It has been less than a month since Cornell men's lacrosse star George Boiardi was struck in the chest by a shot and died after collapsing to the artificial surface of Schoellkopf Field.

Boiardi, 22, became the third college player to die due to a lacrosse injury since the National Center for Catastrophic Sports Injury Research began collecting data in 1982, a 22-year period during which about 120,000 players participated in NCAA men's varsity lacrosse.

Despite its rarity, the March 17 tragedy was met with impassioned calls for improved and additional mandatory equipment, as well as new safety measures, by some of the most respected names in the game.

"I said this years and years ago, that we have to adjust our equipment based on the speed of the game," said former Cornell coach Richie Moran, who is executive director of the Intercollegiate Men's Coaches Association. "Football has added a lot. Why haven't we? The velocity of the ball has increased tremendously with the advent of plastic sticks."

"I'd be very much in favor of a rule change to make it more safe," Johns Hopkins coach Dave Pietramala said. "Guys are shooting the ball so hard now."

Their sentiments were echoed by coaches at all levels of the college game, and all indications are that rules changes pertaining to mandatory equipment will be forthcoming.

Chappy Menninger, chair of the NCAA Men's Lacrosse Committee and athletic director at Mount St. Mary's (Md.) College, said he and Willie Scroggs, chair of the Men's Lacrosse Rules Committee and associate athletic director at North Carolina, have made safety concerns a top priority of their committee meetings in August.

"We have put this on the radar screen as very important," Menninger said. "I would expect some directives from the rules committee to come out of those meetings."

Scroggs agreed but cautioned that the ultimate decision would be made by the NCAA's Competitive Safeguards Committee, which oversees safety and equipment concerns for all sports.

"They have the physicians, the physical therapists, the experts who study these issues specifically," Scroggs said. "Unfortunately, the way things are set up, the system can sometimes move like a glacier. We can certainly convey our concerns, and we plan to do that. All of us do not want to stand by and keep our fingers crossed and hope it doesn't happen again. One of these (tragedies) is too many."

Chief among the topics to be discussed will be making some type of chest protection mandatory.

Currently, only goaltenders are required to wear a chest protector. The only mandatory equipment for other players is a helmet, mouthpiece, shoulder pads, arm pads and gloves.

Ironically, a chest protector may not have saved Boiardi's life. The defensive midfielder was no more than four feet away from a Binghamton player who had just unleashed a shot on goal when he stepped in the path of the ball and was struck somewhere in the upper chest. He collapsed to the turf and was never revived, despite prompt medical attention from Cornell and emergency medical staff.

His parents requested that no autopsy be performed, so medical experts who study catastrophic sports injuries for the NCAA can only speculate on the cause of death. It did bear a striking resemblance to the two other fatal injuries suffered by college players on the field since 1982. They, too, were struck in the chest by a ball, collapsed and died.

In those cases the cause of death was commotio cordis, a phenomenon that occurs when a healthy person, usually a young male (the average age is 14), is struck in the chest wall by a blunt instrument - most often a baseball or a hard rubber object such as a hockey puck or lacrosse ball - at the precise millisecond the heart is repolarizing (just about to begin its upbeat), resulting in cardiac arrest. The age is important because the chest wall is still pliable in young males.

A study published in the March 6, 2002, Journal of the American Medical Association reported that of 128 confirmed cases of commotio cordis studied, fatal blows were inflicted at speeds as low as 30 mph (a lacrosse shot can reach 100 mph) and that 28 percent of the victims were wearing chest protectors.

Those sobering figures worry Steve Stenersen, the executive director of US Lacrosse, which was formed in 1998 with the goal of eventually becoming the governing body of the sport. Currently, the NCAA governs college lacrosse; the National Federation of State High School Associations governs high school lacrosse; and US Lacrosse governs youth lacrosse.

Stenersen said all three organizations have committees of medical experts assigned to study injuries in the sport and ways to better protect players. He said none of the research suggests mandatory chest protectors would prevent commotio cordis.

"The challenge of responding to a tragedy like this is that the immediate response is emotional," Stenersen said. "How can this happen? We have to prevent this from happening again. Frustratingly, it takes a balance of science, practicality, thought and discussion. The fact is there is no immediate way to prevent it from happening again.

"What is known is that there is no known equipment to prevent it. The existing research suggests that a chest protector does not prevent it. It has killed baseball catchers, hockey goalies and lacrosse goalies who were wearing chest protectors. The knee-jerk reaction is not the prudent decision in this case."

Menninger said the NCAA and specifically those who govern lacrosse have been aware of commotio cordis since Eric Sopracasa, a defenseman at the University of Massachusetts, was struck in the chest by a ball during practice in 1999 and died on the field.

"All I can tell you is this came on the landscape about three years ago," he said. "We spent two or three days in Gettysburg supposedly to discuss rules, and we ended up focusing entirely on equipment. We went the whole nine yards, from helmets to shoulder pads to helmets to sticks to try to identify those areas we thought were going to be problems."

Menninger said the committee looked at a prototype for a chest protector, but it was only meant to be worn by goalies. He said chest protectors for other players were discussed, but the issue "went away" due to a lack of prototypes to examine and the medical research suggesting that chest protectors were not the solution.

Now, in the wake of the Boiardi tragedy, there is growing momentum among the sport's governors to do something to make it safer. According to the NCAA, lacrosse is already a relatively safe sport. The NCAA Injury Surveillance System, which tracks injury rates for all the sports it governs, reported that men's lacrosse ranked sixth of 15 sports examined during the 2002-03 season in game injuries per 1,000 participants, behind football, wrestling, men's soccer, men's ice hockey and women's soccer.

