My friend Don Johnson has asked me to write a brief chapter for his textbook Practical Sports Medicine and Arthroscopy titled “Running on the Field.” As it relates to running on the field, I’ve had the privilege of being head team physician for the Denver Broncos as well as the Colorado Rockies. Running on the field is frequent with injuries on the football team, but rarely with injuries on the baseball field. When there’s an injury with the Denver Broncos, it’s hard to miss the white (blond)-haired guy doctor running on to the field and I guess that’s the reason I get the nod to write this chapter. The discussion in this chapter applies not only to a professional football team such as the Denver Broncos, but to other levels of play, such as college, high school, and other sports, such as soccer and basketball, among others. As team physicians, we work closely with the training staff, tending to injuries on the field of play. With the Denver Broncos, we take our lead from the training staff, which is responsible for communication to the coaching staff regarding players’ injuries and removal from play. That may not always be the line of communication. It is important to appreciate that, in order to run on the field and care for injured athletes, the doctor needs a working relationship with the team, including training staff, players, even coaching staff and management. In order to develop such rapport, the doctor must be present in situations in which players and staff can get to know the medical personnel.

In going onto the field, the doctor and training staff are required to make decisions, often very quickly. They’re the ones who are able establish a diagnosis on the field, and to what length this needs to be pursued depends on the circumstances and the situation. In most situations, the physician will perform a quick history and physical
examination on the field, then evacuate the player to the sidelines for further examination, or even evacuate the player to the hospital for assessment in certain situations, such as a spinal cord injury. Unfortunately, doctors might be called upon for dramatic treatment on the field for those who may be in a life-threatening situation. ACLR training and knowledge is important, since one might have to resuscitate a player on the field. At the professional level, there are often EMT personnel to perform such tasks as intubation. Such personnel may not be available at the high school level, in which case the doctor may have to assume that responsibility, or at least be able to resuscitate the patient appropriately. Gratefully, these situations are rare.

In this chapter, we’d like to describe different situations in which a player goes down and outline the role of the doctor in each circumstance. In most circumstances, doctors and trainers are not allowed on the field until there is an appropriate stoppage of play, as indicated by the referee. I personally, however, have seen life-threatening situations in which as a physician I’ve moved very quickly to the scene before any whistle had blown. Training staff and doctors need to practice and be knowledgeable of the principles of resuscitation, and more important, the principles of immobilization, especially when it comes to care for the head-and-neck-injured player. In going on to the field, the physician often must rapidly assimilate knowledge about whether this represents a minor injury, moderate injury, or hopefully not a major potential life- or neurologically-worrisome injury. It is important that the doctors and trainers not get caught up in the excitement of the game and forget that their job is to watch carefully and be alert to situations in which players are injured.