Train for Medical Emergencies: You don’t have to be the NFL

The spectacle of professional player Damar Hamlin going into cardiac arrest Jan 2 on the field during a live national broadcast of an NFL Monday Night Football game between his Buffalo Bills and the Cincinnati Bengals was a shock to many viewers. He is reported to be recovering well with no apparent permanent impairment, likely thanks to his receiving prompt treatment from a team of doctors including cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED), followed by rapid transport to a major hospital.

The cause of the cardiac arrest has not been publicly reported, but the most likely candidate is commotio cordis, a condition usually seen in projectile sports or industrial accidents where an object traveling at a high velocity, such as a baseball or hockey puck, collides with the upper chest and compresses the heart at the precise instant of the cardiac cycle necessary to apply force against the natural motion of the muscle, causing the heartbeat to stop. While rare because the impact must occur within a time window of about 40 thousandths of a second, commotio cordis does occur a few dozen times each year in the US. (False rumors circulating on social media blamed the cardiac arrest on COVID-19 vaccines.) Younger athletes are at greater risk because their chest is not yet fully matured, but Hamlin is 24 and the chest impact was from another player he tackled rather than a projectile, so other causes are being investigated, particularly a previously undetected heart problem.

While there has been a move to mandate improved chest protection, only in 2019 did the National Operating Committee on Standards for Athletic Equipment publish standards for chest protectors. A Tufts University study in 2017 (and therefore earlier than the adoption of the standard) experimented with various designs using a lacrosse ball propelled at 40MPH, finding limited effectiveness.

The single most important way to address the problem would be to encourage training in CPR and first aid as well as provide for widespread equipping of AED machines at all sporting and other public events. In RI, the local chapter of the American Red Cross offers training — — with an on-line-only course in “Adult, Child and Baby First Aid/CPR/AED” offered for $37: “To receive a valid 2-year Red Cross digital certificate that is OSHA compliant and meets other workplace and regulatory requirements, you must enroll in an instructor-led skill session within 90 days of completing the online course which is an additional cost. We recommend verifying the location of the skills session before registering. If immediate certification is needed, we recommend enrolling in either an instructor-led Training or Blended Learning course.” Depending on which components are selected, classes in Providence range from $42 to $82 for the supplements once the on-line classes are passed and from $77 to $117 for the fully in-person classes without any on-line prerequisite.

Not everyone can have the resources of the NFL, but even small schools and other groups can afford basic emergency medical training and equipment. Consumer-grade AED machines cost from $1,200 to $1,900; the Red Cross has a program to facilitate their purchase.