Yet, everyone interviewed for this article firmly believes that even if commotio cordis cannot be prevented by adding equipment, the sport in general could be made safer, and new rules regarding equipment must be created or existing rules must be enforced to make it happen.

Menninger said protection, stick technology and attitude adjustment by players, who generally are passionate about wearing as little equipment as possible, will be hot topics at the August rules and safety committee meetings.

Here's a look at each:

Protection

Compared to football and hockey, the other two major men's contact sports, a lacrosse player is virtually naked. He wears a helmet with a facemask along with a mouthpiece, shoulder pads, arm pads and gloves. His chest, ribs, back and legs are unprotected. Of that mandatory equipment, only the helmets must be certified to meet certain safety standards.

Until the Boiardi tragedy, veteran Syracuse University equipment manager Kyle Fetterly said he thought the existing equipment was adequate. Now, he is not so sure.

"You think the players are adequately protected, and then something like this happens," Fetterly said. "I've done a lot of soul-searching since then. Now I believe it is something that needs to be looked at."

Moran believes all the protective equipment should be looked at closely and updated to correspond to the advances in stick technology and the size, speed and skill of the players. The main area of concern, though, is the chest.

Some shoulder pads resemble football shoulder pads and have a piece that extends midway down the chest. Others have attachments built into them that protect the sternum and ribs. Others are seemingly paper thin and barely cover the shoulders. All are acceptable under the current rules.

For any alteration of the shoulder pad requirement to take place, Menninger said, the rules committee would have to identify it as a problem area when it meets in August, get data from the Injury Surveillance System and then ask equipment makers to provide prototypes to study. He believes that process will occur this summer.

"We're going to implore them to give us some equipment that we can analyze to prove that we're attending to this problem," Menninger said. "Give us something."

Joe Taylor, a salesman for Brine, one of the big names in lacrosse equipment, said there is already equipment available that can protect a player's sternum area and ribs but that the culture of the game encourages players to wear as little protection as possible.

A trip to several local lacrosse equipment stores supported Taylor's assessment, as a variety of items that cover the sternum and rib areas were on display.

How effective they are is another issue, as the NCAA has no certification process for any piece of equipment other than helmets.

Stick technology

Unlike their wooden ancestors, today's lacrosse sticks are constructed of lightweight titanium and plastic and are designed to keep the ball firmly in the pocket while a player winds up and shoots.

They have become perfected to the point that it is nearly impossible to get a ball stick-checked out of the pocket or have it fall out regardless of how far a player winds up before shooting.

The combination has made the 90 to 100 mph shot, once an exception, common on a college lacrosse field.

"In my opinion it almost appears that you have to break a guy's arm to get the ball out," Menninger said. "You can't get the darn ball out of these sticks, and then they're so light that you can really whip them around and add a lot of speed to a shot."

Menninger said the rules committee believed stick technology was so important at its meeting three years ago that the topic received more attention than chest protection. The two will share the spotlight in August.

There is no question that the evolution of the lacrosse stick has changed the game, making the stick check nearly obsolete and forcing defenders to use their bodies to get between an offensive player and the goal as the primary means of defense, a la basketball.

The difference is a basketball player doesn't shoot a hard rubber object at 90 mph toward the basket.

Attitude adjustment

There is no mention in the 2004 NCAA ice hockey rulebook of any mandatory safety equipment outside of a helmet, a mouthpiece and hockey skates for players other than goaltenders.

Yet, no hockey defenseman in his right mind would consider skating onto the ice without other protection under his uniform in the form of shoulder pads, rib pads, thigh pads and perhaps shin guards.

Lacrosse players are apparently a rare breed. Like their hockey brethren, they play a sport in which a hard rubber object is shot at speeds approaching 100 mph and body checking is legal. Unlike their hockey brethren, they prefer to wear as little protective equipment as possible.

According to longtime followers of the sport, it has always been that way.

"When I played, shoulder pads and arm pads were optional," Scroggs said, "and you were considered a sissy if you wore them. Now I have a 14-year-old playing the game and he is asking why he needs the equipment. I just tell him, 'Hey, I know a little bit about this. Trust me.' "

In light of the Boiardi tragedy and the sometimes glacial pace of reform, getting that message across is something that can be addressed immediately.

"We have to change the mind-set of the student-athlete," Hobart coach Matt Kerwick said. "The biggest thing we need to do as coaches is make sure our guys wear as much protection as they can. When you see the way they play and the padding they wear, it is obvious something has to change. Compared to football and hockey, they wear nothing."

"It's pretty out of control," Colgate coach Jim Nagle agreed. "It's not like somebody gets injured every day, but there are some injuries that clearly could be prevented with better protection."

As Taylor said, that equipment is out there now. It's up to the coaches to make sure the players wear it, and it's up to the players to understand its importance.

"If they're athletes," Kerwick said, "they'll adjust."

Ultimately, though, the solution will probably be found in the form of NCAA rules forcing the issue.

"It is going to have to be mandated," Menninger said. "Players simply do not want to wear equipment. And we certainly don't want to encumber play to the point that kids are playing it under the auspices of not getting hurt. That would take away all the fun of a great game. Realistically, though, we have to make it safer."

Perhaps, as the experts say, no equipment could have prevented the Boiardi tragedy. However, it has provided the impetus to do everything possible to ensure that those who play the game do so as safely as possible.

"One more (tragedy) will be one too many," Menninger said.

"Everybody is sick to their stomach about this," Scroggs said. "It is time to look at this issue closely and develop some standards."

© 2004 The Post-Standard. Used with permission.

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