My son’s death during a college football workout was preventable. Lessons must be learned

Late last month, Arizona State hockey player Matthew Mayich collapsed during a team workout. He is now fighting for his life after suffering from exertional heatstroke and, according to the Mayich family attorney, is unlikely to make a meaningful recovery. This young man was drafted by the St Louis Blues but will never get the opportunity to play in the NHL. While he is not the first young athlete severely harmed by heat-related illness in American sports, he should be the last.I have learned more about this preventable injury than I ever wanted to know. On 29 May 2018, my son Jordan McNair collapsed during a strenuous football practice at the University of Maryland. By the time he arrived at the hospital, he was dangerously overheated and never recovered.For two weeks, as Jordan fought for his life through intensive care and an emergency liver transplant, one question kept coming: “What did we miss?”I think about the days before he signed with Maryland, when coaches sat at our kitchen table talking with our family about Jordan. I remember asking two questions:“Can Jordan get some playing time?”And, “What support do you have around mental health and substance abuse?”Those are the kind of questions many parents ask when they have never experienced a life-changing tragedy in collegiate sports. Jordan was going to play football at a Big Ten university. What could possibly go wrong?I didn’t ask:“If something happens to my son, what safety systems do you have in place?”“What is your emergency action plan?”“When was the last time you practiced it?”“Who has the authority to stop a workout when an athlete is in medical distress?”“What happens if my child suffers exertional heatstroke?”“Where is the equipment needed to save his life?”Those questions came in hindsight, as I walked toward the ICU every day while Jordan fought for his life. I kept asking myself:“What did I miss that night at the kitchen table?”Before Jordan collapsed, I thought heatstroke and heat exhaustion were one and the same. I thought if someone became overheated, you moved them into the shade, gave them water, let them cool down, and everything would be fine. I didn’t know a heat-related injury could kill my son. My education came through a baptism by fire.Suddenly, as the Mayich family may be learning now, I had to understand medical terms I had never heard before: rhabdomyolysis. Core body temperature. Multiorgan failure. Exertional heatstroke.Jordan McNair during his time with the University of Maryland football team. Photograph: Courtesy of the Jordan McNair FoundationSince Jordan’s death, I’ve worked alongside medical professionals to cool athletes experiencing exertional heat illness at sporting events across the nation. I’ve seen first-hand how quickly proper recognition and response can change an outcome.One of the simplest explanations of exertional heatstroke has stayed with me. When your core body temperature rises above 104F (40C), it is like putting your body inside a microwave. Your organs begin to cook.There is a critical window of roughly 20 to 30 minutes to rapidly cool the athlete and avert catastrophe. Cold-water immersion can bring the body’s temperature down before the damage becomes irreversible.Time is everything.But what happened to Jordan wasn’t only about what went wrong on the football field on 29 May 2018. What happened to Mayich in Arizona isn’t only about what happened on 20 August 2026. The tragedy began long before.Every organization has layers of protection, and every layer can have weaknesses, the holes in the Swiss Cheese Model. One hole may not cause disaster because another layer can stop it. But when enough holes align, nothing remains between the athlete and tragedy.There was an emergency action plan in Jordan’s case. But having an emergency action plan on paper and being prepared to execute it are two very different things. Imagine having a fire evacuation plan nobody ever practices. Then one day the building catches fire. Who knows where to go, what to do, who calls 911 and who gets people out? The middle of the fire is the worst possible time to figure out the plan. Athletic emergencies are no different.Every time an athlete steps on to a field, court, track or practice facility, an emergency is possible. The systems designed to protect that athlete must be in place before it happens, and the people responsible for those systems must know exactly what to do.I used to say Murphy’s law was in full effect the day Jordan collapsed. While I wasn’t in Arizona for the team practice where Matthew Mayich collapsed, reports from that day reveal unsettling parallels to my son’s case.During a strenuous early-season workout, the athlete’s level of distress wasn’t properly recognized. The escalation from heat exhaustion to exertional heatstroke wasn’t appropriately addressed. The emergency action plan was not properly practiced or implemented. The lifesaving cooling response wasn’t initiated within that critical window. Necessary equipment wasn’t within immediate reach. Changes in the normal practice setting complicated the emergency response, and precious time was lost before treatment began.One hole.Then another.Then another.Until they aligned.By the time Jordan arrived at the emergency room, more than an hour and a half after he collapsed, his core body temperature was approximately 106F. My son never came home.Three days after Jordan died, on 16 June 2018, I began what would become my life’s work as a student-athlete safety advocate. There is a club of parents none of us ever asked to join. We are mothers and fathers who sent our children off to play the sports they loved and eventually had to bury them. We don’t need another member.Maryland players surround the No 79 painted on the field in honor of Jordan McNair before their game against Michigan State in College Park in November 2018. Photograph: Will Newton/Getty ImagesWe certainly don’t need another parent standing outside an ICU asking the same question I asked myself over and over:“What did I miss?”My prayers remain with Matthew Mayich and his family. I pray they receive the outcome every parent outside an ICU desperately hopes for.For years, I kept returning to the questions I asked at our kitchen table.Now, I know the question I should have asked. “Can my child play and will my child be safe?”Parents shouldn’t have to experience what my family has before they learn to ask that question. Medical professionals responsible for the health and safety of athletes shouldn’t wait until an athlete collapses to understand and practice their role in an emergency action plan.Schools and athletic programs shouldn’t discover holes in their safety systems while a child’s life hangs in the balance. Coaches need to understand their role in that system without being expected to diagnose or treat a medical emergency. Athletes should never wonder whether speaking up about how they feel will be interpreted as weakness.The on-field cardiac arrest of Buffalo Bills safety Damar Hamlin demonstrates that having a disciplined emergency action plan goes beyond heat-related injury. Hamlin’s full recovery after immediate CPR and emergent cardiac defibrillation is an excellent example of how lifesaving intervention should be available for athletes at risk. He not only made it to the hospital; he walked out on his own and eventually returned to the playing field.The NCAA, with over $1bn in revenue, owes its players that same level of emergency preparedness.This is an opportunity for youth sports organizations at every level to have mandatory emergency action plans in place for the life-threatening emergencies their athletes face. This includes heat-related injury as well as other serious sports-related emergencies such as cardiac events, traumatic head injuries and complications of sickle cell disease.Students, parents, coaches and administrators must hold athletic organizations accountable to have these resources in place because the next missed opportunity may be fatal. Martin McNair is the father of Jordan McNair and founder of The Jordan McNair Foundation. Dr Simon Fitzgerald is a trauma surgeon and surgical intensivist in Brooklyn, New York, and a medical advisory board member of The Jordan McNair Foundation.