Life-Saving Training Blog

On the evening of Monday, Jan 2, during the first quarter of the Monday Night Football game featuring the Buffalo Bills and Cincinnati Bengals, millions watched either in the stadium or on live television what initially appeared to be a typical NFL play where Bills Safety Damar Hamlin took a hit to the chest. He got up momentarily and then suddenly collapsed in cardiac arrest.

The overwhelming majority of the viewers, including the players from both teams, had never actually witnessed a cardiac arrest. They simply watched in terror as the well-oiled and well-practiced machine of the NFL’s medical first responders rapidly assessed and managed the critical situation right there on the field.

What the viewers of that incident did not realize, however, was that for EMS providers the care was a typical out-of-hospital code, incorporating what we have come to know as the links in the Chain of Survival:

• Recognition/activation of EMS
• Immediate high-quality CPR
• Rapid defibrillation
• Basic and advanced EMS care
• ALS and post-arrest care
• Recovery

But for those closely watching, this was to become a significant emotional event. As the paramedics, trainers, and team physicians carefully loaded the patient into the ambulance after obtaining return of spontaneous circulation (ROSC), the two teams knelt in prayer and the game was ultimately postponed and then cancelled.

The patient was taken to University of Cincinnati Medical Center, a level-1 trauma center, that was well-equipped to manage post-cardiac arrest. Fortunately, after three days of intensive care, Hamlin was reported by his medical team as waking up and neurologically intact. In fact, he was able to write a note to his family and medical team asking who won the game. A physician responded, "You did, you won the game of life!”  

In our lifetimes there are occasionally significant emotional events that we remember the details of for many years. Just ask people where they were when the planes hit the Twin Towers and Pentagon on September 11, 2001, or when President John F. Kennedy was shot, or when the Space Shuttle Challenger exploded. These events include examples like, a wedding day, the loss of child, that terrible car wreck, a first born’s delivery, the list goes on and on.

Some are positive memories, and some are not. But these significant emotional events often prompt us to stop for a moment and reflect, then reevaluate and react (hopefully in a positive way) for our families, friends and community.

One immediate reaction of the public and the media was how could cardiac arrest occur in a 24-year-old who was in excellent shape? Ultimately, after extensive medical testing, the cause of the sudden cardiac arrest will be revealed, yet there is still this anxiety among many who observed the event play out on TV or in the stadium.

It sure sounds a lot like the couple of cases of Commotio Cordis that I am most familiar with. In both instances the young athletes were struck in the anterior chest wall, one by a lacrosse ball, the other by a baseball. The sudden impact during the exact moment of the “T” wave in the cardiac cycle prompted their hearts to go into ventricular fibrillation. The treatment is CPR and AED within the first couple of minutes. One child received both and survived, the other did not and tragically died.

While Commotio Cordis typically occurs to a healthy male heart, it is about as predictable as picking a winning lottery ticket.

There are however, other cardiac issues that can and should be screened for in all athletes by qualified medical providers.

In my mind, having seen the advances in cardiac arrest care over my 45-year-career, as I watched the excellent immediate response of NFL medical responders to Hamlin, I expected a good outcome from the code. I am not at all surprised it took a few days for him to come to and demonstrate he is neurologically intact. (Though, I have been accused of being cautiously optimistic!)

Some of the down time between reports on Hamlin’s condition was probably due to routine post ROSC care such as intubation, mechanical ventilation, sedation and targeted temperature management (TTM) to allow the brain to bounce back after some rest.  

I also suspect in addition to the high-quality hospital care, the prayers of America have helped too. I hope Hamlin comes back next season in excellent health and becomes an advocate for both improving the links in the chain of survival in every community as well as appropriate prescreening for all athletes.

As I see it the real issue here is finding ways for all those affected by Hamlin’s cardiac arrest to not just send money to his foundation (that is easy to do), but to go the extra step and contact their local EMS agency to see how they can help. Here are a few steps you can take right now:

• Learn CPR
• Make sure your address is clearly posted on your home
• Support your EMS system
• Get your children medically cleared before playing sports, and
• Make sure your schools and public places in their communities have AEDs

Remember although this situation played out in public, the number of athletes in the NFL is tiny compared to the numbers of kids who play sports in high schools and colleges across our country. The on-site medical resources and prescreening evaluation of students is not always what it should be and that needs to be reevaluated in every community.

Finally, I would strongly recommend you take a visit to the website http://la12.org where you can learn more about a 14-year-old boy, Louis’ J. Acompora, who died of Commotio Cordis as a result of a blow to his chest while playing lacrosse. This site lists several helpful resources about cardiac arrest and Commotio Cordis.

Over the years in my role as a volunteer AHA advocate, I have been lucky to lobby in New York with Karen Acompora. When Louis died, the entire Acompora family certainly experienced a significant emotional event. They chose to help others to prevent future tragedies (taking our children out of harm’s way). Their ongoing efforts have changed the world we live in and ultimately saved hundreds of lives by advocating for CPR and AEDs and appropriate athlete prescreening.

Now it’s your turn to pick up the ball. 

Need help learning CPR or teaching it others in your community?

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About the author:

Bob Elling, MPA, EMT-P has been involved in EMS since 1975. He was a paramedic with the Town of Colonie EMS Department, Times Union Center, and Whiteface Mountain Medical Services. He is a retired clinical instructor from Albany Medical Center and worked in the Hudson Valley Community College Paramedic Program. He has served as National and Regional Faculty for the American Heart Association (AHA), and as Regional Faculty for the New York State Bureau of EMS. He was also a paramedic and lieutenant for New York City EMS, paramedic program director and associate director of the New York State EMS Bureau, and an education coordinator for PULSE: Emergency Medical Update. He is the ECSI Medical Editor for CPR and First Aid Series of products.