Epidemiology and Prevention of Catastrophic Injuries in Baseball (2002–2023): Applying the Haddon Matrix for Emergency Planning

Prevention and mitigation of catastrophic injuries in baseball requires an understanding of injury patterns, mechanisms, and emergency preparedness. The purpose of this study was to describe the epidemiology and incidence of catastrophic injuries in youth, high school, and collegiate baseball in the United States and examine associated emergency care variables. Catastrophic injuries from 1 July 2002 through 30 June 2024 were identified through the National Center for Catastrophic Sport Injury Research (NCCSIR) surveillance system. Descriptive statistics described injury mechanisms, outcomes, and sport level distributions, with incidence rates calculated for high school and collegiate athletes. A total of 128 catastrophic baseball events were identified (40 fatal and 88 non-fatal). Head injuries (43.8%) and sudden cardiac arrest (30.5%) accounted for the largest proportion of events. Catastrophic events occurred most frequently at the high school level, although incidence rates were higher among collegiate athletes. Emergency care information demonstrated that survival occurred in all cases where CPR or AED use was documented. Together, these findings highlight that while catastrophic baseball injuries remain rare, their outcomes are shaped not only by the mechanisms of injury but by the immediacy and effectiveness of on-field emergency response, transforming preparedness from a precaution into the decisive factor between life and death.