How the Chain of Survival, Effectively Implemented, Resulted in a Positive Outcome for Damar Hamlin

January 11, 2023

On Monday, January 2, the world witnessed Damar Hamlin collapse and suffer sudden cardiac arrest. It was approximately 8:55 p.m. EST. The Cincinnati Bengals and the Buffalo Bills were playing in a Monday Night Football game. With just over 6 minutes remaining in the first quarter, Bengals wide receiver Tee Higgins caught a 13-yard pass from quarterback Joe Burrow. He ran for a few yards to where Buffalo Bills Safety Damar Hamlin waited, ready to make a tackle. Higgins lowered his shoulder, like most wide receivers do when preparing to be tackled. Hamlin and Higgins collided with Higgins’ helmet ramming into Hamlin’s chest. They both fell to the ground, ending the play. Both players jumped up. Seconds later, Hamlin fell backwards and lay motionless on the field. Hamlin suffered sudden cardiac arrest.

The killer of more than 400,000 people a year, sudden cardiac arrest (SCA) causes the heart’s normal heart rhythm to suddenly become chaotic. The heart can no longer pump the blood effectively and the victim collapses, stops breathing, becomes unresponsive, and has no detectable pulse. When someone suffers sudden cardiac arrest, immediate CPR and the quick shock from an AED (Automated External Defibrillator), are crucial to the person surviving. Each minute that goes by without treatment decreases the person’s chances of survival by 10%.

On Monday, January 9, just one week after Damar Hamlin collapsed on the football field, the Buffalo Bills released a statement from UC Medical Center stating, “We are thrilled and proud to share that Damar Hamlin has been released from the hospital and returned to Buffalo. He is doing well and this is the next stage of his recovery.”

Let’s talk about the events that ultimately saved Damar’s life. The American Heart Association has developed a Chain of Survival that includes six crucial steps to saving someone’s life, and each of these steps was executed during Damar’s rescue.

1. Activation of Emergency Response
2. High Quality CPR
3. Rapid Defibrillation
4. Advanced Resuscitation
5. Post Sudden Cardiac Arrest Care
6. Recovery

Unfortunately, the survival rate of sudden cardiac arrest is less than 10%, but when the Chain of Survival is implemented quickly and effectively, odds of survival dramatically improve. Here is how the Chain of Survival was put into action to help save Damar’s life!
 

Activation of Emergency Response

Damar Hamlin’s sudden cardiac arrest was witnessed immediately by the players and referees on the field. A referee blew their whistle, stopping the game, and the Buffalo Bills medical staff rushed to Damar’s side. According to the NFL, their Emergency Action Plan (EAP) was activated. This was a crucial first step. Each team is required to have an EAP in place. It is reviewed and approved prior to the start of every season. This plan requires the designation of one trauma center, along with the presence of two certified paramedic crews and life support ambulances on-site during games. Within 10 seconds, there was a team of medical professionals working together to help save Damar’s life. Within 5 minutes, an ambulance was on the field.
 

High Quality CPR

Once a sudden cardiac arrest is witnessed, the emergency response has been activated, and the EAP has started, CPR must be started immediately. According to sources, the Buffalo Bills medical staff performed CPR right away and did so for almost 10 minutes on the field, helping blood flow to Damar’s vital organs.
 

Rapid Defibrillation

CPR is very important. It is going to keep blood flowing when the heart stops pumping, and it will buy time for the person. Ultimately, someone in sudden cardiac arrest needs to be shocked by an AED quickly to survive. According to sources, an AED was used on Damar on the field. CPR combined with using an AED gives someone the absolute best chance of survival during sudden cardiac arrest.
 

Advanced Resuscitation

Advanced resuscitation occurs when someone is placed in an ambulance and transported to the hospital. Hamlin was stabilized, intubated, and brought to The University of Cincinnati Medical Center, which is a Level One trauma center.

 

Post Sudden Cardiac Arrest Care

Once Damar was being treated by the physicians at the hospital, this is considered post sudden cardiac arrest care. Although he was stabilized, he was still in a critical state. The world was waiting, desperately for an update from anyone saying that Damar Hamlin was doing well, but that takes time. On Tuesday, January 3, 2023, the Buffalo Bills released a statement saying that Damar was sedated and in critical condition. A few days later, they released another statement that Damar had shown remarkable improvement. Although he was still in critical condition, he had shown signs that he was neurologically intact, a term meaning that his brain was functioning normally, and that his lungs were continuing to heal. Hours later, another statement was released saying that Damar was communicating through writing and asked who won the game.

His doctors responded saying, “Yes Damar, you won. You won the game of life.”

The next day, the breathing tube was removed and Damar was able to talk to family, friends, and even FaceTime with his Buffalo Bills teammates. On Sunday, January 8, just six days after suffering sudden cardiac arrest, Damar posted on social media showing that he was watching the Buffalo Bills vs. New England Patriots game with his family.

Damar’s post sudden cardiac arrest care was a huge step in helping him survive.

Damar Hamlin was in an ideal setting when he suffered his sudden cardiac arrest. The NFL, its organizations, and medical professionals are completely prepared with the right personnel, Emergency Action Plan, and equipment to help save someone’s life. It is important to understand that sudden cardiac arrest is NOT rare. It affects people of all ages. It is crucial that all levels of sport are prepared to help save someone’s life when sudden cardiac arrest strikes. From youth sports, to high school, into college, and even at the professional level, we need to be prepared to act. We need to ensure there are always people certified in CPR on site with an AED to use if needed. We can help prevent death from sudden cardiac arrest by ensuring athletics at any level have a plan in place to help save a life!
 

