Rod Williams was a student, an athlete and a performer.
He was a 17-year-old junior at Burke County High School in Waynesboro, Ga., an offensive lineman on the football team and a member of the concert band. He was a jokester, the one who always made those around him laugh. He was loved by his friends, family and peers.
MORE: Notable sports deaths in 2015 | Spurrier may coach high school football | Most incredible college plays
“He was just your all-American high school kid,” Burke County football coach Eric Parker told Sporting News.
Rod Williams (via YouTube)
But Williams was taken from those loved ones too soon.
On Sept. 22, Williams collapsed on the football field about six minutes into practice. He showed no signs of fatigue or strain; his heart and breathing just stopped. The team’s athletic trainer performed CPR and he was rushed to the hospital, where they finally got his heartbeat going again.
Two weeks later, on Oct. 5, Williams “took a turn for the worst,” according to Parker, and died.
MORE: Chicago senior seventh high school football player to die in 2015
An autopsy revealed Williams had a pre-existing heart condition that went undetected. His collapse was caused by sudden cardiac arrest, an event in which the heart stops suddenly.
Williams’ death seems unique to football-related fatalities. It’s easy to link concussions and poor tackling technique — among other common causes — to tragedy on the high school gridiron. It’s a fair assumption, too. Williams was the third high school football player in a two-week span to die — Evan Murray, a quarterback for Warren Hills High in New Jersey, died Sept. 26 of a ruptured spleen, while Kenney Bui of Evergreen High School in Washington died of brain trauma — but the only one whose death was not the result of contact.
“What seems to be a healthy kid on the field suffers cardiac arrest, you just don’t think that’s supposed to happen,” Parker said. “It makes it even more baffling.”
Williams’ case, however, was actually the most common.
According to multiple studies, sudden cardiac arrest is the leading cause of death in high school athletes, contributing to roughly 20 percent of the fatalities in sports. It’s a silent killer with no real symptoms to prepare for. Most cases are the result of a pre-existing condition that goes undetected.
Jonathan Drezner, a family medicine physician and professor in the family medicine department at the University of Washington, said in the past year alone he’s seen 22 cases of sudden cardiac arrest in high school football players, 13 of which died.
“If you look back over many years of trying to understand the relative frequency of these events and you look at football deaths only, they average approximately six high school football deaths per year,” Drezner, who is also a team physician for the Seattle Seahawks, told SN.
This isn’t exclusive to football players, either. Mark Link, a professor at the Tufts University School of Medicine who specializes in different forms of cardiology, including heart disease in athletes, wrote in a study that on average, a competitive athlete in the United States experiences a sudden cardiac death every three days.
Such facts leave us with questions regarding heart failure in high school athletes. What triggers these events? Why are so many of these pre-existing heart conditions undiagnosed? What needs to change/what’s the solution?
PHOTOS: College football's craziest fans | Worst college coaching hires
SN spoke to multiple experts in this field to try to answer these questions, some of which there’s no clear explanation. There are still too many factors relative to cost, infrastructure and effectiveness in play.
What is evident, however, is that there’s a public health crisis at hand — young athletes dying suddenly and unexpectedly — one that doctors say the most advanced technology still lacks the ability to solve.
What triggers these events?
Buddy Singleton has seen firsthand just how unexpected cardiac events can be. And just how tragic they are, too.
Singleton, longtime coach at D’Iberville High School in Biloxi, Miss., felt a father-son bond with his junior fullback, Latrell Dunbar. He would drive him to summer weightlifting sessions and during the season bring him home from practice. They’d spend a good 10 to 15 minutes in the car together each day, and developed a strong relationship over time.
“This kid was as healthy as anyone we had on our team,” Singleton told SN.
That all changed on one play.
Dunbar was the lead blocker on a running play during D’Iberville’s Sept. 9, 2011, game at Gautier High School. He drove into an opposing defender and fell to his knees. He rose and continued to give chase. Then he collapsed suddenly.
Dunbar was attended to by the team’s training staff and transferred to a local hospital via ambulance. D’Iberville continued the game.
Singleton received a call from the school’s athletic director on the bus ride home. Dunbar was dead.
“It hit me like a ton of bricks,” Singleton said. “It was one of those things you’ll never get over and never forget.”
Jackson County coroner Vicki Broadus determined the next day that Dunbar suffered from “an acute cardiac event” that resulted from an undetected pre-existing heart condition.
Dunbar had passed all his preseason physicals, experienced no prior pain or breathing issues. There was no way for anyone to anticipate it.
