moments.  For instance, I remember saying my dad’s work phone number, the only comprehensible item to leave my mouth in the 6-hour span.  Why I could recite that number over my home number is still a mystery to me.  I still wonder if a call to my dad about my demise would be better than the news being delivered to my mother.  Amazing how the mind functions at such stressful times.  I also remember chaos and worry and desperation surrounding me at one point in the emergency room and the calming sound of a person in charge (who I came to realize later during my hospital stay was the physician in charge of my care).  I also oddly remember ice/water towels on me during the ambulance ride and a peculiar combination of oppressive/crushing heat and wonderfully cold water dripping on my chest.

    However, the most important part of my story stems from the night of my collapse.  After being released from intensive care to a regular hospital room, I watched the local late-night news at 11:00 p.m. and watched them tell the story of my exertional heat stroke.  It was powerful to lay alone (Buffalo was 10 hours from my house on Long Island) in a hospital room—utterly exhausted, yet peacefully thankful—and watch a news account about myself.  On August 8, 1985, somewhere between 11:00 and 11:10 p.m. EST, the path of my life unfurled in front of me.  For all the years since then, I have been on a quest to try and prevent and treat exertional heat stroke.  My story is not utterly complicated.  My survival penance has been to save as many possible lives from heat stroke and to prepare others who can do the same.  The following story about Ben is one such example of the lives I have been able to touch.

    While exertional heat stroke is one of the most common fatalities related to sports, it certainly is not the only one. This book is the culmination of the efforts of over 30 of the most respected sports medicine professionals and scientists in the world related to preventing sudden death in sports. It is another chance to recognize my gift of survival and pay it forward with information about the top 10 causes of death in sport that can assist in creating more survival stories.  I have experienced a wide array of emotions in my life, but no feeling is greater than playing a role in saving a life.  When you see a person like Ben, with a spouse and child, that you helped save, it stops you in your tracks and  you realize your life has purpose. "

    Benjamin Arthur, MD
    United States Army
    Fort Benning, Georgia

    "At the time of the Marine Corps Marathon in 2008, I was beginning my third year of medical school.  I was a student at The Uniformed Services University of Health Sciences, the military’s medical school.  I had been married for 4 years to my wife, Sara, and we recently had our first child, Mariella Rae.

    I’m not sure what I dreamed about the night before the marathon, what I had for breakfast or what was on my mind as I rode the metro-rail into DC from my home. Maybe I thought about where I was going to meet everyone after the race, or the chili that was going to be on the menu for dinner that night. I do know that possibly never seeing my wife and 6-month-old daughter again was not in those pre-race thoughts.  No matter what I was thinking about, it took a lot of preparation by the Marine Corps Marathon Medical Staff and the “heat deck” team, and a heroic effort by Dr. Casa and his team to save me from dying.

    Beginning the marathon, I decided that I was going to try to beat my only other marathon time by roughly 20 minutes.  I had trained for the previous 3 months and thought I was ready to run my goal-time the morning of the marathon. Several high-ranking Marine Corps officers generated a lot of excitement from the crowd at the start of the race.  There were thousands of runners, and there was an excitement in the air that only a huge race could cause.

    I started the race fast.  I was running under my pace each mile, but I felt good.  The temperature was in the upper 50’s and I was trained; I thought I could handle it.  It wasn’t until mile 16 that I felt like I had hit a wall.  I thought mile 16 was too early to hit that wall, so I pushed harder.  I maintained my pace through mile 20, then 22, then 24.  During those miles, I started getting tunnel vision and angry.  All I could think about was finishing and how it was almost over.  I thought if I finished strong and made my time, it would all be over soon.  I didn’t know how right I was.  I made it from mile 24-26 with my tunnel vision increasing and my general attitude worsening as well.  I hit the final .2 miles and tried to sprint to the end.  That is where everything went downhill in a hurry.  I fell twice on the final hill and was helped across the line by my running partner as well as a race official.  Looking down as my feet crossed the finish line was the last thing I remembered until the middle of my treatment for my exertional heat stroke.

    Next, cue Dr. Casa and his team.  Twenty to thirty of the most important minutes of my life passed without me knowing how hard perfect strangers were working to keep me alive.  The next thing I remember after seeing the finish line was looking up at the top of a blue tent as I was laying in the ice-bath with people all around me cooling me off as fast as they could.  I answered a few questions to prove that I was conscious and continued to be cooled.  From that moment, it was a whirlwind of activity, a short trip to the ER, and I was still home with time enough to eat that chili I probably thought about on the Metro-rail.

    Dr. Casa and I have exchanged several emails, but I have only had one opportunity to meet him.  It was a year later when he and his team were gearing up for the next Marine Corps Marathon at a local restaurant.  Over the course of the meal, he shared his perspective of my treatment as well some new projects he was working on.  It was evident that he has a passion for preventing deadly sports injuries and is one of the best in the world at what he does.  He and I are connected forever because we both had heat strokes during a sporting event and through our profession we have the opportunity to help others in similar situations.

    Now, having just graduated from medical school, I am blessed with a unique opportunity.  I will start my Family Medicine residency in Ft. Benning, Georgia—where, coincidentally, the most heat injuries in the Army occur due to the high temperatures and intense training programs.  While in Georgia, I will have the opportunity to treat heat injuries at various training events, both immediately on-site and after the initial incident away from the event.

    It is a great honor to provide care for soldiers.  One day I will be the senior medical provider treating heat injuries and will have lives depend on my training and care.  Over the last several years, I have gained a new found respect and professional interest in heat injuries and will hopefully provide excellent care—the same kind of care I received in my hour of need."

    Endorsed by the American College of Sports Medicine (ACSM), Preventing Sudden Death in Sport and Physical Activity is available for purchase on May 25  through the Jones & Bartlett Learning website at or by calling 800-832-0034. Qualified instructors who wish to consider the text for course adoption are invited to request a complimentary review copy. Bulk discounts are available.

    Click here to view a complete table of contents.


    Topics: New Text, New text, preventative measures, Sports, sports

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