Matthew Whittredge had to be excited. The 15-year-old sophomore had so much to look forward to—his fourth year of football, being an Eagle Scout, singing with the school choir. On the first day of football practice at Circle High School in Towanda, Kansas last August, Whittredge took the field with his teammates in the middle of a hot afternoon. The temperature was over 100 degrees when practice began and around 98 when, three-and-a-half hours later, Whittredge collapsed. His body temperature measured 109 degrees when he arrived at a local hospital. He died the next morning.

This story may seem an aberration, an isolated tragic incident. It’s not. Three other high school football players in the United States died of heat stroke in 1998, including one at a Wichita high school a few miles from where Whittredge collapsed. In the past four years, 11 young football players have died from heatstroke in the U.S. From 1960 through 1998 there have been 91 heatstroke cases that resulted in death.

“Heat stroke deaths are preventable,” says Fred Mueller, chairman of the Committee of Football Injuries for the American Football Coaches Association (AFCA). “Sometimes you say, ‘This was an accident, and maybe it wasn’t preventable.’ But I think most heat stroke deaths are preventable.”

Mueller, professor and chair of exercise and sport science, directs the National Center for Catastrophic Sport Injury Research at Carolina. The center issues annual reports on deaths and severe injuries from amateur and professional sports, advising the public on problems such as heatstroke in high school football.

The AFCA initiated the First Annual Survey of Football Fatalities in 1931 at Yale University before it was moved to Purdue in 1946. It has been at UNC-CH since 1965. Mueller took over in 1980, and two years later, thanks to additional funding from the National Collegiate Athletics Association (NCAA), he expanded the report to include all sports and, in the process, has uncovered some surprising statistics.

Football is widely regarded as the most dangerous sport as far as catastrophic injuries and deaths are concerned. But the incidence of injury per 100,000 participants is higher in both gymnastics and ice hockey.

The study focuses both on direct injuries—those which occur during the course of participation—and indirect injuries—those which are related to the activity. One of the most tragic examples of indirect injuries is the danger involved in young players moving heavy, portable soccer goals on and off a field. Since 1979, there have been at least 18 deaths and 14 serious injuries to children when movable soccer goals have fallen on them.

Cheerleading is overwhelmingly the most dangerous sport for female athletes. In 1994 there were 16,000 emergency room visits caused by cheerleading injuries. Since 1982 there have been 18 serious injuries and one death in high school, and one death and 16 serious injuries in college.

“The first couple years after the expansion were interesting,” Mueller says. “I think the first year we saw four deaths in pole vaulting. And nobody knew that this was happening around the country.”

That’s where Mueller comes in. His goal is to educate the masses about potential epidemics in the realm of sports. His method is the science of epidemiology, a discipline which relies on empirical research of sickness or injury and the surrounding environment and circumstances.

The annual injury reports and their recommendations have led to important rule changes in various sports. A 1976 rule in college and high school football prohibited initial player contact with the head while blocking or tackling. Another rule passed at the college level in 1978 and at the high school level in 1980 created a standard for football helmets for the first time. Serious injuries rapidly declined, almost as fast as football helmet manufacturers were run out of business by civil lawsuits, dwindling from 16 before the rule change to just two today.

While an all-time high of 36 deaths directly due to football occurred in 1968, there were none in 1990. Although that remains the only year on record to have no direct football deaths, the average number of deaths per year has plummeted, from 20.7 in the decade proceeding the rule changes (1967-76), to 7.9 in the decade following (1977-86), to just 4.0 during the past 12 years.

The pole vault has been a constant source of contention regarding sports injuries. The sport is enjoying increased popularity, especially with females. The NCAA crowned a women’s pole vault champion for the first time in 1999, and most states have added the girls’ pole vault as a high school event. At the same time, the sport is under continuing scrutiny because of its inherent danger. Since it is an event within the sport of track and field, accurate participation figures are difficult to obtain. If the current estimate of 25,000 pole vaulters in high school is accurate, the sport would have the highest catastrophic injury rate. Some states have considered eliminating the event from high school competition while others are considering requiring the athletes to wear helmets while vaulting.

Mueller’s feelings on the sport mirror his belief about the best way to prevent most sports injuries: coaches with better information and training.

Mueller sends the annual reports to a number of places, including the National Federation of State High School Associations (NFSHSA), which is supposed to disburse it among the state associations and on down to the individual high schools.

