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On-field emergencies: A look at how NFL medical teams prepare for a game-day emergency




CNN

When Buffalo Bills safety Damar Hamlin fell to the ground after going into cardiac arrest earlier this month, help was at his side within 10 seconds administering CPR.

It wasn’t coincidence or luck. Rather, it is the result of careful planning and practice – the execution of detailed choreography performed by the medical staff present at every National Football League game.

Saving Hamlin’s life was the ultimate test.

“What we want is for players to receive the same care here as they would if they were in a hospital or healthcare facility and that’s what the system was put in place for. “, NFL chief medical officer Dr. Allen Sills told CNN. Chief Medical Correspondent Dr Sanjay Gupta on Saturday.

Around 30 medical staff are at each game, including orthopedic and trauma specialists, athletic trainers, paramedics and dentists. Sills gave CNN a rare behind-the-scenes look at the league’s medical staff during Saturday’s playoff game between the Jacksonville Jaguars and Los Angeles Chargers. The goal, Sills said, is to provide hospital-grade care on the grill.

When Hamlin collapsed on Jan. 2, speed was key. Studies have shown that for every minute someone goes into cardiac arrest and does not receive CPR, their chances of survival decrease by 7-10%.

Hamlin’s heart was restarted on the pitch. The 24-year-old spent more than a week in hospital in Cincinnati, then was transferred to a hospital in Buffalo before being sent home last week.

Sills said being in the field was likely a factor for Hamlin: Survival is more likely for someone who goes into cardiac arrest in hospital. One study found that 10-12% of those who suffered cardiac arrest outside of the hospital survive to discharge, but that survival rate more than doubled for those who suffered cardiac arrest inside. the hospital.

“I think he was being resuscitated like he would have been in an emergency room at the time,” Sills said.

The NFL requires all teams to have an emergency action plan, or EAP, for all player facilities, including practice fields.

Plans are filed by teams each year and are approved by the league as well as the NFL Players Association, the players’ union, Sills said. They organize exercises 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 time, everyone knew what to do, how to do it and had the equipment to do it and felt comfortable.”

These plans include details of where ambulances will be located, the quickest route to the hospital, where medical equipment is stored, and even the radio and hand signals that will be used in the event of a medical event.

While the teams are all connected by radio, the sound of the match and the crowd can be overwhelming.

“It gets loud and so having those non-verbal cues is a way for us to communicate,” explained Jacksonville Jaguars chief medical officer Dr. Kevin Kaplan. For example, using both hands as if driving a steering wheel indicates that you need the medical cart, while crossing your arms to make an “X” is a general call for medical personnel.

The home team sends the plan to the away team one week before the game. Then, an hour before kick-off, medical teams from both teams meet to review and confirm details in what’s called a ’60-minute meeting’.

It’s like the NFL’s version of what happens in a hospital: Before doctors perform a procedure, the medical team meets for a “time out” to review who is responsible for what.

Before the football game, they identify team doctors, athletic trainers and key trauma personnel, including an airway specialist who can place a breathing tube in moments, if needed.

In the excitement of game day, there needs to be a simple and clear way to identify who can help in an emergency. At any NFL game, you will see it: a red hat.

NFL airway management physician Dr. Justin Deaton wears a red hat on the sidelines of the Jacksonville Jaguars-Los Angeles Chargers game on Saturday.

“That means I’m the emergency doctor, the respiratory doctor, so even the other team knows when I’m out what my role is,” Dr. Justin Deaton told Gupta. “Once I’m out in the field, I sort of take over, identifying if the patient is unconscious or has an airway obstruction.”

In each game, Deaton stands along the 30-yard line, much like his counterparts in other games.

“We’re standardizing the location so everyone knows where our respiratory doctor will be located,” Sills said.

If the player is not breathing, it is up to Deaton to identify who will administer CPR. If the player’s breathing is blocked and he cannot breathe on his own, Deaton may need to intubate the player on the field. To do this, he carries a videoscope to look down someone’s throat and an ultrasound device.

In the event that Deaton can’t get the patient to breathe through his mouth, he’s prepared to do essentially field surgery.

“If someone has a significant facial obstruction or trauma and we can’t secure the airway through the mouth, we can make an incision and insert that way,” he told Gupta. “I really have all the resources available here that I would have in an emergency room.”

The challenge is that they are surrounded by chaos – not the more controlled environment of emergency department or operating room.

“When you have a taller than average person who is lying flat on the floor and can’t be raised to a certain level with extra equipment, and cameras and other people around, that’s really the confounders and the things that make it harder to deal with,” Deaton said.

In football, it’s not just about executing in the moment, it’s about anticipating. The same is true for medical personnel.

The NFL understands certified athletic trainers from its medical team to serve as observers. They are spread throughout the stadium, including a booth that monitors the entire stadium, to watch the match in real time and in replay – sometimes on a loop – to immediately detect injuries or assess any that may have been overlooked. They have about 30 different angles of the field at their fingertips.

“We watch every game probably at least four times and then we’ll go back and watch it again,” said Sue Stanley-Green, one of the athletic coaches in charge of Saturday’s game. “We just want to make sure we don’t miss anything.”

Observers around the pitch at each game have different views on the plays – and the potential injuries.

Observers who sit in a stadium booth above the pitch can communicate directly with the medical team on the sidelines and direct them to possible plays and injuries. They also have a single line of communication with the referees and the ability to stop play for a medical time-out.

Sills recognizes that there is always room for improvement and that we must evolve.

In September, Miami Dolphins quarterback Tua Tagovailoa suffered an apparent head injury while playing against the Bills. He stumbled after being hit, but was cleared to return to play. The incident has brought new scrutiny to the NFL and its policies.

Subsequently, the league changed its policy on concussions. Now, Sills says, “if we see anything resembling ataxia on video, (players) are done.”

Sills said he believes the NFL’s practice network is working to keep players safe, and the league is currently reviewing the times around Hamlin’s cardiac arrest. One aspect of ER that Sills wants to see more work on is privacy.

In the moments after Hamlin fell, his teammates formed “a sort of shield,” Sills said, which limited Hamlin’s view.

“I think there are some things we could look at,” Sill said. “Obviously all of us would like some privacy at a time like this.”

But when faced with a test like saving a life on the pitch, “everything went really well as you might have asked at the time,” Sills said. “It’s always about the right people, the right plan and the right equipment.”

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