Damar Hamlin is headed home to Buffalo!

swiftaw

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CPR training is one of the many things law school messes up for you. If you perform it on a stranger and they die, be prepared for the lawsuit and everything that comes with it. It might vary by state, though.
I believe some states have Good Samaritan laws to protect those people.
 

trekfan55

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I cannot find records online but I remember Eric Davis of the Panthers being carted off the field in 1997. I was at a class trip for my sister's graduating class and watching the game at a bar. I remember they took their time and brought an ambulance to the field and all. It was pretty grim but I still remember the commentary and the game went on afterwards.

Now, this was not a player being given CPR, but the non cynical me would like to think that there is a procedure in the books and officials on the field basically said "ok, 5 minutes and we restart" and the coaches refused. It could be conceivable that no one from the League Office gave instructions.
 

trekfan55

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I wonder when these guys get back on the field (whenever that is), how triggering it will be if another player falls to the turf injured, maybe from concussion-like symptoms or from another serious injury (like a knee or whatever). Just seeing another teammate go down might be massively traumatizing for these guys.
Don't discount other effects. Like how does Tee Higgibs feel? It would be understandable if he does not want to take the field. He and others.
 

BigJimEd

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Now, this was not a player being given CPR, but the non cynical me would like to think that there is a procedure in the books and officials on the field basically said "ok, 5 minutes and we restart" and the coaches refused. It could be conceivable that no one from the League Office gave instructions.
Which isn't exactly a ringing endorsement of the League Office. They should have taken charge of the situation but not surprising if they didn't. Not exactly a proactive leadership group.
 

Anthologos

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Off the top of my head (in clinic so can't chase it down now) I believe it might have been initially based on recoveries of drowning victims, especially cold water, who occasionally have been resuscitated after REALLY long delays and had much less brain damage than would be expected.

There at least used to be a saying with resuscitations that no one was pronounced as "dead" until they were "WARM and dead" because of that affect.
not a doctor here, just an historian who has read a lot of medical history. The name of Hubert Rosomoff comes up a lot…a pioneer (I believe?) in medical uses of hypothermia. He died maybe 10-15 years ago, so relatively recently. But I think observations of the benefits of cold go back all the way to the big H(ippocrates). Cool stuff.

Ed: should have checked before I posted, but Rosomoff was a big deal in his field. I’m sure the amazing physicians here know all this, so excuse this lay-doctor’s interruption! Thanks for all the insight in this thread.
 

wade boggs chicken dinner

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CPR training is one of the many things law school messes up for you. If you perform it on a stranger and they die, be prepared for the lawsuit and everything that comes with it. It might vary by state, though.
I believe some states have Good Samaritan laws to protect those people.
According to Wikipedia, all 50 states have some form of Good Samaritan law so don't be afraid to save people!

https://en.wikipedia.org/wiki/Good_Samaritan_law#United_States
 

radsoxfan

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Inducing hypothermia is pretty commonly accepted practice in this situation, though after reading the recent data, doesn’t seem to make a big difference (I was surprised to find this article from NEJM below). Data in support is pretty mixed.

Survival is basically a coin flip either way, though hopefully Hamlin’s otherwise healthy status will shift those odds in his favor a bit. And of course some that survive will have long term deficits.

I think part of the problem for these out of hospital arrests is that even with perfect care, there is almost no logistical way to start the process during the truly vulnerable window when there is no blood flow to the brain.

You can try to play catch up at the hospital and decrease the neuron demand for oxygen during the recovery phase, but often it’s simply too late.

Restoring and maintaining a normal electrical rhythm with a pulse ASAP is the critical factor here more than anything else.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8618610/


https://www.nejm.org/doi/full/10.1056/NEJMoa2100591
 
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Traut

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I cannot find records online but I remember Eric Davis of the Panthers being carted off the field in 1997. I was at a class trip for my sister's graduating class and watching the game at a bar. I remember they took their time and brought an ambulance to the field and all. It was pretty grim but I still remember the commentary and the game went on afterwards.
Mike Utley was rendered quadriplegic and the game went on. The NFL is a brutal form of entertainment. Every quarter of every game it seems someone suffer some life altering injury. And even when you don't see it the average life expectancy for an NFL player is 59 years old.

