Heads on the line

The most famous case occurred in 1957, when pitching prodigy Herb Score of the Cleveland Indians took a shot off the bat of the New York Yankees' Gil McDougald to his right eye. His blurred vision would eventually improve, but Score's budding career was effectively derailed.

Boston's Bryce Florie suffered similarly in 2000, also the result of a ball off of a Yankee's bat, when Ryan Thompson's line drive struck Florie in the right eye.

Both were bloody episodes with irreversible consequences. Both were rarities, as few major league pitchers have been hit in the head by a batted ball and still fewer have been seriously injured. Never has such an incident been fatal.

But three times in a span of less than two months late last season, batted balls hit pitchers in the head, drawing unprecedented attention to the vulnerability of the men on the mound.

Spurred by the first of those incidents, discussions within MLB took on new urgency as league officials and equipment manufacturers examined possibilities for protective headgear to lessen the risk. MLB has not yet approved padding for the inside of caps worn by pitchers, but it seems just a matter of time before that occurs.

"MLB is right to do its due diligence," said neuropsychologist Michael Collins, director of the University of Pittsburgh Medical Center's Sports Medicine Concussion Program. "There are missiles coming back at the pitchers, and MLB knows it."

Steeped in tradition, but change possible

On Sept. 5, Oakland's Brandon McCarthy suffered life-threatening injuries -- a brain contusion, epidural hemorrhage and skull fracture -- when a line drive off the bat of the Los Angeles Angels' Erick Aybar struck him in the head. McCarthy, who underwent emergency brain surgery, was cleared to return to pitching after a rehabilitation program, and he signed a two-year deal with Arizona for $15.5 million as a free agent.

A month later, in Game 2 of the World Series, a liner hit by San Francisco's Gregor Blanco hit Detroit's Doug Fister in the head, but Fister was able to remain in the game. Upon seeing Fister get struck, longtime Fox TV commentator and former big league catcher Tim McCarver said: "I never thought this before this year, but I think baseball is going to have to resort to helmets for pitchers like catchers wear."

MLB and the protective equipment manufacturers with which it is consulting have not discussed helmets or masks for pitchers, said Major League Baseball senior vice president Dan Halem, but have instead focused on padded linings for their caps. The objective, he said, is to find something that achieves a balance between comfort and protection. "If we have a product no one will wear, and pitchers are complaining, that doesn't get us anywhere."

McCarthy's injuries, according to Oakland head athletic trainer Nick Paparesta and Collins -- who worked with McCarthy on his rehabilitation -- probably wouldn't have been lessened by a padded cap, because the ball struck him beneath the cap line.

Halem said MLB doesn't have long-term data, but that in 2012, a total of three pitchers were struck above the shoulders by batted balls. In addition to McCarthy and Fister, on Sept. 12, reliever Mickey Storey of the Houston Astros was hit in the face by a ball hit by the Chicago Cubs' Dave Sappelt. Storey left the game, but wasn't seriously hurt and pitched again three days later.

"Outside the Lines" found video of 10 incidents over the past five seasons in which pitchers were hit in the head, beginning with May 21, 2008, when an Albert Pujols line drive struck then-Padre pitcher Chris Young between the eyes.

The 6-foot-10 Young, whose skull was fractured and nose broken, said his neurologist confined him to home for eight weeks because of the risk of meningitis and other infections, as he had an open passageway from his sinus cavity to his brain.

Now 33 and a free agent after spending the last two seasons with the New York Mets, Young said the introduction of padded caps would signify progress, even though he wouldn't have been helped by one where he was struck. Score and Florie also were hit beneath where a padded cap could have cushioned the impact, but in the majority of the last five years' incidents, the ball struck above the cap line.

"My recommendation would be to create something that would protect what possibly can't be repaired, like the eyes and the brain," said Young, a nine-year veteran. "A visor, as in hockey, would have been beneficial to me."

Young's wife, Liz, whom he met when they were both Princeton undergraduates and varsity athletes, has an unusual perspective on any hockey comparison. Her maiden name is Patrick, as in the NHL's Patrick Division, named in honor of her late great-grandfather, Lester Patrick, the first coach and general manager of the New York Rangers. Her late grandfather, Muzz, was a Rangers defenseman and her father, Dick, has been president of the Washington Capitals since 1982. Other close relatives have also worked with distinction in the sport, earning the Patricks the title of "Hockey's Royal Family."

"Baseball is so steeped in tradition," Liz Young said. "Pretty much all of the other sports have changed in equipment for players (like helmets in hockey) and after a little time, it becomes natural."

Batting helmets, now taken for granted, didn't become mandatory in the majors until 1971 -- 51 years after the death of Cleveland's Ray Chapman, who was struck in the head by a pitch from the Yankees' Carl Mays and is the only player to ever die from an on-field injury. This season, according to the collective bargaining agreement between MLB and its players association, batters will be required to wear the Rawlings S100 Pro Comp model helmet, billed as providing protection against pitches of up to 100 mph.

Young, who bears a scar where he was hit and had more than 30 stitches, said the proximity of pitchers to the batters lends validity to what McCarver said. He added that the tragic example of minor league first-base coach Mike Coolbaugh, who died in 2007 after he was struck in the neck by a line drive, shows "it only takes one time."

MLB mandated helmets for base coaches the following season. "The first year, I thought it looked so weird; now I don't think about it," said Liz Young.

That was also the season her husband was hit by the Pujols liner. The Youngs still have the baseball that struck him, and it has a noticeable nick in it -- the Padres said it came from contact with Young's bone, Liz Young said.

