More than an hour and a half passed between when a University of Maryland football player reported exhaustion and when his ambulance departed for the hospital, according to a new investigation into the death of the athlete published on Friday by the University System of Maryland.
The delay of care for 19-year-old Jordan McNair was one of several concerns outlined in a report on the investigation, conducted by the sports-medicine consulting firm Walters Inc. The university should also move student-health and student-wellness positions outside the influence of coaches, the lead consultant said. McNair died in June, two weeks after suffering a heat-related illness during a workout.
McNair’s initial injury evaluation did not include an assessment or documentation of vital signs, including his core temperature. No one identified escalating symptoms linked to a heat illness. And McNair did not receive adequate cooling promptly, the consultant found.
“Hindsight’s 20-20,” said Rod Walters, a longtime athletics trainer whose company led the review. “If we had identified that earlier, it might have changed things. But I think we have to have a plan, we have to identify those escalating systems, and if they are elevated, if there’s something abnormal, have a treatment plan.”
Questions about the university’s responsibility in the case flared in August, after ESPN reported that the Maryland football team’s culture was “toxic.” DJ Durkin, the head coach, was placed on leave after that report, and a strength-and-conditioning coach left the university.
McNair developed cramps in the midst of 10 110-yard conditioning runs, Walters said. He completed his first seven repetitions. But in the eighth and ninth repetitions, he struggled. In his last run, his teammates had to bring him along, the consultant said.
Walters said he had interviewed coaches, trainers, and several athletes.
The system’s Board of Regents took over the review of McNair’s death in August, when top university officials indicated that some of Maryland’s sports policies didn’t align with best practices. The system also said it would manage a separate review of the football program as a whole.
The College Park campus’s president, Wallace D. Loh, has said the university was accountable for McNair’s death, and some critics have questioned his leadership. Before the fall semester began, faculty members lamented their lack of oversight over athletics.
Loh attended a news conference on Friday at which Walters shared his report. Besides Walters, also speaking on Friday was James T. Brady, the board’s chair, who said the university would be in a “better place” to make final decisions after the second investigation is completed.
“We will not act, judge, or speculate before the facts are in,” he said.
The review of the football program will be conducted by an outside panel that includes retired U.S. District Court judges, sports-medicine experts, and professional football players. (One member, C. Thomas McMillen, a former basketball star, U.S. congressman, and Maryland regent, is the brother of Liz McMillen, the editor of The Chronicle.)
After McNair’s death the university said it had increased the number of medical training staff members who attend practices and games. Other changes include bolstering hydration practices and feedback mechanisms, in addition to training first responders to evaluate athletics facilities in emergencies.