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Opinion What we can learn from Damar Hamlin’s tragic cardiac arrest

Buffalo Bills players and staff pray for safety Damar Hamlin during the first half of their game against the Cincinnati Bengals on Monday night. (Joshua A. Bickel/AP)

The shocking collapse of Buffalo Bills safety Damar Hamlin on Monday night has renewed concerns about the dangers of football. While I certainly agree with the need to make football safer, that’s the wrong lesson to draw from this situation.

Rather, Hamlin’s cardiac arrest highlights the need to make automatic external defibrillators (AEDs) readily accessible in all sports facilities, especially where youth sports are played.

The scary moment occurred after Hamlin, 24, apparently slammed his chest into the shoulder of Cincinnati Bengals wide receiver Tee Higgins. Hamlin stood up briefly after the tackle before collapsing on the field.

His heart had stopped. Medical staff members rushed to perform chest compressions and used an AED to shock his heart. According to a statement from the Bills, Hamlin’s heartbeat was restored on the field. An ambulance took him to the hospital, where he remains in critical condition.

As Bills safety Damar Hamlin remains hospitalized after suffering cardiac arrest, players and medical experts discuss his care and ways to make the game safer. (Video: Rich Matthews/The Washington Post)

For Damar Hamlin, first responders’ swift efforts may have been crucial

Details are still emerging about Hamlin’s medical circumstances. The most likely explanation is that he suffered from commotio cordis, a very rare but serious condition after blunt trauma to the chest. If the impact is strong enough and occurs at a specific moment between heartbeats, it can send the heart into an erratic, disorganized rhythm called ventricular fibrillation.

Without immediate treatment, ventricular fibrillation is fatal. Once the heart stops pumping blood, oxygen no longer reaches vital organs. CPR can buy time by manually compressing the heart to pump blood, but what’s needed is to shock the heart back into a normal rhythm.

The sooner the shock, the better the odds of a good outcome. In one analysis of commotio cordis patients, resuscitation that occurred within three minutes resulted in a survival rate of 25 percent. That dropped to 3 percent when resuscitation was delayed past three minutes. Studies using animal models found that time to defibrillation was the essential determining factor: Most animals that were shocked less than two minutes following cardiac arrest survived, but survival rates dwindled to less than half if the shock was delayed more than four minutes.

In Hamlin’s case, the medical team arrived on the field within several seconds of his collapse. He received CPR right away, and an AED was available, along with trained personnel, to deliver the shock. While we don’t yet know his prognosis, that rapid intervention gave him the best chance of survival and recovery.

How CPR and finding an AED can save a life during cardiac arrest

Hamlin’s situation is atypical. Commotio cordis is extremely rare in football. Among 69 well-documented sports-related cases compiled by the National Commotio Cordis Registry, only three occurred in football. Forty-six happened in youth baseball or softball; seven were from ice hockey. Chest blows from a projectile such as a ball or puck were involved in 75 percent of the cases.

In addition, most cases occur in younger individuals. One NCCR analysis of 188 commotio cordis fatalities of athletes found that the average age was 14.7. One explanation is that the chest wall muscles are less developed in younger recreational players than in professional athletes. This might explain why commotio cordis has not been documented in Major League Baseball or, previously, in the National Football League.

Given these facts, it’s imperative that youth sports officials adopt preventive measures. The National Athletic Trainers’ Association encourages youth baseball and ice hockey organizations to use softer baseballs and pucks. Chest protectors can also help reduce the force of projectiles.

Moreover, AEDs must be placed at all athletic facilities including gyms. Crucially, they must be accessible within one minute of cardiac arrest. Every athletic venue, including school training facilities, must have an emergency action plan. NFL games have dozens of trained medical staff present. This isn’t feasible in youth sports, but schools and youth leagues can require all coaches and officials to be up to date on CPR certification.

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Widespread AED availability and prompt bystander resuscitation could help avert tragedies beyond young athletes. Every year, more than 18,000 Americans suffer a cardiac arrest in public and could be saved with immediate defibrillation. All of us can help by learning CPR and knowing how to use an AED.

The focus on AEDs is not meant to absolve the many dangers associated with football. Just three months ago, Miami Dolphins quarterback Tua Tagovailoa was removed from a game following a repeat concussion. That episode highlighted the very real risk of chronic brain damage in football and reforms needed to reduce it, especially in youth sports.

Hamlin’s experience should spark a similar call to action, and once again, the focus should be on where most of these tragedies occur: not professional sports stadiums but rather local high school gyms, baseball diamonds, hockey rinks and youth athletic fields all across the country.

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