When Douglas Casa was 16, he was nearing the end of a 10k race when he collapsed. He got up, then collapsed again close to the finish, falling into a coma. An athletic trainer who realized Casa was experiencing heat stroke saved him by covering him with iced wet towels before he was transported to the hospital. Casa woke up from his six-hour coma in time to watch the story about his ordeal on the local news. Casa went into sports medicine, and heat stroke became his area of expertise. He’s now the chief operating officer of the Korey Stringer Institute at the University of Connecticut’s Neag School of Education. (Stringer, as you may remember, was an NFL player who died in 2001 from exertional heat stroke.) Over the last several years Casa has widened his expertise to other causes of sudden death in people participating in sports or exercise, and he’s edited a textbook on that topic that was released last month. We talked to him about the issue. Here’s an edited excerpt of our conversation: The book covers a bunch of different causes of sudden death. What are the most common? Cardiac conditions , heat stroke, head injuries and exertional sickling, which may happen to people who have the sickle cell trait. [Those people have one copy of the abnormal gene but not the two required for full-blown sickle cell anemia.] They do intense conditioning without recovery and their hemoglobin molecules sickle and can’t deliver oxygen, which causes rhabdomyolysis [the breakdown of muscle fibers and the resulting release of potentially harmful contents into the blood]. What are the sports or activities where sudden death happens? In America at the high school and college level, the most common sport where you see problems is football. Only half of high schools have athletic trainers. Parents should be scared about that, because the coach is deciding what the condition is and how to treat it. With almost every condition in the book, what you do in the first five to ten minutes will often dictate whether

an athlete lives or dies. What should parents know about the sports programs in which their kids participate? They should demand that their school system has an athletic trainer at the high school. That’s by far and away the most important thing. They should ask what training the coach has. And they should check with kids to see how they’re treated.  Sometimes coaches think they have control over fluids [like water and sports drinks]. But fluids should never be used as a weapon or a tool by a coach. Athletes should have free access to them. Parents should also make sure there’s proper equipment, including automated external defibrillators. They should make sure the AEDs are near the fields. Where do you see problems in recreational sports? For the public at large, it’s running — road races. That’s probably because of the sheer volume of people who participate. And the problems that arise? Cardiac conditions, heat stroke and hyponatremia [low levels of blood sodium that can be caused by drinking too much water during extended exercise]. So what do you tell people about knowing whether they’re in trouble? People need to heed their body’s warnings. With heat stroke, for example, people will feel that things are much harder than they usually are. There’s a feeling of overwhelming fatigue. People will try to fight that and to keep up a pace at 90 degrees that they’d keep at 60 degrees. I’d also advise any recreational athlete embarking on a new activity to see his or her personal physician first. I guess this doesn’t give me an excuse to skip a workout. The health benefits of exercise obviously outweigh the risks we’re talking about. But almost all the ways athletes die in sports are avoidable, whether by implementing proper prevention strategies or by utilizing appropriate and expedient recognition and treatment plans. There are precautions you can take. Bonus: Four Tips for Lowering Heat Stroke in High School Athletes Image: Associated Press

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Health Blog Q&A: What Kills Athletes on the Field