August 12, 2011 by · Leave a Comment 





The United States and other Nations have many Great, Dedicated, Trustworthy, Reliable, Teacher Coaches. But a small percentage of Coaches, like Doctors, Attorneys, Judges, Teachers, Construction Workers, and other professions and trades have some that need better Education and Awareness.


Athlete Victim:
 Serious Injury and/or Death of the Child and Youth Athletes
 Who sustain Child and Youth Human Rights Disorders
 Who sustain Child Athlete Abuse Syndrome, Physical and/or Psychological (Emotional) Endangerment, Maltreatment and/or Sexual Abuse

Coach Victim:

 Coach might face Criminal Prosecution and Civil Suit
 Prevent Blindsiding Coaches with Education and Awareness:

A. Coaches are hired to Coach Athletes who are often, nowadays, Obese, Indoor Electronic Sedentary Inhabitants

B. Coaches are often hired to Coach in Bottom Line, Win-At-All-Costs Dysfunctional Sports Communities. Their superiors and associates who contribute to that dysfunction are School Boards, School Officials, Fans, Media, Parents, Sports Medicine Doctors, FAmily Doctors, High School and College/University Athletic Associations and Federations etc.

Coaches if not Educated and made Aware might be hung out to dry by Dysfunctional Sports Communities. These communities might make a lot of noise around the community, but the Coach will sit alone with his Attornies at the Defendants Table in Court.

C. Coaches should be Educated and Made Aware and Trained to be calm teachers and trustworthy mentors of student-athletes; trained to have Respect for the Athletes’ Humn Dignity, take Responsibility for the Safety, Health and Welfare, develop Positive Relationships with the Athletes and always Recognize the Athlete for proper play execution and a job well done.

When the Coach is a Hardnosed, Coercive, Win-At-All-Costs, Yelling-Screaming Coach, who believes he/she is Immune to Prosecution or Civil Trial and is not Educated or Aware about the Consequences of Crossing the Line and the Coach Pushes and Punishes Athletes beyond their Physical and Psychological (Emotional) Limits, legal trouble lurks around the corner for the head Coach.

D. Coaches should be Educated and Made Aware and Trained about Drastically Different Inside and Outside Environments, Global Warming, Air Pollution, Improvement of Safety Standards Inside and Outside

E. Coaching Behaviors can put the Coach in the Front Yard of Society one week and the Top of The Stairs of the Court House the next, because Ignorance of Child and Youth Amateur Athlete Human Rights and Child Protection and Supervision Laws are no Excuse and no Court Defense.

• Coaches and Teachers are directly Responsible to Unlawful Behavior
• Coaches and others were targeted as potential Abusers and Perpetrators by the Surgeon General
• COaches and Teachers in this scenario are like the Football player who scores a Touchdown. The player who crosses the goal line with the football gets credit for the TD.
• The Coach who crosses the line by pushing and punishing Athletes beyond their Physical and Emotional Limits or initiates Sexual Athlete Abuse, whether the Coach ignored, overlooked Rules of Law or did not know the Rules of Law or the violations were intentional or willful, the Coach gets the blame for the Unlawful Behavior.
• When the Coach crosses the line with Bad Behavior, the Coach catches the liability for the Risk.
• Unfortunately, Child and Youth Athlete Protection and Supervision Law Enforcement are Most Important Deterrent to Preventable, Non-Accidental Injuries and Deaths.

Crimes against Children and Youth in Sports Have Been and Will Be Disciplined, Penalized, Punished, Prosecuted.



Recently the book, FACTORS UNKNOWN by Rodney Daugherty went on sale. It tells Daugherty’s and other viewpoints about the tragic death of Max Gilpin. In our great country, everyone is free to have an opinon.

Coach Jason Stinson, former Coach of Louisville PRP, was tried and acquitted for the Death of Football Athlete, 15 year old Max Gilpin. The death was 3 days after Max Gilpin collapsed, 20 Aug 2008. The Criminal Trial was Sept. 2009.

In an interview Coach Stinson said he learned a great deal of information during his trial. He said had he known all those facts, he would have cancelled practice the day Max Gilpin collapsed.

When a Coach becomes an Athlete Safety 1st Advocate and describes the Lessons he Learned after a Tragic Injury or Death of one of their Athletes, that Coach becomes one of the strongest Advocates for Athlete Safety.

Hopefully, Coach Jason Stinson will continue his advocacy for Athlete Safety from the Lessons Learned from his experiences.



Children are Entitled to protection on Every Inch of This Earth During Every Second of Time in Every Nation. That is U.S. State, Federal, International Law. Everyone, Everywhere has a Duty to Serve Child Protection Law


Coaches must be educated. When Coaches Cross the Line Punishing and Pushing Athlete Beyond Athlete Physical and Psychological (Emotional ) Limits is where Coaches cause Preventalbe, Non-Accidental Injuries and Deaths and self infllict their own Legal Problems.

Max Gilpin, a 15 years old, Louisville PRP High School Football Athlete, collapsed, August 20, 2008, 2 years ago today. He died 3 days later. Condolences to and Prayers for the family. May Max Gilpin Rest in Peace. His death was not in vain because we have learned many lessons that might save others. What are the lessons learned?

 The First Reaction to the Death of Max Gilpin was The Grand Jury Indictment of Coach Jason Stinson, because he practiced his PRP team in a dangerous environment according to one of the detectives who investigated and testified, that caused Child Endangerment that resulted in serious injuries and death
 COACHES are shocked to learn they can be investigated, indicted and tried in Court after a Report of CAAS
 Even in Contact and Collision Sports
 Even though the Coach followed High School Athletic Association / NCAA Rules to the letter.
 High School Athletic Association and NCAA Rules, Regulations and By-laws are not Legal Authority.
 Those are Contract Rules Between Member Schools and Associations To Obey to Play Interscholastic Intercollegiate Games Competitions by the Rules.
 Coaching Behaviors can put the Coach in the Front Yard of Society one week
The Top of The Stairs of the Court House The next
 Ignorance of Child /Youth Protection Laws are no excuse and not Court Defense
 Unfortunately, Child Protection Law Enforcement is Most Important Deterrent to CAAS
 Crimes Against Children and Youth in Sports Have Been and Will Be Disciplined, Penalized, Punished, Prosecuted
 Athlete Criminal Injuries and/or Death Puts The Coach At Risk For:Criminal Charges and Civil Suit
 Coach Stinson was the first Coach to be indicted and tried for the Death of a High School Football Athlete.
 Former Kentucky high school football Coach Jason Stinson was acquitted in the death of Max Gilpin. He was facing reckless homicide and wanton-endangerment charges in connection with 15 year old Child Max Gilpin heat-stroke death. Max wasn’t even old enough for a drivers license.
 Coach Stinson was acquitted on all criminal charges September, 2009.
 During the Civil Wrongful Death Suit Insurers for Jefferson County Public Schools and its employees have agreed to pay $1.75 million to the parents of 15-year-old Pleasure Ridge High School football player Max Gilpin, who died from heat stroke three days after he collapsed at a practice in August 2008.” [http://www.courierjournal.com/apps/pbcs.dll/article?AID=2010309160053]
 The final settlement was said to be $1.74 million


