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Inquest reveals confused and chaotic medical response prior to Joao Carvalho’s death

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A court in Dublin has ruled MMA fighter Joao Carvalho died by misadventure. The inquest also heard about the chaos and confusion that surrounded the medical care for the critically wounded fighter.

This week an inquest was held at Dublin’s Coroner’s Court regarding the death of Portuguese MMA fighter Joao Carvalho. Carvalho died as a result of injuries sustained in a August 9th, 2016 MMA bout with Charlie Ward.

The fight, which was promoted by Total Extreme Fighting, took place at Dublin’s National Boxing Stadium. The event, like all MMA in Ireland, was overseen by the Irish MMA Association, which is not connected to any government body.

The Irish MMA Association is an affiliate of the IMMAF (International MMA Federation) and its president is SBG Ireland head coach John Kavanagh.

Both Kavanagh and Ward were present at the inquest, along with Carvalho’s brother Jose Alexandre Silvestre (per Independent.ie). Ward, and others who were at the TEF event, gave testimony about the moments immediately after the fight.

Referee Mariusz Domosat, who called off the fight in third round, said he stepped in because Carvalho, “looked exhausted.” When the fight was waved off, Carvalho was down and receiving punches to the side of the head. Carvalho received 41 total blows to the head during the fight.

“There was loads of heavy punches, but it wasn’t anything unusual,” said Domosat of the overall fight. “Maybe the tempo was unusual, both were fighting really hard.”

Domosat also added that both athletes, “showed huge heart in that fight.”

Ward also spoke about the end of the fight. “He staggered back to the other side of the cage, we both fell. I punched him a number of time and the ref stopped it.”

After the fight, Ward and Carvalho chatted in a backstage medical room. “Joao said he didn’t expect the fight to be so tough and I said the same,” reported Ward. “He asked for a photo of me and Conor McGregor. When I heard later that he’d died I was devastated.”

While he was chatting with Ward, and inquiring about his SBG teammate McGregor, the Portuguese fighter was experiencing a lucid interval; which often occurs after a traumatic brain injury like the subdural hemorrage suffered that night.

A subdural hemorrage (a bleed between the brain’s dura mater) takes time to reveal itself. Bleeding can slowly pool in and around the brain of an injured person for varying amounts of time, while showing little to no symptoms. Tim Hague – like many other fighters who have died from TBIs – experienced a lucid interval before he passed away in June, 2017.

For Carvalho, according to the inquest, his lucid interval lasted around ten minutes; after which he began losing consciousness.

Medical cover for the event was provided by EventMed; a private company that supplied three doctors and one Red Cross ambulance.

Lawrence Fitzpatrick, the ambulance driver on duty at the event, told the inquest that the medical room was small and crowded. Fitzpatrick also claimed that it was challenging to remove Carvalho from the room due to a three foot wide corridor, which he described as ‘chocabloc.’

“The stretcher was there but they literally couldn’t get him out of the room, people were standing around looking,” said Fitzpatrick.

Fitzpatrick also reported that Carvalho, when he was eventually placed in the ambulance, was placed on the floor of the vehicle; not secured on a gurney. The driver said he had never had this happen before and that it meant he had to ‘drive safer’ when transporting Carvalho to an emergency centre.

EventMed owner and paramedic Kate Michilic told the inquest it was her decision to keep Carvalho on the floor of the ambulance. “The main thing is time, to go straight to hospital,” she said.

After Carvalho was put in the ambulance, there was confusion over where to take him. Carvalho was first transported to Mater Hospital and then later to Beaumont Hospital (3.48 miles/5.6 km away).

Carvalho died at Beaumont Hospital on April 11th, 2016. The cause of death was acute subdural hemorrage due to blunt force trauma to the head, with aspiration of gastric contents as a contributory factor.

The inquest heard that concerns regarding the medical standards deployed at the TEF event were raised ahead of time. Safe MMA co-founder Professor Daniel Healy, a neurosurgeon, told the court he contacted the event promoter Cesar Silva to express his concerns.

“Mr. Silva indicated there was a limited budget for the event and the safety standards required were not possible,” said Healy.

After hearing testimony the inquest’s jury returned a verdict of ‘death by misadventure’. This type of verdict is common in the UK and Ireland when a death is ruled as the result of the deceased voluntarily engaging in an activity which carries risk of serious harm or death.

Along with officially declaring Carvalho’s cause of death the jury also recommended that a national governing body for MMA is set-up in Ireland and that nationally qualified paramedics are used for all events in the country. As well, the jury recommended that MMA Ireland adopt the country’s current boxing safety standards.

The final verdict means it is unlikely that criminal charges will be filed. In December, 2016, Irish authorities had stated that charges were ‘being contemplated.’

At this time, it is not known whether Carvalho’s family will take any legal action regarding the incident. Joao Carvalho was 28-years-old and a father of two.

Since the death of Carvalho, Safe MMA, in partnership with the Irish MMA Association and event medical support provider Code Blue, have secured the use of infrascanners for use at Irish MMA events.

The infrascanner is a handheld device that can detect brain bleeds immediately after a fight (during a potential lucid interval). This means someone suffering a brain bleed could be sent to an emergency centre before they show more noticeable symptoms of the injury. The sooner surgery to alleviate pressure on the brain occurs, the better the chances are for survival.

Safe MMA has advised that all fighters receive a handheld brain scan after their fights. Safe MMA also advises that fighters receive CT scans at a hospital if the infrascanner detects a bleed, or if they were knocked out, received a large amount of head shots, or a cage side doctor requests it.

Infrascanners are also used by the California State Athletic Commission, the Pittsburgh Steelers, and Russian Sports Agency Olympic Teams.

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