Panel examines post-fight treatment options

Friday, Nov. 25, 2005 | 6:59 a.m.

When Leavander Johnson and Martin Sanchez suffered head injuries during boxing matches in Las Vegas this year, both were transported to area hospitals and subsequently died.

But while Sanchez was taken to the emergency room at Valley Hospital Medical Center, Johnson was transported to the Level I trauma center at University Medical Center.

While the outcomes were the same in both cases, some medical experts believe the Nevada State Athletic Commission would be better served by considering a policy to transport all brain-injured boxers to either UMC's trauma center or to the Level II trauma center at Sunrise Hospital and Medical Center.

Post-fight treatment of boxers is among the topics being examined as a special five-person panel established by the commission looks into ways to possibly make the inherently dangerous sport of boxing safer.

Some medical experts say that trauma centers, as a rule, are better prepared and equipped than emergency rooms to handle brain injuries, including blows to the head as well as injuries caused by falls, gunshot wounds or traffic accidents.

Several studies have found that a patient's chances of survival from such injuries are 8 to 10 percent higher if he is taken to a trauma center rather than an emergency room, said Dr. David Hoyt, director of trauma programs for the American College of Surgeons.

They should go to a trauma center, said Hoyt, who doubles as trauma director at the University of California at San Diego. You have all the equipment needed for diagnostic testing at a trauma center, whereas you might not have that in an emergency room. You also have organized critical care services that you might not have in an emergency room.

But Dr. Jeffrey Davidson, the ringside physician who recommended that Sanchez be treated at Valley Hospital, said that the hospital's emergency room, which Davidson directs, routinely performs brain surgeries and has state-of-the-art diagnostic equipment. The same neurosurgeons who work at the trauma centers also have performed surgeries at Valley, he said.

Davidson, whose ringside duties include post-fight examinations, said it is not always easy to determine where a fighter should be transported.

It's not a black and white issue, Davidson said. It's gray. There are a lot of head injuries where the fighter says he is fine and there are other fighters who look horrible but when they have a CAT scan it's normal.

Still, Davidson said that he would support a dialogue among ringside physicians, the athletic commission and its medical advisory board to establish guidelines to determine scenarios when it would be better to transport a boxer to a trauma center or an emergency room.

It would make things standardized, he said. If we had guidelines with set criteria, it would reduce questions the media might raise or what the general public doesn't understand.

Establishing a policy of transporting brain-injured boxers to trauma centers is very reasonable to suggest, said Dr. Michael Metzler, head of the Sunrise Hospital trauma center.

We see people who have head injuries more often than emergency rooms do, Metzler said. I certainly think that the two trauma centers in town are enough to serve boxing and the centers are both close to the Strip.

Why wouldn't a boxer be afforded the same thing as others who suffer head injuries?

Chief deputy attorney general Keith Kizer, the commission's legal adviser, said the commission does not have a policy on whether to transport boxers to trauma centers versus emergency rooms. Instead, those decisions are left up to ringside physicians on a case-by-case basis.

There's no written policy on this because the commission is not a medical group, Kizer said. We rely on the ringside physicians. We don't micromanage the physicians.

In Sanchez's case, Davidson learned that Dr. Jason Garber, a neurosurgeon, was available at Valley to treat the fighter. Sanchez was treated for a brain injury but died July 2, a day after his fight at the Orleans.

Davidson's fellow ringside physician, Dr. William Berliner, who worked the same fight, said there was nothing wrong with transporting Sanchez to Valley.

The key is the availability of a neurosurgeon, Berliner said.

Dr. John Fildes, head of UMC's trauma center, said that in general brain-injured boxers need to be treated in a center that can give immediate access to diagnostics and definitive care.

While Fildes said there may be incidents where an emergency room could handle a brain-injured boxer, he agreed it would be worthwhile for the commission to discuss the issue.

Trauma centers routinely treat people with severe and life-threatening injuries whereas emergency rooms tend to treat people with heart attacks and minor injuries, Fildes said. What a trauma center has to offer is the availability of physicians to manage these patients.

Steve Kanigher can be reached at (702)-259-4075 or by e-mail at steve@lasvegassun.com.