Cheerleader deaths: Unimaginable but true

April 21, 2008 Chang died on April 14 during a meet in Worcester, Mass., after she was accidentally kicked in the chest while performing a "basket catch" routine.

"Lauren died doing what she loved … cheerleading and being with her friends," her sister, Nancy Chang, told reporters last week.

Smith came close to losing her own life after falling 15 feet and landing on her head at a meet in Sacramento, Calif.

"I just can't believe girls are still being injured and girls are dying over cheerleading. If anyone told me cheerleading could be the cause of my death I would never have thought that," Smith told ABC News.

But it almost was. In 2006, Smith was a "flier" for a team at Sacramento City College. Smith was performing a trick that required her to do a handstand and then be thrown before landing in the arms of her teammates. But the trick didn't go according to plan because "the guy who was going to catch me lost his balance and I came straight down on my head," said Smith. She ended up with a spinal fracture that doctors say was a millimeter away from paralyzing her.

And, it turns out, Smith is one of the lucky ones.

Say Phommanyvong's 17-year-old daughter, Patty, died after sustaining a brain injury last October in Los Angeles while cheering for Marshall High School's football team. Phommanyvong said his daughter was hit in the chest during a catch and her heart stopped. There reportedly was not a working defibrillator at the stadium. Her family says it took 30 minutes for an ambulance to arrive and by then Patty had suffered serious brain damage because of a lack of oxygen.

Phommanyvong is a recent immigrant from Laos and can only watch helplessly as his daughter spends her days – mostly unresponsive – in a California rehab hospital. "Her body is very, very stiff. She opens her eyes and sometimes blinks. She cannot eat or talk. I think she recognizes us, sometimes. I think so," Phommanyvong told ABC News.

And then there's 14-year-old Ashley Burns, of Medford, Mass., who on August 9, 2005 died of an injury to her spleen during a practice session at East Elite Cheer Gym in Tewksbury, Mass. Burns was in the middle of a move known as an arabesque double-down when she failed to complete the second of two twists. She landed chest down and died shortly after.

Her mom, Ruth, describes her only child as an athlete who loved rock music and animals. "I miss her every day," said Burns in an e-mail exchange with ABC News. She has had to piece together what happened to her daughter bit by bit. Burns believes the coaches waited too long to call the ambulance, until her daughter was throwing up blood and having convulsions. "She was pronounced dead before I even got there," said Burns.

Ashley Burns was believed to be the first cheerleading death in Mass., making Chang's death the second. Chang was an all-star cheerleader. During a meet at the Minuteman Cheerleading Championships, Chang was kicked in the chest; she staggered off the floor and collapsed. Her coach Kim England calls what happened to Chang a "freak, freak accident."

Chang's family hopes that the death of Lauren will lead to reforms." We hope her death will shed light on the inherent risks of cheerleading and we hope that additional safeguards are taken," Nancy Chang said.

"Accidents are just preventable injuries," said Kimberly Archie, executive director of the National Cheer Safety Foundation. The problem, according to Archie, is that when the public pictures cheerleaders they think of the Dallas Cowboy Cheerleaders. "They wink into the camera, the wiggle their pom poms and that's about it," said Archie.

Archie has compiled a list of injuries sustained by cheerleaders going back more than decade. The list includes broken backs, concussions and paralysis. Archie's own daughter, Tiffani Bright, broke her arm in two places when she was 15 years old. After that, Archie started to ask questions and what she found out frightened her. "No one is trying to shut cheerleading down, we just want some protection for the girls," said Archie.

Part of the problem is it's hard to figure out who is responsible for protecting what in the world of cheerleading. The United States All Star Federation for Cheer and Dance Teams (USASF) oversees elite teams like Lauren Chang's. But there's also the National Federation for High School Sports, and various state sport associations. And the International Cheer Union, one of the biggest purveyors of related cheer paraphernalia, uniforms, camps and competitions.

States differ even as to whether or not they call cheerleading a sport or an activity. In Massachusetts for instance, cheerleading is not officially classified as a sport, but in neighboring New Hampshire it is.

Mass. State Rep. Peter Koutoujian, chairman of the Joint Committee on Public Health, was contacted by the Chang family in the wake of their daughter's death. "They always say it's not your father's Cadillac, well this is not your mother's cheerleading. It's a highly competitive and grueling sport," said Koutoujian. Koutoujian is concerned about the high number of injuries in the sport, although he doesn't necessarily believe regulations are the solution. "We are going to hold some meetings and it appears they might be followed up with some oversight hearings," said Koutoujian.

There are roughly 3,000 coaches and 10,000 athletes like Chang governed by the USASF. The organization was started in the 1990s and provides a certification process for coaches and rules that govern competitions. Les Stella, the vice president of programs for USASF, wants to get a tape of Chang's meet to review it and try to understand exactly what happened. "We will investigate it, we are trying to keep kids safe … our hearts go out to the family, the industry as a whole is upset about this," said Stella.

But Stella also said that "football has more deaths per year than you have had in cheerleading in 10 years" and that the sport is ultimately safe. Jessica Smith, Ruth Burns, Say Phommanyvong, and Lauren Chang's family would no doubt disagree.