 “Juvenile and Family Court Judges are the Gatekeepers of our nation’s Child (Athlete) Abuse Systems.”
 The Child is a very special creation. The definition of Child, a minor less than 18 years of age, is the defining label that alerts those who have the duty for Child Protection and Supervision.
 A Child can be an Athlete without a Sport, such as a Cheerleader (as the struggle continues), a student without a school or an orphan without a home,
 yet when born in the U.S. and most of the World, thanks to the U.N., they are entitled to Proper Child Protection and Supervision. Sports, schools, and homes are merely different settings. They are not the Child. Settings are not the essential requirement …Child is.
 “An Abused or Neglected Child” means a child whose health or welfare is harmed or threatened with harm when his parent, guardian, or Coach who are expected to exercise Protective Custodial Control or Care-Giving Supervision of the child, fails to provide Proper Protective Custodial Care and Control and/or Proper Supervision.
 Juvenile and Family Courts serve a Dual Purpose
 1. Punish Juveniles when they commit a Crime
 2. Punish Adult offenders who commit a Crime against a Child
 Juvenile and Family Courts have exclusive jurisdiction for all types of Child Abuse and Neglect:
 the Juvenile session of the District Court or the Family division of the Circuit Court Shall have exclusive jurisdiction for Children less than 18 years and who allegedly are neglected, or abused; KRS 610.010
 The Burden of Proof for Criminal Child Abuse is less than charges in Adult Criminal Coourt.
 The County Attorney or Prosecutor can file charges of Criminal Child Abuse in Juvenile and Family Court.
 In Adult Criminal Court, the County Attorney or Prosecutor must bring the case to the Grand Jury for an Indictment.
 “In cases where criminal charges arising out of the same transaction or occurrence are filed against an adult alleged to be the perpetrator of child abuse or neglect, such charges shall be tried separately from the adjudicatory hearing held pursuant to this chapter.” KRS 620.120.
 In other words there can be collateral or parrallel Court Cases in J/F Court and Criminal Court.
 Adjudication did not occur in Family or Juvenile Court independent of the other criminal adjudication in Jefferson Criminal District Court in the case of Max Gilpin.
 Attorneys did not prosecute the case in Jefferson Juvenile Court.
 Children have special needs during court proceedings. Thus the concept for Child Protection and Human Right of the Child in Juvenile and Family Courts.
 An example is the Coach Stinson Criminal Case: Children witnesses were paraded across the witness stand in a trial that was open to the public and video streamed by the Courier Journal newspaper over the Internet. Children’s testimonies appeared hesitant and altered by their inappropriate examination and their public display.
 Children Witnesses public exposure and spectacle were unfortunate.
 That is the reason why all types of Child Abuse and Neglect are the exclusive jurisdiction of Juvenile and Family Court. These Courts are not open to the public; No TV or publications. The Human Rights of all Children are protected.
 All Children have Rights in Court Defendants, Plaintiffs, Witnesses, every Child
 Juvenile and Family Courts have been created to take care of the special needs of All Children and protect Children’s Rights during a Child Abuse proceeding.
 Child Victims, Offenders and Witnesses’ Rights are protected.
 If a 15 year old High School Football Athlete with Exertional Heat Stroke and Acute Respiratory Distress Syndrome is examined and treated in the Emergency Department, because of the nature of the Injury and the Extreme Weather Conditions, the hospital notifies the CPS Child Protective Services. CPS, in turn, notifies the police. The agency initiates and investigation that results in proceedings in Juvenile/Family Court. At the same time after a criminal investigation by the County Attorney of Criminal Prosecutor initiates felony proceedings in Adult Criminal Court.
 In such cases there are often two separate, simultaneous court proceedings involving the same victim, the same alleged Adult Offender, and to a large extent, the same incidents of maltreatment.
 Unless there is coordination between these two proceedings, there are duplications of effort, inconsistent decisions, wasted resources, and needless trauma to child victims and child witnesses. Coordination is needed at all stages: investigation, case preparation, and litigation.
[Coordination of Juvenile and Criminal court Child Abuse and Neglect Proceedings, by Marcia Sprague and Mark Hardin, University of Louisville Journal of Family Law Volume:35 Issue:2 Dated:(Spring 1996) Pages:239-324]


 Possibly CPS refused to investigate Max Gilpin’s Death since there was adjudication in Adult Criminal Court
 Jefferson Juvenile Court was not involved
 There was no Coordination of Juvenile and Criminal Court
 CPS (Child Protective), DCBS (Department of Community Based Services) and The Kentucky Cabinet for Health and Family Services are mandated to investigate all cases when a Teacher/Coach is suspected of Abuse. They SHALL be investigated the Federal law states. “Caretaker” is a person who is responsible for the supervision and well-being of a Child 42 U.S.C. 5106a(b). The federal word SHALL means mandated by law.
 Doctors are the most important hands-on immediate advocates for Athletes. Doctors can intervene for an athlete instantly for Athlete Safety.
 The Kentucky Department for Community Based Services [DCBS] “provides family support; child care; child and adult protection, improve safety and permanency for children and vulnerable adults;” Recently in Kentucky, The Child Safety Branch of DCBS responded to the question regarding coaches as caregivers. Their answer and policy follows:
 “Our agency [DCBS] investigates abuse and neglect allegations involving situations where a person is providing care, has custody or has control of a child. Teachers, camp counselors, bus drivers, babysitters, grandparents, coaches etc fit in to that category if they are left to care for a child and the parent is not present for supervision. We are investigating these type situations in this manner across the state. If [DCBS] staff have questions about whether a person falls into these categories, they can consult with Central Office or their regional attorney.”
 The definition from the Government’s Guidance on Adult Abuse: “a person aged 18 years or over….who is unable to protect him or herself against significant harm or exploitation”.
 However, there is a Fiduciary Trust of Relationship of the College/University Coach and their Athlete. The Coach is charged with scrupulous, honorable, conscientious, trustworthy Protection of the Youth Athlete.
 Doctors who fail to Report Serious Injuries and/or Death that result from Child Maltreatment, Endangerment and Abuse of any kind, are subject to charges of Failure to Report and possible malpractice claims.
 When such reports are received by social services or health care agencies, and involve allegations of sexual abuse, serious physical injury, or life-threatening neglect of a child, there shall be an immediate referral of the report to a law enforcement agency with authority to take emergency action to protect the child.
 All reports received shall be promptly investigated, and whenever appropriate, investigations shall be conducted jointly by social services and law enforcement personnel, with a view toward avoiding unnecessary multiple interviews with the child.
 CPS in Louisville possibly refused to investigate the Death of Max Gilpin according to a reliable source after the criminal adjudication.
 But the County Attorney conducted a several month long investigation
 Doctors are mandated to report serious injuries and/or death to authorities (the County Attorney, CPS) when the doctor suspects Child Athlete Abuse and/or Negligent Coaching Supervison or any Child Abuse and/or Neglect.
 ”Doctors are the eyes and ears of Child Welfare”.
 Several witness to the football practice reported to the County Attorney that Max Gilpin collapsed from suspected maltreatment as they are mandated to report, when a person suspects Child Athlete Abuse or Negligent Coaching Supervision.


 Children are mandated to attend school. The Protective Custody and Care-Giving Supervision are transferred to the Teacher for curricular activities and the Coach during extracurricular school activities. They have a Duty to Protect the Child.
 The premise for this duty is that a child is compelled to attend school. “The result is that the Protective Custody of Teachers and Coaches are mandatorily substituted for that of the parent.
 Teachers and Coaches assigned to supervise Children and Youth during school sponsored curricular or extracurricular activities have a duty to exercise that degree of care that ordinarily prudent teachers or coaches engaged in the supervision of students of like age would exercise under similar circumstances.


 Max Gilpin, a 15 years old, Louisville PRP High School Football Athlete, collapsed, August 20, 2008. He died 3 days later.
 His official Cause of Death was Exertional Heat Stroke
 Dr. Doug Casa,PhD was in 2009 the director of athletic-training education at the University of Connecticut
 Dr. Casa was “the prosecution’s primary expert witness in the trial of former PRP head coach Jason Stinson”
 Coach Stinson was “facing charges of reckless homicide and wanton endangerment in Max’s death”
 Dr. Casa said “Max Gilpin would have survived if Pleasure Ridge Park’s coaching staff had treated his heat stroke correctly after he collapsed at a football practice last year
 Dr. Casa “told jurors that though the 15-year-old’s body temperature reached 109.4 degrees shortly after he collapsed
 “His life would have been “guaranteed” saved if staff would have taken Max into the school’s locker room, about two minutes away, and put him into an iced whirlpool within five minutes of when he went down.” Kiddy Pool filled with Ice and Water
 “If treated immediately and aggressively … it’s 100 percent survivable,” Casa told the jury. “No kid should ever die from heat stroke.”
 “Casa served on the medical staffs at the Boston and New York City marathons and is the author of numerous studies on heat illness”
 “Stinson’s defense objected to that comment, arguing that Casa is not a medical doctor”
 “With jurors out of the courtroom, Judge Susan Schultz Gibson agreed, ruling Casa could not testify about the factors that caused Max’s death or whether he was dehydrated when he collapsed.”
 Many disagreed with that ruling because Dr. Doug Casa is a certified Trainer and first Emergency Medical Responder and Professor of Athletic Trainers. who themselves are First Responders during Marathon Events where Dehydration and Heat Illness and Heat Stroke are frequently documented, diagnosed and treated.
 Kosair Hospital doctor, “Dr. Leslie Greenwell, a pediatric emergency physician who was the first doctor to treat Max at Kosair that day, testified that Max’s urine sample suggested (Max) was adequately hydrated.”
 Dr. Katherine Potter, “a pediatric intensive care physician, who began treating Max in the internal-care unit that night, told jurors she diagnosed Max as a victim of heat stroke and dehydration, based, in part, on his elevated heart rate, high temperature and that he needed four liters of fluid when he arrived at the hospital.”  “Prosecutors have said Stinson ran players excessively and denied them water at the practice. Max died Aug. 23 at Kosair.”
 Defense lawyers have argued that while the practice might have been more strenuous than usual, Stinson violated no (High School Athletic or Jefferson County Public School) rules or policies and Max was not dehydrated.
 High School Athletic or Jefferson County Public School are NOT Rules of Child Protection and Supervision Law.
 “Stinson’s defense is also alleging that Max’s use of the prescribed drug Adderall, an amphetamine used to treat attention-deficit hyperactivity disorder
 “and had a viral illness that defense lawyers believe Max may have had the day of practice contributed to his collapse, due to blool Lymphocyte Count.
 Max Gilpin’s Blood Lymphocyte Count was due to Weight Lifting and Exercise to Exhaustion, not a virus, typical 1-3 hours after Weight Lifting and Exercise to Exhaustion.

