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A Stanford doctor hits the field with the 49ers — as their airway management physician

Stanford Medicine's Peter D'Souza shares his experience as an airway management physician who attends NFL games with the 49ers.

Peter D’Souza, MD, never played football, unless you count mud football, but the Stanford physician has been on the field for most San Francisco 49ers home games since 2006, as well as Super Bowl 50. As the Levi Stadium’s airway management physician, he offers a critical skill set to the medical support squad: emergency medicine.

The role of airway management physician is relatively new to football. Teams have traditionally had orthopedic surgeons and team physicians. But starting 12 years ago, there was recognition of the potential for airway complications, particularly high cervical spine injuries. When D’Souza started, only a handful of teams featured airway management physicians, but the league now mandates that each team have a physician on the field who can intubate if necessary.

“A cervical spine injury could result in diaphragm paralysis,” D’Souza explains. “That would necessitate a breathing tube and management of spinal injury. That’s the one that frightens everyone. The other is a cardiac arrest.”

Two and a half hours before the start of 49ers home games, D’Souza is waved through security and heads to the team’s locker room; sacred space for many football fans, familiar territory for D’Souza. He greets trainers and team physicians he knows well by now, then checks to make sure all of the equipment and medications are in the airway emergency bag he created several years ago. He runs through a mental checklist, envisioning different scenarios and planning step-by-step how he would respond to each.

Sixty minutes before the game, D’Souza has a meeting with the physicians and athletic trainers from both teams, the paramedic supervisor, the referees, the injury spotters, and the unaffiliated neurotrauma consultants who are there to address possible concussions. The team reviews the stadium-specific emergency action plan outlining different scenarios and where resources are located.

After meeting with the 49ers team, D’Souza heads across the field to introduce himself to the paramedic team dedicated to the visiting sideline. He supports both teams during the game and wears intentionally neutral gear — an NFL hat and polo shirt.

Before kickoff, he heads back to the 49ers locker room one last time to grab a quick snack and check radios. And then, he is ready for the tunnel.

“The tunnel has fog machines and lights,” D’Souza explains. “You feel like a rock star. The team runs out first and then we follow. When I worked Candlestick Park, I couldn’t help thinking about Joe Montana and Steve Young walking out that same tunnel to championship games.”

Kickoff, D’Souza explains, is an especially high-risk time. “People are flying at very high speeds,” he says. Then, after every play, D’Souza scrutinizes the pile of players, making sure everyone is getting up. He scans the cluster for signs of trouble; players standing, waving to the sidelines, indicating a fallen teammate. If he sees a player not moving, he grabs his gear bag and runs onto the field. Once he ran out during the NFC championship game and could see the television camera zooming just over his head. It was, he says, a little nerve-wracking.

D’Souza usually stands at a fixed position between the 25- and 30-yard line, to the right of the 49ers. Occasionally, he ends up on television, particularly during the Harbaugh era, when the highly-animated coach often drew camera shots.

At halftime, D’Souza grabs an extra layer of clothing; his post is usually in the shade during the second half. He doesn’t chat much on the sidelines, but has met his share of celebrities, business leaders, and, of course, players. When he worked at Candlestick, he found himself standing where third base would have been (during baseball season), and thought, with some reverence, of Pablo Sandoval. He later had the opportunity to meet Sandoval, who was visiting the 49ers sideline and told him of the moment.

Surprisingly, another risky time is post-game. “There is something about the physiology, their volume status is down because of dehydration,” D’Souza explains. “So, I typically stay for at least an hour until I get the all-clear from both teams.” He says it has been interesting to be present during so many wins and losses, but he gets his “insider” information from reading Bleacher Report.

D’Souza is quick to conclude, “I don’t understand football enough to know strategies. I’m never thinking the coach should have called this play or that.” He pauses and shakes his head. “I can’t believe I get to do this. I’m not athletic. I’m studious. But I was there during Super Bowl 50 with tens of millions of people watching. Surreal. Definitely a little surreal.”

Photo at the Super Bowl courtesy of Peter D'Souza

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