Olivier Louis told his family he was excited about finally getting a chance to prove himself on the football field.
Louis, an energetic 15-year-old, reported to Wekiva High School near Orlando for his fifth practice with the freshman team on Sept. 7, 2010. His family moved from Haiti in 2001 and it was Louis' first opportunity to play organized football. He often lifted weights with his older brothers, who said Louis was a promising athlete. He was projected to play linebacker or defensive end.
Louis collapsed and died at practice that day from complications of sickle cell trait and heat stress. His family did not know Louis had the trait, a condition that has been tied to sudden death in 17 athletes since 2000.
"It's so confusing because they told us he was perfectly healthy," said Ruth Louis, Olivier's sister. "… The medical examiner said that shouldn't have caused his death."
"We don't have closure because we don't understand how this could have happened to him."
Eighteen months before Louis collapsed, UCF freshman wide receiver Ereck Plancher collapsed and died following an offseason workout held less than 30 miles from the Wekiva campus. A medical examiner determined Plancher died from complications of sickle cell trait. A jury recently ordered the UCF Athletics Association to pay Plancher's parents $10 million in damages.
Plancher's death generated major media attention in Louis' backyard, but it wasn't enough to save his life.
While advocates for sickle cell trait education say great strides have been made during the past 10 years, they still see holes in the system. They are concerned athletes, parents, coaches and athletic trainers don't always receive critical information about proper precautions and treatment of athletes with the trait.
Youth leagues and high schools
Sickle cell trait differs dramatically from sickle cell anemia, a debilitating disease that requires constant medical care. People with sickle cell trait often suffer no symptoms or health problems. However, under extreme stress, red blood cells can warp into a sickle shape, clog blood flow and quickly damage vital organs.
Sickle cell trait has been linked to the deaths of 17 athletes since 2000.
University of Oklahoma head athletic trainer Scott Anderson helped write the National Athletic Trainers Association guidelines on sickle cell trait. He's heard of at least two cases of 12-year-olds participating in youth football who died from trait complications.
"If more pediatricians were having conversations with families about sickle cell trait, they would understand the risks and precautions," he said. "I think that would go a long way toward protecting young athletes."
The three major youth football leagues in the United States — Pop Warner, American Youth Football and USA Football — all work with sports medicine organizations to provide youth coaches with information about a variety of health issues, including sickle cell trait.
High schools are putting a greater emphasis on sickle cell trait education, as well. In Florida, questions have been added to the physical exam forms to help determine which athletes have the trait. And nationally, a push has been made to better educate high school athletic trainers.
There is some indication those efforts are starting to pay off. Orlando Freedom High coach Andy Johnson said one of the keys to his team's success is his close relationship with the school's athletic trainers.
Johnson said during typical Freedom varsity football workouts, two full-time athletic trainers and two student athletic trainers from UCF are on the field at all times.
He said he has a basic working understanding of sickle cell trait after being informed by an athletic trainer before the 2006 season one of his best players had the trait.
"They gave us a brief overview of what it was and what to watch out for," Johnson said of the athletic trainers' conversations with the coaching staff. "We never ended up having an issue with that player and nothing ever came of it."
While Johnson's situation is encouraging, it's not clear if it is typical. Coaches interviewed by the Orlando Sentinel all said they have heard of sickle cell trait and trust athletic trainers to help them treat athletes in distress.
However, there is some concern all high school athletes don't receive the same level of attention and care.
Dr. Michael Davidson, a sports medicine physician in Boca Raton, is concerned statewide budget cuts have slashed the number of athletic trainers available to help supervise all athletes.
"There is a dearth of high school athletic trainers in the state of Florida, and many of them are stretched way too thin," Davidson said.
"I think they pay attention to football pretty closely, but they're usually responsible for all sports teams at a school. State budget cuts have made it harder for the high schools to hang onto their trainers. And I've definitely seen a knowledge deficit about both heat illness and sickle cell trait."
Colleges and pros
Sickle cell trait has generated the most attention at the college and NFL levels, but many in the medical community are concerned players and coaches at the highest level of the sport still are not provided with enough information.
"Football coaches, strength coaches, athletic trainers, team doctors – everyone should know about an athlete's sickle cell trait status," said Anderson, the University of Oklahoma trainer. "Athletic trainers should be empowered to intervene when any athlete shows signs of distress. Everyone needs to know about sickle cell trait and understand that it's an intensity illness, so to speak, and the workouts have to be properly managed so it is safe."
Last season, the NCAA began requiring that all athletes be tested for sickle cell trait unless they sign a waiver opting out of the screening program.
In the recently expired NFL collective bargaining agreement, the league agreed to test all athletes at the NFL Combine for sickle cell trait and provide counseling if an athlete tested positive for the trait. Each franchise decides whether to test players who did not go to the combine.
The NFL Players Association launched a campaign to inform more players about the trait. And it has taken steps to make sure athletic trainers and team doctors are famililar with sickle cell trait precautions recommended by the National Athletic Trainers' Association.
Some players, including free-agent defensive tackle Brian Atkins and Pittsburgh Steelers safety Ryan Clark, are well aware of their trait status and understand the precautions they should take while working out. But other players have not heard much about the trait.
NFL player and Orlando native Chris Johnson said he couldn't recall whether he had ever been tested for the trait and whether the league ever discussed the topic with players.
"I'm sure they talked about that, but that probably wasn't one of those days where I was too concerned about all those things or paying too much attention," said Johnson, who still isn't sure whether he has the trait. "They usually talk to us about that kind of stuff in camp, but camp is so long, it's a whole month, so after so many meetings you kind of block your mind out of certain things. But I'm sure that's very important."
Dez Johnson, a Florida International graduate hoping to earn an NFL tryout, said he was familiar with sickle cell trait because a former teammate had the condition. Johnson said his friend struggled through a team workout, prompting athletic trainers to talk with the team about the trait.
Johnson could not recall being tested.
"I guess it wouldn't hurt to get screened, but I've been going so far without having to worry about that problem so that's why I just thought I don't need to get screened right now," he said.
Pinellas and Pasco chief medical examiner Dr. Jon Thormartin said he wishes more people from all walks of life would look into their sickle cell trait status. He stressed it can affect both African-Americans and people from all other ethnicities.
"I've seen it over and over again," he said. "Under serious stress, it can cause life-threatening problems. I wish people were taking it more seriously."
It is hard for the Louis family to consider what steps could have been taken to save Olivier Louis' life.
Ereck Plancher's mother, Gisele, has felt that same pain.
"That was a terrible thing, a mother losing a child," she said. "I don't want that to happen to anyone. I want Ereck to keep helping others. I want him to save others."
Shannon Owens contributed to this report. email@example.com.