[3. Human lymphocyte subpopulations effect of epinephrine. D T Yu and P J ClementsClin Exp Immunol. 1976 September; 25(3): 472–479. PMCID: PMC1541403
4. The Endocrine System in Sports and Exercise By William J. Kraemer, Alan David Rogol 5. Exercise and sport science (Book) By William E. Garrett, Donald T. Kirkendall 6. Effects of brief, heavy exertion on circulating lymphocyte subpopulations and proliferative response. Nieman DC, Henson DA, Johnson R, Lebeck L, Davis JM, Nehlsen-Cannarella SL. Med Sci Sports Exerc. 1992 Dec;24(12):1339-45
Department of Health, Leisure, and Exercise Science, Appalachian State University, Boone, NC 28608. 7. Exercise and disease By Ronald Ross Watson, Marianne Eisinger 8. Eur J Appl Physiol Occup Physiol. 1991;63(6):449-57
Circulating leukocyte and lymphocyte subpopulations before and after intensive endurance exercise to exhaustion. Gabriel H, Urhausen A, Kindermann W. Institute of Sports and Performance Medicine, University of Saarland, Federal Republic of Germany. 9. Advances in exercise immunology By Laurel T. Mackinnon 10. LYNPHOCYTES AND EXERTION, Immune response to heavy exertion David C. Nieman J Appl Physiol 82: 1385-1394, 1997;]

 “Dr.Melissa Porter, said the teen had no viral infection. But he did test positive for amphetamines, though the results did not say in what amount.
 Brian Butler, an attorney for Stinson, showed Porter a notation staff member at the hospital wrote that Max “may not have been feeling well on day of collapse.”
 Dr. Porter “said she was not sure who the hospital staff member had spoken to and testified that Max’s mother, Michele Crockett, told her Max had been feeling fine that day.
 Prosecutors have said Stinson ran players excessively and denied them water at the practice. Max died Aug. 23 at Kosair.
 Coach Stinson said to the players we’re going to run till someone quits
 Someone quit that day as Max began to die
 Defense lawyers have argued that while the practice might have been more strenuous than usual, Stinson violated no rules or policies and Max was not dehydrated.
 High School Athletic or Jefferson County Public School are NOT Rules of Child Protection and Supervision Law.
 High School Athletic Associations do not promulgate rules for High School practice or Junior High Sports. They have no rules or policies to violate in practice.
 “Stinson’s defense is also alleging that Max’s use of the prescribed drug Adderall, an amphetamine used to treat attention-deficit hyperactivity disorder, and a viral illness that defense lawyers believe Max may have had the day of practice contributed to his collapse.
 “Dr. Melissa Porter, said the teen had no viral infection.
 “But he did test positive for amphetamines, though the results did not say in what amount.
 It is an Oxymorom to have a normal Urine Specific Gravity and have Amphetimine Toxicity at the same time. Traces of ampetamine will not alter the Specific Gravity.
 “Brian Butler, an attorney for Stinson, showed Porter a notation in Max’s medical records in which a staff member at the hospital wrote that Max “may not have been feeling well on day of collapse.
 ” Porter said she was not sure who the hospital staff member had spoken to and testified that Max’s mother, Michele Crockett, told her Max had been feeling fine that day. [Jason Riley, Courier Journal Sep. 10, 2009]


Everyone is entitled to their Medical Opinion
Coach Stinson’s University Football Coach Was a Bear Bryant Disciple
Stinson said “We’re going to run till someone quits, the day Max Gilpin collapsed.
 Someone quit that day……as Max Gilpin Began to Die
Responders attempted to recusitate Max but he slipped further into unconciousness.
Max Gilpin’s helmet, jersey, pads and pants were removed, ice bags were applied and he was doused in water
EMTs were called. He was transported with a teammate to the hospital.
IV’s were started, IV fluids administered, EMTs attempted unsuccessful intubaion (tube in the lungs), Oxygen was mask insuflated, his body was cooled in route
 Max Gilpin’s diagnoses on presentation to the Emergency Department (not after hours in the hospital after secondary organ systems failed), in my medical opinion, were Exertional Heat Stroke and ARDS secondary to Ozone Toxicity from the synergism of Ozone and dangerous Heat, and Rhabdomyolysis, severe muscle damage, from Exercise to exhaustion.
 The transient increased lymphocyte cell count in the emergency department was typical for Exercise to Exhaustion 1-3 hours after weight lifting and 1-3 hours after running gassers. Not a viral infection.
 The second blood count had a typical granulocyte cell count. A viral infection would not have changed the white count in those few hours.[Many References]
 Approximately 10 football athletes had the same condition, retching and difficulty breathing near the end of practice, Hallmarks of Exercise to Exhaustion in Heated Ozone.
 An Additional Athlete was hospitalized at the same time as Max Gilpin with Severe Asthma from the Synergism of Heated Ozone.
 Common things occur commonly
 The medical dictum is applicable: “WHEN YOU HEAR HOOFBEATS THINK HORSES NOT ZEBRAS.”.
 Activity diesel school buses arrived before the end of football practice according to testimony. Did these buses possibly create a “hot spot” of Ozone from their exhaust emissions to the practice field?
 Did the Diesel School Busses push the already dangerous environment over the edge and contribute to the dangerous Football Environment Illness Epidemic
 Max Gilpin was not dehydrated according to laboratory findings. Yet that has been the continued unsuccessful line of questioning.
 August 20, 2008, the day Max Gilpin collapsed, the Heat index was 94* and the AQI was near 106, unhealthy for sensitive groups. Today, Aug 20, 2010, Friday, the Louisville AQI will be near 104 and the Temperature will be 95*. Since this is game day, most games will be at night.
 The Air Alert for August 20, 2008 was announced publicly in Metro Louisville.
 If the diagnosis, ARDS, was only on the Chest X-Rays packet with the name Maxwell D. Deruces, rather than Maxwell D. Gilpin and both names had the same account number, and if the Criminal investigator only requested the medical records under the name, Maxwell D. Gilpin, the records under the name Maxwell D. Deruces might not have been available to the Criminal investigator and ARDS and Ozone Toxicity not entertained in the differential diagnosis. Only one possibility.
 ARDS, Ozone and Air Alert were never mentioned in the Criminal Trial
 Young physically fit Athletes can continue exercising despite not feeling well, over heated and having difficulty breathing.
 If the high heat load from exercise and climate is not removed the heat load might progress into heat stroke, where the extreme body temperature (above 40.5 ºC, 104 ºF) will lead to damage to cellular structures and the thermoregulatory system and a high risk of mortality. [08 September 2003 The health impacts of 2003 Summer Heat Waves Briefing, Delegations 53rd session of the World Health Organization Committee]
 Aug 20, 2008 was the 7th straight day that PRP practice had been conducted in a Heat Index of near 94 degrees according to the Coach’s Log Book.
 The 20th was not the first day PRP practiced in a Dangerous Heat Index. The team was acclimated to the Heat.
 The PRP High School football team had practiced about 4 weeks prior to Max Gilpin’s Collapse.
 Heat alone was not the Predisposing Risk Factor. Max was in the heat for 4 weeks prior to his collapse.
 Increased Ground Level Ozone might have been the only difference in Aug. 20th and the other preceding practice days days.
 Max Gilpin’s urinalysis revealed a normal Specific Gravity. That was inconsistent with Dehydration. Max Gilpin was not Dehydrated.
 There was no evidence that Max Gilpin was taking Creatine Enhancement.  The elevated Creatinine in his blood was accompanied by an elevated Myoglobin in the blood analysis, secondary to Rhabdomyolysis, muscle breakdown, secondary to Exercise to Exhaustion associated with Anaerobic Metabolism in Heated Ozone.
 Creatinine doping would not cause increased Myoglobin in the blood.
 Max Gilpin had been taking a minimal normal dosage of Adderall (an amphetamine) while playing football several years prior to collapse on Aug 20, 2008.
 He took the same dosage of Adderall during the 4 weeks of prior practice.
 Detectives counted the pills remaining in his bottles and the pill-count added up to his taking one 20 mg XL dosage pill per day as attested by his parents and the detective.
 No bottles of Creatine Enhancement Drugs were found
 It is virtually impossible to have toxic effects of Adderall or any other amphetamine as the Predisposing Risk Factor to Max Gilpin Exertional Heat Stroke without evidence of dehydration in the urine
 Amphetamines speed up the heart rate and dry out the body.
 He had a Normal Urine Specific Gravity. Amphetamine toxicity is inconsistent with normal urine SpGr.
 Amphetamine Toxicity and Normal Urine SpGr are an oxymoron, incongruous, contradictory. Can’t have one with the other at the same time.
 Why the continued, persistent line of questioning?
 Scientists the month before Max Gilpin collapsed during the 2008 Beijing Olympics described the hazardous effects on Athletes from the Synergism of dangerous Heat combined with increased ground level Ozone.(Many References on request)
 The smog and Ozone during the 2008 Beijing Olympics were widely publicized in KY and the U.S.
 “Jefferson County Schools Superintendent Dr. Sheldon Berman is commended for his appropriate reactions the summer of 2009 to the death of Max Gilpin in 2008. He was the 2nd reaction to the Death of Max Gilpin. He got it right.
 Dr. Sheldon Berman got it and Connected the dots few others have.
 He was “extremely troubled” by (Coach) Stinson telling players they would run until someone quit.
 “Such motivational tools are not acceptable,” Berman said.
 In other words, Child Athlete Verbal (Psychological) and Physical Abuse are not acceptable.
 “Berman said the Jefferson School District is planning training sessions later this month for coaches, with the goal of teaching them how to use positive motivation with athletes.”
 “Dr. Berman and Jefferson County Public Schools to begin relaying air pollution warnings to coaches and had a plan in place to modify outdoor practices according to pollution levels.”
 In other wordsm Dr. Berman was considering that Air Pollution, Ozone, probably contributed to the death of Max Gilpin.
 KHSAA had a Heat Index Plan in Place for modifying football practice
 The Partnership for a Green City with paratners Louisville Metro Government, the University of Louisville, and the Jefferson County Public Schools that began in August 2004, was the first in the country
 The Partnership for a Green City received an award in 2007“that represented a collaborative effort to improve environmental education, environmental health, and environmental management by three of Louisville’s largest public entities: Louisville Metro Government, the University of Louisville, and the Jefferson County Public Schools.”
 But all that Partnering Education failed to Prevent the Death of Max Gilpin, because those responsible overlooked or ignored environmental hazards.
 JCPS teachers, students and classes were actively participating in Air Pollution Health Education at the time.
 The Grand Jury Indictment of Coach Jason Stinson was because he practiced his PRP team in a dangerous environment according to one of the detectives who investigated and testified, that caused Child Endangerment that resulted in serious injuries and death.
 No one notified Coach Stinson about the Air Alert Aug 20, 2008
 Criminal adjudication and Civil depositions did not follow Dr. Berman’s lead, but continued the unsuccessful Dehydration Line of Questioning.
 House Bill 383, that resulted in new KY state law was the 3rd Reaction, this one by the Kentucky Legislature to Max Gilpin’s death.
 Max Gilpin did not have Hypertrophic Cardiomyopathy (HCM) or any other heart disease but AEDs, Automated External Defibrillators, for sudden athlete cardiac arrest became compulsory in HB 383 the reaction to Max Gilpin’s death.
 Fortunately, the Sports Safety Work Group Committee was an off spring of HB 383 and additional more pertinent features of the Bill were enacted, appropriaate reactions to his Death.


