At an oaklike 255 pounds, T.W. Josey High School football player Chevalier Brown wouldn't appear to worry about anything. But he does: dehydration.
"If you don't get any fluids," the offensive and defensive tackle said, "it may happen to you. You may die."
Of the 23 football-related deaths last year, only eight were the direct result of injuries, according to the National Center for Catastrophic Sports Injuries, which today released its annual analysis of football deaths. Three of them, including the high-profile death of Minnesota Vikings tackle Korey Stringer, were heat-related.
Now is the most dangerous time of all, with practice just starting in the fierce heat, said the center's director, Frederick Mueller.
"Most of them happen in the first week or two, especially in the high schools," said Dr. Mueller, the chairman of the Department of Exercise and Sports Science at the University of North Carolina-Chapel Hill, where the center is based.
The annual survey has been conducted since 1931, but only recently has there been an increase in heat-related deaths. Since 1995, there have been 20; in the six years before that, there were only three, Dr. Mueller said.
"I don't know what's going on, but there should be a real concern that the number of heat-stroke deaths have increased so dramatically," he said.
Of the 23 deaths, eight resulted from injuries on the field, and 12 were related to underlying medical conditions exacerbated by the physical stress of the game.
A researcher at the Medical College of Georgia is looking at whether the sickle cell trait, found in 8 to 10 percent of blacks, may be part of the reason.
Michael Bergeron, a researcher in the Georgia Prevention Institute at MCG, found in preliminary work that dehydration in people with the sickle cell trait accelerated the sickling, or warping, of oxygen-carrying red blood cells. That can lead to the choking-off of blood flow to organs and collapse or sudden death, Dr. Bergeron said. Giving fluid to the subjects kept the sickling from increasing.
The National Collegiate Athletic Association doesn't recommend testing athletes for the trait, but it is partially funding Dr. Bergeron's study. Knowing whether it is a risk factor could help prevent future problems for those players, Dr. Bergeron said.
"Everyone needs to (stay hydrated) but certainly the ones with the trait, I would think if people were appreciating that this can occur, then they would be paying a lot more attention to those people," he said.
Josey football coach Barney Chavous already has built hydration into his planning and has an assistant to do that.
"The old way of doing things, you didn't get water during football practice," he said. "Now, because of the amount of deaths, it has brought more attention to it, so you have to have someone really responsible for the players having water and getting breaks."
In 2001, there were 23 deaths related to football at all levels, from Pop Warner to the National Football League. Of those:
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