Fortunately, deaths at the college and professional levels of football are extremely rare. In fact, only one player has ever died on field during an NFL game, Lions receiver Chuck Hughes, who suffered a heart attack on October 24th, 1971. However, there are only about 1,700 active players on NFL rosters each year, compared to what the NCAA projects to be about 73,000 NCAA players, and 1.1 million high school players. Factor in youth football, non-NCAA college teams (such as community colleges or club teams), and semiprofessional leagues, and there are millions of football players each year in the United States alone.
Due to the small sample size of players and injuries in the NFL, catastrophic brain injuries, such as those caused by second-impact syndrome, aren't often discussed by the media or understood by people involved in or fans of the sport. By this point, pretty much everyone following football in any capacity knows the signs and long-term risks of concussion, or at least that they exist, but few know about second-impact syndrome. A couple weeks ago, I wrote about Patriots receiver Julian Edelman, who possibly played through a concussion in Super Bowl XLIX against the Seahawks in 2015. Edelman didn't miss a snap for the rest of the game after getting hit, and ended up catching the game-winning touchdown. He was praised by some media outlets for his toughness. By the reality is that, if he was concussed, he was literally one hit away from a possible death. I mean, that's kind of true in football (and a lot of things in life) all the time anyway, but sustaining a second concussion before the first one has healed can lead to rapid swelling of the brain, leading to a mortality rate of around 50%, and a near 100% chance of permanent disability, such as paralysis and/or coma.
During a concussion, the brain, normally suspended in and protected by cerebrospinal fluid, makes contact with the skull, causing shearing forces which damage axonal tissue. This bruising leads to chemical imbalances as the brain attempts to repair itself.1 If the brain receives a second blow before recovering from the first, these imbalances prevent the brain from regulating intracranial pressure and blood flow. Cerebral edema, the excess accumulation of fluid in the brain, leads to brain herniation, or rapid swelling; the brain essentially continues to expand, but is physically constrained by the limits of the skull, and death can occur within minutes.2
It goes without saying that in football, there's a culture of playing through injuries. But, learning about second-impact syndrome will ideally encourage players to report concussions to medical staff. In 2014, a survey of 730 NCAA football players by Harvard and Boston University revealed that for every concussion officially diagnosed, there were many other instances of suspected concussions or concussion-like symptoms that players chose not to report to medical staff. Even ignoring the long-term health concerns associated with concussions, hopefully increased awareness of the rare but often fatal condition of second-impact syndrome will incentivize players to remove themselves from games or practices when experiencing concussion symptoms, and, just as importantly, not return to play until all symptoms have dissipated.
1 http://www.brainfacts.org/about-neuroscience/ask-an-expert/articles/2015/what-happens-in-the-brain-during-and-after-a-concussion/
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672291/
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