 There was public and legal outcries from the Witnesses to the grueling Practice the day Max collapsed. One witness actually told the Coach, as reported in testimony, “quit abusing those kids”
 Louisville PRP Coach said to his team after weight lifting followed by practice while running wind sprints after exercise to exhaustion “We’re going to run till someone quits”
Verbal and Emotional Coachng Abuse Erodes Trust of Athlete for Coach
Core of Coaching = Trust
Golden Rule is the First Rule of Coaching. Do Unto Others as you would have others do unto your child being coached. “First Do No Harm” or the Latin: Primum Non Nocere
Yelling Intimidation elicits the Fear Emotion which stimulates high in the amygdala where Post Traumatic Stress Disorder / Syndrome dwells
Yelling For not playing well
Screaming for losing
You’re stupid, worthless
Embarrassment Humiliation Athletes
Rarely use praise as + feedback
Demeaning Athletes
Plays 4th Grade “head games”
Yellers Damage Athlete Self-Esteem / Confidence
Causes Nightmares / PTSD
Always leaves Athletes feeling badly about themselves
Kills Athletes’ Enthusiasm Joy, Love of the Game
Verbal Emotional Athlete Abuse Sets The Tone For:
1.Teenage Dating Violence
2. Domestic Violence


 A great Law. HB 383 resulted in crucial changes for KY High School Athletes. Although Max Gilpin did no have heart disease, AED will safe other Athletes. Hopefully, the Sports Safety Work Group Committee which resulted from HB 383, which first met June 1, 2009, will make continued environmental recommendations to those responsible. They have addressed Heat Index and Air Quality to date.

A Mandated AED, Automated External Defibrillator at practice would not have saved Max Gilpin. He had no heart trouble. His EKG was normal in the hospital.


