Takeaways from the ‘most-watched cardiac arrest in the history of humankind’
The emergency physicians who resuscitated Damar Hamlin share their insights into SCA and CPR training
NEW ORLEANS — On Jan. 2, 2023, NFL safety Damar Hamlin collapsed on the field during the first quarter of a Monday Night Football game. The on-field EMS crew administered CPR in front of 67,000 fans and a home audience of 25 million people.
The 2023 EMS World Expo kicked off with a remarkable keynote presentation delivered by two of the emergency physicians who were part of that on-field team – whose planning, training and execution of that training contributed to Damar Hamlin’s resuscitation, recovery and return to the NFL.
University of Cincinnati School of Medicine Emergency Physicians Bentley Woods Curry, MD; and Jason McMullan, MD, shared insights into the “most-watched cardiac arrest in the history of humankind,” the NFL’s on-field Emergency Action Plan, and the unique considerations in treating sudden cardiac arrest in athletes.
“You don’t rise to your top level of performance; you fall to your level of training.”— Jason McMullan, MD
“Just put the pads on. If you have an AED, use it. Don’t let your lying eyes tell you something else.” — Bentley Woods Curry, MD
“I didn’t get a good night sleep for several days, not until he woke up and could follow commands and I didn’t get a great night sleep until he was extubated” — Bentley Woods Curry, MD
“The world is saying look at these supermen and women, look at what they did. We provided CPR, BVM, defibrillation and post-ROSC care, that every single one of you either did yesterday or will do tomorrow.” — Jason McMullan, MD
“CISD is beautiful and it mobilizes resources for the big one, but the peer support team is there for the death of a thousand paper cuts.” — Jason McMullan, MD
“I still don’t know how to process this, because I just did my job, and I’ll tell you, it wasn’t a perfect resuscitation. The outcome was great, but it wasn’t perfect.” — Jason McMullan, MD
Rapid Response: Paramedics get ROSC as world watches NFL player’s on-field treatment
When Buffalo Bills player Damar Hamlin collapsed on the field in cardiac arrest, he received out-of-hospital BLS and ALS care from team personnel and EMS before transport to the hospital
While Drs. Curry and McMullan were clear in respecting Damar Hamlin’s privacy and in deflecting the praise for their on-field actions, they shared compelling takeaways from the events.
1. ‘Just put the pads on’
Drs. Curry and McMullan cemented one key takeaway: in the unconscious athlete, assume cardiac arrest.
“The unconscious athlete is in cardiac arrest until you prove otherwise,” Dr. Curry stressed.
And in the athlete in prime physical condition, unconscious means not following commands. They may be breathing and their eyes may be open. SCA looks different in athletes, they stressed.
In a case of exercise-associated cardiac arrest, not following commands is usually the first sign of illness (only 8% report prior symptoms). They may exhibit posturing, increased tone, myotonic jerking and spontaneous breathing or abdominal gasping.
SCA in athletes is most commonly associated with basketball, then football, then track/cross country and soccer. “Basketball and football are going to be your high-yield sports,” Dr. Curry noted.
It’s not surprising that the survival rate in SCA in athletes is fairly high. What makes the difference: planning and equipment availability. “Emergency action plans and AEDs save lives,” Dr. Curry said. He cited data comparing SCA survival in schools with an emergency action plan (79% survival), versus those without an EAP (44%). Survival averaged 80% if there was an AED present at the incident, and 50% if the AED was brought by ambulance.
Having an AED at the field of play is essential, Dr. Curry added. “It doesn’t do anyone any good if it’s locked in the training room somewhere.”
2. Establish an emergency action plan
“Hope is a plan; just not a very good one,” Dr. Curry noted. He encouraged attendees to reach out to athletic personnel at local schools and sports organizations. They want to work with you to practice their EAP, they just don’t know who to ask, he promised.
Not everyone is familiar with emergency action plans, Dr. McMullan said, but we’re all familiar with the all-hazards approach. Think of the EAP in the same way, a plan that outlines what we are going to do when something goes wrong. This should be a living document that answers these questions:
- Emergency personnel. Who responds and what are their roles?
- Emergency communication. Who will contact EMS and how will responders communicate?
- Emergency equipment. What is available and how often is it tested?
- Emergency transportation. What are the options and probable response times?
- Roles of first responders: If there’s a cardiac arrest, who runs the code?
3. Practice identifies the gaps
An EAP on paper is a great start, but it is the practice which will surface potential complications.
Dr. McMullan shared before the Monday Night Football game and Damar Hamlin’s collapse, the medical team practiced their EAP and found that the screen of the video laryngoscope which had been provided was impossible to see in the sunny conditions on field. “We wouldn’t have known if we hadn’t run through,” he noted.
Perhaps the facility has multiple gyms, or parking lots. How will responding units know where to find the emergency? Teach the athletic staff to 1. Identify if the person is OK, and 2. If they are not, pull the closest fire alarm. Fire alarms are easy to identify and help locate the victim.
4. Create force multipliers with citizen training
Dr. McMullan noted their organization has taken some of the limelight from the high-profile resuscitation and directed it into positive change for their community with citizen CPR training.
He shared the story of a Kentucky athletic trainer who taught athletes’ parents CPR at the start of the soccer season. When he collapsed, it was two of those parents who stepped in and saved his life.
He noted Cincinnati has taken a page from Austin’s Take 10 CPR program, and have adopted the concept to provide public training for free in 10 minutes in the time and place of the trainee’s choosing, which removes all barriers to CPR training.
Remove the barriers to citizen training, and reach out to local teams and teach CPR at parents night, Dr. McMullan encouraged. “You spend your life and career to save their lives, but can they save yours?”