Cage Side Medicine with Dr. Jon Lucas, MD

Friday, May 24, 2013

This is the first UG Guest Blog from Dr. Jon Lucas, MD, from Greenville, SC. Dr. Lucas will convey what it is like to be a fight doc on fight day.

I had worked as a ringside physician for kickboxing events that were promoted by the head trainer of the gym I trained at, so when mixed martial arts became legal in South Carolina and training partners began taking MMA fights, I was interested in working as a cage side physician to help keep the events as safe as possible.  When an event was scheduled locally, I contacted the promoter and offered to assist with his event. 

Efforts to increase fighter safety start well before an event, and they involve many more people than just the physician at cage side.  In order to obtain a fight license in South Carolina, fighters have to pass a physical examination, ophthalmologic examination, and blood work that assesses for communicable diseases.  Depending on the age of the fighter and their fight history, additional tests such as an ECG or head CT/MRI may be required as well.  Once these requirements are met, a license can be granted and they are eligible to fight.  Promoters are required to have at least one physician and two medics present at cage side, and an ambulance on site.  I always check with the medics when I arrive at the event to make sure we have an automated external defibrillator (AED) and other trauma/resuscitation equipment positioned with easy access to a cage door. The specific role of the cage side physician is to administer the pre-fight physical that is required on the day of the event, monitor the fighters during their fight, and then to perform a post-fight evaluation and help manage injuries as necessary.  

The pre-fight physical typically occurs in the locker rooms of the venue about three hours before the event starts, once the fighter and their corners have completed their licensing paperwork.  The goal of the pre-fight physical is to evaluate the fighter for any conditions that present a risk to the fighter or their opponent.  In particular I look for any evidence of vision problems, cardiovascular abnormalities, neurologic deficits, orthopedic injuries or communicable skin diseases.  There is a limited amount of time to perform the evaluations, and there are often twenty or more fighters who need to be evaluated.  Efficiency is of paramount importance, as the fighters are all waiting to get warmed up and get their hands wrapped.  In addition to the physical examination, this evaluation offers an opportunity to see how the fighters talk and act; which makes it easier to evaluate their neurologic status after they fight. 

During the event, I am watching for signs of significant injuries that compromise the safety of a fighter, as well as more minor injuries that will need to be evaluated after the fight.  While the fight is taking place, the safety of the fighters is primarily in the hands of the referee.  I have been fortunate to have worked with some very good referees who are skilled at quickly realizing when a fighter is unable to defend themselves intelligently, or when a fighter is injured.  I watch fights very differently when I am the physician for the event than when I am there as fan.  From the cage side, I look for significant strikes that may have caused facial fractures that will need to be evaluated later, or sudden changes in a fighter’s stance or striking style that might indicate a broken hand or foot.  Occasionally, I will be asked to evaluate a cut or other injury during the fight or between rounds.  Cuts that present a danger to the fighter due to their location, large size, or by bleeding directly into the eye, necessitate stopping the fight.  Protecting the fighters from significant injury is of paramount importance, but I do not want to needlessly end a fight that someone has been training hard for, and possibly affect their career.  There is a very short amount of time to decide if a cut fighter can continue, so I have probably spent more time discussing with other physicians what criteria should be used to make that determination than any other fight medicine related topic.  

The end of the fight brings another assessment of the fighters.  When a fighter is knocked out or rendered unconscious from a choke, I will attend to the downed fighter to assist their regaining of consciousness, check for signs of serious brain injury, and to ensure they do not injure themselves further by trying to stand up and walk down the stairs out of the cage too soon.  If a fight goes to a decision, I will evaluate the fighters quickly in the cage, starting with the losing fighter, to make sure there are no significant injuries that need attention while awaiting the official announcement of the results.  Minor injuries and cuts will be assessed quickly at the end of the fight, with further treatment to follow at the end of the event.  Fighters with more serious injuries are stabilized with the assistance of the paramedics at the event and are then transported to the hospital for further management.

Injuries I have treated during events have ranged from cuts and minor fractures like bones of the hands and noses, to a fighter who broke both bones in his lower leg (tibia-fibula fracture, almost identical to the one Corey Hill sustained during the UFC’s Fight for the Troops) when a hard leg kick was checked.  Surprisingly, not all of the medical issues that have arisen during events have occurred inside of the cage.  Once one of the paramedics had a seizure at cage side during the second round of a fight (this occurred at the same event as the leg fracture mentioned above), and at another event fan tore his Achilles tendon walking down the bleacher stairs prior to the start of the fights. 

Once the event is over, I can check on the fighters again and attend to any injuries not treated at cage side after their fight.  Lacerations get sutured, recommendations for follow-up of injuries are discussed, and the fighters that need further follow-up are given the insurance forms they will need.  I inform the commission and the fighters of any medical suspensions or specific conditions for return beyond the standard suspensions for a knock-out or TKO, and I try to stress to the fighters and their trainers the importance of not returning to sparring, hard grappling or other training where head impacts are likely until their concussion has had time to heal. 

While there will always be a risk of significant injury or death associated with competing in mixed martial arts, a fact we are unfortunately all too familiar with in South Carolina, my hope is that with good medical supervision we can minimize the occurrences of those tragic events.