The collapse and subsequent hospitalization of ASU hockey player Matthew Mayich on Aug. 20 has led to scrutiny of the University's heat illness policies.
The lawyer representing Mayich's family said he experienced exertional heat stroke during a team workout and has "no chance of recovery."
Since then, the University released a review of the case that seven members of the team anonymously disputed in a letter to ASU President Michael Crow. Head coach Greg Powers has since been placed on paid administrative leave.
Sports wellness experts said proper acclimatization and heat illness prevention are key to keeping athletes healthy, especially in the Arizona heat. The University's review demonstrates ASU Athletics failed to follow critical procedures.
A spokesperson for ASU Athletics declined several opportunities to comment on the situation.
READ MORE: The latest on ASU hockey, Matthew Mayich. What has happened since Aug. 20
What experts said
Getting accustomed to a different climate is a delicate balance, Joseph Marsit, a professor in ASU's College of Health Solutions who oversees the undergraduate degree program in sports science and performance said.
He said when an athlete begins the process of transitioning to play a sport in a different environment than they are used to, they must acclimate themselves.
The typical acclimatization process will take anywhere between 11 and 21 days, and two weeks is recommended, Marsit said.
Susan Yeargin, a professor of athletic training at the University of South Carolina, said there are several different atmospheres the human body can adapt to: "cold environments, hot environments, hypobaric environments, which is altitude, and hyperbaric environments, which is scuba diving."
When temperatures surpass 95 degrees Fahrenheit, the body starts experiencing stress. The Valley experiences particularly extreme conditions, Marsit said.
When beginning the acclimatization process, a person's general response to exercise will be somewhat more dramatic. Marsit said the body will secrete sweat earlier, and the heart rate will increase more quickly.
If a person listens to their body, takes appropriate time to rest and stays hydrated throughout the two weeks, they will gradually readjust to their normal workload, he added.
"Your body's built first and foremost to keep itself alive," Marsit said. "That's our physiological build."
In cases when athletes and teams have to travel, Marsit said they are exposed to these conditions to an extreme degree.
"That's where good nutrition, good rest, good recovery and then also proper substitution patterns fall into place," Marsit said. "People can't necessarily do the same workload they were doing at wherever they're from."
If an athlete is "normal and healthy for the most part," even when exerting extra effort, their experience won't be much different, Marsit said. Major complications tend to be the result of changing climates within a short time frame, he added.
An athlete who mostly exercises indoors may be strong in terms of fitness level, Yeargin said, but that doesn't automatically translate to a hot outdoor environment.
"Even if he (Mayich) was a very fit individual inside the ice rink, that doesn't then give him a leg up," Yeargin said. "He still has to go through the heat acclimatization process."
Yeargin pointed to four categories of exertional heat illness: heat cramps, heat syncope, heat exhaustion and heat stroke. She said it is a myth that one heat illness necessarily progresses to another.
There are risk factors that can predispose someone to heat illnesses, Yeargin said, but only an elevated core body temperature causes heat stroke.
The most notable factors that create vulnerability to heat-related illnesses are dehydration, not being properly acclimated and not being physically fit enough for the activities one is asked to perform, she added.
"A lot of times, what we will see with high-level athletes — Division I, professional — they are fit, but what is being asked of them is just too much," Yeargin said.
Other potential factors that may increase the risk for heat illness are body mass index, nutrition, sleep deprivation and the environment, she said.
When an athlete works out in the full sun or high humidity, Yeargin said the body is more likely to experience an increase in core temperature.
"It's never a good idea to work out in the middle of the day," Yeargin said.
She added that it is recommended to avoid exercising outside from 10 a.m. to 6 p.m., and workouts should be done either before or after, when conditions are likely slightly safer.
ASU's report on the Aug. 20 incident
Mayich collapsed before 8:30 a.m. during a workout at Sun Angel Stadium on Aug. 20, the first event of the year led by the coaches, according to an initial report from the University's review by James Rund, senior vice president of Educational Outreach and Student Services.
On that day, outdoor temperatures were calculated based on data from local sensors close to Sun Angel Stadium, ranging from 86 to 89 degrees Fahrenheit with a relative humidity of 51% to 46%, according to the report.
But data from a 2021 study by five ASU faculty members captured average August temperatures at Sun Angel Stadium, where the hockey team practiced on Aug. 20. The study found temperatures on the track at the stadium were nearly 10 degrees higher than the average of locations across the Valley.
READ MORE: ASU hockey players dispute University's review of Matthew Mayich's hospitalization
The report also said all of the athletes who participated in the practice that day were medically cleared for participation.
A timeline published by the University indicates that Mayich arrived in Tempe from Canada on Aug. 12, eight days before the team workout during which he collapsed. A team physician and an athletic trainer medically cleared him to participate on Aug. 13.
The athletes were told to rest and hydrate in preparation for the practice, according to the report.
A break was taken about 20 minutes into practice for drinking water, the report said, and another when the athletes were being given instructions for a wind-down exercise of running with a medicine ball.
"When running, Matthew appeared to struggle, and then in rapid succession stumbled, dropped the medicine ball, and fell to the ground," the report said. "He attempted to get up and resume running but fell to his knees."
READ MORE: BREAKING: ASU hockey player still hospitalized after collapse in team exercise Thursday
That is when an athletic trainer started assessing his condition and began applying iced towels and water to him, according to the report.
The report said Mayich was initially responsive, but his condition deteriorated. The trainer called 911 and asked for emergency medical services to respond.
That is when Mayich was moved to a shady area, according to the report.
ASU Athletics' exertional heat illness policy, which offers safety guidelines for all athletic activities, requires a cold tub half-filled with water on-site and several ice coolers to immerse an athlete if a heat illness episode occurs.
ASU's review did not mention the use of a cold tub in treating Mayich.
Long-term consequences
"Exertional heat stroke is one of the top three causes of sport-related death in the United States, and in July and August, it often becomes the No. 1 cause of sudden death in sport," Samantha Scarneo-Miller, a professor focusing on athletic injuries at Old Dominion University, said.
Heat stroke is fatal when a person obtains a core body temperature above the 105 degrees Fahrenheit critical threshold, Scarneo-Miller said, but heat stroke "is 100% survivable if the patient is recognized to have exertional heat stroke and cooled under 102 degrees within 30 minutes of collapse."
Any time frame longer than 30 minutes raises concern for long-term consequences, Scarneo-Miller said, such as acute kidney injury or a coma.
Scarneo-Miller emphasized institutions should have a heat illness plan that is reviewed each year to ensure protocols are kept up to date, and everyone knows their role.
"Heat illness prevention, recognition and management preparedness is of the utmost importance for any level of play everywhere in the entire nation," Scarneo-Miller said. "Every single institution needs to be prepared with an exertional heat illness policy and procedure, and then a corresponding emergency action plan, and both of those documents need to be based off of best practices."
Andi Ruiz contributed to this story.
Edited by Carsten Oyer, Alan Deutschendorf III, Kate Gore and Sophia Keeling.
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Emma Bradford is a senior reporter at The State Press and in her senior year, studying both journalism and political science with minors in business and Spanish. She has previously interned with AZ Big Media and NEWSWELL Chicago, and completed her capstone at the Cronkite News D.C. bureau; she is currently interning with KJZZ. This is Bradford's sixth semester with The State Press; she was a part-time politics reporter for three of those semesters and a full-time politics reporter for one.
