‘Our game is on now’: Veteran N.J. paramedic describes how sidelines react when players go down

Monday night incident in which NFL player had cardiac arrest on field has increased awareness of — and attention to — emergency action plans

Les Barta. (Rutgers University)

While the fans in the stands are watching the plays on the field, Les Barta and the dozens of other medical professionals at a Rutgers University football game are watching the players.

Barta, the director of simulation at the Ernest Mario School of Pharmacy at Rutgers, has been a paramedic since the mid-1990s and helps coordinate the in-service work for the athletic training staff for all Rutgers sports, including football and basketball.

That’s why he’s watching the game differently.

A call for CPR

Les Barta, a simulation director for Rutgers University and a RWJBarnabas Health paramedic for decades, stressed that you don’t have to have an extensive medical background to be able to help in an emergency situation — especially in the case involving cardiac arrest.

You just need to know CPR.

“As someone who has taught CPR for almost 25 years, I can tell you that we know that the majority of the population is not-CPR trained,” he said. “That’s the first step any layperson can do — and it is the only thing that will buy time until the rescuers can arrive and use a defibrillator or advanced life-support techniques.

“The lay person or the first rescuer is so important because, for every minute that goes by without any assistance, we typically lose that 10% survival rate. It’s extremely hard to get someone back who has been laying pulseless or breathless for 10 minutes, versus someone who had a bystander at least doing chest compressions.”

“When I’m standing on the sideline, I’m typically trying to watch the play itself to see who is getting hit, who’s getting up — and who’s not getting up,” he said. “So, in the instance of what happened Monday night, where you’re seeing a player fall back immediately, the potential for action would have been instantly heightened in all of our minds on the sideline.

“When someone immediately goes back down, that immediately triggers us to say, ‘OK, our game is on now.’”

What happens next is a coordinated response — one that has not only been written and talked about, but actually practiced. It’s the only way an emergency action plan can truly work, Barta said.

At Rutgers, that means 2-3 athletic trainers immediately go onto the field. The rest of the support teams wait intently for signals — given by hand movements, such as a full moon or the crossing of the arms above the head — that will indicate the course of action.

The athletic training staff, who will have extensive knowledge of the injury background of the fallen player, will make a quick assessment.

“The first people that go out there will make contact with the player and immediately assess: Is the player awake, are they breathing?” Barta said. “If they are not, the advance team will activate everyone else to come out. And they’ll do it by hand signals, because crowd noise can sometimes prevent you from communicating verbally.”

Barta said the signal can dictate what medical personnel — and what equipment — is needed.

“This will start an orderly response, one where everyone has a role,” he said.

Here’s the key: That response — that emergency action plan — has to not only have been put in place, but it has to have been practiced by the people who will be involved, Barta said.

“I can’t stress how important that is,” he said. “You don’t want to be meeting someone for the first time on the field during a crisis.

“One of the things that we do here is that we actually run simulations that are timed to make sure that the team can get to that player, access to the airway, give the first breath, if needed, within 90 seconds of that event happening.”

Barta, who has worked in various EMS roles for nearly three decades and provided emergency medical/event stand-by services for more than 25 years, said the medical staff at the Buffalo Bills-Cincinnati Bengals game Monday were ready for the incident. He said the actions they took potentially could improve the outcome for Damar Hamlin, the fallen player.

He credits both teams, acknowledging that the medical personnel from both teams not only would have discussed scenarios in which they both were needed ahead of time, but met each other, with face-to-face introductions, before the game.

Barta said the impact of working at large-scale events, where everything is happening in front of 50,000 people or more and often on television, should be part of the plan.

“Most of us that work in this field understand the psyche of what it is to be on the sideline waiting for something like that to happen,” he said. “You’re always thinking: ‘How do I prepare for this? How do I make sure that we have everything that we need?’ That’s how you’re going to do the best that you can, given the circumstances that you have.”

A good emergency action plan takes into account every possible scenario — and not just potential injury situations. How the facility is equipped, the number of medical people present and the availability of additional help, all need to be analyzed — especially at events beneath the professional and major college level, Barta said.

“You need to know where your EMS is coming from and their average response time,” he said. “You need to know how they’re going to gain access to this field — are there special gates that need to be unlocked, can you drive an ambulance onto the field, because, in some places, you might sink?

“Every venue, every team is unique.”