Former NFL group physician explains Damar Hamlin’s collapse, medical employees protocols

On Monday night time, the NFL group held its collective breath as Buffalo Payments security Damar Hamlin collapsed on the sphere following a deal with of Bengals broad receiver Tee Higgins. Hamlin acquired again to his ft after which instantly fell again to the bottom as gamers from each groups instantly referred to as for medical help. 

The physicians, athletic trainers, paramedics and assist employees all did an incredible job, as has been reported a number of instances by the groups and broadcasters, in offering rapid life-saving care to Hamlin. 

The medical employees swiftly assessed the participant after which began CPR — which incorporates well-scripted and rehearsed cardiac and pulmonary measures to instantly resuscitate Hamlin. He was then transported by ambulance to the College of Cincinnati (UC) Medical Middle in vital situation, the place he was reported to be intubated (a respiratory tube was positioned in his trachea), and vitals stabilized. He’ll endure additional testing there.

The Payments formally reported Hamlin suffered a cardiac arrest. Cardiac occasions can occur for quite a lot of causes, nonetheless, in such a younger, match athlete, these are fairly uncommon occasions. 

One of many uncommon situations that happen when there may be blunt trauma to the guts is named Commotio Cordis.  In Latin, this implies “agitation of the heart” and it occurs when a person takes a blunt drive on to the entrance of the rib cage (chest wall), inflicting a short trauma to the guts muscle.

Now, if the blunt trauma happens throughout a really particular time inside the heartbeat (which is managed by electrical impulses within the coronary heart), and particularly through the repolarization section of the heartbeat electrical sign, it could trigger a life-threatening cardiac arrhythmia — which is usually ventricular fibrillation also referred to as V-Fib. 

One of the best ways to deliver somebody out of V-Fib, in response to the American Pink Cross, is: 1. Immediate recognition and activation of the emergency life assist system; 2. Beginning high-quality CPR; 3. Early Defibrillation with a defibrillator; and 4. Transport to a complicated life-support middle. That is precisely the sequence of occasions that occurred on the sphere for Hamlin, and is a credit score to the medical staffs of each groups to supply collaborative life-saving intervention. 

What can we apply for an occasion like this within the NFL?

As a former head group doctor for the New England Patriots, along with my coaching within the U.S. Navy, we routinely rehearsed the Emergency Motion Plan (EAP). That is performed by each NFL group and contains all of the medical employees concerned with participant care. 

The EAP is rehearsed, in individual initially of each season, on the sphere the place their group’s residence video games are performed, in addition to at any apply facility. There’s a printed EAP for each member of the medical group in addition to the visiting group. 

Not solely does the medical group rehearse precisely for an occasion reminiscent of this, we additionally apply backboarding, cervical backbone and lumbar backbone dealing with precautions, and in addition easy methods to deal with the facemask, helmet and pads. Along with that, the situation of all AED’s on the sphere is reviewed, in addition to the roles of each group member.

It doesn’t cease there. Sixty minutes previous to kickoff of each NFL sport, the important thing members of the medical employees meet to assessment the EAP on the stadium, to make sure everybody is aware of their roles in case of an emergency, and to ensure everybody is aware of the closest Stage I hospital trauma facility. 

What contains the NFL medical group that gives life-saving care on the sidelines?

All members of the medical group are well-versed in a number of facets of NFL participant care and every has outlined roles in case an emergency arises.  

We had greater than 40 health-care professionals on the sphere once I was a head group doctor, and it was vital everybody knew their position. This was the important thing to Hamlin’s fast cardiac care. 

Many followers may not remember, however there are a number of medical professionals skilled in particular areas to supply the very best stage of care to NFL gamers. 

A number of the key medical group members on the sphere of each NFL sport embrace:

  • Head group doctor and/or Medical Director. Typically, this individual is an orthopedic surgeon or musculoskeletal knowledgeable, however there are several types of physicians on this position.
  • Head athletic coach. This individual helps to coordinate all ranges of medical look after the group
  • Assistant head athletic coach(s)
  • Airway administration doctor. Typically, this individual is an emergency drugs doctor, trauma surgeon or anesthesiologist — somebody who is extremely aware of coping with a cardiac/pulmonary occasion.
  • Visiting group medical liaison. Typically, an emergency drugs doctor to help with all facets of medical look after the visiting group
  • Ambulance group. Typically, these are seasoned veterans, together with paramedics and EMTs who’ve the aptitude for fast sequence intubation in addition to administration of cardiac drugs.  The ambulance group is one which the groups have labored with, often year-in and year-out, and are extremely aware of not solely the EAP, but in addition the roles and duties of every member of the NFL medical group. They’ve the aptitude to supply all facets of cardiac/pulmonary care capabilities on the ambulance, which must be adjoining to the sideline, often in one of many tunnels. They know the quickest path to the designated Stage 1 trauma middle.
  • Unaffiliated neurologic consultants. There are three UNCs (Unaffiliated Neurologic Consultants) whose main job is to evaluate for concussion. There are two UNCs (one on every sideline), and one other within the sales space serving to spot for potential concussive occasions.
  • ATC spotter. This individual assists with the UNC and all facets of recognition of a probably concussive occasion.

What’s Commotio Cordis?

Commotio Cordis could be very uncommon — the truth is, there have been simply over 200 circumstances reported to the U.S. Commotio Cordis registry for the reason that mid Nineties.  

Commotio Cordis is extra widespread in sports activities reminiscent of baseball, softball, lacrosse and hockey, the place a tough object (ball or puck) is shifting at a excessive price of pace and strikes the person within the higher portion of the chest. 

Commotio Cordis usually impacts adolescents with a imply age of 15 years outdated. Nonetheless, it could occur in adults, particularly ones who steadily have interaction in athletic and get in touch with sports activities. The most typical sport wherein Commotio Cordis happens is youth baseball, typically involving the pitcher, catcher or batter. Chest protectors are additionally controversial on this situation because it has been proven that they could be of help, however different research haven’t proven a conclusive profit, as Commotio Cordis occasions have been documented regardless of the usage of a chest protector.

An AED and fast medical response are important to the survival of people that suffer from this. In accordance with the Nationwide Commotio Cordis Registry, in a research by Maron, BJ et al. they discovered that although 75% of circumstances have been from a projectile that was a part of the sport, 25% have been attributable to physique contact or collisions with teammates and opponents. 

Initially, it was thought that resuscitation was very troublesome, however current information reveals it has elevated from round a 15% survival price to better than 50% in recent times. That enchancment can possible be thanked to fast care, good medical planning and rapid availability of AEDs. 

Fortunately, the medical employees was capable of get Damar Hamlin’s heartbeat restored and to the hospital the place he may obtain the cardiac care wanted. Our ideas and prayers are in fact with him, his household and his teammates right now whereas we look ahead to future updates on his situation.

Famend orthopedist Dr. Matt Provencher and his firm,, ship data-driven harm insights to soccer followers. On this first-of-a-kind position as Athlete Damage and Efficiency Analyst for FOX Sports activities’ digital platforms, Provencher supplies vital predictive participant well being and restoration details about post-injury efficiency, the impression of climate, area situations and extra. 

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