Is there a doctor in the house? How well would your company handle an emergency?

Is There a Doctor in the House? In the picture-perfect world of theatrical dance, spectators don't expect to hear that question called out from the stage. Imagine the surprise of performers and audience alike when a principal dancer collapsed onstage two-and-one-half-hours into a performance of Pacific Northwest Ballet's Cinderella in March of 2002. Two physicians and a nurse in the audience responded, hurrying backstage to check on the fallen dancer. Also found was a prince to finish the performance. While a CPR-certified physical therapist administered first aid backstage, the new lead couple quickly discussed their impending unrehearsed performance. The company continued, repeating the final pas de deux.

Says Olivier Wevers, the prince who came to the rescue, "It was ah amazing moment. We were all nervous but we knew what to do: 'The show must go on.'"

Emergencies are an ever-present, if uncommon, risk in dance. The types of emergencies range from ah accident on the stage to ah acute episode of a pre-existing medical condition to the rupture of ah Achilles tendon.

Dancer choreographer Dan Wagoner, who teaches at Connecticut College, recalls ripping his foot on a protruding iron nail in the floor when dancing with the Martha Graham Dance Company in Samson Agonistes in 1961. Paul Taylor and Martha Graham proceeded to dance around the pool of blood, carefully avoiding the nail. (Then they got him to a hospital in a cab.)

In a recent interview, choreographer David Parsons talked about "doing the pit"--when a dancer somehow falls into the orchestra pit, as he himself had done while directing a rehearsal of his signature piece Caught. The solo is danced with a strobe light in a completely dark theater. Parsons dove, head first, ten feet into a concrete pit. He went into shock, was immediately taken to the hospital, and was told that if he hadn't been in good shape and warmed up, he would have suffered serious injury.

"My performers are adept at improvisation," says Parsons. "It's not like we're dancing Serenade of Swan Lake. We can improvise through the unexpected injury of emergency--even in front of thousands of people. The show only stops when the lights go out."

PNB co-artistic director Francia Russell says, "In my career, I've seen many injuries. Yet out of thousands of performances during our tenure as artistic directors, the dancer collapsing onstage was a first. Still, it was enough to make us think carefully and critically and see how we could strengthen our response."

At New York City Ballet, Marika Molnar, physiotherapist for the company, notes that it helps for the theater and studios to be located only several blocks from the hospital. Says Molnar, "I can remember a rehearsal on stage when one of the dancers was leaning over a second-story balcony and fell onto a fence. Ah emergency response team was on the set within eight minutes. Even now, if someone needs to go to an emergency room, a physician whom the dancer knows, who is familiar with ballet, is already at the hospital by the time the dancer arrives."

Molnar says that part of the company's emergency-response protocol involves educating the dancers to take care of themselves and others if something serious happens. "The dancers feel that there are many safety nets in place For their protection," she says. "We have emergency procedures that everyone knows--from stage hands to dancers to administrators. This includes having everyone's cell phone number."

Says PNB's Francia Russell, "'The show must go on'--but not at a dancer's expense. The dancer needs to take precedence. This is also true for smaller companies. There are usually many health professionals in the community who are willing to help out, who are interested in dancers and volunteer their services. It's not necessarily expensive."

Cher Carnell, a former principal with BalletMet and Louisville Ballet who now teaches in Bellingham, WA, agrees. Companies she has worked with have had a dedicated volunteer doctor on hand during performances. She acknowledges the need for such support, recalling a time when a partner snapped his knee ligaments, sending him into shock. "We covered him with a blanket and talked to him," says Carnell.

Companies that perform strenuous and potentially dangerous work might need to be especially alert. A case in point is Elizabeth Streb's high-impact movement. "With Streb work, the risk is higher since the physical intensity is higher," says Streb. "The trust element is critical, so I need to know about preexisting conditions, It's hard for dancers to talk about this because we are so vulnerable, especially in the fragile dance economy we're in. But we depend on each other in performance to be OK. If someone gets hurt, it won't be just him or her--it will be other dancers as well."

At the Boston Ballet, emergency-preparedness is a priority. According to Dr. Lyle Micheli, Director and Ruth Solomon, Coordinator of Dance Medicine Research in the Division of Sports Medicine, Children's Hospital, Harvard Medical School, the Boston Ballet reserves two seats near the stage for the physician providing medical coverage and two seats for a physical therapist at every performance. An up-to-date doctor's bag and physical therapy equipment are kept in the physical therapy room at the theater.

According to Molnar, NYCB's physical therapists are backstage for every performance until the end of the first intermission, The New York State Theater provides a physician at each performance, and NYCB's orthopedic consultant, Dr. William Hamilton, or an associate, is usually in attendance. Backstage, there is a defibrillator and at least two people, certified in CPR, who can use it. A backstage therapy room has crutches, aircasts, bandages, etc., as well as a fully equipped doctor's bag.

Preparing for the unexpected--within reason--makes good sense. Says PNB's Russell, "It's not just the legal thing to do, it's the humane thing to do. We supply first aid kits, a physical therapist, and ice buckets backstage--as well as maintain a well-supplied doctor's bag. What we learned from our experience two years ago is that, although there may be ah available doctor in the house to administer during an emergency, often he or she does not have a completely equipped bag--they don't bring them into the theater." PNB now maintains a fully equipped kit, which is periodically checked in both their studios as well as the theater. "The dancers know that we have such equipment," says Russell. "The more secure the dancer is, the better the performance."

The story of the 28-year-old dancer who collapsed during Cinderella indeed has a happy ending. At the hospital, he was diagnosed with a form of irregular heartbeat. A short two weeks later, the company applauded his return to class and rehearsal.

For the rare serious medical emergency, it is not enough to have a doctor in the house. Dance companies need to have a fully equipped medical bag and staffers certified in CPR and qualified to treat shock. Dancers need to mentally rehearse for such events--so that a new prince of princess can be found, a partner can be reassured, and the dance can go on.

Be prepared

How can dance companies (and theater management) prepare for the odd emergency? In addition to the physical and medical aspects of safety procedures, the psychological and emotional aspects are also important. Preparation for emergencies helps maintain dancers' trust and enthusiasm, and good employer-employee relations. Dr. Richard Gibbs, a former ballet dancer who is now the head physician at San Francisco Ballet, notes that, "It's rare to see a dancer collapse on stage. It's more likely that someone will drop in the audience, not on stage if for no other reason than the younger age of the performers." He believes that no company is too small to be prepared for a first response. The Following are Dr. Gibbs' recommendations for emergency preparedness.

* Ice buckets backstage

* A physical therapist at each performance

* A medical office on site

* Emergency medical supplies, complete and updated, ready for any doctor to use

* Planned response with dancers and production personnel--as with an earthquake or fire drill

* Staff certified in CPR

FOR INFORMATION ON CPR TRAINING www.cpr-training-classes.com/ www.redcross.org/services/hss/courses/

FOR INFORMATION ON PREPAREDNESS www.bt.cdc.gov/ www.shape.bc.ca/resources/publications.html

Gigi Berardi contributes to Dance International and The Olympian. Her book Finding Balance: Fitness, Training, and Health for a Lifetime in Dance, will be published by Routledge Press in November.