Al Salmi, left, stands beside FOX NFL reporter Erin Andrews at Lambeau Field in Green Bay. Salmi, a Gladstone native, works for the NFL as an independent concussion physician on the visiting team sidelines. (Dennis Grall/The Daily Press)

Al Salmi can relate to his own personal experience as he stands on the Lambeau Field visitor’s sideline.

Not as a football player, but as a physician.

The 1988 Gladstone High School graduate attends every game at Lambeau Field as the visiting team’s independent concussion doctor. Technically, he is the NFL unaffiliated neurotrauma consultant.

He arrived in Green Bay in 1999 and has spent 18 years in the emergency room at St. Vincent’s Hospital.

“We take whatever strolls through the door,” Salmi said. “Every day is different. We don’t know what we will be busy with.”

Employed by the NFL at each game in Green Bay as a visiting team medical liaison, Salmi is one of three emergency physicians on each sideline.

“It is an extra layer of independence,” he said of a position that was sought by the NFL players union to avoid potential conflict of interest medical decisions made by each team’s medical staff. “If someone is injured on the field or removed from play that day, that is when the concussion protocol kicks in.”

Salmi and similar sideline physicians only go on the field for neck injuries or heart conditions. Otherwise, they evaluate players on the sidelines and go into a medical center deep in the bowels of Lambeau Field if further testing is required.

“We do our exams together with the team’s training staff,” Salmi said. “We work in conjunction with them. It is a mutually agreed upon decision.”

Salmi’s earliest concussion experiences came when his last basketball game at Gladstone, when he tumbled over a Ludington player and struck his head on the floor in a regional championship game at Houghton Lake.

“I was clearly out on my feet,” he said. “I got a CAT scan and clearly had a concussion. I don’t remember anything until (getting to) the hospital. I didn’t feel well for a month. I had nausea, headaches. I clearly should not have been back in any sport, had we been playing any more.”

Buoyed by that personal experience, which he said may be the reason he entered the medical field, he knows better than most how important it is to handle concussion situations promptly and correctly.

Injured players, at every level of athletics, typically want to return to that game as soon as possible and certainly don’t want to spend time receiving medical attention in the locker room while the game is underway.

Salmi said injured players will likely come out of a game with an ankle injury and apply ice.

“You can’t see a concussion. There is no swab or blood test or image of patients that have a concussion,” he said, adding that a concussion followed by another concussion can cause the brain to rapidly swell. “That is a bad thing, swelling of the brain, and you can get real sick real quick.”

Concussed athletes must pass a series of tests before they are allowed to resume practice or play in games, such as walking on a treadmill or counting the months of the year backwards. Green Bay defensive back Sam Shields has been unable to pass the concussion test since getting injured early in the season.

The attention to concussed players has risen dramatically in the past decade, undoubtably led by the 2015 film “Concussion” starring Will Smith as pathologist Dr. Bennet Omalu, who did extensive research on concussions.

Regarding that movie, which did not get favorable reviews from the NFL, Salmi said “the NFL was ahead of it already. They had a concussion protocol in place. That (movie) helped bring more public awareness to it.”

He said the “end result of multiple concussions” brings a higher risk of Chronic Traumatic Encephalopathy (CTE), a progressive degenerative disease which affects brains of people who have suffered repeated concussions. Studies have shown it has led to suicides and other debilitating symptoms after retirement, including memory loss, depression and dementia.

Salmi, who has been certified by the NFL for three years, said the NFL has preseason concussion exams of every player and physicians use that information available on an iPad to ask the same questions and provide the same tests when a concussion is diagnosed. Many high schools are also using preseason neuro testing to help diagnose concussions.

“One of the biggest frustrations is getting the actual symptoms reported by the players,” said Salmi, who said some players have purposely altered their preseason tests downward to make it easier to clear the protocol if they become concussed. “Players want to be tough but they may face long-term health hazards.

“It is the culture of I’m tough and I’m invincible and I want to get back into the game no matter what,” he added. “They want to shake it off and get back into the game. We (fans) cheer when a player comes back onto the field.”

Game referees are trained to watch for possible concussions and a spotter in the press box also reviews the plays and has the authority to remove a player.

“If I see something suspicious, I can get the line judge’s attention,” Salmi said.

The medics will evaluate the player and review film of the hit, whether from helmet-to-helmet or elbow/knee to the head.

“There are so many collisions that come from so many angles, the speed of the game and how fast things happen,” Salmi said. “We are supposed to watch every play” from their sideline spot near the kicker’s net at the end of the bench area. We are not there to ask for autographs or take pictures. It is a professional job and we are there to do our part and keep our mouth shut and not stand out.”

The physicians must file a report of every concussion incident within 24 hours of the game that details findings and treatment.

“No evaluation goes on without an independent doctor there,” Salmi said.

Salmi said fans can also sustain concussions.

“If you bounce your head (falling to the floor as an example) you at least have a mild concussion,” he said.

Salmi said his St. Vincent’s physicians landed the sideline positions because injured players are brought to that hospital to handle their injuries. He handled scheduling of SVH physicians at games and served at games before the concussion protocol was instituted.

He was approached about his current sideline spot by long-time team physicians Dr. Patrick McKenzie and Dr. John Gray and head trainer Pepper Burress. That trio and Salmi now provide annual preseason refresher courses and receive credentials from the NFL.

The group deals with medical issues, hospitalization and prescriptions that athletes may need as they fly home after games. The group is on-call from the moment the team arrives at Appleton International Airport (formerly Outagamie County Regional Airport).

Salmi, the son of Al and Dolly Salmi of Kipling, said a third of the home games do not have any concussion situations but “you need to be there just in case.”