A 14-year-old who collapsed and died after an August varsity football practice at River Bluff High School in Lexington County died of a pre-existing heart condition exacerbated by the heat that afternoon.
“Lewis N. Simpkins died as a result of complications of a fatal arrhythmia secondary to a pre-existing heart condition,” said Lexington County Coroner Margaret Fisher in a 5:25 p.m. press release on Tuesday.
Simpkins’ “pre-existing conditions, along with external environmental factors such as the high heat and humidity of the day, likely contributed to this in a setting of strenuous physical exertion (football practice),” Fisher wrote.
However, nothing in the medical tests turned up “electrolyte abnormalities” that would have suggested dehydration, “nor was there any definitive evidence of heat stroke,” Fisher wrote.
Fisher identified the pre-existing heart conditions as cardiomegaly and “severe concentric left ventricular hypertrophy.” That means Simpkins had an abnormal enlargement of the heart as well as a severe thickening of the walls of the heart’s main pumping chamber that causes the heart to work harder, Fisher explained.
Lexington School District 1 spokeswoman Mary Beth Hill, asked if any changes in football practices and physical evaluations had been made since Simpkins’ death, said, “Today’s release of the coroner’s report has stimulated conversation in Lexington District 1 about how we can provide an even better environment for our student athletes. Those conversations are still in the beginning stages.”
Susan Yeargin, assistant professor of athletic training in the exercise science department at the University of South Carolina, said conversations about how to further improve high school football player training safety are also taking place in the S.C. Medical Association sports medicine committee that advises the S.C. High School League.
Any new guidelines about practice emergency action plans and high heat and humidity that come out should be mandatory, she said.
“Right now, the state does a good job of strongly encouraging all of these things, but I think South Carolina should go one step further,” Yeargin said. Unless any new guidelines are mandated, not all schools will have the safest practices, she said.
Jerome Singleton, S.C. High School League commissioner, could not be reached for comment to answer questions about upgrading player safety.
Simpkins was two weeks shy of his 15th birthday and had just started 10th grade at River Bluff, one of Lexington County’s newest high schools, when he died. A popular, friendly defensive tackle who had played junior varsity in ninth grade, Simpkins was 6-foot-2 and 270 pounds and hoped to play football at Clemson University.
An autopsy was performed on Aug. 11, the day after Simpkins died, but its results were inconclusive and the coroner’s office ordered more extensive medical tests whose findings took longer to process.
In her statement, Fisher also said, “Most students get a routine physical before the season starts. That exam isn’t always done by a doctor. And it usually doesn’t include a test called an electrocardiogram.”
Fisher went on to say that an electrocardiogram “can uncover signs of dangerous and irregular heart rhythms but doesn’t catch every damaged heart. Also, it sometimes flags a heart as defective when it is perfectly healthy but slightly enlarged due to rigorous training.”
Because of the possibility of false alarms about a defective heart, Fisher said, “some doctors may be against including electrocardiograms in sports physicals. A healthy heart that is misidentified as damaged may encourage kids to give up sports they love.”
Fisher said Simpkins had had two doctor’s physicals since July 2015 and neither had picked up any heart abnormalities. Neither physical included an electrocardiogram, she said.
On Aug. 10, the day Simpkins died, the temperature in the Columbia area was 87 degrees around 5 p.m., when River Bluff’s football practice started. The relative humidity was 65 percent, generating a heat index of 95, according to the National Weather Service. People should exercise “extreme caution” with prolonged exposure to heat index conditions above 90, according to the weather service’s general warning about heat indices.
According to a Lexington School District 1 release, River Bluff’s football team practiced more than two hours, or until about 7:15 p.m., the day Simpkins died. During practice, the players took regular water breaks every 15 to 20 minutes during which the members are required to leave the field and drink water, the press release said.
There are water hoses available at all times, as well as coolers and water, and trainers are on hand “at all times” to monitor the athletes and make sure they take water breaks, according to the district. The release did not say how much water Simpkins drank, or whether he was hosed down to cool off during practice.
The press release also said two athletic trainers and a River Bluff coach began treating Simpkins, using CPR and a defibrillator, a device that uses electricity to restart the heart.
During that Aug. 10 practice, players were apparently wearing helmets, equipment that reduces the body’s ability to cool itself because the head is enclosed.
A report card from the University of Connecticut’s Korey Stringer Institute shows that South Carolina meets only one of seven of the minimum best practices recommendations laid out by the institute, which partners with such organizations as the National Football League and the National Athletic Trainers’ Association. The institute was founded in part by the widow of an NFL football player who died from exercise-caused heat stroke in 2001.
The seven guidelines, which set recommendations for heat acclimation procedures such as phasing in equipment usage and requiring specific lengths for practices and rest breaks, have been adopted by 16 states nationwide. They include neighboring Georgia and North Carolina as well as Florida, Alabama, Mississippi, Arkansas and Texas.
In a press release late Tuesday, Lexington 1 Superintendent Greg Little said, “Five weeks ago tomorrow, we lost Lewis Simpkins, and our thoughts and prayers continue to be with the Simpkins family. As others go back to their normal lives, there is a hole left in the Simpkins family that cannot be filled.
“Lewis was a fantastic student, who touched the lives of so many students and adults. Our district and our community are better because he was here.
“I would also ask you to remember his teammates, trainers, coaches and classmates, who are still grappling with this loss. Keep them in your thoughts in the weeks and months ahead.”
Fisher said the Simpkins family will release a statement at a later date.
THE TOP KILLERS
The top killers of high school student-athletes are:
traumatic brain injuries
and exertional sickling events, which are related to the sickle cell blood trait.
SOURCE: Susan Yeargin, assistant professor of athletic training at the University of South Carolina’s Department of Exercise Science