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Korey Stringer's death lingers on a final trip to Mankato

MANKATO, Minn. -- Echoes. They're everywhere.

This is where Korey Stringer took his final steps.

This is where he slept his last night and ate his final meal.

This is the road the ambulance followed as it delivered him to the hospital where he died.

As the Minnesota Vikings train at Minnesota State University, Mankato, for the last time this summer, team officials and fans alike are awash in sentimental thoughts. Memories surface from the meals they ate at institutions such as Jake's Pizza, with its framed photographs of players and coaches dating back six decades. They range from the bizarre -- Remember Dimitrius Underwood, a first-round draft choice who reported to camp in military fatigues and went missing the next day? -- to the tragic.

For those who were here on Aug. 1, 2001, it is impossible to experience Mankato without staggering at the memory of Stringer's death. Even 16 years to the day later, we see the physical and emotional triggers, and it is no less shocking that a healthy 27-year-old star died because he got overheated during a humid football practice.

I hope that Stringer's memory, and the frightening lessons of his demise, will not fade when the Vikings shift their camp to their new year-round facility next summer. His death spurred overdue changes in the way professional sports teams train in summer heat, and efforts that culminated in the creation of the Korey Stringer Institute (KSI) have improved conditions for members of the military and outdoor laborers as well.

But on the anniversary of Stringer's death and during the Vikings' final trip to Mankato, it's important to understand how much work remains. Tragically, the number of documented cases of heat stroke deaths at the high school and college football levels has risen since 2001, as the accompanying chart shows. KSI has developed a heat acclimation plan targeted at state-level high school sports associations, but fewer than half of the states have adopted it.

"The big thing is that we know death from heat stroke is 100 percent preventable," said Douglas Casa, the CEO of KSI and a professor of kinesiology at the University of Connecticut. "Globally, we've made a lot of progress in saving people's lives. There has not been a single death in cases of heat stroke where our guidelines were followed. But there are still these hard-core situations, mostly at the high school level in July when kids are working out without supervision, where they're not doing the things they could, and it sometimes ends in tragedy."

Founded in 2010 at UConn with contributions from the NFL, Gatorade and other corporations, KSI has worked to set a medically based standard for exertion in heat. Its recommendations include a number of protocols that could have saved Stringer's life.

I was covering camp on July 31, 2001, the Vikings' second day of practices that summer. The heat index approached 90 degrees by mid-morning, and it was so humid that my laptop screen fogged over when I opened it for the first time. Stringer practiced for nearly three hours in full pads, refusing breaks, and collapsed shortly after the practice's conclusion.

He was led into a medical trailer, and as medical staffers observed what they believed to be dehydration, Stringer lost consciousness. He was taken by ambulance to a regional hospital, where his core body temperature was recorded at 108.8 when he arrived. He died early the next morning.

The KSI heat acclimatization plan calls for limiting practices to one per day for the first five days of activity and waiting until the sixth day to wear full pads. It warns high school-level parents that kids who spend much of their summer inside -- most of them, in other words -- will need a more gradual heat acclimatization timetable. And it suggests having manual cooling methods, including ice tubs and cold towels, on hand to use immediately if needed.

"It is so important to start bringing down that body temperature right away," Cass said. "We don't want it to wait until people go to the hospital."

This week, KSI announced the results of an eight-month study performed in conjunction with WHOOP, a company that produces a device known as the Strap 2.0 to measure athletic performance, sleep quality and other health-related data. (WHOOP also partnered recently with the NFL Players Association to help professional-level players monitor their own exertion.) Among the biggest conclusions, according to WHOOP CEO Will Ahmed, is that quality and quantity of sleep correlated to performance and health in hot conditions.

WHOOP devices measure the stages and length of sleep to use in a "recovery score" that gives the user a sense of the body's condition relative to its baseline.

"A lot of what we're measuring has preventative capabilities," Ahmed said.

These protocols and research results generate benefits beyond the world of sports. Members of the KSI staff spent time recently at Lackland Air Force Base in Texas, working on strategies to help airmen perform better and more safely at boot camp. Among the implemented changes was hiring athletic trainers to supervise recruits' conditioning work. KSI also has worked with government agencies such as OSHA to standardize conditions for outdoor laborers.

Without a doubt, awareness and treatment of heat stroke have improved dramatically in the years since Stringer's death. I still remember walking onto the field to cover my first NFL training camp in 2000 with a bottle of water in my hand on a hot day.

A security guard quickly pounced.

"No water on the field," he said.

I asked why. His response stunned me: Players weren't allowed to get water whenever they wanted to, so no one else on the field could, either.

Needless to say, that barbaric policy soon faded away. Now every NFL training camp is equipped with the tools it needs to prevent and treat heat stroke. But the fatality statistics at the college and high school levels remind us that heat stroke remains a threat.

Yes, a healthy but unprepared person really can die by overheating while exercising. We saw it happen 16 years ago. The echoes are everywhere. It's impossible to forget.