(CNN) — When Damar Hamlina player for the Buffalo Bills, collapsed from a heart attack earlier this month, help arrived in less than 10 seconds to provide CPR.
It was not coincidence or luck. Rather, it is the result of careful planning and practice, the detailed choreography of the medical personnel present at every NFL game.
Saving Hamlin’s life was the ultimate test.
“What we want is for players to receive the same care here as if they were in a hospital or health facility, and that’s what the system was created for,” Dr. Allen Sills, the NFL’s chief medical officer, said Saturday. to Dr. Sanjay Gupta, CNN’s Chief Medical Correspondent.
In each game there are 30 members medical staff, including trauma and orthopedic specialists, sports trainers, paramedics and dentists. Sills allowed CNN a rare behind-the-scenes look at the league’s medical staff during the game of playoff Saturday between the Jacksonville Jaguars and the Los Angeles Chargers.
The goal, according to Sills, is to offer hospital-quality care on the field of play.
When Hamlin went down on Jan. 2, speed was of the essence. According to studies, for every minute that passes when someone goes into cardiac arrest and does not receive CPR, their chances of survival decrease by 7-10%.
Hamlin’s heart lifted on the field. The 24-year-old spent more than a week in a Cincinnati hospital and was then transferred to a Buffalo hospital before being released last week.
According to Sills, being in the field was probably a determining factor for Hamlin: Survival is more likely for someone who goes into cardiac arrest in the hospital. According to A study10% to 12% of people who experience cardiac arrest outside the hospital survive to discharge, but that survival rate is more than doubled for people who experience cardiac arrest in the hospital.
“I think he was being revived like he would have been in an emergency room at that point,” Sills said.
follow the plan
The NFL requires all teams to have an Emergency Action Plan (EAP) for all player facilities, including training camps.
The plans are submitted by teams each year and approved by the league as well as the NFL Players Association, the players’ union, Sills said. They run drills on the plan, so when an event like Hamlin’s cardiac arrest occurs, the choreography of the medical team is almost automatic.
“The EAP was followed to the letter that night,” Sills said. “At that point everyone knew what they had to do, how they had to do it and they had the equipment to do it and they felt comfortable.”
These plans include details about where ambulances are located, the quickest route to the hospital, where medical equipment is stored, and even what radio and hand signals will be used in the event of a medical incident.
Although all the teams are connected by radio, the noise from the match and from the crowd can be overwhelming.
“There’s a lot of noise, so making those nonverbal cues is a way of communicating,” explains Dr. Kevin Kaplan, chief medical officer for the Jacksonville Jaguars. For example, using both hands as if steering a wheel indicates that the medical cart is needed, while crossing your arms to make an “X” is a call to all medical personnel.
The home team sends the plan to the visiting team one week before the game. Then, one hour before kickoff, medical teams from both teams meet to review and confirm details in what’s known as a “60-minute meeting.”
Medical teams for the Los Angeles Chargers and Jacksonville Jaguars conducted the 60-minute meeting before kickoff Saturday. Credit: CNN
It’s like the NFL’s version of what happens in a hospital: Before doctors perform a procedure, the medical team meets during a “time out” to review who is responsible for what.
Before the football game, they identify team doctors, sports coaches and key trauma personnel, including an airway specialist who can place a breathing tube in no time, if needed.
look for the red cap
In the excitement of game day, there has to be a simple and clear way to identify who can help in an emergency. At any NFL game, you’ll see it: someone in a red cap.
Dr. Justin Deaton, NFL Respiratory Management Physician, wears a red cap in the sideline of the Jacksonville Jaguars vs. the Los Angeles Chargers on Saturday. Credit: CNN
“That means I’m the ER doctor, the airway doctor, so even the other team knows what my role is when I go out,” Dr. Justin Deaton told Gupta. “Once I’m out in the field, I take over, identify if the patient is unconscious or has an airway obstruction.”
In every game, Deaton stands along the 30-yard line, just like his counterparts in other games.
“We standardize the location so that everyone knows where our respiratory physician is going to be located,” explains Sills.
If the player is not breathing, it is up to Deaton to determine who will administer CPR. If the player’s breathing is blocked and he is unable to breathe on his own, Deaton may need to intubate the player on the field. To do this, he carries a videoscope to look down the throat and an ultrasound machine.
If Deaton can’t get the patient to breathe through his mouth, he’s ready to operate in the field.
“If someone has a blockage or major trauma to the face and we can’t secure an airway through the mouth, we can make an incision and put it in there,” he told Gupta. “I really have all the resources here that I would have in an ED.”
The challenge is that they are surrounded by chaos, not the more controlled environment of the ED or operating room.
“When you have an above-average-sized person lying on the floor and you can’t get them up to a certain level with additional equipment, plus cameras and other people around, those are really the confounding factors and the things that make it harder to handle,” Deaton said.
detect injuries
In football it is not only about acting in the moment, but also about anticipating. The same goes for medical staff.
The NFL includes certified track and field trainers who serve as observers on its medical team. They are spread throughout the stadium, including a booth that monitors the entire stadium, to watch the game in real time and again on replay, sometimes over and over again, to immediately spot any injuries or assess any that might have been missed. high. They have at their disposal about 30 different angles of the field.
“We watch every play probably a minimum of four times and then we watch it again,” said Sue Stanley-Green, one of the sports coach’s spotters assigned to Saturday’s game. “We just want to make sure we don’t miss anything.”
Observers who are on the field in each game have different views of the plays … and the potential injuries. Credit: CNN
The observers, who sit in a stadium booth on the pitch, can communicate directly with the sideline medical team and direct them to plays and possible injuries. They also have a single line of communication with the referees, and the ability to stop the game to call a medical timeout.
Sills recognizes that there is always room for improvement and a need to evolve.
In September, Tua Tagovailoa, quarterback for the Miami Dolphins, suffered an apparent head injury while playing against the Buffalo Bills. After being tackled, he stumbled but was allowed back into the game. The incident put the NFL and its policies under scrutiny.
Later, the league changed its policy on concussions. Now, Sills says, “if we see something that looks like ataxia on video, (players) come out.”
Sills said he believes the NFL’s practice net is working to keep players safe, and the league is currently reviewing the moments surrounding Hamlin’s cardiac arrest. One aspect of emergencies that Sills wants more work on is privacy.
In the moments after Hamlin’s knockdown, his teammates formed “sort of a shield,” Sills said, limiting Hamlin’s vision.
“I think there are some things we can look at,” Sills said. “Obviously any of us would want some privacy at a time like this.”
But when faced with a test like saving a life in the field, “everything really went as smoothly as you could have asked for at the time,” Sills said. “It’s always about having the right people, the right plan and the right team.”
