Dr. Neal ElAttrache, Head Team Physician, Los Angeles Rams
Dr. David S. Gazzaniga, Head Team Physician, Los Angeles Chargers Moderator: Michal Lev-Ram, FORTUNE

Brainstorm Health 2023 - Special Teams: The Role Of NFL Doctors On And Off The Field 

Conferences

Dr. Neal ElAttrache, Head Team Physician, Los Angeles Rams
Dr. David S. Gazzaniga, Head Team Physician, Los Angeles Chargers Michal Lev-Ram, FORTUNE

Special Teams: The Role Of NFL Doctors On And Off The Field 

Dr. Neal ElAttrache, Head Team Physician, Los Angeles Rams
Dr. David S. Gazzaniga, Head Team Physician, Los Angeles Chargers 
Michal Lev-Ram, FORTUNE

It was a frightening moment on the gridiron back in January Buffalo, Bills player Damar Hamlin suffered cardiac arrest on the field mid game after a tackle. And I'm sure we all remember those startling images of his collapse playing out almost as dramatically was the quick response of the medical staff who administered CPR and restored dear's heartbeat on scene before he was taken to the hospital DEMAR survived. And as you all probably know, announced last week that he's cleared to return to play the actions of the medical professionals that that day resonated with so many people, even those who don't follow football regularly. So what does it take to be a medical specialist on the sidelines ready to ensure the safety of players at any moment? What's it like on the inside? I'm going to be joined by two doctors who are definitely in the know on this, Dr Neil Ella Trash is head team physician with the Los Angeles Rams. Doctor David S Gaza is head team physician with the Los Angeles Chargers and we are thrilled to have them with us today. Hey, we're very l A heavy today. Um I wanna just start with, you know, giving us a sense of who's actually there, who's on the sidelines. What's the team made up of what happens on game day? So, the medical staff, uh, there's, there's a meeting at 60 minutes before the game starts. And so it's probably easiest to, to describe who's there based on that meeting. So, uh, let's say our teams are playing each other Neil and I would be there two internal medicine doctors, there would be a um physician is in charge of airway management in case somebody needs to be intubated on the field. There's a visiting team, medical liaison who's there, uh who helps the other team in case they need to prescribe medicine or go to the emergency room. Um There's uh each sideline has a neurotrauma specialist that's there, they're unaffiliated. So if someone has a concussion, they get evaluated um by an unaffiliated neurotrauma specialist, there's also one up in the box that's watching the game from there. There are two spotters that watch for concussions constantly throughout the game. Um And so that sort of makes up and then there's E M T s with an ambulance that sits right at the doorway on the edge of the field. Uh So there's AAA fairly large group of people for the efforts. Uh A dentist, I don't think there's, I don't think it's hyperbole to say that um probably the safest place you can be in public if you have uh a life threatening emergency, uh is on the NFL football field. Uh, you know, if you consider the number of people that David, um sort of enumerated there that, uh the people that are trained and ready to, to save somebody's life, everybody from the, from the people that are on the staffs of the medical staffs of the teams and also the, the paramedics and um that are, they are ready to go, uh, all trained in, in CPR AC L S. Um So, and you saw the, the people jump into action when it came to what happened to, you know, the, the, the, the trainer that was doing CPR for over nine minutes, basically saved his life. And the head team physician, uh Les Bisson who did a fantastic job directing that, that emergency when it was there until the paramedics could come and take care of it. It was remarkable, really, really something. So you're just, you're ready to spring into action at any moment and Neil brings up a good point. Uh just one, give special attention to the head athletic trainer. It's, it's a position that's underappreciated uh in the, in the world. You know, when you see someone go down on the field and someone runs out, um, they were instrumental all during COVID, they had to, you know, make sure all their players were safe and um head athletic trainers pretty much run the show as far as that goes. I want to get back to the dentist though. What, the teeth getting knocked out. What's the, it's, it's just, you know, they're ready for any occurrence essentially. So, um, you know, those, those things are just available and, uh, I used to be the team doctor for the New York Islanders hockey team and a dentist was highly regarded. They all have great smiles, all the hockey players, they're not real teeth. That's why, what, um, this is probably a silly question. But, you know, I think obviously we have a lot of doctors in the room also and we're all very familiar with the oath that a doctor takes with what the, the, the mission and the mandate of the medical profession is. Is it any different when you're a team physician? What's your, what's your purpose? What's your mission? Do you see it any differently? Yeah. You know, uh when I, we have a medical meeting before the start of every season and we're supposed to talk about specific things. But when I introduce myself to the new players, is that one thing I try to make sure that they know is that I don't covet my position as a team position, meaning that I cannot root for a team and try to look for team success and care for the individual at the same time. So I have to be able to separate that. It's