College athlete died after collapsing at practice. How can these tragedies be prevented?
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Calvin 'CJ' Dickey Jr. was a college football player who had many interests outside the game.
He loved to cook, travel and go to museums, said his parents. They also said their son loved history and science and wanted to be a pharmacist.
'He was more than just an athlete,'' his mother, Nicole, told USA TODAY Sports.
However, Dickey had a condition that has afflicted other athletes over the years. He was diagnosed in 2024 with the sickle cell trait, which has been linked to the deaths of 14 college football players since 2000, according to the National Registry of Catastrophic Sports Injuries (NRCSI). The death toll is 30 on a list that dates to 1963.
Dickey was an 18-year-old freshman when he collapsed July 10, 2024, on the first day of the Bucknell football team's workouts. He died two days later in a hospital, and a medical examiner's autopsy and a private autopsy both cited sickle cell trait as a cause.
Questions about negligence and how to prevent similar deaths among college athletes have emerged since then.
The genetic disorder is found in about one of 12 Black Americans and in about one in 500 white Americans. Dickey was Black. On April 3, an attorney representing Dickey's parents filed a wrongful death lawsuit against Bucknell. They allege the school knew Dickey had sickle cell trait but failed to take action that could have prevented his death.
The risks are greatest when players overexert themselves in high temperatures. But sickle cell experts say that by following universal precautions, such as adequate hydration and rest, athletes who have the trait can still safely compete.
What is sickle cell trait?
For those with sickle cell, red blood cells can lose their natural shape and become crescent-shaped sickles that block blood flow. But sickle cell trait should not be confused with sickle cell disease.
Sickle cell disease is more serious and can lead to problems such as organ damage, strokes and anemia. By contrast, those with sickle cell trait 'typically live normal lives,'' according to the American Society of Hematology (ASH).
But for people with sickle cell trait, ASH also reports, 'Rarely, extreme conditions such as severe dehydration and high-intensity physical activity can lead to serious health issues, including sudden death …' However, neither the NCAA nor ASH regard sickle cell trait as a condition that should disqualify athletes from competing.
'Based on the data and the rigor that we see, we continue to hold the position that universal interventions to reduce exertion-related injury and death is effective in all athletes, including those with sickle cell traits,'' said Chancellor Donald, an active member of ASH and an assistant professor at the Tulane University School of Medicine.
Though ASH asserts sickle cell trait does not lead to exertional-related death, it cites a study that showed sickle cell trait was associated with a 54-percent higher risk of rhabdomyolysis. Exertional rhabdomyolysis, triggered by physical activity, can be fatal, breaking down muscle tissue and causing damage to the kidneys, liver and heart.
Dickey suffered from rhabdomyolysis, according to his parents' lawsuit, which said he went into cardiac arrest at least five times before he died.
Protecting a family's 'treasure'
On June 28, 2024, Dickey completed the NCAA-mandated sickle cell testing, according to his parents' lawsuit. The test revealed he had sickle cell trait, and his medical records were uploaded electronically to Bucknell's medical reporting platform, per the lawsuit.
Two weeks before Dickey reported to Bucknell's campus in Lewisburg, Pennsylvania, according to the lawsuit, a school trainer called Dickey's mother, Nicole, 'to discuss CJ's positive sickle cell trait test. Nicole was assured that adequate precautions would be taken to accommodate this condition."
Induced by heat and overexertion, athlete deaths associated with sickle cell trait have almost always occurred at practices or workouts. But some coaches have found creative ways to take precautions with players who have the trait.
Under former Kansas football coach David Beaty, players with sickle cell trait wore different colored jerseys and helmets at practice so they could be easily identified and protected from overexertion.
In 2006, Beaty was an assistant coach at Rice when Dale Lloyd II, then a 19-year-old freshman defensive back, died from complications of sickle cell trait after he collapsed during a workout.
"I vowed that if I ever was in control of it, that I would take every measure possible and then some from that point,'' Beaty, who was the head coach at Kansas from 2015 to 2018, told USA TODAY Sports. "So there was no excuse for anybody, anybody, to not be taking great care of somebody else's family treasure."
At Miami, athletes with sickle cell trait wear red armbands during practice to alert coaches and support staff, according to Carter O'Toole, the school's executive associate athletic director for strategic communications/chief of staff. He said those athletes are also listed on injury reports provided to coaches during the season.
But according to the Dickeys' lawsuit, Bucknell did not take the necessary precautions before their son joined the offensive linemen on the first day of workouts.
"The death of a student is always a tragic loss," Bucknell University said in a statement provided to USA TODAY the day the Dickeys' lawsuit was filed. '...While the University will not comment on pending litigation, we again extend heartfelt sympathies to CJ's family, and we will continue to focus on our most important priority — the health and safety of all Bucknell students."
