A Decade of Deaths: CDC Issues Report on Football Fatalities

Two days before the National Football League Playoffs began on January 8th, the US Centers for Disease Control and Prevention (CDC) released a report detailing just how much damage the sport can do.

Simply titled “Traumatic Brain and Spinal Cord Fatalities Among High School and College Football Players—United States, 2004-2015,” the study was authored by Kristen L. Kucera, PhD, and colleagues, and was published in the CDC’s Morbidity and Mortality Weekly Report.

Although heat exhaustion and internal injuries also cause football deaths, the CDC’s report focused solely on fatalities caused by injury to the brain or spine. The researchers found that between 2005 and 2014, 24 high school players and four college football players were killed in such fashion while participating in football events, whether practices, scrimmages, or games.

Catastrophic and sometimes fatal brain and spine injuries have been associated with football for longer than it has at all resembled the modern sport. They've been part of the game since before Teddy Roosevelt’s “football summit,” a gathering (possibly somewhat apocryphal) when college coaches and athletic directors of the then-rugby-like melee were convened to address the dozen-and-a-half deaths the college game produced in 1905.

“Picked up unconscious from beneath a mass of other players, it was generally found that the victim had been kicked in the head or stomach, so as to cause internal injuries or concussion of the brain, which, sooner or later, ended life," the Washington Post wrote that year.The summit’s rule changes, including the advent of the forward pass, began the slow process of transforming football from the loose amateur street fight it began as into the rigid, strategically warlike affair that it is today. Turning the players from petty brawlers into human missiles, unsurprisingly, didn’t remove the dangers they faced, it just altered the nature of them.

The CDC’s new report cites 26 of the 28 deaths they examined as resulting from a brain injury, including all four of the college deaths. Subdural hematoma, the flooding of the brain with blood as a result of head trauma, was the culprit in 46% of the deaths.The CDC report was even able to pinpoint the positions involved in the largest number of fatal incidents. Linebackers (21%) and running backs (32%) accounted for a combined majority of the deaths, and eight of the 28 fatalities were a result of “head first/head down contact.” The CDC also found that 18% of the high school fatalities were in players who had suffered a concussion in the preceding month, consistent with an earlier finding from 20 years of data that put the number at 16%.Several suggestions emerge from the report, including the emphasis of proper, safer tackling technique, both on the part of the player making the hit and the player receiving it. Due to the speed of the game, however, the report expresses concern that, without early and constant reinforcement of the safer techniques throughout their lives, players are liable to revert to poor habits when making split-second decisions.

The CDC points out that all 50 states and the District of Columbia have laws on the books to require concussion education and safety measures, such as discouraging same-day return to play and requiring professional examination and clearance. Compliance from administrators and players, however, is the tricky part. “The implementation and impact of these laws are an important area for future inquiry,” the report acknowledges.

Adequate presence of medical professionals in football safety is a key issue and cause for concern.

The report found that while most school districts have them at games, 30% of public high schools nationwide had no access to a medical trainer, and a full 50% of them did not have anyone trained in protocol for “catastrophic football injury events” present at practices. Of the 24 brain-or-spine-related deaths among high school football players the paper examined, four of them (17%) occurred in practices.

The report’s focus period of 2005-2014 does not include one of the deadliest high school football seasons in recent memory. In 2015, at least 11 players died as a result of football activities, six of which appeared related to brain and spine injuries. One was caused by a broken neck and five others were attributed to blunt force trauma.

“He didn’t die from football,” a principal of one Texas high school said of Cam’Ron Matthews, a team captain for the Alto Yellowjackets, who collapsed on the field in October of 2015 and died the next day. “He had an aneurysm, and it just happened to be on the football field.”

Months later an autopsy was released that proved the principal’s statement untrue: Matthews was killed by "anoxic encephalopathy following resuscitation from cardiac arrest from unspecified blunt impact."

The CDC report is meant, in part, as a call to action.

“These findings support continued surveillance and safety efforts to ensure proper tackling techniques, emergency planning, and medical care, particularly during competition, and adherence to protocols for safe return-to-play after a concussion,” the authors concluded.

It’s not known how those efforts are faring in Alto, Texas, where Matthews died. The school did later name its football field after him, though.