From the moment Buffalo Bills safety Damar Hamlin collapsed after being tackled in a Monday night NFL game against the Cincinnati Bengals, he likely had just three minutes to receive help before he died on the field.
Following his collapse, medical personnel rushed to his side and started the agonizing process of CPR, all while viewers at home watched players weep and pace frantically on the sidelines as their friend and teammate fought for his life mere feet away. Soon an ambulance arrived to take him to a hospital where it was announced he was in critical condition following a cardiac arrest.
William Kraus, a professor of medicine and cardiologist at Duke University, was also watching the game. He told The Daily Beast that he was pretty sure he knew what happened “within five seconds.”
“It’s a rare event that happens when you get struck right over the heart at a certain velocity and energy,” Kraus said.
He explained that there’s a fraction of a second when the heart is relaxed and about to start its next beat, and “if you strike it at the right time, with the right force, you can actually stop it.” The condition is known as commotio cordis, a latin term meaning “agitation of the heart.” While the exact reason for the shocking injury has yet to be officially announced, medical experts including Kraus have largely suspected this to be the cause.
“He got hit by the opposing player at about the right speed with substantial force and he unfortunately happened to be at that part of his heart rate,” Kraus added. “His heart stopped and he stood up, but his heart wasn’t beating so he had no blood flow to the brain. So his body went flat.”
Commotio cordis is actually rare in football. Among sports, it and occurs most often in lacrosse, hockey, and youth baseball where the balls and pucks travel at roughly the speed and velocity—about 40 mph—needed to trigger it. In fact, in his entire career, Kraus said he had never seen an event like commotio cordis occur in football.
However, when it does happen, time is of the essence. In fact, if the victim doesn’t receive CPR and a heart defibrillator with a device like an automated external defibrillator (AED) within minutes, they’re likely going to die.
“You want to respond to this within three minutes,” Kraus said. “The mortality has been terrible with this until recently with the advent of AEDs and immediate response. But [Hamlin] got attention fairly quickly and they were able to shock him and get his heartbeat back to take him to the hospital.” While a lot of deserved criticism has been levied against the NFL for their response to the injury, the medical personnel on hand likely saved Hamlin’s life on Monday night by quickly jumping into action by administering CPR and the AED.
Despite all that, though, the entire situation has created one of the most shocking and grim crises in NFL history—thrusting the league’s troubling history with player health and safety back into question.
A look at recent history bears this out: Hamlin’s injury occurred mere months after Miami Dolphins quarterback Tua Tagovailoa suffered a gruesome concussion-related event when he began seizing on the field following a play—which occurred just weeks after he collapsed due to a separate concussion following a brutal hit in an early season game.
In the background of all of this is the NFL’s checkered past of denying the connection between football and degenerative brain diseases like chronic traumatic encephalopathy (CTE)—including evidence that the league even intimidated scientists to suppress research into the connection. For large swaths of the NFL’s history, this resulted in concussions going largely untreated and underreported.
While the league has created brand new concussion rules numerous times after these issues came to light—and more recently after Tagovailoa’s on-field seizure—some medical experts say the rules still fall well short of what’s needed to properly protect their players.
For example, the current protocol to assess whether or not a player is okay to be on the field includes a questionnaire to test memory and concentration. As former Denver Broncos quarterback Peyton Manning once told ESPN in 2011, “They have these new tests we have to take before the season [...] After a concussion, you take the same test and if you do worse than you did on the first test, you can’t play. So I just try to do badly on the first test.” That means it’s incredibly easy to “fool” the test and get yourself a passing grade even after a particularly hard hit—transforming the concussion test into a bit of useless medical theater.
The fact also remains that the sport is incredibly destructive on players bodies—even in the best of circumstances. One study by Harvard T.H. Chan School of Public Health researchers found that NFL players died much earlier than MLB players (59.6 years vs 66.7 years). The death rate from brain disease was 3 times as high, and heart disease was 2.4 times higher for pro football players.
“The sport of football is inherently dangerous,” Kevin Farmer, an orthopedic surgeon and a team physician for the University of Florida Athletic Association, told The Daily Beast. “At some point, players and parents need to have assumed risk or almost informed consent that there are dangers of playing high-level contact sports.”
He explained that the NFL has done a lot when it comes to changing the rules and updating concussion protocols in order to ensure the health and safety of their players. However, at some point, there’s just not a lot they can do as players and training styles evolve.
“The bigger issue is that athletes are bigger, stronger, and faster,” he said. “There’s only so much you can do to offset those kinds of physics because of that. You could have all the helmets and shoulder pads in the world—but if the athletes are running 25 mph and weigh 220 pounds, there’s only so much you can do to stop that.”
Commotio cordis will remain a rare risk, but a risk nonetheless. As the game evolves, that risk may even grow. There’s no new helmet, padding, or concussion tech capable of preventing the immovable fact that football is and always will be an incredibly violent and destructive sport posing dangers to people’s lives. A bit of medical theater on the sideline cannot change that fact.
Perhaps the best thing the NFL can do is the only thing they’ll never do: tell people to stop playing football—or at least, tell them not to play football until they’re much, much older. There are nearly 20 billion reasons for them not to change tact
But, as was on full display after Hamlin collapsed Monday night and he was surrounded by weeping teammates, thousands of fans in the stands, and his heartsick mother who was trying to make it onto the field to be by her son’s side as he fought for his life on the gridiron he devoted his life to, it only takes a few seconds for it to stop being a game—and start being about life and death.
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