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It’s the average of the fourth division in a tie game, admirers are screaming, and you get the signal. It’s go time.

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Eli Manning isn’t the alone one faced with this blazon of burden situation. Jason Emmel could be advance into activity on any accustomed Sunday at MetLife Stadium.

While Manning’s aggregation is the New York Giants, Emmel’s is the New Jersey Sports Exposition Authority (NJSEA) Emergency Medical Services. While Manning’s signals appear from coaches, Emmel’s appear from the Giants’ medical staff. If Emmel sees the “all come” arresting – a trainer miming axis a council caster – he contest assimilate the acreage in his cart, ambience off a apposite emergency activity plan both apparent and concealed to the public.

“There are 80,000 bodies in the amphitheater watching you and afresh addition actor at home watching you,” said Emmel, EMS appropriate ops supervisor. “But they’re still a accommodating and you aloof go aback and you do what you accept to do and amusement them the aforementioned way we would amusement anyone. You aloof accept to affectionate of bethink that at the end of the day, it’s still a patient. They’re an NFL player, they are actual accepted throughout the apple with bodies watching the NFL, but at the end of the day, they’re still a accommodating and you aloof accept to focus on that.”

This is the best arresting allotment of the job. Due to the concrete attributes of the game, every fan has apparent a amateur carted off the field. What they don’t see is the afore and after.

Four acreage aggregation associates – two on the home side, two on the visitors – get to the amphitheater at 9:30 a.m. for a 1 p.m. kickoff. Ronnie Barnes, chief carnality admiral of medical casework and arch able-bodied trainer for the Giants, brand them to be there aback the visiting team’s buses arrive. Aboriginal they put out their accessories on the field, including an oxygen accumulation for both benches. Afresh 60 account above-mentioned to kickoff, there is a abounding medical affair with trainers, arch aggregation physicians from both teams, medical spotters, and referees. They get to apperceive anniversary added and altercate area anybody will be during the game.

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And afresh no one wants to see the EMS aggregation again. Unfortunately, that isn’t consistently the case.

“The doctors await on Jason’s aggregation because they apperceive they apperceive the players, and they’re acclimated to alive on players,” EMS administrator Fran Guthrie R.N. said. “The doctors are doctors, but that doesn’t beggarly they assignment with big football players and their big, avant-garde necks and altered things. There are altered things that go into intubation and aloof ambidextrous with a amateur and their personality. These guys accumulate a akin arch while everybody abroad you can see their adrenaline pumping and they’re on the hot seat, so to speak, aback somebody goes bottomward and whether they airing abroad or not initially. It’s a appealing acute feeling.”

Guthrie directs a aggregation that includes EMS coordinator Antonio Vagueiro, EMS administrator Anthony Tremarco, Emmel and the appropriate operations aggregation of Henry Ruiz, Joseph Dyl, Melanie Alberto and Brian Mende.

In the blow of a astringent injury, a alternation acknowledgment is set in motion to get the amateur to the hospital. There is an escort from the amphitheater to the Lincoln Tunnel, which is afresh best up by Port Authority and taken through the tunnel, and afresh the NYPD takes over from there to get them to the hospital.

“We are acutely advantageous to accept the actual best stadium-based emergency casework in the country,” Barnes said. “We await on the paramedic agents at MetLife Amphitheater for emergency advantage at our practices and games. They are awful accomplished and acutely accomplished in sports trauma. Tony Vagueiro and Fran Guthrie appeal excellence, and we account abundantly from their leadership.”

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The aforementioned casework are accustomed to the abroad team, from demography X-rays to acrimonious up medications to alteration trainers, players and ancestors associates to the hospital.

“The Giants are actual acceptable with the opposing teams’ players,” Vagueiro said. “They’ll say, ‘Listen, you accept to aces up the trainer and player, anticipate you can handle that? So we’ll accelerate a administrator out to aces him up and delay for him and you accept a alike on the tarmac. Now we accept to accomplish arrange with Port Authority – ‘We’re advancing in this gate, can you accommodated us, can you advice us out, can you get us out to the [plane]?’ So now we’ve got to be cleared, we get cleared, and it’s the aforementioned affair if we accept to booty a amateur to New York. It’s to the point area we’re a well-oiled machine.”

Each May, it gets a tune-up.

The EMS aggregation and the Giants’ abounding medical agents get calm for a day at the Quest Diagnostics Training Center. They go over every book and set up apish situations in the fieldhouse with mannequins and game-day equipment.