“That’s the thing that bothers you,” Singleton said.
Heart failure isn’t limited to high school athletes, but it’s most documented at that level due to the sheer number of participants — there are about 1.1 million high school football players alone in the United States compared to thousands of professional athletes. The greater frequency of such events is inevitable.
According to Link, a large majority of sudden cardiac arrests are a result of underlying conditions that were exposed through physical activity. The most common of those is hypertrophic cardiomyopathy (HCM), which, according to the American Heart Association, is found in about one in every 500 people. HCM is a genetic condition that causes the thickening of the heart muscle. Too much vigorous physical activity can cause a person with HCM’s heart to beat at an abnormally dangerous rate.
Link said there are about 20 hidden cardiac diseases that predispose people to sudden cardiac death. Physical activity puts a person with one of these diseases at a greater risk.
“Physical activity puts a stress on anybody’s heart,” Link said. “If your heart is healthy it can tolerate that stress quite well. If your heart has one of these diseases it can lead to a malignant arrhythmia that causes no blood flow and you drop dead.”
Drezner said these diseases typically manifest themselves as a child physically matures through puberty, meaning it’s been present since he or she was about 13 years old. He said he doesn’t know why the event takes years later to occur, but added that 80 percent of the deaths happen during exercise.
“I think there are nuances of the heart and things that happen that create a perfect storm where maybe paths cross and things happen,” he said. “We don’t have a good reason for the ‘why now.’
“Given you only exercise one or two hours a day as an athlete, it really is a trigger or risk factor for exposure that makes it more common for athletes.”
Why do so many go undiagnosed?
Sept. 22 had been a normal day for Williams before he collapsed on the Burke County High School practice field. He lifted weights in the morning, went to class and ate lunch. There were no outward signs of trouble, nor did he complain of feeling ill.
The school gathered his last three years’ worth of physicals after his collapse and found nothing out of the ordinary — no high blood pressure or cardiovascular concerns.
“Whatever happened just crept up on everyone,” Parker said.
But that’s what's so dangerous about these heart conditions, most people living with these problems don’t experience any symptoms.
That makes screening essential.
Student-athletes are required to undergo yearly physicals from a physician in order to participate in high school sports. However, in most cases a standard check up from a primary care physician is not enough when it comes to the heart.
“Just listening to their heart you’re going to miss some things,” Barry Boden, a specialist in sports medicine at The Orthopaedic Center in in Rockville, Md., told SN.
Boden, who’s studied fatalities in high school and college football players documented in articles in The American Journal of Sports Medicine, said the biggest issue right now is there is no perfect, low-cost way to screen these athletes for heart abnormalities.
The most widespread initial heart exam is the electrocardiogram (EKG), which tests the heart’s electrical activity and is presented as line tracings on paper. These aren’t found in a typical primary care physician’s office.
Boden said many athletes don’t have access to advanced screening due to financial constraints. If an EKG, which can cost about $50 per person, detects an abnormality, then the next step would be for the patient to receive an echocardiogram, which uses ultrasound waves to produce a visual display on one’s heart activity. Those alone can range from $1,000 to $2,000. To expect them from athletes as part of a preseason physical is unrealistic.
“We need a better cost-effective screening test and that just isn’t available right now,” Boden said.
Link said the prevalence of undetected heart conditions isn’t a matter of cost, but of the inconsistencies with the tests themselves, particularly EKGs. According to Link, EKGs reveal abnormalities in 10 to 25 percent of athletes. Such abnormalities would then require an echocardiogram and perhaps even an MRI.
But even those tests are filled with gray areas.
“So you’re going to end up doing a lot of (echocardiograms), a lot of MRIs and still not end up with crystal clear diagnoses in a lot of people,” Link said.
Drezner is among those physicians who set the standard for using advanced screening on his athletes. He echoed Link’s sentiment, saying current screening methods are riddled with imperfections and don't catch every condition.
“The kids are still dying and they’ve all been screened so our screen is ineffective,” he said.
What’s the solution?
One conversation changed Mark Ladner’s life, and his career.
Ladner, a registered echocardiographer, was working in an office in Pascagoula, Miss., when he struck up a conversation with one of his patients, Latrell “Fred” Dunbar Sr., father of the D’Iberville football player who died of heart failure at 17 years old.
It was about a week after Dunbar’s death. Fred Sr., still grieving but looking to make a difference, told his son’s story and asked Ladner if he could’ve detected the problem had Dunbar been checked out earlier.
