Three Periods: Hockey doctor pushes for ER at every NHL game after Peverley scare

Nicholas J. Cotsonika’s weekly Three Periods column appears on Thursdays. This week’s topics include how the NHL might change its emergency medical standards after the Rich Peverley incident; Ryan Miller’s adjustment to seeing fewer shots with the St. Louis Blues isn’t as easy as it seems; Alex Pietrangelo and Jay Bouwmeester are a better defensive pair after playing in the Olympics; and, Thomas Vanek’s passes can be hard to handle.

FIRST PERIOD: Could Peverley incident lead to ER doctor at every game?

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NHL officials are discussing changing their emergency medical standards in the wake of the Rich Peverley cardiac incident, as they did after the Jiri Fischer cardiac incident in 2005. One idea: posting an emergency-room doctor at every game.

“Who does this on an everyday basis? ER docs,” said Tony Colucci, head physician of the Detroit Red Wings and co-chair of the emergency care task group. “ER docs are sitting in a room in a certain designated area, and anything can fall in their laps at any second, some disaster. Well, that’s exactly what’s happening here, and that’s why I think they’re the best trained.”

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Fischer, then a 25-year-old defenseman with the Wings, went into cardiac arrest during a game Nov. 21, 2005. Colucci was prepared: One, he was an ER doctor used to handling everything from car accidents to heart attacks. Two, he knew Fischer had a heart condition and had put an Automated External Defibrillator near the Wings’ bench as a precaution. Three, he sat in the stands near the Wings’ bench at Joe Louis Arena, because that’s where his predecessor, longtime Wings physician John Finley, had sat.

Colucci reached Fischer seconds after he collapsed on the bench and reacted without needing to think. He defibrillated Fischer on the spot and saved his life. Fischer never played again, but he’s 33 now. He’s the father of two sons – one who was born 10 months after the incident – and works in the Wings’ front office.

At the first gathering of NHL doctors after the Fischer incident, Colucci was asked to tell the story. Most NHL doctors are not ER doctors. They are trained to handle illnesses and injuries. “There were a lot of gasps,” Colucci said. “There were a lot of guys that were like, ‘I don’t know if I really know what to do. We don’t have that in our building. We don’t know where our AED is.’ ” A lot of guys didn’t sit in the high-priced seats near the benches, either.

The standards changed. Each team must have at least two physicians at each home game, and one must have completed hockey-specific trauma management training or Advanced Trauma Life Support training in the previous three years. The physicians must be seated within 50 feet of the bench with immediate access to the bench and the ice. There must be one AED at the home team’s bench and another on an ambulance dedicated to the players.

Peverley, a 31-year-old winger with the Dallas Stars, went into cardiac arrest during a game March 10. The Stars were prepared: One, they have an ER doctor at every game. Two, they knew Peverley had a heart condition. Three, their doctors sat near the bench and had direct access to it.

The Stars’ doctors reached Peverley seconds after he collapsed on the bench and reacted without needing to think. They had to pull him into the hallway because there wasn’t enough room to work on the spot, but they defibrillated him quickly and saved his life. He has had another procedure and is out for the season. No decision has been made about his career.

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“It was deja vu,” said Stars general manager Jim Nill, who was the Wings’ assistant GM when Fischer collapsed. “It was as smooth as could be. It was amazing how quickly it was taken care of. Even when he came back around, the first thing he asked was, ‘Well, what’s the score in the game? What’s the time in the period?’ It was almost like it never happened.

“He’s doing well. He’s been at practice almost every day. If you saw him, it’s like Fischer. You’d think nothing happened. It’s amazing.”

Not every team has an ER doctor at every game, though. Team physicians might be seated nearby, might have an AED handy and might have completed training, but handling a life-and-death emergency is still not what most are used to doing.

Members of the emergency care task group held a conference call after the Peverley incident and plan to hold another one Friday, including: Colucci; co-chair Jason Serbus, the head athletic trainer of the Phoenix Coyotes; Winne Meeuwisse, co-chair of the NHL/NHL Players’ Association joint health and safety committee; and, Julie Grand, NHL senior vice president and deputy general counsel. NHL doctors will meet as a group in June in Orlando, Fla.

Among the discussion points is whether an ER doctor should be mandatory at each game – either as one of the two team physicians or as a third physician. Colucci feels an ER doctor would add an extra layer of protection for everything from cardiac arrests to skate cuts like the one Clint Malarchuk suffered in 1989. Malarchuk lost a lot of blood after his jugular vein was severed, and his life was saved by a trainer who had been an Army medic in Vietnam.

“Good, better, best – never let it rest,” Colucci said. “We want to perfect it.”

SECOND PERIOD: Adjusting to Blues not as easy as it sounds for Miller

When Ryan Miller was traded from the Buffalo Sabres to the St. Louis Blues, he went from the worst team in the league to the one of the best. Great for a goalie, right? Of course. But that doesn’t mean it’s an easy adjustment.

Miller went 15-22-3 with a 2.72 goals-against average and a .923 save percentage with the Sabres. His record and his goals-against average are better with the Blues: 8-2-1 and 2.12. But his save percentage is lower: .913.

Why? The Sabres allowed lots of shots for two reasons: One, they were bad. Two, they played a system in which the skaters let Miller handle the shot while they tried to handle everything away from the puck. The Blues allow few shots for two reasons: One, they're a top possession team. Two, the skaters try to get in lanes and block shots.

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Miller has gone from seeing 35.3 shots per game to seeing 23.9 shots per game. “Obviously keeping Ryan focused throughout the game is probably a challenge because he’s not as involved as he usually is,” said winger Steve Ott, who came from Buffalo to St. Louis with Miller.