Role of the NCAA in athlete safety
Mike Caspino, an attorney representing Dickey's parents, said they're not suing the NCAA because the organization has "no duty of care" – meaning no legal obligation to protect athletes.
The NCAA, responding to a lawsuit filed by Lloyd's parents after their son died at Rice in 2006, wrote, "The NCAA's Constitution confirms that member institutions expressly retained the responsibility for the conduct of intercollegiate athletics..."
However, that argument has not spared the NCAA from criticism for failing to police health-and-safety performance by its member schools.
'Even if you look at the NCAA Constitution, health and safety doesn't fall under the realm of enforcement,'' said Brian Hainline, who served as the NCAA's first chief medical officer from 2013 through May 2024. 'So there's a shortfall there, if you will. It's like, 'OK, member schools, this is what you're supposed to do. Make certain that you do it.' ''
A legal settlement between Rice and Lloyd's parents after their son's death led the NCAA to require all athletes have their sickle cell trait status confirmed. The hope was that schools would be better-prepared to help the athletes.
Attorney Eugene Egdorf, who represented Lloyd's parents, said the case is the highlight of his 35-year career.
"Because it made that difference,'' Egdorf told USA TODAY Sports.
The NCAA-backed sickle cell testing began in August 2010. In the prior decade, 10 football players died of complications from sickle cell trait. But in the decade after the testing was introduced, and as educating athletic trainers and coaches about the disorder increased, there were only two such deaths.
But Dickey's death is the second fatality related to sickle cell trait in four years – despite the fact that it's '100-percent preventable'' when schools know an athlete has it, as required by the NCAA, said Scott Anderson, a leading researcher of sickle cell trait in college football deaths.
'My hope would be that everybody is just incensed,'' Anderson, a former athletic trainer at the University of Oklahoma, told USA TODAY Sports of Dickey's death. "That everybody at the NCAA is incensed … That all the stakeholders are just incensed.''
What can be done?
James Borchers, chief medical officer for the Big Ten, has started the U.S. Council of Athletes' Health (USCAH) in hopes of preventing deaths like Dickey's.
'Historically in these situations, I think there is usually two types of failures," Borchers told USA TODAY Sports. 'One is an individual failure, and it can be an individual that's doing something that's inappropriate. But there's also usually a system failure somewhere. You have to look at both of those.
'And I think my guess is that you'd find failures in both cases, in both the individual and system approach here similarly to historically where you find in other places."
The plan, Borchers said, is for USCAH to audit and accredit systems in place at schools –designed to prevent deaths and also provide education. The USCAH already partners with more than 20 conferences and more than 280 of the NCAA's approximately 1,100 member schools, according to Borchers.
He has the backing of Hainline, the former NCAA chief medical officer, who joined USCAH as a senior advisor. 'I think it can become a third arm that is really going to be beneficial to the NCAA,'' Hainline said.
The NCAA has endorsed recommendations for schools to prevent catastrophic injury and death. But the organization has drawn scrutiny for a lack of enforcement.
A key recommendation is for each sports venue to have an Emergency Action Plan (EAP), a written document outlining procedures for responding to an emergency.
"These things need to be rehearsed,'' said A.J. Duffy, the president of the National Athletic Trainers' Association.
According to the Dickeys' lawsuit, Bucknell did not have an EAP in the facility where their son collapsed.
With an event like Dickey's death, Borchers said, the USCAH tries to highlight best practices that also address similar deaths, such as those resulting from heatstroke and cardiac arrest. (Since 2000, in addition to 14 deaths associated with sickle cell trait, 13 college football players have died from cardiac arrest and seven have died from heatstroke, according to the NRCSI.)
Anderson, who spent 26 years as an athletic trainer at Oklahoma, did not address the specific situation at Bucknell but did say, "There has to be a change in the way we train and condition these individuals. There has to be a change in coaching. We can't emergency-treat our way out of this.''
Remembering CJ
Not long before he died last summer, Dickey boarded his family's boat, joining his sister, Patrice, 20, and their parents near the family's home in Land O' Lakes, Florida, the Dickeys recalled in their interview with USA TODAY Sports.
'He helped me launch it and unload it,'' Calvin Sr. said.
'CJ really knew how to do everything,'' Nicole said.
The name of the boat: Just 4 Us.
Now it's just the three of them as their legal fight ensues.
During a recent interview, however, the Dickeys seemed less interested in the legal battle than in sharing memories of their only son.
"He loved to eat,'' Nicole Dickey said, adding that CJ planned a family vacation to New Orleans. "We hit every joint for crabs and crawfish and lobster, and, yeah, that was CJ.''
She also said CJ got the family to create accounts on LinkedIn.
"He was like, 'Yeah, Mom, I'm going to start making my network,' " Nicole Dickey said. "He was already thinking beyond football.''
CJ's LinkedIn account still reads, "Student Athlete at Bucknell University.'' Along with 2024-2028, the time he planned to stay.
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