“It was real, real sad, and moved me,” Ladner said. “I knew that in most cases with either an EKG or an ultrasound, if he had an enlarged heart it was definitely diagnosable by an ultrasound.”
Ladner added: “(Fred Sr.) was walking away, turned around and said, ‘If you can do something about this, man, you ought to do it.’”
Ladner was inspired.
Thus he founded Safe Sports Scans, a mobile heart screening company geared toward saving young athletes with undetected heart conditions. Ladner acquired a portable EKG and ultrasound from acquaintances in his field and bought an RV from a friend for a cheap price. He refurbished the vehicle and opened business.
Ladner travels as far as three or four hours away to test student-athletes — he said he’d go even further if a school can book enough students. He charges about $99 per test, which includes a standard questionnaire, a blood pressure test, an EKG and a quick ultrasound read by a paid cardiologist. Ladner said his price is roughly 10 percent of what a hospital would charge for a similar procedure.
One of Ladner’s most recent stops, of course, was to D’Iberville High School.
Ladner approached Singleton about testing football players, and perhaps all student-athletes, at D’Iberville. The school hasn’t changed any of its preseason testing or emergency response procedures since Dunbar’s death, but Singleton said he’s open to more elaborate testing if it can help prevent another incident like the one from four years ago.
The issue, however, is the price, which adds up when considering there are about 75 to 100 players in the football program.
“I know the school district could afford it but if they did it for football then they’d have to do it for all sports and you’re talking about maybe 250 students because of all the sports we have,” Singleton said.
“It’s something that probably should be done for all sports.”
Singleton said he plans to meet with Ladner in the spring and push for a fundraiser or some kind of sponsorship to help cover the cost for the team. He said more advanced screening for next season would help put him at ease about his players’ health and safety.
“I think it would be great,” he said.
But as Link, Drezner and Boden have all said, there’s still no precise form of detecting these conditions. A mobile heart-screening service is convenient and potentially life saving — another step toward combating this issue — but it doesn’t change the fact that EKGs aren’t 100 percent effective.
Drezner said bluntly that better screening methods are essential. Their inconsistencies are leaving heart conditions unseen.
“We have to solve the infrastructure gap,” he said.
But it doesn’t mean they shouldn’t be used. According to Drezner, male basketball and football players account for 60 percent of all sudden cardiac deaths in athletes. Allocating the best resources to testing in those two sports while a clearer solution is still unavailable would be a place to start.
Drezner said it’s also necessary to educate all physicians in how to properly screen the heart.
“EKGs are really based on risk and resources,” he said.
The next best answer for now, Link said, is fluid resuscitation. That means the need for an emergency action plan that includes an athletic trainer available at all times, staff trained in CPR and defibrillators at hand.
However, not all schools are prepared to handle a sudden cardiac event, whether it’s due to a lack of emergency planning or equipment available.
“In my opinion in 2015 that’s just unacceptable,” Drezner said.
CPR training is mandatory for graduating high schools in 27 states. Link said it should be required for anyone involved in sports programs, including coaches, trainers and players. That alone could lower the amount of sudden cardiac deaths.
“If you’re in a sports program and you know how to do CPR, that would save a lot of lives,” Link said.
Although in many cases there are no symptoms of heart disease, Boden said it’s important for athletes to be aware of the potential signs, which include fainting, shortness of breath and chest pain during exercise. Heart conditions are hereditary, so if a student-athlete had family members who died young due to cardiac arrest then it’s possible they may have an undetected heart condition as well.
Sudden cardiac arrest is a case of the unknown, with no clear symptoms or solutions. The fact that teenagers are dying unexpectedly should be a concern. It’s certainly a concern at Burke County High School now. Parker said the school did everything it could at the time of Williams’ collapse, but that it’s trying to improve its emergency response, even with a change as simple as making it easier for ambulances to have access to the practice field.
It’s also a concern at D’Iberville High School, where Singleton is hoping he’s found a way to, if nothing else, limit the possibility of ever having to endure losing one of his players again. One time was too much already.
“I live with it every day,” he said. “This will probably stay with me until the day I die.”
And it's a concern for cardiologists, who acknowledge the need for stronger methods and struggle with the lack of solutions. Because right now, the uncertainty has formed an expectation from the outside that change won’t come in the near future.
“At the end of the day, I don’t know if you can ever totally eliminate that,” Parker said. “That’s just not something you can ever do. There’s always the possibility that this is going to happen or could happen. You just pray it doesn’t.”