 75,200,000 U.S. Children <18 YO in 2010. 9.  ~20,000,000 U.S. Children 6 -18 played organized, Non-School Amateur Sport  ~25,000,000 played organized School Amateur Sports  .: ~45,000,000 (~60%) U.S. Children played one School or Non-School Amateur Sport in 2010.10  1 in 10 Child Athletes Injured, Experts Say 12.  .: 4,500,000 Child Athletes Injured yearly @10%  .: 2,250,000 Child Athletes Yearly At Risk Preventable, Non-Accidental Injuries or CAAS @50% of 4,500,000 PERMISSION TO PARTICIPATE IN SPORTS  ACCIDENTAL SPORTS INJURY –INJURY AND/OR DEATH FROM RISKS THAT ARE INHERENT OR NATURAL TO THE GAMES ATHLETES PLAY  Parent / Guardian Permission To Participate is Granted for Risks Inherent To Game the Athlete Will Play  Non-Accidental, Preventable Sports Injury – Injury and/or Death from Risks, Mistreatment, harm and abuse that are NOT Inherent or Natural to the Games Athletes Play PEMISSION TO PARTICIPATE IS NOT GRANTED by the Parent / Guardian FOR THESE RISKS that are NOT Inherent to the games they PLAY Sports Participant does not waive / release claims based upon unlawful abusive Coaching misconduct The U.S.Supreme Court has ruled that waivers cannot void liability for gross negligence. Gross negligence is reckless, wanton or willful misconduct, not mere neglect. 100. AMATEUR ATHLETE HUMAN RIGHTS DISORDERS AND CHILD ATHLETE ABUSE SYNDROME (CAAS) Sports Participation has evolved with serious costs and consequences to Children’s Human Rights in Youth Sport, They are: o Over-training o Physical, psychological (emotional) and sexual abuse o Doping and medical ethics o Lack of education concerning Human Rights in Youth Sport o Child labor o Lack of accountability of governments, criminal justice, high school athletic associations, sports federations, coaches and parents [Human Rights in Youth Sports by Paulo David, 2005, UN] DEFINITION CHILD ATHLETE ABUSE SYNDROME, “NEW DISEASE” Child Athlete Abuse Syndrome is a Short Title for a Clustering of Child (<18) or Youth (15-18) Athlete Serious Injury, Disease and/or Death secondary to: ► Physical endangerment, maltreatment and/or abuse ► Psychological (Emotional) endangerment, maltreatment and/or abuse ► Sexual Abuse ► Failed child custodial protection ► Negligent care giving supervision ► Human rights violations ► That were inflicted, caused, created, or allowed to be inflicted, caused, created, directly or indirectly by the Problematic Coach, including the Strength Training, Conditioning and other specialty Coach, Problematic Parent or other Problematic Caretaker Person who has Child and Youth Athlete custodial protection, supervision, care and control during Sports, Recreation and Exercise Participation ► Failure to report the morbidity and mortality to Authorities is Illegal. [1.] [6.] ► In most United States, Children are minors when less than 18 years of age. ► The United Nations define Youth as persons between the ages of 15-24. Child Athlete Abuse Syndrome and Cruelty to Children in Sports, Recreation and Exercise (SRE) are matters of importance to Doctors and Health Care Personnel. They summons all Doctors and Health Care Personnel into action for the Awareness and Prevention of these Child Athlete Preventable, Not-Accidental morbidities and mortalities. REPORTING CHILD ATHLETE ABUSE SYNDROME Anyone who has information about suspected Child Abuse whether Athlete or not are mandated to Report it to Authorities Should Not Be False Made in Good Faith To County Attorney and Child Protective Services (CPS) International Violations such as U.S. Olympians or other overseas competitions to th U.S. Attorney in Your State and U.N. Comm. Rights of the Child Reporter is Granted Anonymity and will remain Unknown Reporter is Granted Immunity HIPPA violation NO AUTOPSY  Deputy Coroner Sam Weakley’s report, “his finding is the entire matter is an accident.” The report said Max collapsed while practicing in “intense heat” and was transported with another player to the hospital, where his body temperature reached 107 degrees. Max “eventually went into multiple-systems organ failure” and died of complications from heat stroke on Aug. 23, according to the report. Max’s death certificate lists the same cause of death and complications. [Coroner’s Report call Max Gilpins Death an Accident, Jason Riley, Courier Journal, 10:28 PM, Aug. 29, 2009 ]  An autopsy with an internal examination of the body was not performed on Max Gilpin after his Death.  An autopsy with internal examination is mandated by law KRS 72.025: When the death of a child appears to indicate child abuse prior to the death, occurs as a result of an accident, occurs under the age of 40 and there is not past medical history to explain the death, is sudden and not explained, when the death of a human being and the decedent is not receiving treatment by a licensed physician and there is no ascertainable medical history to indicate the cause of death. There was no internal Autopsy. AUTHORITY IN SPORTS PRACTICE  Yanero vs Davis, Kentucky Supreme Court; “The KHSAA does not promulgate rules for PRACTICES or for junior varsity games and competitions.”  KHSAA only promulgate rules for Interscholastic Games and Competitions. Max Gilpin collapsed during football practice.  Supreme Court of the United States opinion on High School Athletic Associations: ”there is no “symbiotic relationship” between the State of Tennessee and the TSSAA, contrary to the majority’s assertion, “the fiscal relationship with the State is not different from that of many contractors performing services for the government……”The TSSAA provides a service –the organization of athletic tournaments and games– in exchange for membership dues and gate fees, just as a vendor could contract with public schools to sell refreshments at school events……Moreover, these cases do not suggest that the TSSAA’s activities can be considered state action, whether the label for the state-action theory is “entwinement” or anything else.”[SUPREME COURT OF THE UNITED STATES, No. 99—901, BRENTWOOD ACADEMY, PETITIONER v. TENNESSEE SECONDARY SCHOOL ATHLETIC ASSOCIATION et al.]  All citizens serve the Rule of Law during football practices, not Arbitrary Rules authored by non-law-making Associations, who especially have no authority during football practice.  High School Athletic Association Interscholastic Rules, Regulations and By-Laws are not the Rules of Law for adjudicating the Death of a Child Athlete.  702 KAR 7:065. Designation of agent to manage high school interscholastic athletics. STATUTORY AUTHORITY: NECESSITY, FUNCTION, AND CONFORMITY: KRS 156.070(2) “Section 1. The Kentucky High School Athletic Association (KHSAA) shall be the Kentucky Board of Education’s representative to manage INTERSCHOLASTIC ATHLETICS AT THE HIGH SCHOOL LEVEL IN THE COMMON SCHOOLS, including a private school desiring to associate with KHSAA and to compete with a common school.” Doesn’t mention practices.  A witness to a Child Athlete Death from a strike of lightning would answer NO to the line of questioning “did the Coach violate any KHSAA Rules during football practice during lightning in the electrical storm”, because the KHSAA has no rules or authority concerning lightning or severe weather during football Practice. They only have Rules for Interscholastic Competitions and Games.  A witness to a Child Athlete Death from the Synergism of Heat and Ozone would likewise answer would be NO to a similar question because the KHSAA had no Rules for Synergism of Heat and Ozone during Practice then and has none now.  Example from the KHSAA Rules, Regulations and By-Laws: “The Referee or head official shall delay or cancel a (INTERSCHOLASTIC) COMPETITION at the first site of lightning or sound of thunder at the site and the site shall be cleared of all persons immediately by event administration.” Doesn’t mention practices.  Coach Stinson did not violate KHSAA Rules during practice because there were no KHSAA rules for practices to violate.  Coach Stinson appeared to violate Child Protection Laws, the only Criminal Codes of Conduct for the Death of an Abuse or Neglected Child. The Kentucky Unified Juvenile Code, KRS 600-645, was never mentioned during adjudication except by this witness.  “NCAA legislation provides practice opportunities during which institutions can conduct workouts,”  “Determination of the content of those workouts are best handled by the local athletics staff to meet the individual needs of student-athletes.” “[An institution is] responsible for establishing a safe environment for its student-athletes to participate in its intercollegiate athletics program.”  In other words, Athlete Safety Responsibility is the responsibility of the School and Coach ATTORNEY PROCEEDINGS  Did some attorneys have no knowledge about the Kentucky Unified Juvenile Code, KRS 600-645, KY Child Protection Laws?  “BE IT RESOLVED, that the American Bar Association encourages individual attorneys and state and local bar organizations to work more actively to improve the handling of cases involving abused and neglected children as well as children in foster care. Specifically, attorneys should form appropriate committees and groups within the bar to … work to assure quality legal representation for children.”  NATIONAL ASSOCIATION OF COUNSEL FOR CHILDREN (NACC) Recommendations for Representation of Children in Abuse and Neglect Cases EXECUTIVE SUMMARY “The lack of standards of practice or guidelines for attorneys representing children in child protection proceedings has frequently been cited as a major cause of substandard and ineffective legal representation of children.  When Children are endangered, maltreated, harmed and damaged by abnormal behaviors by the Coach or anyone, who fails their Child Protective Custody or to Properly Supervise Child Athletes, as any other Reasonable Coach or person would supervise athletes in similar coaching situations, these incidents are mandated to be properly Reported, Investigated and Adjudicated by the Criminal Codes of Child Protection in Juvenile or Family Court.  During the Civil complaint depositions the Dehydration line of questioning continued.  Adjudicating A Criminal Trial Based On Whether The Coach Violated High School Athletic Association Rules or Not…… is Phony Masquerade of Legal HSAA Rules Interpretation as if they were Rules of Law, which they are not.  Attorneys and Judges Must Pound on Facts and Law of the Case…… Not Pound on the Table with Phony Masquerade of Imaginary HSAA Rules interpretations as if They Were Law.  