Athlete injury and performance analyst
On Monday night, the NFL community held its collective breath as Buffalo Bills safety Damar Hamlin collapsed on the field following a tackle by Bengals wide receiver Tee Higgins. Hamlin stood up and suddenly fell back to the ground as players on both teams immediately called for medical attention.
The doctors, athletic trainers, paramedics and support staff did an incredible job, as teams and broadcasters have repeatedly reported, in providing immediate care to Hamlin.
Medical personnel quickly evaluated the player and then began CPR, which includes well-scripted and rehearsed heart and lung measures to immediately revive Hamlin. He was then transported by ambulance to the University of Cincinnati (UC) Medical Center in critical condition, where he was reported to be intubated (a breathing tube was placed in his trachea) and stabilized their vitals There he will undergo further tests.
The Bills officially reported that Hamlin went into cardiac arrest. Cardiac events can occur for a variety of reasons, but in such a young and fit athlete, these are fairly rare events.
One of the rare conditions that occurs when there is blunt trauma to the heart is called Commotio Cordis. In Latin, this means “fluttering of the heart” and occurs when an individual takes a blunt force directly to the front of the rib cage (chest wall), causing a brief trauma to the heart muscle.
Now, if the blunt trauma occurs during a very specific time within the heartbeat (which is controlled by electrical impulses in the heart), and in particular during the repolarization phase of the electrical signal of the heartbeat, it can cause a cardiac arrhythmia that life threatening which is usually ventricular fibrillation also known as V-Fib.
The best way to get someone out of V-Fib, according to the American Red Cross, is to: 1. Rapid recognition and activation of the emergency life support system; 2. Initiate high-quality CPR; 3. Early defibrillation with a defibrillator; and 4. Transport to an advanced life support facility. That’s exactly the sequence of events that unfolded on the field for Hamlin, and it’s a credit to the medical staff of both teams for providing a collaborative, life-saving intervention.
What do we practice for an event like this in the NFL?
As the former head team physician for the New England Patriots, in addition to my training in the US Navy, we regularly rehearsed the Emergency Action Plan (EAP). This is done by all NFL teams and includes all medical personnel involved in player care.
The EAP is rehearsed, in person, at the start of each season, at the field where their team’s home games are played, as well as at any training facility. There is an EAP printed for each member of the medical team as well as for the away team.
Not only does the medical team rehearse exactly for an event like this, we also practice cervical and lumbar spine manipulation precautions, as well as how to handle the mask, helmet and pads. In addition to this, the location of all AEDs in the field is reviewed, as well as the roles of each team member.
It doesn’t stop there. Sixty minutes before kickoff of every NFL game, key members of the medical staff meet to review the EAP in the stadium, to ensure everyone knows their role in an emergency and to ensure – make sure everyone knows the nearest Level I trauma hospital. installation
What does the NFL medical team that provides life-saving care on the sidelines include?
All members of the medical team are well-versed in multiple aspects of NFL player care and each has defined roles should an emergency arise.
We had over 40 health professionals in the field when I was a team leader doctor, and it was important that everyone knew their role. This was the key to Hamlin’s rapid cardiac recovery.
Many fans may not know this, but there are many medical professionals trained in specific areas to provide the highest level of care to NFL players.
Some of the key members of the medical team on the field for every NFL game include:
- Chief physician of the team and/or medical director. This person is usually an orthopedic surgeon or a musculoskeletal specialist, but there are different types of doctors in this role.
- Head of sports coach. This person helps coordinate all levels of medical care for the team
- Assistant athletic trainer(s).
- Doctor in respiratory tract management. This person is usually an emergency physician, trauma surgeon, or anesthesiologist, someone who is very familiar with treating a cardiac/pulmonary event.
- Visiting team medical liaison. Generally, an emergency physician to assist with all aspects of medical care for the visiting team
- Ambulance team. These are generally experienced veterans, including paramedics and EMTs who have the ability to perform rapid sequence intubation as well as the administration of cardiac medications. The ambulance team is one that teams have worked with, usually year after year, and are very familiar with not only the EAP, but also the roles and responsibilities of each member of the NFL medical team . They have the ability to provide all aspects of cardiac/pulmonary care capabilities to the ambulance, which must be adjacent to the touchline, usually in one of the tunnels. They know the fastest route to the designated Level 1 trauma center.
- Unaffiliated Neurological Consultants. There are three UNCs (non-affiliated neurological consultants) whose main task is to assess concussion. There are two UNCs (one on each sideline) and one in the stand that help locate potential concussive events.
- ATC observer. This person assists with UNC and all aspects of recognizing a potentially traumatic event.
What is a heart attack?
Commotio Cordis is very rare; in fact, there have been just over 200 cases reported in the US Commotio Cordis registry since the mid-1990s.
Commotio Cordis is most common in sports such as baseball, softball, lacrosse, and hockey, where a hard object (ball or puck) moves at high speed and hits the individual in the upper chest.
Commotio Cordis usually affects teenagers with an average age of 15 years. However, it can happen in adults, especially those who frequent sports and contact sports. The most common sport in which Commotio Cordis occurs is youth baseball, which usually involves the pitcher, catcher, or batter. Breast protectors are also controversial in this condition as they have been shown to be of help, but other studies have not shown conclusive benefit as events of Commotio Cordis have been documented despite the use of a chest protector.
An AED and rapid medical response are vital to the survival of those suffering from this. According to the National Commotio Cordis Registry, in a study by Maron, BJ et al. they found that while 75% of cases were from a projectile that was part of the game, 25% were caused by body contact or collisions with teammates and opponents.
Originally, resuscitation was thought to be very difficult, but recent data show that it has increased from a survival rate of around 15% to over 50% in recent years. This improvement can probably be attributed to prompt care, good medical planning, and the immediate availability of AEDs.
Fortunately, medical personnel were able to restore Damar Hamlin’s heartbeat and get him to the hospital where he was able to receive the necessary cardiac care. Our thoughts and prayers are of course with him, his family and his teammates at this time as we await further updates on his condition.
The renowned orthopedist Dr. Matt Provencher and Company, ThePredictors.com, provides data-driven injury information to soccer fans. In this unique role as an athlete performance and injury analyst for FOX Sports’ digital platforms, Provencher provides important predictive information on player health and recovery regarding post-injury performance, the impact of weather, field conditions and more.
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