October 19, 2011

An Ordinary Football Game, Then a Player Dies

By JORGE CASTILLO

PHOENIX, N.Y. — Football coaches and school administrators at John C. Birdlebough High School congregated in a small room off the library Monday, huddling around a computer for a most painful and unusual review of game video. They examined every play that one student was involved in, assuming the role of medical examiners.

They were trying to discern which collision of the hundreds in a football game at Homer High School on Friday night might have caused Ridge Barden, a 16-year-old defensive tackle, to fall to the turf in the third quarter and die within a few hours. The coroner attributed Barden’s death to a subdural hematoma, or a brain bleed.

“There’s nothing here; there’s still nothing there; there’s nothing there; there’s nothing there — and now he’s laying on his stomach,” Jeff Charles, the head coach, said while watching the sequence frame by frame.

As those who play and coach football learn new ways to improve safety — through training, medical response and equipment — sometimes they are left to contemplate this: brains remain vulnerable, and even the most ordinary collisions on the field can kill.

Teenagers are especially susceptible to having multiple hits to the head result in brain bleeds and massive swelling, largely because the brain tissue has not yet fully developed. According to the National Center for Catastrophic Sport Injury Research, Barden was the 13th high school player to die from a brain injury sustained on a football field since 2005 and the third this year. Including college and youth football players, there have been 18 fatalities since 2005.

With heightened attention focused on brain injuries in football in recent years, Barden’s death delivered an unwelcome reminder that even the best-known practices sometimes fall short. As it happened, the Senate Commerce Committee, the latest group in Washington to explore the topic, held a hearing Wednesday to discuss concussions in sports and the controversial marketing of “anticoncussion” equipment.

Barden had no history of head trauma and showed no concussion symptoms, his coaches and father said. The Cortland County coroner’s office said the autopsy showed no evidence of a pre-existing problem.

Barden’s helmet, a Riddell Revolution, was purchased by the school two years ago directly from Riddell. It was reconditioned after last season and recertified for use in 2011 by Stadium System, a company based in Canaan, Conn., that reconditions helmets for hundreds of schools around the country.

Two certified athletic trainers and three student trainers from the nearby State University of New York at Cortland were on hand and treated Barden on the field, and emergency medical technicians arrived with an ambulance within minutes.

“You can have the perfect plan in place but if all of these things happen, it can still result in a catastrophic injury and death,” said Kevin Guskiewicz, the chairman of the department of exercise and sports science at the University of North Carolina and a leading researcher on sports concussions.

Dr. Jeffrey Kutcher, director of the Michigan NeuroSport concussion program at the University of Michigan, was among the witnesses who testified at the Senate hearing Wednesday. “Those kind of injuries are very rare, they’re catastrophic, they will happen and there’s no real way of preventing them through equipment,” he said about Barden’s death in an interview after the hearing. “That’s going to happen any time there are impacts to the head of significant force.”

After reviewing the video, the coaching staff deduced that the critical blow was sustained on Barden’s second-to-last play, a routine collision with an opposing lineman at the line of scrimmage. But Barden appeared to be fine as he prepared for the next play.

At first, after collapsing, he was groggy but responsive and coherent, Mr. Charles said. Barden told his coach that he had sustained a helmet-to-helmet hit and that his head hurt. Barden rolled over on his back then sat up on his own, but his condition quickly deteriorated. He began moaning and closing his eyes. When asked to stand up, he tried but immediately collapsed.

The emergency technicians planned to take Barden to University Hospital in Syracuse, about 45 minutes away, but they rerouted when Barden went into cardiac arrest. While the crew performed CPR, the ambulance drove three minutes to Cortland Medical Center instead.

When Barden’s father and grandmother arrived from Phoenix, the doctor told them he was dying; only CPR was keeping him alive. At 10:18 p.m., less than two hours after the seemingly ordinary play at the 6-yard line, Barden was pronounced dead.

Dr. Guskiewicz said the only way Barden might have been saved from a subdural hematoma would have been if he had undergone immediate surgery to relieve the pressure on his brain. But a CT scan would have been needed to diagnose the problem, and, according to accounts, Barden’s condition deteriorated too quickly for him to have a CT scan.

Dr. Robert Cantu, a neurosurgeon at Boston University and a leading expert in sports-related head injuries, said that in cases similar to Barden’s, in which the person was conscious right after the hit before quickly deteriorating, he had discovered that the subdural hematoma was not the cause of death but rather massive brain swelling. And in many cases the condition began with a previous hit and a second impact was the lethal blow.

Dr. Cantu said he could not speak to the particulars of Barden’s case without examining the brain.

“All I can simply say is that when I see this precipitous deterioration, my ears immediately go up and I wonder about second-impact syndrome in association with subdural hematoma,” Dr. Cantu said, adding that an original blow can be sustained off the field. “But it’s the second impact that’s the lethal part.”

Students, coaches and administrators remembered Barden this week as a straight-A student who would walk a long way from his home to school for voluntary workouts in the summer. Friday night’s game was his first start with the varsity team.

The community was left wondering what could have been done differently. The coach, Mr. Charles, contemplated whether he could return to coaching football. His team’s last game of the season has been canceled.

“I will never bad-mouth the sport of football,” Mr. Charles said. “I played it and I loved it and I’ve coached for years, but it does make me take a second look at it.

“I’ve had a few people asking if I’d coach again, and you know what, I don’t know. Right now I think the irrational thing would be to say: ‘No, I don’t feel like coaching again. It scares me.’ But to be honest, I don’t know how it’s going to affect my coaching. It scares me right now that I don’t know if I will be a good coach.”

Barden’s father, Jody, said he had no objection to the sport in the wake of his son’s death.

“I just don’t want a negative spin on this,” Mr. Barden said Sunday. “There is no blame in this. I don’t want to scare kids from playing the game. Ridge loved playing the game, and I know he wouldn’t want it to get a bad name.”