National Collegiate Athletic Association Football and Conditioning Deaths—A Positive Progress Report

In 2010, this author reported on a decade of National Collegiate Athletic Association (NCAA) football athlete deaths and noted the striking association that 18 (86%) of 21 indirect (nontraumatic) deaths were connected directly to conditioning sessions or tests (6). A call to action was made at that time to modify or eliminate inappropriate and unnecessary drills to protect the health of all NCAA football players. This report was followed in 2011 with an editorial by DeMartini and Casa (3) which speculated on who should be held responsible for the deaths of players resulting from conditioning sessions as well as encouraged adherence and implication of appropriate emergency preparedness plans and improved strength/conditioning coach certification guidelines. In 2012, a commentary by Anderson (1) expounded on the historical/cultural mentality behind such inappropriate conditioning sessions (which seemed to be based more on “mental toughness” development as opposed to sound football-specific physiologic principles). Also, in 2012, The Inter-Association Task Force for Preventing Sudden Death in Collegiate Condition Sessions produced a best practices recommendations document (2). This comprehensive 10-point plan included general recommendations as well as specific medical condition (e.g., exertional sickling, rhabdomyolysis, heat stroke, etc.) oriented guidelines with the endorsement of multiple sports medicine groups in conjunction with several strength and conditioning professional societies. Additionally, in 2014, the NCAA passed legislation requiring Division 1 colleges and universities to use strength and conditioning coaches who possess a nationally accredited strength and conditioning certification in response to “heightened concern about student-athlete safety around the country” (7). Since the original 2010 review of this topic, there is an encouraging trend to report: Even in the face of increasing participation in NCAA football at all levels (participation has increased from approximately 58,000 student-athletes in 2001 to approximately 73,000 athletes in 2015) (8), the number of indirect (nontraumatic) deaths associated with football activities in general and with preseason drills or offseason conditioning sessions specifically has decreased significantly. In the 5 academic-year span from 2011/2012 to 2014/2015, there were nine indirect (nontraumatic) deaths (4). Of these nine deaths, three had no temporal association with football activity, leaving six directly related to a football team activity (i.e., practice, games, conditioning). Of these six, only four have been directly associated with off-season conditioning sessions and/or preseason drills (5). At this rate, a 10-yr potential total of eight deaths associated with conditioning activities would be anticipated from 2011 to 2020. This would represent a marked reduction from the previous decade’s total of 18. However, as encouraging as this turnaround would be, the goal of zero conditioning session associated deaths should still be pursued. A breakdown of these most recent indirect deaths associated with football conditioning activities reveal programmatic problems that might have been anticipated/avoided and even an admission of negligence in one case (9). It is recognized that this is not a scientifically rigorous evaluation of trends in NCAA football deaths. Also, it is impossible to definitively attribute cause and effect relationships to what factors (e.g., medical literature editorials, the interassociation consensus statement, new legislation for improved coaching certification, etc.) may have contributed to this reduction in NCAA football deaths related to conditioning practices and drills. Despite these uncertainties, it seems reasonable that increased awareness and education of all parties involved in the training of NCAA football players resulting in physiologically sound modifications of these conditioning activities, as well as improved adherence to guidelines about emergency action plans, CPR training, and automated external defibrillator (AED) availability have likely contributed to improvements in football student-athlete safety. It is imperative that efforts should continue in these minimal cost and common sense areas to (hopefully) continue this encouraging trend for reduced mortality in NCAA football conditioning activities.