NHL adds ER doctor at every game: League takes lesson from Jiri Fischer, Rich Peverley cardiac incidents

Jiri Fischer remembers lying in a hospital bed, recovering from cardiac arrest, thinking about some stitches near his eye.

Fischer collapsed on the bench while playing for the Detroit Red Wings on Nov. 21, 2005. In a way, he was lucky. He was at home. The team physician, who was also an emergency-room physician, had a seat behind the bench and had an Automated External Defibrillator (AED) nearby because he knew Fischer had a heart condition. He reached Fischer in seconds and saved his life.

A few nights earlier, the Wings were on the road. Fischer took what he called a “routine stick in the eye, no big deal.” He had to wait until the end of the period to get stitched up, because the doctor was sitting in a suite near the rafters and had to walk all the way downstairs.

What if Fischer had heart trouble then? Would someone else have saved him – the trainers, paramedics? You’d like to think so. Still ...

“It would have been a whole different scenario for me going into cardiac arrest in another building besides Joe Louis Arena back then,” Fischer said.

The NHL strengthened its emergency medical standards after the Fischer incident. Each team needed two doctors near the benches at each home game, and at least one needed current training in hockey-specific trauma management or Advanced Trauma Life Support (ATLS). Each team needed one AED at the home bench and another on an ambulance dedicated to the players.

Now, after the Rich Peverley incident last season, the NHL has strengthened its standards further. Each team needs three doctors near the benches at each home game – an orthopedist, a primary care physician and an ER physician – and at least one, if not all, must have current training in ATLS and Advanced Cardiac Life Support.

If and when there is another life-threatening emergency – a cardiac incident, a severe laceration, an obstructed airway – there will be an extra layer of expertise and experience to aid in the response.

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Nine years ago, it was rare for an ER physician to staff an NHL game, and it was rare for any team physician to have seats behind the bench. Those seats generate lots of hockey-related revenue.

Red Wings physician Tony Colucci happened to be an ER physician by day. He happened to have a seat behind the bench because he inherited it from his predecessor, longtime Wings physician John Finley.

Doctors knew Fischer had a heart abnormality, but they weren’t sure exactly what it was. Colucci put the AED near the Wings bench as a precaution.

Fischer, then a 25-year-old defenseman, had finished a shift against the Nashville Predators when he collapsed on the bench. He had suffered ventricular fibrillation, his heart beating rapidly and failing to pump blood through his body.

Colucci jumped down and did what he does all the time. He did chest compressions and defibrillated Fischer right then and there.

“Within 20 seconds, he started working on me,” Fischer said. “That would never happen if the doctor is sitting somewhere in a suite, being entertained by the game. No chance.”

“There was a lot of yelling and screaming, and the one guy that wasn’t confused was our team doctor,” said Brendan Shanahan, who played for the Wings then and was on the bench when Fischer collapsed.

At the first regular gathering of NHL team physicians afterward, Colucci was asked to tell the story.

“I had to explain what preparations we took and why prior to Fischer’s incident,” Colucci said. “Some doctors had come up to me and said that there would be apprehension if such an incident would happen to them and wanted to know what we had in place to have a successful outcome. Even if everything is in place and everything is done textbook-like, it doesn't ensure a successful outcome, but it certainly improves your odds.”

The standards changed.

Fast forward to last season: The Dallas Stars knew Peverley had atrial fibrillation, the most common abnormal heart rhythm. Doctors discovered it last September during his preseason physical. He underwent a procedure to shock his heart into normal rhythm, took medication and was constantly monitored. He missed a game March 4 because he didn’t feel well, and the doctors adjusted his medication.

Peverley, then a 31-year-old winger, had finished a shift March 10 against the Columbus Blue Jackets when he collapsed on the bench. He fell in front of the tunnel – and right in front of Dave Zeis, the Stars’ head athletic trainer.

Zeis straddled the bench and checked for a pulse. By that time, team physicians Robert Dimeff and William Robertson, who were seated behind the bench, were already there. Robertson grabbed Peverley’s arms, Zeis grabbed his legs and they pulled him out of sight and into an area by the dressing room.

The Stars also had an ER doctor staffing the game: Gil Salazar. They had signed a contract a couple of years before with UT Southwestern, a medical university in Dallas with a lot of resources, and that was one thing they had added. Salazar was seated a section over from the other doctors, behind the visitors’ bench, up about 15 rows. He arrived in less than a minute, followed quickly by Dallas Fire and Rescue paramedics.

“We just kind of worked as a unit,” Zeis said.

They removed Peverley’s sweater and shoulder pads. They did chest compressions, gave him oxygen, started an IV and defibrillated him. They needed to shock him only once before he regained consciousness. It all happened in less than three minutes.

(For the record, they used the paramedics’ LifePak defibrillator, not the AED at the bench. The LifePak is designed for trained personnel. The AED at the bench, designed for use by all types of responders, has voice prompts and requires time to analyze the rhythm, which takes additional time prior to delivering the shock.)

The standards have changed again.

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Zeis said NHL officials debriefed the Stars afterward. They broke down the incident. They asked for a detailed timeline. They asked what could have changed. “They were pretty good with analyzing it and trying to make ourselves better because of it,” Zeis said.

Adding an ER physician at every game isn’t easy. There is added cost. There are chemistry concerns. You have to find the right people in every city – physicians with the appropriate skill set, who understand NHL dressing room dynamics, who fit with already well-trained, cohesive medical teams.

This had to pass through two medical committees and an executive board, and then it was presented at the annual NHL team physician society meeting in June. There was a group discussion and Q&A session.

“Some doctors don’t like it because they feel they can administer that care,” Zeis said.

But it’s not that team physicians are incapable. It’s that ER physicians deal with life-threatening emergencies every day. It’s about being prepared for worst-case scenarios and having everything and everyone in place to handle them.

The NHL is giving teams a grace period. “There are exceptions and exemptions that we have to make to be able to facilitate this and get to as close to 100-percent compliance as we can,” Colucci said.

“Personally, I think it’s a huge benefit,” Zeis said. “The value comes, from my perspective, in those major, have-to-act-within-three-minutes type scenarios. Those guys deal with them. That’s where Dallas Fire and Rescue comes in. They deal with that kind of stuff – car wrecks, CPR in awkward scenarios and things like that. …

“We do all these walkthroughs and all these other things, and they’re real scripted. It gives you a foundation for what you’re going to do. But when things start happening, the people who are experienced with it just kick into gear. …

“It’s such a fast sport, a collision sport, skating with blades on your feet. It’s just another level of comfort having those people around.”

Fischer never played in the NHL again. He had two more heart episodes shortly after his first. After one-and-a-half years of rehab and research, trying to find a way to keep playing, he had to move on. He’s 34 now, a father of two, the Wings’ director of player development. He plays in alumni games sometimes. He hugs Colucci often. He smiles a lot.

Peverley’s outlook is uncertain. He had surgery after his incident. He has been cleared to work out with the Stars but not to skate with them. He is unavailable to the media for the time being. But he’s 32 now, and if and when another player goes through what he did, that player should receive the same type of response he did.

Fischer looks at the awareness that has been raised not just in the NHL, but across the hockey world; not just in hockey, but in all sports; not just in sports, but in all walks of life. There are AEDs in lots of places now – from rinks to gyms to offices to malls.

“Unfortunately sometimes someone has to volunteer to good things can happen,” Fischer said. “It will to continue to happen. That’s the saddest part about it. But the positive is, all these measures that have been taken, hopefully more people are going to survive.”