Those Actions Promote Closed Sports Societies. As Dr. Edwin R. Guise and Dr. Richard M. Ball said in 1981 “Socially Approved Athletic Child Abuse” and “Battered-Child-Athlete-Syndrome”  Approved Societies that want to be impervious to the Rules of Law, function freely without outside intervention and govern themselves.  The Sports Community wants to be a Closed Approved Societies that operate with their on Rules and Regulations. That notion is not only Prepostrerous but also Unconstitutional. COACH INDIVIDUAL IMMUNITY In Kentucky, Coaches are not immune. When Yanero (Civil Case) was decided in 2001 it looked as if at least some of the cloak of immunity had been pulled back. A high school baseball coach was named as an individual defendant following a mishap at batting practice. Justice Cooper, in his customary scholarly fashion, assembled a cogent history of sovereign immunity and got rid of Malone’s blanket immunity for individuals, that included the Coaches. Official Immunity : “The issues with respect to the negligence of the coaches vis-a-vis that of Yanero and/or Coker is best left to a jury properly instructed in accordance with KRS 411.182. There will be allocation of fault for Coaches in tort actions. KRS 411.182 Allocation of fault in tort actions — Award of damages — Effect of release. • In all tort actions, including products liability actions, involving fault of more than one (1) party to the action, including third-party defendants and persons who have been released under subsection (4) of this section, • the court, unless otherwise agreed by all parties, shall instruct the jury to answer interrogatories or, if there is no jury, shall make findings indicating: • The amount of damages each claimant would be entitled to recover if contributory fault is disregarded; and • (b) The percentage of the total fault of all the parties to each claim that is allocated to each claimant, defendant, third-party defendant, and person who has been released from liability under subsection (4) of this section. SYSTEMS IN CRISIS FORM THE SURGEON GENERAL [Surgeon General’s Workshop on Making Prevention of Child Maltreatment a National Priority: Implementing Innovations of a Public Health Approach, Surgeon General’s Workshop Proceedings, Lister Hill Auditorium, National Institutes of Health. Bethesda, Maryland. March 30–31, 2005. United States Department of Health and Human Services. Office of the Assistant Secretary for Health, Office of the Surgeon General] SURGEON GENERAL 2005 DECLARED CHILD ABUSE PREVENTION NATIONAL PRIORITY FOR ALL TYPES AND VENUES OF CHILD ABUSE • In Every Venue, Included Coach Offenders • SG Recommended a Prevention Method: The Implementation of Public Health Innovations NOWADAYS, WHY DOES the U.S. HAVE ATHLETE INJURY CRISIS DURING SPORTS PARTICIPATION? BECAUSE PEOPLE and SYSTEMS ARE NOT DOING THEIR JOB and DUTY FOR CHILD / YOUTH ATHLETE PROTECTION, SYSTEMS IN CRISIS THAT ARE NOT DOING THEIR DUTY TO PREVENT CRUELTY TO CHILD ATHLETES • Failure Doctor Reporting • Criminal Justice System – Failure Enforcement of Child Protective Laws for Athletes • Public Health • Social and Child Welfare Services • Education / Awareness services • Failure of Doctors To increase Awareness and Education about CAAS • Failure of Doctors To Intervene: When Coaches Exercise and Punish Athletes Beyond Physical and Emotional Limitations • Substandard Sports Medicine: Some Sports Medicine Doctors Have Sold Their Souls To Coaches. They Don’t Take Helmets, Sneakers rather allow Athletes to participate in sports while injured • Failure Coach Education by High School and University Athletic Associations Concerning Child and Youth Athlete Protection Law • Coaches and others were targeted as potential Abusers and Perpetrators by SG • Lack of Attorney Standards of Practice and Guidelines in Child Protection Proceedings [NATIONAL ASSOCIATION of COUNSEL for CHILDREN / NACC and AMERICAN BAR ASSOCIATION / ABA] ____________________________________________________________________ Lessons Learned from Fatal Episodes of Heat Stroke Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19, 2009 (GETAC – Governor’s EMS & Trauma Advisory Council, Texas Department of State Health Services) There are no new lessons to be learned about heat stroke, only new athletes, coaches, trainers, and parents to educate. There are no new events, just the same well-known circumstances that are repeated every year with new, unwary victims. At least 21 young athletes have died from heat stroke during the last several years. (30, 31) The deaths of Korey Stringer, the Minnesota Viking’s Pro Bowl offensive lineman, on August 1, 2001 and Eraste Autin, the University of Florida’s freshman who collapsed July 19, 2001 after a summer training session and spent six days in a coma before dying, are only two of many widely publicized examples of tragic, but preventable, deaths. We may also recall Matthew Thomas, the 14 year old Victoria Texas High School freshman, who succumbed shortly after football practice during a 92-degree afternoon on August 12, 2003, 17 year old Chris Stewart from Oklahoma City who died of heat stroke in August 2005, (21-28) and Max Gilpin, a 15 year-old Louisville, Kentucky player who collapsed and died when his temperature rose to 107 degrees following a series of wind sprints called “gassers” on a 94 degree day in August 2008. (48, 49, 50, 51, 52, 53) The typical heat stroke victim is usually not well-acclimatized to the Texas heat. It should be no surprise that student athletes who have spent the summer watching TV and playing video games in the comfort of their air-conditioned homes may not be physically prepared for exertion in the heat. (6, 17) Overall, however, student athletes are extremely motivated, perhaps sometimes even overzealous, individuals who may push themselves beyond their level of endurance and heat tolerance in their attempt to excel in their sport. (17,19,32,43) During team try-outs an athlete may feel pressured to perform beyond his capability in the heat, ignoring signs and symptoms of impending heat-related illness. When the brain signals that something was wrong, the athlete can override his brain and keep exerting himself. A competitive athlete is not going to voluntarily take himself out of the competition, an action which might jeopardize his place on the team. Disregarding his brain’s signals, the athlete consciously continues to participate beyond the threshold of safety. His brain even starts to fail, manifested by confusion and atypical behavior, as he generates more body heat than he can possibly lose. His body simply overheats. The human body has a thermal regulation system that strives to maintain temperature at 98.6 degrees Fahrenheit. That temperature is the comfort zone in which all human biological systems operate efficiently. (46) The body dissipates heat with radiation, conduction, convection, and from the evaporation of sweat. (2, 43, 46) Radiation transfers heat energy via infra-red waves from a hotter to a cooler source, like the glow from a red-hot branding iron as skin capillaries dilate to increase blood flow causing the skin to become red and hot. Heat transfer through conduction occurs through direct contact with an object such as heat gain by touching a hot surface or heat loss by direct contact with ice packs or cold water immersion. Convection occurs when a cool breeze flows over the hot surface causing heat loss into the ambient air much like heat leaving the cooling plates of a car radiator. Finally, the evaporation of sweat also causes heat loss as liquid water turns into water vapor. The cooling effect of sweating islessened by high humidity that prevents evaporation. Sweating is also decreased by dehydration from insufficient water intake, normal respiratory water loss, and fluid losses from vomiting. When fluid losses are great, the body starts to lose intravascular volume—the volume of fluid in arteries and veins. (45) The pulse rate increases as the heart tries to maintain circulation and an adequate blood pressure. To avoid going into shock, the body closes capillaries to direct blood flow away from the skin, gut, and muscles to more vital organs, such as the brain, kidneys, and liver. (44) When the skin capillaries close, the blood leaves the skin surface. Sweating may stop. The skin becomes cool and clammy and goose bumps may appear. (17, 18, 46) The shunting of blood from the skin is what causes people to feel chilled when going into shock. Vomiting and muscle cramps may occur. (7, 38) The failure of the body’s cooling mechanisms—the radiator effect and the sweating-evaporation process—causes an internal heat surge. Excessive accumulation of heat energy causes thermal injury to biological systems including breakdown of muscle tissue, rhabdomyolysis, potentially irreversible multi-organ failure, and sometimes death. (2, 8, 9, 12, 16, 17, 32, 43, 46) Early symptoms of heat injury include: thirst, dizziness, lightheadedness, paleness, headache, poor concentration, missed assignments, irritability, altercations, apathy, weakness, fatigue, and a feeling of being limp. More advanced symptoms include: warm and flushed (red) skin, muscle cramping, nausea, and vomiting. Emergency symptoms of impending heat stroke include: the appearance of cool and clammy skin, absence of sweating, dry skin, rapid breathing, confusion, a change in personality often perceived as “goofing off” and not following instructions, fainting, and eventual collapse. (2,3,11,12,13,14,17,20,31,43) Treatment must include immediate rapid cooling in the field with ice packs and cold water, with total body immersion if possible. Restrictive clothing should be removed. Every minute of exposure at high core temperatures causes more tissue damage. Every minute counts in a “heat” attack, much like a heart attack. (31) Emergency hospital care is needed for anyone who collapses during heat-related exertion, and rapid cooling should begin in the field and continued during transport to the hospital. (1,12,17,31,32,33,43) Prevention strategies are the main approach to reducing the risk of exertional heat stroke. The following measures are recommended. 