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INDIANAPOLIS - Two high school athletes died of injuries directly related to football last season, the fewest in the United States in 10 years.
According to an annual report released Monday by the National Federation of State High School Associations, four other deaths were caused by heart-related ailments and were listed as indirect fatalities, the fewest since 1994.
The improvement resulted in part from a greater emphasis on safety by schools in recent years, said Jerry Diehl, NFHS assistant director and staff liaison to the federation's rules committee.
"Not that they haven't been concerned with that before, but they've taken those extra measures just to remind them," Diehl said. "It's a change of attitude from the coaches as they approach practice, knowing a healthy player and a well-hydrated player is better off than somebody that can't continue into that fourth quarter."
The Indianapolis-based NFHS is the umbrella group for the 51 state associations encompassing about 18,200 U.S. high schools and more than 10-million students.
The direct fatalities last season resulted from an injury to a player's brain and from an injury to an artery in a player's neck, Diehl said. He would not say where the deaths occurred.
There were a record 26 direct deaths in 1968, but that number has dropped since a 1976 rules change that banned initial contact with the head while blocking or tackling. There have been an average of four direct fatalities a year in the past decade.
Diehl also credited quick medical attention when an injury first occurs, instead of letting the athlete continue playing at the risk of a more serious injury.
"We've changed some attitudes a little bit, and that's for the betterment not only of football, but we're seeing that in a lot of our sports now," he said.
Indirect fatalities also may include heat stroke, though for the second straight year, none were for that reason in 2003.
The heart problems, for the most part, cannot be detected in advance.
"It is something that is congenital. It just happens to be a weakness that was there," Diehl said. "To discover that weakness takes a huge battery of tests. ... The doctors even say that sometimes the tests won't even show it."
The NFHS report includes recommendations for further reducing head and neck injuries, such as conditioning exercises to strengthen the neck; practicing fundamental skills, particularly blocking and tackling; and using properly fitted equipment.