“That’s really difficult,” said Darren Pang, the TV analyst and former NHL goaltender. “There are crickets for 15 minutes at a time. You start thinking and wandering, and when you start wandering, then they get one chance and you’re off your angle or you’re not quite as sharp.”

The shots Miller does see often come through traffic. Coach Ken Hitchcock said the Blues have Miller playing a little deeper in the net as a result. “When you play really aggressive in our system and there’s bad bounces, it ends up looking sometimes like it’s an open-net goal,” Hitchcock said.

Miller also likes to handle the puck. He handles it better than Jaroslav Halak. So he has had to adjust to his defensemen and vice-versa. “In his very first practice in Phoenix, morning skate, you could sit in the stands and hear him asking the defensemen where they want the puck,” Pang said. “ ‘You want it on your forehand? You want it on your backhand? You want me to play it up?’ ”

Hitchcock said Miller is about 70 percent through the process.

“It’s certainly not something anybody wants to hear a goalie complain about, seeing fewer shots,” Miller said. “It’s still the NHL. You’re going to get quality opportunities. The other team’s going to get chances. So you just have to stay ready. For me, it’s just more learning about our team and setting up for tendencies.

“You get used to playing with a team in different situations over the course of a couple years sometimes, and tendencies come out, and you kind of look for certain things. Here, you don’t really have that. You’ve got to kind of figure it out. That’s kind of what I’ve been spending my time doing.”

THIRD PERIOD: Pietrangelo and Bouwmeester even better after Olympics

After playing on the big ice at the Sochi Olympics, Blues defensemen Alex Pietrangelo and Jay Bouwmeester returned to the NHL ice for an optional skate. Bouwmeester threw a pass across, and Pietrangelo skated backward – right into the side boards.

“I had another seven feet usually,” Pietrangelo said, laughing.

They needed about a week to readjust. But otherwise, the experience of winning gold for Team Canada made them better for the Blues.

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Pietrangelo and Bouwmeester became a pair after the Blues picked up Bouwmeester at the trade deadline last season. Playing a full season together has helped them gel – but not as much as playing in Sochi, according to Hitchcock. Pietrangelo, 24, had never played in the Olympics before. Bouwmeester, 30, had played in 2006, when Canada failed to win a medal in Torino.

They logged hard minutes, playing against top competition under intense pressure at even strength and on the penalty kill. They learned about preparation and poise from guys like Duncan Keith, Jonathan Toews and Sidney Crosby who had won gold medals and Stanley Cups before.

“They were unsure of themselves when the Olympics started, but they were very sure of themselves when it finished,” Hitchcock said. “I think you’re wondering if you can play at that level, and I think as [coach Mike Babcock] put them out there more and more against top players, I think their confidence grew.”

Pietrangelo and Bouwmeester play against top competition in the NHL, too. But not quite like they did in Sochi and not quite under the same circumstances.

“Ever since the Olympics, I think we’ve kind of taken things to the next level,” Pietrangelo said. “We kind of used some of the stuff that we talked about over there and brought it over here.

“You’re never really going to put five guys in the NHL that are that creative on this ice. It’s never going to be that quick. Not that things have slowed down, but maybe we’ve been able to skate a bit more. Maybe we keep forgetting we’re on the smaller ice. I don’t know what it is.”

OVERTIME: Keep an eye on Vanek in Montreal

Thomas Vanek can score. But he can pass, too, and you better be ready, as Max Pacioretty has discovered since the Montreal Canadiens acquired Vanek from the New York Islanders.

“He’s trying to make plays,” Pacioretty said. “I think at first, it was tough to really build off that. I was surprised when pucks were landing on my stick when I didn’t think there was any possibility of it happening. So I think I’ve got to be more aware. He thinks the game different than everyone else.”

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Pacioretty scored Tuesday night against the Sabres, but he also missed the net twice after receiving passes from Vanek. The timing was off. It wasn’t that Vanek was too quick with the puck; it was that Vanek was so patient with it. Pacioretty wasn’t expecting the puck anymore. When he got it, he rushed his shot.

“He holds it until the last second, or he waits for someone to get off me or someone to go to him,” Pacioretty said. “That’s what makes him so successful. He’s able to read plays like that. He’s unbelievable from the top of the circles down.”

SHOOTOUT: Notes from around the NHL

— Babcock on Canadiens goalie Carey Price, who won gold for him in Sochi: “I always knew he was a huge talent. I didn’t know he was a great pro.” Babcock compared Price to Ken Dryden in that he made the saves he should have for a good team and “didn’t generate offense” for the opponent. Babcock also said that after what Price was used to in Montreal, the hoopla in Sochi was “probably like two weeks off for him, to tell you the truth.”

— Rene Bourque was a three-time 20-goal scorer for the Calgary Flames. In parts of three seasons with the Habs, he has not exceeded single digits. He has nine goals in 56 games this season. But after three games as a healthy scratch, he has one goal and three points in his past three games on a line with Danny Briere and Brian Gionta. “It’s really the first time this year I’ve been on the same line for more than a game, so it’s kind of nice to stick together,” Bourque said. “It’s been tough in Montreal for whatever reason. I haven’t picked up where I left off in Calgary.”

— Ottawa Senators right winger Bobby Ryan seemed to slump after failing to make the U.S. Olympic team. He produced only five goals and 12 points in 28 games. But now we know he played through a sports hernia since November – he had season-ending surgery Thursday – and his season seems pretty impressive. He had 23 goals in 70 games, a 26-goal pace for a full 82-game season, not far from his usual 30-plus goal output. The question is how much Team USA knew about his injury.

— Over this first three NHL seasons, Rangers defenseman Ryan McDonagh scored 12 goals in 169 games. This season, he has 14 goals in 74 games. He’s maturing at age 24, and he has more freedom offensively under new coach Alain Vigneault than he did under former coach John Tortorella.