not easy sometimes because obviously the competitive juices get flowing. But for me, I tell the individuals that I'm most concerned about their health, their family, their ability to provide for them and that sort of allows for trust to be built up in that way that they, they know that I'm not, you know, flying on the corporate jet and I'm not, you know, going to dinners and hobnobbing and things like that. Um, you know, you're wearing a Charger hat but I have mostly because I'm bald but Neil anything dad. Well, you know, I um here in L A, we, we are, we're one of the prime destinations for professional player care in the country. Um when people tend to get injured and, and if they are gonna leave their hometown, they, they, this is the number one place they come, we take care of so many people from so many different teams. Um and that they've mentioned the word briefly uh mentioned trust that, that, that builds over time. And so, you know, I think that I can safely say that I don't know of a physician in the NFL that's taking care of these players that is considering his team obligation or his team affiliation over and above taking care of the player. I mean, we can get into some specifics that have happened recently with regard to medical legal issues that, that show that the, the physician is really that, that physician player relationship is uniquely stands on its own. It's, it's unprotected. Um and it, uh it only works because there is that, that, um, relationship between the physician and the player. Um, and so the, the team is sort of, you know, protected and on the side. But, uh, the physician and the, and the player that, that patient doctor relationship really is what it is. Uh, so it takes precedent and, uh, I think that, um, you know, like I said, we can get into that but it's, uh, it's really come into focus recently with, yeah, so give an example of that and, and that tension really, um, the C B A for, in, in the leagues prevents a player for bringing litigation against trainers who are employees of the, of the team and against the team. Um, the physicians are not protected in that situation. Um So the, if, if there is something that goes awry in the training room, if, um, if they can say that the physician wasn't paying attention to their rehab or certainly, you know, with their surgical medical care, um, then the physician is, is that relationship is direct, there's no going through the team. The physician is not indemnified by the team as the entire staff of the team is. And so if you don't have the physician's best interest at heart, I mean, I'm sorry, the player's best interest at heart as a physician, you're, you're really on 10 ice. And so I don't think you see that, uh, the NFL especially, um, but the major leagues, um, in this country, I think have amassed the, the best orthopedic and sports medicine talent that there is, um, in, in this country. And, and so I, I think that, uh, I think that everybody's intentions and priorities are in the right place. And Neil, uh, just an example. We Neil and I were just at the NFL combine and there was a new doctor that joined the team and they were discussing all the risks involved with being a team physician. And, uh, this new doctor stood up and said, um, I just want to say, what the heck did I just get myself into? You know, and, uh, it seems like this, it is an amazing opportunity and, uh, but the balance of risk and reward is, is, um, is always uh something to consider, um, and a little bit of a tangent. But I think, you know, obviously one of the areas where there's been a ton of, of scrutiny is on concussions and concussion protocol. And, um, I was wondering if, if either of you could just kind of walk us through what the protocol is now because it's pretty complex, right? And I think it also, you know, one of my questions here is like, it seems like another point where there could be a bit of um, tension between the player and the doctor because I'm assuming a lot of players want to get back out there. But correct me if I'm wrong. No, I think you're correct. There are times where, um, and like I said, there's a spotter who's up in the, up in the box and he's, if he sees a player that has any psychomotor dysfunction or any difficulty after a play, he will, uh, announce to the referee, the referee will take the player to the sideline and that player has no choice but then to go through the protocol and be assessed. So they go to that little tent that you see that, um, he sits in there and then, um, the unaffiliated neurotrauma specialist will be involved as well as the, um, the team primary care physician. Uh, and they will begin to ask the questions that, um, are typical for, um, an initial concussion uh evaluation based on that, they also have to watch a video to see what the impact looked like. If it looked like something that would be worthy of continuing on or if it was, you know, there was no trauma to the head. Uh, and then from there, they have to go into the locker room and then there's, um, a test that they have to take, um, on an ipad or a similar device, a tablet. And, uh, and then based on that, the neuro trauma specialists will decide if they're ready to go back into the game where they're cleared or they need to then get onto this protocol, which then takes place after they, uh, after the game is over, they meet up then with a, uh another neuropsych specialist. And so you have to go through a series of hoops to jump through and, and is it correct that some players are not so eager to do this or are they submitting themselves to, you know, I think that, uh, the, the education around brain injury