"Greg Maddux (then a pitcher for San Diego in the final year of his career) told me at the time," Young said, "that it was a 'one-in-a-million shot,' and 'you had your one, so you should be OK after this.'"

A year after Young was battered and bloodied, San Francisco's Joe Martinez -- pitching in relief with two outs in the ninth inning of just his second major league outing -- was struck on the forehead above the right eyebrow by a Mike Cameron line drive, resulting in hairline fractures of the skull, a concussion and bleeding inside his head. Unlike Young, had Martinez been wearing a cap with protective padding, it might have prevented some of the damage, he said.

Martinez, 29, who has pitched in parts of three seasons in the majors and is now in the Indians' camp on a minor league contract, said he, like Young, sees potential for padded caps, but he doesn't see it going much further. "They (pitchers) aren't going to want anything that makes them look goofy -- it sounds ridiculous, you think safety would be so much more important than what you look like, but baseball players like looking good."

Multiple padded cap options being studied

Halem said the hope had been to approve some forms of padding for caps in time for spring training, so pitchers could begin trying the products on a voluntary basis. MLB has received proposals from six companies, said Halem, but only two of the six -- Unequal Technologies and EvoShield -- have submitted padded cap prototypes for testing at a University of Massachusetts-Lowell laboratory.

Unequal president Rob Vito said he independently made spring training appointments with all 30 MLB teams to bring three variations of his Pennsylvania-based company's DuPont Kevlar composite padding for pitchers to try out. Vito said he is presenting a new prototype that is about half the thickness of the approximately 1/8-inch thick products he first showed MLB and also at least 25 percent lighter. He said the padding, originally named "CRT" for "concussion reduction technology" (although Vito said the company doesn't make any claims about concussion prevention), was recently renamed "SHP," or "supplemental head padding."

Justin Neifer, EvoShield's vice president of business development, said the Georgia company is taking a different approach, preferring to wait for MLB approval before introducing anything to pitchers with whom it doesn't already have a working relationship. Niefer said after discussions with MLB and pitchers with whom EvoShield consults, the company determined the 1/4-inch advanced foam "gel-to-shell technology" padding EvoShield initially presented to MLB needed to be lighter, so EvoShield reduced its weight in half to about 2.4 ounces (about half an ounce lighter than what Unequal said its newest prototype weighs).

Halem said it's taken longer than hoped for "these companies to develop something to be proven as a viable product, to make us comfortable that it provides adequate protection." He said "it's not impossible," however, that a padded cap lining could be approved in time for Opening Day.

Regardless of whether MLB gives its stamp of approval to an item, a pitcher isn't precluded from wearing padded caps or other headgear -- even helmets -- in games, said Halem.

Dave Halstead, technical director of the Southern Impact Research Center in Tennessee and a technical consultant to the National Operating Committee on Standards for Athletic Equipment (NOCSAE), said it would essentially be a fallacy to attribute to thin padding beneath a soft cap the power to protect against the ultimate risks of baseballs traveling faster than the speeds at which they were thrown, in excess of 90 miles per hour. "It has to be at least a half-inch thick and have a rigid exterior shell or it will not save your life -- anything less than that is a false sense of security."

That conclusion, according to Halstead, is based on extensive lab testing of materials of varying degrees of thickness.

The bottom line, said Halstead, is "there are things they can wear, but if they have to pass the mirror test, there's nothing." Caps, Halstead said, don't cover the high-risk temporal bone and mastoid area and provide significantly less coverage than helmets.

The safety issue isn't just a matter of headgear for pitchers, who can have about one-third of a second to react to line drives hit back at them.

MLB Network analyst and former pitcher Jim Kaat, who won the American League Gold Glove 14 straight years beginning in 1962, said today's pitchers "need to be more diligent about being in fielding position and anticipating."

Al Jackson, who has pitched and coached pitching in the major and minor leagues for more than half a century, said, "the first thing is you have to teach pitchers to protect themselves -- very little is being taught."

"Guys finish crossed over, they are not prepared to get out of the way," said Jackson. "You need to see with both eyes, not one."

Kaat and Jackson bemoaned the modern emphasis on pitchers maximizing the speed of their pitches, rather than developing a technique that leaves them ready. And Kaat suggested other equipment measures, perhaps in addition to headgear, could help protect pitchers -- "they should standardize bats and not make the baseballs so hard."

Said Angels manager Mike Scioscia: "I don't think there's ever been an era when the baseballs come off the bat with more velocity than now, these guys are bigger, stronger, [have] better bat speed, [and use] lighter bats."

Reliever Bill Bray, who signed in December with the Washington Nationals after six years with the Cincinnati Reds, said he hasn't been struck in the head by a line drive and is more concerned about being impaled by a broken bat. Any protective headgear, including padded caps, Bray said, would be a tough sell for him and perhaps other pitchers, because of pitchers' comfort with what they've always worn.

But when he saw footage of McCarthy getting hit, Bray said, "You get that pit in your stomach and cringe, because you know it could be you."

Seeing her husband get hit and severely injured five years ago, 10 weeks after she gave birth to their first child, "definitely taught me something," Liz Young said. "I used to be nervous about whether he'd win. Now I just enjoy it and am thankful he's out there and healthy."

William Weinbaum is a producer for ESPN's "Outside the Lines." Correspondent Steve Delsohn and Rayna Banks, Jennifer Chafitz, Kaiti Decker, Raul Fernandes, Dominique Ponticiello-Collins, Jenna Shulman and Josh Vorensky contributed to this report.