1. Gradually acclimatize participants to heat with light work-outs the first week of practice. Most heat strokes occur during the initial few days of practice when athletes are not acclimatized to the exercise intensity and equipment. (9,17,18,31,32,43,46) 2. Provide free, unlimited, unquestioned access to cool, palatable water. (5,19,30,31,43) 3. If a player is thirsty he is already dehydrated. He must be allowed to drink without having to ask permission. Drinking 8 ounces of a balanced electrolyte solution such as found in sports drinks every 15 minutes, up to a liter per hour, is recommended before a player feels thirsty. A single swallow from a squirt bottle is not sufficient fluid replacement. (9,11,12,13,16,31,43) 4. Weigh players before and after practice to verify proper fluid replacement. If players lose weight during practice, they are dehydrated and at risk of compromising one of their chief means of cooling — sweating. (17,20,43,46) 5. Take mandatory breaks in the shade and allow players to remove helmets. (31,43) 6. Bathroom facilities should be available, as their absence may discourage adequate oral hydration by players who may feel embarrassed if they need to urinate. 7. Although water and balanced electrolyte solutions are helpful, salt tablets are not recommended. (10,11,12,13,14,29) Like drinking seawater, taking salt pills can be harmful. In order to eliminate excess salt the body loses water, water it can not afford to lose during conditions of over-heating. (46,47) 8. Good hydration alone does not prevent heat stroke! Even if one drinks plenty of water and sports drinks and is making lots of dilute urine (a sign of good hydration), heat stroke can still occur if the body generates or absorbs more heat that it can dissipate by its usual cooling mechanisms. (16,17,19,43,46) 9. Exposure to direct sunlight increases the radiant energy absorbed as heat. Test this phenomenon by placing a hand on the hood of a car parked in direct sunlight compared with a car parked in the shade. The air temperature is the same, but the vehicle in the sun is much hotter than the one in the shade. If a practice is held in direct sunlight, the heat index increases by up to 15 degrees F, and those 15 degrees should be added to the heat index given by the National Weather Service to determine the risk of heat-related injury. (2,37) 10. Do not allow any outdoor activity if the heat index is 130 or greater. (37) 11. The above guidelines may vary with the age, weight, and conditioning of individual players. To be on the safe side, in his newspaper column “To Your Good Health” Dr. Paul Donohue recommends suspension of practice if the heat index is 90 or greater (Exertional Heat Stroke, a Preventable Cause of Death, Victoria Advocate, July 14, 2007, page E-5). (35) 12. Monitor players for symptoms of heat exhaustion. (1) A player is unlikely to admit that he is feeling weak or lightheaded. He is unlikely to pull himself out of the practice. A buddy system, like one used by scuba divers, may help one player protect and monitor another. (17,18,31,32,37) 13. If a player is dizzy, lightheaded, not “feeling right” or vomits, he must stop practice immediately and be allowed to cool off in the shade with ice packs and soaked towels, or with a cool water mist and fan, with his uniform removed. Vomiting should prohibit anymore practice that day. Notify the parents so the player is monitored at home and properly fed and rehydrated. (12,13,14,17,31) 14. If a player collapses, or if exertional heat stroke is suspected, a player should be rapidly cooled by immediately removing all equipment and uniforms and immersing him cooled in a tub of ice water until EMS can assume care and transport to the hospital. It is important to cool first, transfer second. Every minute spent above a body core temperature of 104 degrees F, measured rectally or with an esophageal probe, worsens the tissue damage and increases the risk of death.(2, 12, 13, 14, 17, 19, 20,31,32,43,46) Oral, tympanic membrane, and temporal artery temperatures do not accurately measure core temperatures in this setting. (17,43) 15. Avoid stimulants such as highly caffeinated “energy-boosting” drinks (which have fluid-losing diuretic effects), ephedra, ephedrine, amphetamines, and cocaine, which can cause cardiac rhythm disturbances. (2,12,17,32) 16. Practice during the cooler parts of the day, when the heat index is lowest, preferably less than 90, although practice with a heat index of less than 105 may be more practical and acceptable, with appropriate precautions. (17,43) 17. Do not gauge the intensity of practice by pushing players until they get cramps, vomit, or collapse. Remember that if a player is having one symptom, more are likely to follow, possibly in a rapid cascade of downhill events. (32,46) 18. Heat stroke has occurred in marathon runners in relatively cool temperatures of 60 degrees! (32,33,43) The fundamental principle causing exertional heat injury is the generation of heat faster than the heat can be lost. The result is a harmful rise in body core temperature. A core (rectal) temperature of 104 is very dangerous; at 108 the person is likely to die. (1,2,12,16,17,31,38,43,46) 19. The sickle-cell trait, present in 8% of the black population and also found in people of Mediterranean descent, can pre-dispose an athlete to a sickle-cell crisis during times of heat-related stress. A high index of suspicion is necessary when such participants demonstrate any sign or symptom of illness, such as muscle cramps or abdominal pain. Treatment with immediate intravenous hydration and supplemental oxygen may be life-saving and may prevent damage to vital organs. (1,15,17,40,41,42,43) 20. Players who are ill with fever, diarrhea, vomiting, or viral illnesses should refrain from exertion in the heat. (17,19,32,43) 21. Create a team effort to prevent dehydration and heat stroke involving the coaches, trainers, administrators, parents, and athletes. (31) 22. Remember that poor concentration, missed assignments, frequent penalties, irritability, altercations on the field, muscle cramps, loss of liveliness and spirit, apathy, and increasing frustration of the players and coaches in the fourth quarter may be prevented by what is done in the first quarter regarding proper fluid and electrolyte replacement. A player’s poor performance may not be due to lack of desire or not wanting “it” enough. Sub-par performance may simply be due to a lack of water and over-heating! (16,19,31,43) Like continuing to drive a car with a dry radiator, engine failure is likely to occur. 23. Consider posting an educational heat stroke poster in the locker room. (39) 24. Refer to the accompanying temperature/humidity chart to determine the heat index, or use the programs on www.zunis.org to determine the wet bulb globe temperature and follow the football guidelines and recommended precautions. (37) For example, the National Weather Service uses the Steadman Heat Index on the following page to provide hot weather advisories to the general public. Using the table, an air temperature of 90 with a relative humidity of 60% produces a Heat Index of 100. This heat index is associated with a low risk of heat-related illness, but appropriate precautions should be taken because heat injury can still occur. If players are exposed to direct sunlight, however, the heat index in the same conditions rises to 115 degree F, a danger zone for exertional heat injury. (37) During practice the coach should ask this question: “Are my players being exposed to direct sunlight casting shadows shorter than their height?” If the answer is “Yes” then add 15 degrees to the heat index chart and take appropriate precautions, such as practicing early in the morning, late in the evening, or inside a gym. (2,37,43) A heat index of 105 and greater represents a danger zone, and heavy exertion should be avoided. In addition, mandatory breaks in the shade with helmets off and mandatory consumption of 8 ounces of water or a sports drink every 15 minutes should be the rule. A few swallows from a squirt bottle are not sufficient to maintain adequate hydration. Because the judgment of the athlete may be impaired in this setting, the player is unlikely to pull himself out of training exercises. Therefore, trainers and coaches should be observant, monitor their athletes for any symptoms of heat-related illness, and insist that players be removed and protected from dangerous environmental conditions. Prevention and treatment strategies must be in place. (4,5,17,19,43) Remember the advice of experts: “the cooler you stay, the better you play.” (17,18,19) Note: Exposure to full sunshine can increase HI values by up to 15° F Alternatively, add 5° F to the temperature when athletes are exposed to direct sunlight Green Highlighted Heat Index: 90—104. When the heat index is between 90° F and 104° F, heat exhaustion and heat cramps are possible with prolonged exposure and physical activity. Ad lib access to cool water is necessary. Mandatory breaks in the shade every 20 to 30 minutes and extra fluids (water and/or sports drinks) are recommended. Ice water and cold, wet towels for rapid cooling in the shade should be immediately available. Cooling water mist fans are desirable. Observe players carefully! Yellow Highlighted Heat Index: 105—129. Practice is dangerous in this setting. Under these conditions, instructional “walk-through” drills with minimal running and no contact should be considered. Ad lib access to cool water is necessary. Mandatory breaks in the shade every 15 to 20 minutes and extra fluids (water and/or sports drinks) are needed. An ice water tub for total body immersion or cold, wet towels for rapid cooling in the shade should be immediately available. Cooling mist fans are helpful. Red Highlighted Heat Index: 130 and Higher. Outdoor exposure and any type of outdoor practice should be prohibited, as heat stroke risk is very great at this level of humidity and temperature. The body’s ability to cool by convection and evaporation of perspiration is severely impaired. In fact, in this environment the body will passively absorb heat from the ambient air and direct sunlight, and cooling by the sweating-evaporation mechanism is not possible because evaporation does not readily occur. Any exertion under these circumstances produces a high risk for exertional heat stroke. Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19,2009 Heat Stroke References 1. Vertuno Jim, The Associated Press, Longhorns Tackling the Heat: Pill Helping Texas Survive Rising Temperatures, published by the Victoria Advocate, August 15, 2007. 2. Hyperthermia, Wikipedia Encylopedia, October 2006, Retrieved from “http://en.wikipedia.org/wiki/Hyperthermia” 3. Heat Illness, Heat Exhaustion, Heat Stroke. The Nemours Foundation/Kids Health at www.revolutionhealth.com January 3, 2007. 4. Joseph Rampulla, MS,APRN,BC (June 2004). Hyperthermia & Heat Stroke: Heat-Related Conditions (pdf). The Health Care of Homeless Persons pp.199-204. Boston Health Care for the Homeless Program. Retrieved on 2007-02-22 at: http://www.bhchp.org/BHCHP%20manual/pdf_files/part2_PDF/Hyperthermia.pdf . 