UTK Special 1/11/23

Always Prepared: The Gameday Medical Staff

Reader Orioles Fan Meg suggested something that I’d considered last week and forgotten:

With the events in the NFL last week, one thing I found particularly interesting was the description of all the medical precautions that occur before each football game.

Now, I grant you that football is inherently more dangerous than baseball but at some point could you put a piece together that discusses all the medical personnel at the games and the training that team personnel have. Seems like a good off season topic that other readers might be interested in as well.

That’s a great suggestion and I love reader questions and suggestions like this, so let’s dig in. As Meg noted, the injuries expected in the NFL or collegiate levels require more personnel and various views, if only for maintenance. As the Damar Hamlin situation showed, the planning put everyone on both sides in the right place and everyone executed perfectly, saving a life. However, this has happened in professional baseball and not long ago.

Most MLB medical staffs include a couple Athletic Trainers (all teams have two, with a couple having three.) Some strength and conditioning staff, rehab focused staff, or even massage therapists are around and most will have CPR and AED (automatic external defibrillator) training. The AED is now required in or near the dugout, along with a spinal board and cervical collar.

In the stands, or down in the training room, there is at least one doctor. This is either the primary care specialist or the orthopedic surgeons. These doctors normally rotate through the home games, though there can be more than one at a game. Unlike the NFL, MLB does not often travel with its doctors, so teams regularly use other doctors. Telehealth has made it easier to consult back with a team’s own doctors when thats needed.

As well, there’s EMT on hand with two paramedics. They’re stationed differently depending on the layout of the stadium, but all have easy in and out access, as well as a plan for getting out of the stadium area. Every team has a hospital on standby for any situation, usually with police escort to help the ambulance get through what can often be unusual and heavy traffic around a ballpark on game day.

There’s also often an EMT in the stands. While netting has helped avoid ball strikes, there are still issues in the stands and those paramedics could get involved in a more serious issue.

I asked Roger Caplinger, the long time Athletic Trainer and Medical Coordinator for the Milwaukee Brewers who recently retired, about planning and procedures. Caplinger was regularly working with MLB, MLBPA, and others to come up with plans for things like the concussion policy and dealing with COVID in-season, as well as all the duties with his own team.

I asked Caplinger about what kind of planning each team does. “Each MLB club, has to create and maintain an Emergency Action Plan (EAP) for their respective stadium that encompasses, players, coaches, umpire, and staff for home clubhouse, visiting clubhouse, umpires room, and batting tunnels,” he explained. “At the beginning of the regular season, each club is responsible for going over the EMP plan, with ALL team physicians who cover games, Athletic Trainers, [strength] coaches, stadium operations personnel, grounds crew, and security personnel.”

Since teams are cycling through and traveling, I asked how they keep up with things. “At the beginning of each home stand series, the home head Athletic Trainer must review the EAP plan with the opposing/visiting head Athletic Trainer,” he told me. Pretty simple, but effective, as we’ve seen with a number of situations.

One that comes to mind for me is the facial injury to Giancarlo Stanton, then of the Marlins. That happened in Milwaukee:

As you can see from the video above, Marlins medical personnel got to Stanton right about the ten second mark. Inside of a minute, Brewers team doctor William Raasch was working with people on the field (he’s in the leather jacket), while Brewers AT Dan Wright can be seen signaling for the paramedics, who are equipped with a cart at Miller Park (now American Family Field.)

The quick and diligent work by all the professionals here might not have been life saving, but Stanton’s eye could have been compromised and the difference between a career ending injury and the $300 million plus deal he got just a few years later.

I asked Caplinger what types of injuries a medical staff expected to deal with. While something cardiac is possible and planned for, it’s seldom top of mind. “Concussions and collisions,” he answered. He also mentioned hit by pitches, especially on the hand. (Padded gloves!) All MLB parks will have an X-ray, but for advanced tests or treatment, players are sent to the designated hospital or one of the doctors on call for the team.*

The Brewers also had an injury that Caplinger noted that was very similar to Hamlin’s. A minor leaguer named Julio Mendez was hit in the rib cage by a pitch and suffered cardiac arrest much as Hamlin did, the result of the process known as commotio cordis. Brewers medical staffers were able to get to Mendez quickly and using both CPR and an AED, Mendez survived though he was in critical condition for some time. While Mendez never played again, he’s alive today.

The quick, professional work and action plans in place around baseball will echo these, but unfortunately, lower levels have less and less resources. Without an Athletic Trainer at many practices, players are at more risk. Without an AED at hand, minutes can be lost, along with a life. At travel tournaments and Little League fields, there’s seldom anything or even a plan that’s passed to the coaches.

It’s my hope that the Damar Hamlin situation will lead to more notice across sports of the importance of these medical professionals, of the proper resources, and of having a good plan in place with proper practice. The NFL’s visibility and the positive result here should help, but there will be a next one.