Knockout!

Mixed martial arts, more commonly referred to as MMA, has steadily gained a growing fan base since arriving in the U.S. in 1993 under the auspices of the Ultimate Fighting Championship (UFC).¹ However, the evolution of MMA has faced hurdles like being deemed too violent in its early days, which led to revamping rules, mergers of various companies, and, ultimately, emergence into mainstream America and its own reality series, "Ultimate Fighter."

MMA is classified as a combat sport,² just as boxing, karate and wrestling, and is not technically a new sport. Combat sports date back to 3 B.C. Punic funeral rites and later the Greek Olympic Games in 1 B.C., but is most often associated with the Roman gladiators,³ who fought in a coliseum and were armed with various weapons.

MMA fights are held in a caged octagon, where two fighters wearing open-fingered, 4-ounce gloves, a groin protector (chest protector for female fighters) and mouthpiece battle it out. When most of us think about MMA events, the perception is pay-per-view fights and large venues like Las Vegas. The reality is that these events, more commonly at the amateur and up-and-coming fighter levels, take place at county fairs, casinos and MMA schools and training camps throughout the U.S.

Scoring and Fight Night Injuries

The objective of an MMA fight is to win over your opponent in five, 5-minute rounds in one of four ways.⁴ First is by knockout or technical knockout, where one fighter is knocked out (KO), or the referee sees that a fighter is defenseless and cannot continue (TKO). Second is being choked out by the opponent's arm or leg. Third is arm or leg lock, where one fighter's arm or leg is locked in such a way that he cannot break free, so he taps out with his hand and the fight is stopped. Last, a fighter can outscore his opponent and win by decision.

Since MMA is a combat sport that allows the use of fists, elbows, knees and feet, you get some idea of the types of injuries that may be encountered during an MMA event. The leading cause of fight stoppage is head impact from either a strike to the head or being slammed to the mat. The second leading cause is musculoskeletal stress applied to a joint. The next two causes of fight stoppage, which are about equal in occurrence, are chokes (asphyxiation) and various soft tissues injuries, typically lacerations where bleeding cannot be controlled.¹ Most soft tissue injuries are managed by the fighter's trainer and fight physician, and only occasionally require EMS intervention.

Assessment and Management

When arriving for an injured fighter at the professional level, you will be met by the ringside physician, who is required at all fights, though this might not be the case at amateur events. If your service is not providing EMS coverage at the event, EMTs or paramedics who are covering the event may have already initiated treatment.

You will want to perform a scene size-up as you approach the cage, and be aware of scene safety, which, for the most part, will involve the crowd. If this is a professional fight, venue security will typically have access and egress well secured, although, like any scene, 360-degree situational awareness should be maintained at all times.

Obtain an initial history of what occurred from the fight physician, referee, venue EMS, or an appropriate individual. If the injury is to the head or neck, consider c-spine stabilization, based on the mechanism and/or history and assessment of the fighter's level of consciousness (LOC).

Assessment of the airway is the next priority: Is the airway open and patent? If the answer is no, open it using a jaw thrust, which can often be accomplished by the responder who is manually stabilizing the c-spine. Suction the airway, if necessary, followed by insertion of an oral or nasal airway, depending on the fighter's LOC.