5. “Are you ready for extreme heat?” Courtesy: Federal Emergency Management Agency, Department of Homeland Security. Available from FEMA at: www.fema.gov/areyouready/heat.shtm. Updated August 20, 2007. This information may have changed or been updated since it was accessed. For the most current information, contact FEMA at http://www.fema.gov/. 6. Scott Anderson “Preventing Muscle Cramping in Football”. Coach and Athletic Director. May 2001. At www.FindArticles.com, 15 September 2007. http://findarticles.com/p/articles/mi_m0FIH/is_10_70/ai_n18611880 E. 7. Randy Eichner “Muscle cramps: the right ways for the dog days”. Coach and Athletic Director. August 2002. FindArticles.com. 15 Sep. 2007. http://findarticles.com/p/articles/mi_m0FIH/is_1_72/ai_n18613963. 8. Maddali Sirish, Rodeo Scott, Barnes Ronnie, Warren Russell, Murrell George: Post-exercise Increase in Nitric Oxide in Football Players with Muscle Cramps. The American Journal of Sports Medicine 26: 820-824, 1998. 9. Ruiz E J, Mitchell I D, Eberman L E, Cleary M A. Severe dehydration with cramping resulting in exertional rhabdomyolysis in a high school quarterback. In Cleary M A, Eberman LE, Odai ML eds. Proceedings of the Fifth Annual College of Education Research Conference: Section on Allied Health Professions. April 2006; 1: 31-35. Miami: Florida International Univeristy. http://coeweb.fiu.edu/research_conference/. 10. Cleveland Minot. Musle Cramp. University of Illinois Medical Center at Chicago: Health Library, at www.uimc.discoveryhospital.com, March 13, 2000; reviewed January 4, 2007. “Salt tablets are not useful and should be avoided.” 11. Texas Children’s Hospital. Preventing Heat Illness. Texas Children’s Hospital: Caring for Your Child’s Health at www.texaschildrenshospital.org, 2005. “Salt pills are unnecessary and possibly dangerous.” 12. Centers for Disease Control and Prevention. Frequently Asked Questions about Extreme Heat. Emergency Preparedness and Response Website at www.bt.cdc.gov/disasters/extremeheat/faq.asp. August 15, 2006. “Do not take salt tablets unless directed by your doctor.” 13. Gillis Rick (reviewer). Heat-Related Illness Can Quickly Become Serious. Healthlink: Medical College of Wisconsin at: Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19, 2009 7 www.healthlink.mcw.edu/article/1031002770.html, June 28, 2007. “Salt pills should not be used without first asking your health care provider.” 14. Taylor-Oring Leslie. Is it Heat Exhaustion or Heat Stroke? Tae Park Tae Kwon Do at: www.eod.gvsu.edu/tkd/newpage22.htm. March 14, 1999. “Give them cool liquids—NO SALT PILLS.” 15. Eichner Randy. Curbing Muscle Cramps: More than Oranges and Bananas. Hot Topics in Sports Nutrition. Gatorade Sports Science Institute, at: www.gssiweb.com/ShowArticle.aspx?articled=619. July 25, 2003. 16. Coyle Edward. Fluid and Carbohydrate Replacement During Exercise: How Much and Why? Gatorade Sports Science Institute, Sports Science Exhange #50, Volume7 (1994), Number 3, at: www.gssiweb.com/Article_Detail.aspx/articleid=23&level=2&topic=2. 17. Eichner Randy. Heat Stroke in Sports: Causes, Prevention, and Treatment. Gatorade Sports Science Institute, Sports Science Exchange #86, Volume 15 (2002), Number 3, at: www.gssiweb.com/Article_Detail.aspx?articleid=597&level=2&topic=7. 18. Eichner Randy. Heat Stroke in Sports: How to Protect Yourself and Help Your Teammates. Gatorade Sports Science Institute, Sports Science Exchange #86, Volume 15 (2002), Number 3 Supplement, at: www.gssiweb.com/Article_Detail.aspx?articleid=597&level=2&topic=7. 19. Murray Robert, Eichner Randy. Preventing Heat Illness: Keeping Athletes from Falling into Danger Zones. Gatorade Sports Science Institute, Sports Science Library at: http://gssiweb.com/Article_Detail.aspx?articleid=570&level=2&topic=7. 20. Casa Douglas, Murray Robert. Sports Science News: Preventing Exertional Heat Illness: A Consensus Statement. Gatorade Sports Science Institute, Sports Science Library, 2007, at: http://gssiweb.com/Article_Detail.aspx?articleid=625&level=2&topic=7. 21. Conrad Mark. Mark’s View: Heat Stroke and Football Practice (A comment on the heat stroke death of Minnesota Viking Korey Stringer). Mark’s Sportslaw News, 2001, at: www.sportslawnews.com. 22. CNN News. Vikings football player dies of heat stroke, at: www.CNN.com./U.S., August 1, 2001. This is a CNN news story about Korey Stringer. 23. Associated Press, Mankato, Minnesota. Vikings tackle Stringer dies from heatstroke, August 2001. 24. The Associated Press, Gainesville, Florida: Florida player Autin dies six days after heat stroke. Volume 101, No. 187, Thursday, July 26, 2001. This article discusses the heat stroke death of 18 year old freshman Eraste Autin who collapsed during a work out in 88 degrees, 72% humidity, heat index of 100. 25. Smith Michael. Football Practice Heat Stroke Deaths Preventable (An article about the heat stroke death of 18 year old Chris Stewart). MedPage Today, Daily Headlines, Oklahoma City, August 18, 2005. 26. Sparks Tara. Death has parents concerned. Victoria Advocate, page 1, August 15, 2003 at: www.nl.newsbank.com/nl-search/we/Archives?p_product=VA&P_t. Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19, 2009 8 This article describes a parents’ safety meeting following the death of 14 year-old Matthew Thomas. 27. Victoria Advocate staff writer. Autopsy not yet released. Victoria Advocate, page 1, August 15, 2003, at: www.nl.newsbank.com/nl-search/we/Archives?p_product=VA&P_t. 28. deLench Brook. To Nineteen Youth Athletes Dying Young. MomsTeam, A Parents Trusted Youth Sports Source, at www.momsteam.com. August 25, 2007. 29. Reddy Vinay. Heat Cramps, Heat Exhaustion, and Heat Stroke. Dr. Reddy’s Pediatric Office on the Web at http://www.drreddy.com, 1/12/07. 30. Williamson David. UNC Warns of Possible Heat Strokes for High School Atheletes, at www.unc.edu//depts/nccsi, 2004. 31. Roberts William. Death in the Heat: Can Football Heat Stroke be Prevented? Current Sports Medicine Reports. (3), 2004. 32. Roberts William. Common Threads in a Random Tapestry: Another Viewpoint on Exertional Heatstroke, The Physician and Sports Medicine. 33(10) 2-5, October 2005. 33. Roberts William. Exertional Heat Stroke during a Cool Weather Marathon: A Case Study. Medicine & Science in Sports & Exercise, Official Journal of the American College of Sports Medicine, pages 1197-1203, January 2006 at http://www.acsm-msse.org. 34. Fighting Heat Stress, at http://fighting_heat_stress,asp.htm. 35. Donohue Paul. Exertional Heat Stroke: A Preventable Cause of Death, To Your Good Health. Victoria Advocate, page E-5, Saturday, July 14, 2007. 36. Jung Alan, Bishop Phillip, Al-Nawwas Ali, Dale Barry. Influence of Hydration and Electolyte Supplementation on Incidence and Time to Onset of Exercise-Associated Muscle Cramps. Journal of Athletic Training 40(2): 71-75, April-June 2005. 37. The Zunis Foundation. How Hot is Hot? How Safe if Safe? At www.zunis.org, April 8, 2007. 38. It’s Hot, It’s Humid, It’s Sunny: Information on Heat and Sun-Related Illnesses. Street Medics, www.action-medical.net 39. Hirsch Larissa. Heat Exhaustion and Heat Stroke: A Poster. This is a handy instructional “Heat Sheet” found at www.kidshealth.com 40. Bergeron Michael F, Cannon Joseph G, Hall Elaina L, Kutlar Abdullah. Erythrocyte Sickling During Exercise and Thermal Stress. Clinical Journal of Sport Medicine. 14(6): 354-356, November 2004. 41. Gallais Daniel Le, Bile Alphonse, Mercier Jacques, Paschel Marc, Tonellot Jean Louis, Dauverchain Jean. Exercise-induced death in sickle cell trait: role of aging, training, and deconditioning. Medicine and Science in Sports and Exercise. 28(5): 541-544, May 1996. 42. Kark J A, Posey D M, Schumacher H R, Ruehle C J. Sickle-cell trait as a risk factor for sudden death in physical training. New England Journal of Medicine. (317): 781-787, September 1987. 43. Binkley Helen M, Beckett Joseph, Casa Douglas J, Kleiner Douglas M, Plummer Paul E. National Athletic Trainers’ Association Position Statement: Exertional Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19, 2009 9 Heat Illnesses. Journal of Athletic Training. 37(3): 329-343, July-September 2002. 44. Guyton Arthur C, Hall John E. Circulatory Shock and Physiology of its Treatment, Chapter 24, Textbook of Medical Physiology, Eleventh Edition. W.B. Saunders Company, Philadelphia, June 2005. 45. Guyton Arthur C, Hall John E. The Body Fluid Compartments: Extracellular and Intracellular Fluids, Chapter 25, Textbook of Medical Physiology, Eleventh Edition. W.B. Saunders Company, Philadelphia, June 2005. 46. Guyton Arthur C, Hall John E. Body Temperature, Temperature Regulation, and Fever, Chapter 73, Textbook of Medical Physiology, Eleventh Edition. W.B. Saunders Company, Philadelphia, June 2005. 47. Guyton Arthur C, Hall John E. Regulation of Extracellular Fluid Osmolarity and Sodium Concentration, Chapter 28, Textbook of Medical Physiology, Eleventh Edition. W.B. Saunders Company, Philadelphia, June 2005. 48. Graves, Will. Case of Kentucky Coach puts Football on Trial. The Associated Press. The Victoria Advocate, page C-7, Friday, January 30, 2009. 49. Mahalo.com. Max Gilpin, at http://www.mahalo.com/max-gilpin 50. Louisville News, Homepage. Witness: Teen’s Death was Preventable. August 27, 2008. http://www.wlky.com/news/17315849/detail.html Copyright 2008 by WLKY.com. 51. Konz, Antoinette. 911 Call: PRP player drifted in, out of consiousness. Courier-Journal.com, Louisville, Kentucky at http://www.courier-journal.com/article/20081107/NEWS01/811070437/1008/rss01, November 7, 2008. 52. WLKY.com. PRP Football Player Collapses at Practice, In Critical Condition. http://www.wlky.com/sports/17267086/detail.html. August 22, 2008. 53. WLKY.com. PRP Football Player Dies 3 Days after Collapse in Practice. Louisville, Kentucky. At http://www.wlky.com/health/17280899/detail.html, August 27, 2009. 54. Binkley, Helen; Beckett, Joseph;Casa, Douglas; Kleiner, Douglas; Plummer, Paul. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. Journal of Athletic Training. 2002 Jul-Sep; 37(3): 329-343. 55. Parents’ and Coasches’ Guide to Dehydration and other Heat Illnesses in Children. National Safe Kids Campaign. Adapted from: Inter-Association task force on exertional heat illnesses consensus statement: National Athletic Trainers’ Association. June 2003. Available at: www.nata.org/industryresources/heatillnessconsensusstatement.pdf. Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19, 2009 10