In my latest newspaper column, I discussed my state’s compliance with guidelines to prevent sudden deaths in high school sports. These are guidelines published by the Korey Stringer Institute. While I discuss South Carolina specifically, the ideas I share apply to high schools in all states. If you want to see where your state falls in terms of compliance with guidelines for heat acclimatization, emergency action plans, concussions and more, check out the Korey Stringer Institute website (listed at the end of this article).

Tragedy strikes a local high school football team

The death of 14-year-old Lewis Simpkins has once again raised questions about whether we are doing enough to prevent sudden deaths in sports.
Youth football
The sophomore defensive tackle at River Bluff High School stumbled through the end of a 2 hour, 15-minute practice last week before collapsing in the locker room. Coaches gave him CPR and used a defibrillator. Paramedics took him to Lexington Medical Center, where he was pronounced dead.

Deaths in college and high school football

Over a recent 20-year period, 243 deaths occurred during high school and college football practices and games. That’s about 12 per season. The most common causes were heart failure, brain injury and heat illness. The cause of Simpkins’ death has not yet been determined.

The Korey Stringer Institute

A recent article in The State newspaper pointed out that South Carolina high schools show poor compliance with guidelines to prevent sudden death. These guidelines come from the Korey Stringer Institute, a leader in research and education to improve safety and prevent sudden deaths for athletes and the military.

Korey Stringer was an NFL offensive lineman for the Minnesota Vikings. He died from exertional heat stroke after an August practice in 2001. His wife Kelci partnered with heat stroke expert Douglas Casa, PhD, ATC at the University of Connecticut to create the Korey Stringer Institute. The NFL, Gatorade and other companies and organizations contribute to the Institute’s efforts.

Football helmetIn the article, South Carolina High School League commissioner Jerome Singleton noted that he wasn’t familiar with the Institute or its guidelines. He did point out that coaches in this state must complete online courses regarding heat acclimatization and concussions. He also emphasized that the SCHSL reviews its medical policies annually.

Also read:
Athletic trainers save lives
Ronald Rouse’s death an important reminder for young athletes

Preventing deaths from exertional heat stroke in football

One area of concern for football teams in the South is the heat. 63% of deaths from heat stroke in football occurred in the South. Fortunately, these deaths are largely preventable. Unfortunately, South Carolina does a poor job complying with guidelines that can prevent these deaths.

While neighboring states North Carolina and Georgia, as well as Alabama, Mississippi, Arkansas and Texas, meet the minimum best practice guidelines for heat acclimatization, South Carolina only meets one of the seven KSI guidelines. These guidelines include limits to the number and length of practices in the first weeks of summer football and recommendations for gradually adding protective equipment.

Wet Bulb Globe Temperature (WBGT)

South Carolina schools also meet none of the guidelines regarding the use of Wet Bulb Globe Temperature (WBGT). The WBGT requires a special device to measure the outside environment for heat stress. It’s likely that the cost of the device plays a factor in our poor compliance, but Georgia meets all nine of the best practice guidelines for WBGT.

AEDs and emergency action plans for high school sports

South Carolina does somewhat better with access to automated external defibrillators (AEDs) and training in CPR and AED use. Our schools meet 5 to 6 of the Korey Stringer Institute’s eight best practice guidelines.

In terms of plans for emergencies like the tragedy at River Bluff, South Carolina again needs work. Of the 11 guidelines issued by KSI regardingHigh school football player holding helmet emergency action plans – schools coordinating with local EMS, athletic trainers and physicians on-site to develop plans should a medical emergency occur – South Carolina meets none of them.

The South Carolina High School League needs to adopt these heat acclimatization and emergency action plan guidelines. It should work with its high schools and the state legislature to arrange funding for WBGT and certified athletic trainers for each school.

Also read:
Prevent heat deaths in summer football practice now
Practice changes a good start to prevent heat illness

What can concerned parents do?

Schools, though, don’t have to wait for a statewide mandate to take action. Concerned parents of high school athletes can talk to the athletic directors and coaches to discuss plans to treat and prevent deaths from cardiac arrest, heat stroke and brain injury.

I’m not at all trying to point blame at the South Carolina High School League or the athletic directors and coaches at our high schools. I want to raise awareness and encourage change.

As tragic as the sudden death of a high school athlete is, it creates a perfect time to take steps to prevent another one.

Note: A modified version of this article appears as my sports medicine column in the August 19, 2016 issue of The Post and Courier.


Lewis Simpkins stumbled during River Bluff’s practice before collapsing. By Cynthia Roldan. The State. August 12, 2016.

SC trails other states in ‘sudden death’ football safety policies. By Jeff Wilkinson. The State. August 11, 2016.

High School Policies. The Korey Stringer Institute.

Boden BP, Breit I, Beachler JA, Williams A, Mueller FO. Fatalities in high school and college football players. Am J Sports Med. 2013 May;41(5):1108-16.