During the first Monday night football game of 2023, Buffalo Bills player, Damar Hamlin, 24, collapsed from cardiac arrest after tackling a player from the Cincinnati Bengals. The medical staff from both the Cincinnati Bengals and Buffalo Bills, as well as the EMS crews at Paycor Stadium in Cincinnati were immediately at his side. The chain of survival was quickly initiated. Many viewers and spectators watched in collective disbelief as medical personnel and first responders performed CPR and used a defibrillator on Hamlin.

While the exact cause of his arrest remains unknown, the events that unfolded in the moments afterward show the importance of building a system of care to respond to and treat such incidents immediately. This recent, high-profile cardiac emergency serves as an educational opportunity to re-visit some crucial principles of Basic Life Support (BLS) care as well as discuss the ongoing need to strengthen the community response in the chain of survival.

• BLS and Early Recognition: The foundational step in Hamlin’s - and all cardiac arrest care - is BLS. The recognition of cardiac arrest is the single most important step besides the actual performance of CPR. Typical EMS response times to out-of-hospital cardiac arrests (OHCA) take an average of eight minutes from the time the 911 call is placed to on scene arrival. The National Football League® requires multiple medical providers of various levels to be on the field and accessible throughout every game. The medical staff from the Buffalo Bills were at Hamlin’s aid and performing CPR in less than a minute after he collapsed because they recognized the symptoms of cardiac arrest. BLS instructors and training institutes should stress the importance of recognition when teaching both Hands-Only CPR and conventional CPR.

• Keeping the patient on the scene until Return of Spontaneous Circulation (ROSC) is achieved: It is important for EMS managers, providers, and medical directors to understand the importance of treating the patient in the location of their arrest. Once normal considerations, such as scene safety, have been addressed, the patient should not be moved from the position where they were found. Much of the reason for the success of the medical team in Hamlin’s case should be attributed to the excellent care provided by the medical team on the field at the stadium.

Reports show that BLS care and a defibrillator resulted in ROSC prior to Hamlin being moved into the ambulance. Chances of survival to discharge were significantly greater (17.2%) when ROSC was achieved on scene versus only (0.69%) when transport was initiated before ROSC, according to a study titled, “Cardiac Arrest Survival Is Rare Without Prehospital Return of Spontaneous Circulation,” published in

Prehospital Emergency Care. Classes taught to professional rescuers in the prehospital space should stress the importance of not moving the patient until ROSC has been achieved. EMS stakeholders should continue to follow their protocols and advocate for evidence-based changes in cardiac arrest treatment on a local, regional, and state level.

• Strengthening the chain of survival: The high-profile save of an OHCA patient has greatly captured the public’s interest in CPR, which also presents an opportunity on how to consider strengthening the community response in the chain of survival. Both prehospital and healthcare professionals greatly rely on community members to carry out the first few crucial links in the chain of survival when a person suffers from OHCA. The response to OHCAs can be augmented by also considering training community members in professional rescuer BLS, which is training that is typically undertaken by law enforcement and fire departments. AHA Training Centers and CPR Instructors can act as important advocates for interagency cooperation to assist with strengthening this aspect of the response.

In addition to training others in BLS, another strategy to strengthen the community response is for the AHA Training Network to advocate for the adoption of applications that can alert community responders to the need for CPR, especially when public safety response times may be delayed, or when the patient will be difficult to access.
The prehospital providers who attended to Hamlin that night displayed amazing professionalism and delivered excellent care. The basic principles of BLS being followed, the systems of care being in place, and the ability of the prehospital providers to remain calm and work Hamlin on the field have contributed to Hamlin now being awake and even more likely to make a full recovery.

As AHA CPR Instructors, we have a duty to use our expertise to ensure we teach our students and the public the importance of these principles and advocate for widespread CPR and BLS training in our communities. Together, we will continue to make cardiac arrest a more survivable event into the future.Joshua A. Worth, Sr., B.S., CEMSO, NRP, is the Chief of Operations at Medical Rescue Team South Authority in Pittsburgh. He also is an AHA BLS Instructor. He serves on the Faculty, ALS Programs, Community College of Allegheny County: Public Safety Institute. Additionally, he is on the Board of Directors for the American Paramedic Association.

To read more click here: Damar Hamlin’s Cardiac Arrest Highlights The Importance Of The Principles Of High-quality BLS Care