“I’m not sure how far it dwindles down to the coach in Podunk High School somewhere. Which is important, that’s the guy who needs the information,” Mueller says.

University News Services helps by getting the report on the Associated Press wire, which generates a large volume of telephone calls from reporters to Mueller. He sees this as an important part of his role in the study. “Sometimes when it gets in the newspapers, it’s better than getting it in the medical journals somewhere,” Mueller says. “Because the people reading the newspapers are the guys who need to know this information.”

Several sources help Mueller collect data on injuries. Then he consults with Robert Cantu, a neurosurgeon at Emerson Hospital in Concord, Massachusetts, to make recommendations in each report. The NCAA, the AFCA, the NFSHSA, and colleagues around the nation send information to Mueller, who also subscribes to a newspaper clipping service that monitors about 14,000 newspapers. Once a serious injury happens, Mueller contacts the school, coaches, or athletic director to collect as much information as possible. Cantu contacts the supervising physician. It isn’t always a smooth or easy process.

“Sometimes the information is difficult to get, especially if a lawyer gets in too soon,” Mueller says. “If I don’t get them pretty quick, sometimes the lawyer will say ‘no information about this accident.’ They’ll tell the school that, they’ll tell the coach that, they’ll tell everybody. Sometimes the school personnel are concerned that if they let this information out, it makes them look bad. But you’ve got to let them know that what you’re trying to do is help the situation, trying to prevent future injuries.”

Mueller has been exposed to sports and injuries since he arrived at Carolina in 1956. After finishing his undergraduate studies, when he also played offensive guard for the football team, he completed master’s and doctorate programs before joining Carolina’s physical education department. In all that time, the worst series of cases Mueller has seen occurred in 1997.

In the span of six weeks, three college wrestlers died while trying to reduce their weight to qualify for competition. Each of the athletes was wearing a rubber suit and performing intense cardiovascular exercises in an attempt to shed 12-15 pounds in a very short time. All under the supervision—perhaps encouragement—of an assistant coach. One of the athletes, a 19-year-old freshman at Campbell University in North Carolina, began working out at 2 a.m. in an attempt to drop six pounds before a 6:30 a.m. weigh-in. He refused to drink water and collapsed while trying to step off an exercise bike. Officials said he died from a heart attack.

“In one case, the kid had to crawl to the scale. He couldn’t walk, he was so weak. And it took time for those coaches to realize they had a problem, before they had to call for medical help,” Mueller says. “It was awful. It was the worst thing I ever read about.”

Mueller, winner of the 1997 Dr. Ernst Jokl Sports Medicine Award presented annually by the United States Sports Academy, continues to expand his areas of study. He recently began working with Little League baseball to explore the possibilities of adding new protective measures to the oldest, most popular sports league in the nation. Among consideration are movable bases, face masks for batters and infielders, and chest protectors for batters.

“There are a number of Little League kids who get hit in the chest with the ball, right over the heart, and it hits at the exact time the heart is between beats,” Mueller says. “The kid drops. He’s dead and you can’t bring him back. About seventy-five kids in the last twenty years were killed that way. So some people say they should wear the chest protectors. That’s something people are looking at.”

People like Mueller, who will continue to analyze injuries of the past in an attempt to reduce injuries in the future. You can’t turn back time to prevent what happened to Matthew Whittredge. You can only learn from the tragedy and try to prevent it from happening again.

Revising the Rules

Reports generated by the National Center for Catastrophic Sport Injury Research based at Carolina have led to several significant rule changes, including a 1976 provision which made it illegal for a football player to initiate contact with his head. This change, combined with new helmet standards adopted between 1978-80, helped dramatically reduce the number of serious injuries and deaths in all levels of football.

Other significant rule changes spurred by the research:

· Since the National Federation of State High School Swimming Association adopted a rule on minimum starting depth in 1992, there have been no catastrophic injuries or deaths in swimming. There were seven serious injuries in swimming prior to the rule change, all directly related to the racing dive in the shallow ends of pools.

· Ten people have been seriously injured when they were struck by a discus, shot, or javelin. A 1993 rule change required the back and sides of the discus circle to be fenced.

· In high school pole vault, there were 13 deaths, seven permanent disabilities and six serious injuries from 1983 to 1997. All 26 of the accidents involved the athlete bouncing out of or landing out of the pit area. A 1987 rule change required all individual units in the pole vault landing area to include a common cover or pad extending over all sections of the pit.