Recovery

Sudden cardiac arrest survivors need both a physical and an emotional recovery. It is difficult to understand how and why this happened, especially when you are seemingly healthy. Damar is currently experiencing the sixth link in the Chain of Survival and that is recovery. He is now in Buffalo and it will take some time. We continue to keep our thoughts with Damar Hamlin, his family, his friends, and his teammates as he recovers.

Since this is one of the most witnessed cardiac arrest events we have seen, we understand there are many questions that may have come up, from people who really didn’t know about sudden cardiac arrest before. Here are some frequently asked questions that might help you understand what happened in Damar Hamlin’s case and how medical professionals helped save him.

 

What is sudden cardiac arrest?

The killer of more than 400,000 people a year, sudden cardiac arrest (SCA) causes the heart’s normal heart rhythm to suddenly become chaotic. The heart can no longer pump blood effectively and the victim collapses, stops breathing, becomes unresponsive, and has no detectable pulse. SCA can strike anyone, anytime. Children, teenagers, athletes and seniors - can all have SCAs. Although the risk of SCA increases with age, and in people with heart problems, a large percentage of victims are people with no known risk factors.
 

Is SCA the same as a heart attack?

No. Both the heart attack (myocardial infarction) and a sudden cardiac arrest have to do with the heart, but they are different problems. SCA is an electrical problem; a heart attack is a “plumbing” problem. Sometimes a heart attack, which may not be fatal  itself, can trigger a sudden cardiac arrest.
 

What is the recommended treatment for SCA?

Defibrillation is the only treatment proven to restore a normal heart rhythm. When used on a victim of SCA, the automated external defibrillator (AED) can be used to administer a lifesaving electric shock that restores the heart’s rhythm to normal. AEDs are designed to allow non-medical personnel to save lives.
 

What is commotio cordis?

According to The Korey Stringer Institute, “Commotio Cordis refers to the sudden arrhythmic death caused by a low/mild chest wall impact.” It is mostly seen in athletes participating in sports where a strike to the athlete in the chest occurs that can cause an arrhythmia. This condition is rare, but dangerous. Immediate CPR and use of an AED is crucial to help save someone’s life when they suffer commotion cordis.
 

What is CPR?

According to the American Heart Association, CPR – or Cardiopulmonary Resuscitation – is an emergency lifesaving procedure performed when the heart stops beating. Immediate CPR can double or triple chances of survival after cardiac arrest. CPR keeps the blood flow active – even partially – extends the opportunity for a successful resuscitation once trained medical staff arrive on site.
 

How is CPR Performed?

There are two commonly known versions of CPR. For healthcare providers and those trained: conventional CPR using chest compressions and mouth-to-mouth breathing at a ratio of 30:2 compressions-to-breaths. For the general public or bystanders who witness someone suddenly collapse: compression-only CPR, or Hands-Only CPR. Hands-Only CPR is CPR without mouth-to-mouth breaths. It is recommended for use by people who see a teen or adult suddenly collapse in an out-of-hospital setting.

 

What is an AED?

According to the American Heart Association, an AED is an electronic medical device. An AED can check a person’s heart rhythm. It can recognize a rhythm that requires a shock. And it can advise the rescuer when a shock is needed. The AED uses voice prompts, lights and text messages to instruct the rescuer on the steps to take. AEDs are very accurate and easy to use. 

 

How much time do I have to respond if someone has a sudden cardiac arrest?

Only minutes. Defibrillate within three minutes and the chances of survival are 70 percent. After 10 minutes without defibrillation, the chances of survival are negligible.

 

What is an Emergency Action Plan?

The Korey Stringer Institute offers incredible resources and templates modeling Emergency Action Plans. Here is some information directly from their web site:

An EAP is necessary for any school or university and all of the venues within these institutions where athletes exercise. The EAP provides information to ensure response to an emergency is rapid, appropriate, controlled and precise. All personnel involved with the organization of athletic activities share a professional and legal responsibility to ensure that guidelines are in place to manage any emergency that could arise. The EAP defines the standard of care for these situations, and therefore an institution without an EAP can be found to be negligent in cases of catastrophic injuries. To learn more about EAPs, click here.


To learn more about Defibtech and to join us on our quest to save lives from sudden cardiac arrest, visit www.Defibtech.com.

Sources:

https://www.cnn.com/2023/01/03/us/damar-hamlin-bills-nfl-response-timeline/index.html

https://www.insider.com/buffalo-bills-safety-damar-hamlin-a-complete-timeline-of-the-nfl-incident-and-health-updates-2023-1#he-rose-to-his-feet-immediately-after-the-play-but-a-moment-later-hamlin-collapsed-without-bracing-his-fall-to-the-turf-17

https://www.espn.com/nfl/story/_/id/35391812/bills-damar-hamlin-breathing-own-tube-removed?device=featurephone#:~:text=CPR%20was%20administered%20to%20Hamlin,and%20taken%20off%20the%20field.

https://cpr.heart.org/en/resources/what-is-cpr#:~:text=CPR%20%E2%80%93%20or%20Cardiopulmonary%20Resuscitation%20%E2%80%93%20is,one%20dies%20from%20cardiac%20arrest.

https://cpr.heart.org/-/media/cpr-files/training-programs/aed-implementation/aed-programs-qa-ucm501519.pdf

https://ksi.uconn.edu/prevention/emergency-action-plans/

https://ksi.uconn.edu/emergency-conditions/cardiac-conditions/commotio-cordis/