Six deaths directly caused by football occurred in 1988, according to a report covering professional, college, high school and sandlot activities. All the deaths occurred in high school play, with four occurring during games and two in practice. Four of the deaths resulted from injuries to the head, one from chest injuries, one from neck injuries. In the 1988 deaths, two victims were injured while tackling, one while being tackled, one was being blocked, one was in a pile-up, and the activity of one was unknown. In addition, there were 11 indirect deaths associated with football recorded in 1988. Ten of those were with high school football.

Football is not the only sport reporting deaths and sizable numbers of injuries. The National Safety Council reports the following data about the number of injuries and deaths:

Sport Injuries Deaths

Baseball 327,620 7

Basketball 460,420 7

Boating 3,635 896

Gymnastics 37,671 1

Hang gliding NA 6

Parachuting NA 6

Scuba diving NA 66

Skateboarding 80,242 0

Snow skiing NA 1

Swimming 99,161 1,700

Tennis 21,201 1

Water skiing 21,828 21

Contact sports have higher injury rates than non-contact sports. Although boys are injured at twice the rate of girls, rates are similar if contact sports (in which boys participate more than girls) are eliminated. The highest injury rate (and the most serious injuries) for secondary school girls occurs in basketball, the women's sport with the most contact.

Prevention

Successful interventions in sports injuries have been reported. For example, trampoline injuries tended to be especially severe, resulting in paralysis or death. An American Academy of Pediatricians warning and the refusal of insurance companies to provide coverage for these devices resulted in the elimination of trampolines from school gymnastic and cheerleading programs and a drastic decline in injuries.

Prohibiting dangerous practices has been successful when enforced. For example, a 1976 rule change prohibiting "head butting" in football led to a decline in deaths.

Personal protective devices are effective. Ice hockey eye injuries declined when facial protective devices were made mandatory. However, evidence suggests that such protection may make athletes feel safer and lead to more aggressive play and an increase in other types of injuries.

The following guidelines, not all inclusive, would further aid in the reduction of sports-related deaths and injuries:

- Rules strictly enforced by officials

- Dangerous and illegal techniques must be prohibited

- Coaches should be versed in first aid and prevention of injuries

- Personnel trained in injury care and CPR should be available at all games and practice sessions

- Properly fitting equipment should be worn

- Injured players should not return to play without a physician's permission

- An emergency plan using the Emergency Medical Services system should be implemented.

More recommendations than the above could be formulated. A comprehensive injury prevention and control effort in organized competitive sports programs should be implemented at all playing levels.