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Experts break down medical response to Damar Hamlin’s collapse: Quick thinking saved his life

Bills safety Damar Hamlin went down after making a tackle in the first quarter of Monday night's game.Joshua A. Bickel/Associated Press

The Buffalo Bills confirmed at 1:48 a.m. Tuesday that safety Damar Hamlin had suffered cardiac arrest during the first quarter of Monday night’s game in Cincinnati. The Bills also confirmed that Hamlin’s heartbeat was restored, and that he was sedated and in critical condition at a local hospital.

Otherwise, details of Hamlin’s condition were scarce as of late Tuesday morning, other than a Monday night update from Jordon Rooney, Hamlin’s marketing representative, who tweeted that “his vitals are back to normal.”

The fact that Hamlin was alive at all, though, was the product of teamwork between Bengals and Bills medical personnel, and the NFL’s “emergency action plan,” which prepared them for a situation that hadn’t occurred in the league since 1971, when the Lions’ Chuck Hughes suffered a cardiac incident on the field and was later pronounced dead.

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Medical personnel provided CPR to Hamlin on the field for approximately nine minutes and appeared to bring his heart back to functioning before they loaded him into an ambulance.

“From an emergency action plan perspective, things worked as designed,” NFL senior vice president Jeff Miller said overnight. “There was terrific collaboration both with the team medical staff and independent medical providers who are there if something happened.”

Hamlin, 24, suffered the cardiac incident after taking a hit to the chest from Bengals receiver Tee Higgins. Hamlin stood up after the hit but collapsed to the ground after a couple of seconds.

It appeared to be a case of “commotio cordis,” which the National Institutes of Health calls “the second-most common cause of sudden death in athletes.” Per the NIH, early defibrillation is critical for survival. Resuscitation of the heart within three minutes results in a survival rate of about 25 percent. Beyond three minutes, the survival rate drops to just 3 percent.

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Fortunately for Hamlin, doctors and trainers from the Bills and then the Bengals were attending to him almost immediately. All NFL stadiums have an automated external defibrillator on hand, and the home team provides emergency medical personnel at all games. Hamlin was placed on a backboard to provide resistance for the CPR. And he was taken to a Level 1 trauma hospital just 4 miles from the stadium.

Professional sports venues are one of the few places where quick, decisive medical action can take place. Most victims of commotio cordis aren’t so lucky. In 1995, Quincy High School hockey player Matthew Messing died after taking a bodycheck to the chest. In 2004, Cornell lacrosse player George Boiardi died after the ball struck him in the chest.

Bills fans and community members gather for a candlelight vigil for Damar Hamlin Tuesday night in Orchard Park, N.Y.Joshua Bessex/Associated Press

“Other than a hospital, there is probably no better place for this to happen than an NFL field,” said Dr. David Chao, who was the Chargers’ head team physician for 17 years and now writes about NFL injuries for SICscore.com. “If you look at commotio cordis, there’s a high fatality rate, but that’s for people in a car accident, or minor sports without two dozen medical professionals there and a dedicated emergency physician.

“When Hamlin went down, the Bills staff was there within seconds. Very quickly after that, you could see Bengals head trainer Matt Summers appear in the picture. The Buffalo team physicians and both athletic trainers were undoubtedly there to take a turn at CPR, because CPR is exhausting. Kudos to the Bills and Bengals for acting quickly and running a tight ship.”

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Chao has been involved in the NFL since 1997, and he said Monday night was the first time he had ever seen CPR being given on the field.

In 1998, NHL defenseman Chris Pronger of the St. Louis Blues had a similar incident; during a game against Detroit, he took a puck off the chest, stood up, took two strides, and collapsed, needing to be resuscitated. Pronger tweeted Tuesday that he was cleared to play four days later after wearing a heart monitor for 24 hours and undergoing a battery of tests.

“A shoutout to [Blues trainer] Ray Barile and the Detroit Red Wings medical staff,” Pronger tweeted. “They acted swiftly and are a big reason I had the outcome I had.”

Fans look on as the ambulance leaves carrying Damar Hamlin after he collapsed during Monday's game.Dylan Buell/Getty Images

During the NFL preseason, each team’s medical staff goes over a dry run of all the major issues for an emergency — identifying the location of the ambulance, cart, backboard, X-ray room, and local hospital, plus assigning roles for performing medical functions.

And on game days, the medical staffs from each team meet 60 minutes before kickoff to identify where everything is, and for the home team to provide any assistance to the visiting team. The home team’s head trainer is generally the person in charge of coordinating. That person Monday night was Summers, who was hired last April to replace Paul Sparling, who retired after 30 years.

“The guy in charge does not do CPR or touch the patient; he’s just in charge,” Chao said. “So someone jumps in to do CPR. Someone is recording the events in case they need to go back and see how much medicine was given. Someone is getting the AED device and getting it ready to go. Someone else is starting an IV whenever they can. Someone gets the backboard.

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“All of that happens at once quickly, and that’s what you drill for. And then the guy in charge starts giving orders.”

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Ben Volin can be reached at ben.volin@globe.com.