“That’s the NFL aggravating to accomplish aggregate uniform,” Guthrie said. “So bristles years ago, bodies were accomplishing things their own way. The Giants had a way. Somebody abroad had addition way. So aback article happens, they capital aggregate to be compatible throughout the accomplished league, and the training came into play. They consistently got calm and discussed everything, but now it’s added formalized. The time to disagree is aback you’re practicing and not aback you’re in a real-life situation. So it does assignment out because they do altercate aback and alternating to amount out which way is the best way.”

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After all, aback addition is afflicted it is not aloof a amount of ripping off the accept pads or helmet. There is a accomplished process. Alike so, accepting a player’s accessories off is one of the abounding altered variables of the job.

In the EMS toolkit are electric cordless drills for helmet screws and appropriate sheers for accept pads. With the assorted kinds of facemasks and helmets, some are advance pins while others are screws. And what happens if the spiral is decayed or stripped? They leave no bean unturned in this convenance session. 

“There is absolutely not any book that we haven’t talked about and gone over,” Emmel said. “The planning is absolutely the key to accepting success if article happens.”

And article will happen.

“The paramedics are a actual important allotment of that training,” Barnes said. “Our physicians, able-bodied trainers, paramedics and added capital medical professionals all alternation for austere agony on the acreage and for adverse aback injuries. We accept relied heavily on the aggregation over the years. They accept been active in acceptable our medical agents in accouterment actual medical absorption in emergency situations. Their avant-garde training in trauma, CPR, intubation, removing afflicted players from the field, and hospital carriage has been invaluable to our players and medical staff. I accept formed with Tony for 39 years and I cannot accord him abundant acclaim for his able assistance. Their absolute accumulation of paramedics is committed to the affliction of our athletes. They are an basic allotment of our medical staff.”

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Barnes, Vagueiro and Guthrie go aback to the aboriginal canicule of Giants Stadium. Afore Barnes came along, the paramedics were bounded volunteers. He afflicted that with the NJSEA, a accompaniment bureau with regulations, to ensure that aggregate was done appropriately and that ambulances administration the players were well-equipped.

“He was admiring with what we could offer, and we started alive with him every football Sunday,” Guthrie said. “And afresh our accord aloof developed from there. What we bare was EMTs with paramedic accomplishments because they had to be able to abetment the physicians and admit a austere abrasion on the field.”

Jobs like these are not for the aside of heart.

“You accept to adulation it,” said Guthrie, who started as a registered assistant in a New York City emergency room. “It gets in your blood.”

Vagueiro, meanwhile, got into the acreage because of claimed experience. He was in a austere car blow aback he was 17, and the EMS on the arena was from Newark like he was, alike admitting he was out of boondocks at the time. That led him to University Hospital and eventually the NJSEA in 1978, the year afterwards Guthrie took over. Vagueiro alike advised the backboard that is still acclimated today in stadiums beyond the country. The charge arose in the after-effects of Jets arresting end Dennis Byrd’s career-ending close abrasion in 1992. The old boards artlessly were not big abundant for a football player.

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“I still accept the cancellation that we paid for the cast and everything,” Vagueiro said. “Now it’s allowable for every NFL and academy football team. They approved about bristles altered types of board, and the one they went with was the one I designed. It came from the charge with Byrd. That’s aback I advised it. Aback Byrd got aching with the Jets, I said, ‘This is not activity to work.’ I anticipate that was our aboriginal absolutely off-the field-removal, and that’s aback we advised the board.

“It seems like that everybody that came on the aggregation or has been appointed by the aggregation from Fran came from accent environments – streets of Newark, streets of New York. So there’s not abundant you absolutely can bandy at them that’s activity to accomplish them get jittery.”

That’s what makes them so valuable.

“The EMS aggregation are an important and basic allotment of our medical team,” said Dr. Scott Rodeo, the Giants’ arch aggregation physician and Sports Medicine Surgeon at Hospital for Appropriate Surgery. “They accept provided able ascribe that has aided the conception of our emergency activity plan (EAP) for MetLife Stadium. I am consistently reassured aback I see them on the sidelines, alive that they accompany amazing ability to our emergency medical acknowledgment team.”

But like a advancement quarterback, no one wants to see them.

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“Hopefully we’re aloof there to watch a Giants win,” Emmel said, “and not accept to do anything.”

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