I hope Damar Hamlin will be alright.
That’s the first thing I keep coming back to after the events on the field at Paycor Stadium in Cincinnati on Monday night. This was far from a normal event and this is something we will look back on as a “where were you?” moment years from now. In the moments, hours, and days following the events of Monday, it’s been tough to process. There are a lot of feelings, uncertainty, and fear that is associated with this, and rightfully so.
As someone who covers the Buffalo Bills and AFC East as a whole when it comes to injury analysis, it has become my role to analyze, interpret, and explain injuries as they occur. While this is an injury, this is also an unprecedented injury. As Physical Therapists, many of us have a doctoral level of education which gives us a deep understanding of the physiology and anatomy of the structures involved when discussing bodily issues.
One area that I am not well versed in is acute emergency management during events such as this. And I won’t try to act like I am the expert either.
It’s not something that I deal with in my line of work when dealing with specific interventions at the moment. I typically deal with some of the management after the initial event and rehab/recovery afterward. I feel I would be doing a disservice if I tried to act as though I have a deep understanding of everything.
I do appreciate each and every person that follows me and interacts with the site. So what I have created below is a timeline of verified, trusted sources of information that helps paint a picture of what has happened and what is going on.
Some links are just that, links to read on Twitter. Others links provide information or context as to what the tweet discusses. I will also try to provide my own context to the information as I am able. I will do my best to provide accurate information but not over-explain either. Please click on the links for further reading.
Consider this an ever-evolving document as more information is updated. Please check back often.
First reactions following the Damar Hamlin hit
WARNING
This is the hit as seen on the broadcast view. I include this as I think it’s important to see how normal-looking the hit was and the immediate moments following. If you don’t want to see it, please scroll past it.
Steps taken following the training staff began to work on Hamlin:
A possible cause for why Damar Hamlin collapsed, you can view the video below.
The condition that is described is commotio cordis. This is the result of a low/mild blow to the chest at a critical point in the heart’s electrical cycle. Here is a link that provides a comprehensive overview of the issue along with causes, how often this occurs, management, and survival rates. Below is a picture of the electrocardiogram cycle within the heart. The heart is regulated through electrical signals which when disrupted, can cause arrhythmia, some manageable and some lethal.
This possible cause of commotio cordis is an incredibly rare event with only 200 cases reported since 1995. Honestly, prior to Monday, this was a term I was loosely familiar with, at best.
However, this has not been definitively accepted as the cause of cardiac arrest. There are other possible causes as mentioned in the articles cited above.
The issue with commotio cordis is when the chest is hit during the T-wave at the very end of the EKG signal seen below.
The EKG rhythm strip shows how the heart contracts normally and when there is an abnormality, there are a variety of different rhythms that can cause different problems. However, with cardiac arrest, it’s possible that the rhythms seen were ventricular fibrillation. This presents as no consistent or purposeful contraction seen below.
AED’s can help shock the rhythm of the heart back into a regular sequence which is what happened with Hamlin, but he had additional complications of not breathing which a lack of oxygen via the blood could cause neurological issues such as brain damage.
Other similar cases
Hockey HOF Chris Pronger suffered a similar situation during the 1998 Stanley Cup as seen in the clip below.
It’s important to note that Pronger’s heart was able to spontaneously restart on his own. After a checkup, he was cleared to return to play two days later. This is all detailed in a recent article in The Buffalo News, certainly worth the read. A far different outcome than what we are seeing right now.
A similar situation local to Buffalo is worth reading
In another story in The Buffalo News, the athlete within the story was struck by a baseball in his chest and suffered a similar response to that of Hamlin. He was rushed to the hospital and sedated for three days followed by another three days as he recovered. This occurred in late October of this year and he was able to resume training the following week, slowly ramping his activity level back up.
The one key thing we do not know yet is how Hamlin has been affected neurologically. That’s why while there are two more high-profile cases mentioned, each had a different cause and outcome.
Update: Damar Hamlin appears neurologically intact per reports and doctors do not yet know what caused this issue. Considering he had issues with his breathing may reveal additional details not yet know.
Recovery
Below is an excellent thread of what happens in the moments after cardiac arrest. This includes the interventions and reasoning behind the techniques.
Some brief insight from a former AT/PT for the Kansas City Chiefs and Philadelphia Eagles.
Some early insight from Dr. David Chao, former team doctor of the San Diego Chargers.
Some insight into the NFL Emergency Action Plan that is part of every NFL team’s protocol.
Initial updates from the team regarding Hamlin along with game updates.
A list of all the medical personnel required at each NFL game.
Hamlin needed to be intubated which means place a tube down his throat to help him breathe, unfortunately, this is common after serious events such as this.
Following the news of a ventilator, there may have been some initial confusion as to what was reduced in the following tweets below.
When someone receives oxygen in the hospital, they receive pure oxygen, not room air which is only 21% oxygen. With regards to a ventilator, there are different settings on the ventilator that allows for the machine to perform the breathing or to assist with breathing, or only kick on if there are not adequate breaths. This is a fantastic resource that breaks down the basics of breathing and types of ventilation assistance.
From my interpretation of the reporting, he may have been bumped down from the machine performing the breathing to the machine only partially helping. He may have also been on a higher dosage of oxygen earlier to help his breathing, but possibly began turning it down as needed.
In either instance, these are positive developments.
Flipping him on his stomach reduces pressure on the lungs in order to breathe. Normally, the diaphragm is the major muscle for respiration, bringing air in and out for breathing, When sedated and in supine, it moves up in the lung cavity due to the abdominal organs, pushing on the area due to it not being actively used.
Putting him in prone reduces that issue. This allows for alveoli to expand and improve oxygenation and once sufficient oxygenation is achieved, then a person can be flipped back over and maintain their current status.
Updates
The Bills signed S Jared Mayden and released CB Xavier Rhodes. They have not officially placed Hamlin on injured reserve yet, but out of respect, they have not placed him on the injury report.
It is impossible to see how this will play out. It appears as though it is moving in a positive direction so far. This situation was unprecedented within the NFL. There have been other instances where athletes have required CPR on the athletic field, but for different reasons other than what Hamlin suffered.
I do not know if he will be able to live a normal life away from football. It’s unknown if he will have any lasting neurological deficits from the initial injury. I cannot say with any level of certainty how this will play out. It is simply too soon to tell.
What I can tell you is that he is getting the best possible medical care at a Level I trauma center and he will have the resources available to him to recuperate.
Further updates:
I am deeply impressed and commend the medical professionals able to jump in at a moment’s notice to save Damar Hamlin’s life in front of the nation. It is truly remarkable.
I wish Damar Hamlin the best of luck in his recovery as he, his family, his team, and everyone else navigates this terrible event.
Top Photo Credit: Buffalo Bills
Personally I think comittio corditis is unlikely. It requires a strong impact on a small area, which is why all the examples are from fast-moving balls and pucks. He got hit with a shoulder pad into a chest pad. That disperses a lot of force. Are there *any* known cases of it happening in football?
Look up the chest protectors kids use in baseball, they’re either snake oil or there’s basically no chance it can happen in football.
Thoughts?
That’s why I didn’t say it was the exact cause, it fits but it’s not definitive right now. There’s other causes and I haven’t found anything specific to Football at this time, but this is a continually evolving situation so I may find Football related cardiac arrest issues.
K then. I guess I’m not surprised but you could at least
email me your thoughts.