has, has, has been and now at all levels, um going back all the way into when these kids are playing in school. And, uh, so I think the there's more and more understanding that, you know, these are, can be cumulative problems that can end a career and can ruin a life. Um There's been some tragic things that were high in the media of some very, you know, well known, you know, top notch players that, uh what's happened to them and it's been related to brain injury. So I think that that player education has been good, uh that so I think the, the willingness to sort of hide these things. Uh I think it, yeah, you may want, you may want to stay in the game, you may not want to want to show that you're dinged so to speak. But, um, I think that the, the understanding is that you, somebody's going to notice it and, and it's going to, and it's going to be a problem and if you continue to play with, with that, with that injury during that game, it's going to mean a lot more time out. So it may happen but much, much less frequently than previously. Uh One thing that's not spoken of as, uh Neil is mentioning is that it depends on the player and his position with the team. Uh, and you know, where he is in terms of contracts. So there are a lot of things they get involved with it. Um, football is fairly unique. It's such a violent sport, but the contracts are not uh necessarily guaranteed. Uh So if you don't go forward and play, then you don't get paid and, and so a player that's very much on the bubble might behave differently, you know, but that's where the education really becomes important where, you know, you can't have short term goals that don't have long term success. So, yeah, it makes sense. Um I think we have a question for you over there and we'll come over. Hi, I'm Alicia Bazzano. I just finished my tenure as the Chief medical Officer of the Special Olympics and uh different population, but a lot of the same kinds of challenges, especially around stress, around game day stress and uh and trauma related mental health conditions. And I was curious to know what's the relationship between you as the head team physicians and the mental health, uh team members on your team? And what are the processes and protocols generally for that as well as just more broadly? What do you think that we can learn as health care teams from what you do. You know, you, you, you bring up a really excellent topic and that's the, not just the familiarity but the relationship of, uh, of the physician with the people that they're taken care of. I mean, it doesn't matter if it's in, if it's in your office, in your private practice or if it's taken care of a team, you know, to, to know, to know these people, to be around them, to understand what their personality is like and how that may change when they're under the stress, pre competition or during a competition. And to understand, you know, that player, some of them become non verbal, you, some of you, you can't even speak to. But if you, if you know them, if you develop that sort of that relationship, then then you can communicate with them where pretty much no one else can. And that's, that's really important because if something does happen to them in a game, they're a completely different person sometimes on that field or before a game than they are. And it doesn't matter if it's, if it's a special Olympics population or, or, you know, anxiety does that to people. And, and so I think that that stresses that intimate relationship, that, I mean, David and I, we can be, we're completely ineffective if we're not in that training room frequently enough where the players know us and, and we know them. And so I think that this speaks to your, your bigger question is, I mean, the lesson learned is just a reinforcement of what, what you all know that that nothing happens without that relationship, that intimate relationship that you have with them and nothing can replace it. Um We're a little short on time, but I, I want to just very, very quickly ask both of you. Um You know, I think it, it, it just kind of hit me as we were talking backstage. You have an incredibly insane travel schedule. I mean, you're on the road, you're working in the off season, of course. But how many football games have you both watched? Um, more for Neil than for me. But, uh, even though he has more hair and do you actually, are you watching because you're observing for something very specific? Are you able to enjoy the game? Yeah, it's, it's, um, as we were talking backstage, you know, um, I moved to California. I had no intention of being in the NFL as a team doctor. And then I got called by the Chargers as they were moving up to Los Angeles and my name got into the mix and, uh, I talked to my wife and she said, oh, the kids will love it. You should do it. I'm like, all right. So that's truly what happens. And then after about the second season, she's like, what the heck you're never around. That's uh, this job sucks. So, we have to travel with the team. Yeah. Yeah. Yeah. So, so the reality is, it's, it's, it's very harsh, it was harsh on me. Um, because I had very small Children at the time and, and so literally every weekend you're spoken for, for five months, um, more so if you're with the Rams. But, um, the, uh, the, uh, the reality is, it's just, it's a very, I love the, those soft digs here. We're more so for the Rams because they play in the postseason more than we do. But, and we do need to wrap. I'm so sorry. But we, we got, you know, we got a sense of just how many games you've been to. So, um, Neil David, thank you so much for being with us. Thank you. It's fascinating what you do.