If you watch, you are on some level okay with it all. There's no high ground here.
 

Ed Hillel

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BigSoxFan

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Pro wrestling is a business run by psychotic carnival barkers though. Ostensibly, "real" sports should be above this kind of disgraceful shit.
No disagreement here. But not sure the NFL is much better than McMahon and Co when it comes to caring about the athletes. Hopefully, we see some real change here.
 

HomeRunBaker

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I cannot find records online but I remember Eric Davis of the Panthers being carted off the field in 1997. I was at a class trip for my sister's graduating class and watching the game at a bar. I remember they took their time and brought an ambulance to the field and all. It was pretty grim but I still remember the commentary and the game went on afterwards.

Now, this was not a player being given CPR, but the non cynical me would like to think that there is a procedure in the books and officials on the field basically said "ok, 5 minutes and we restart" and the coaches refused. It could be conceivable that no one from the League Office gave instructions.
If the “5 minute restart” did occur (has this been confirmed by anyone?) it would almost certainly be done on the field by the officials who run the game. Once things got beyond that misguided decision (if it did occur) and the teams are back in the locker room the league would have the necessary time to assess the situation and not make an immediate emotional decision.
 

MiracleOfO2704

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Which isn't exactly a ringing endorsement of the League Office. They should have taken charge of the situation but not surprising if they didn't. Not exactly a proactive leadership group.
It’s a league that played ball days after JFK was assassinated. And yeah, I know Rozelle regretted it later, but still…
 

trekfan55

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Which isn't exactly a ringing endorsement of the League Office. They should have taken charge of the situation but not surprising if they didn't. Not exactly a proactive leadership group.
Absolutely not endorsing the NFL office. I do remember Buck and Aikman saying that te¡he teams were told they wold have 5 minutes to warm up and then the coaches spoke to each other and away we went.

So yeah, it remains to be seen whether in fact they were told to restart in 5 minutes.

And yes, the league should have taken over things the minute the ambulance was on the field.
 

radsoxfan

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Some form, yes, but I believe there are states where you’re not covered if you don’t perform it correctly, for example. Not the easiest thing for a non-professional in a life of death situation.
I have heard this before but find it very hard to believe.

Survival rates for patients needing CPR in cardiac arrest outside of the hospital (especially without an AED) are like 10-15%.

Perform it perfectly, perform it poorly, whatever. It’s a very dire situation.

It would be crazy to be able to sue a bystander for not doing it right or saying their conduct more likely than not created a bad outcome.
 

lexrageorge

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The criticism of the league seems misplaced. It was a situation that was developing in real time. The league supported the decision by the coaches and players to at first suspend and then cancel the game within the hour, which did give time for the ambulance to leave the stadium area with Hamlin’s mother.
 
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wade boggs chicken dinner

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Some form, yes, but I believe there are states where you’re not covered if you don’t perform it correctly, for example. Not the easiest thing for a non-professional in a life of death situation.
I believe that all US Good Sam laws covers people who help victims who are having cardiac arrest (i.e., providing CPR) so long as people are willfully negligent.

While this is not legal advice, I generally think encouraging people to get CPR training and to perform it if the situation arises is the correct thing. One thing I didn't know while looking some of this up - some states require the assistance to be "without renumeration" so accepting a gift could theoretically void the protection (although I think the likelihood of someone giving a rescuer a gift and then successfully suing the rescuer is slim - this again not being legal advice).

Obviously if people want legal advice they should consult an attorney.
 

Jungleland

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The criticism of the league seems misplaced. It was a situation that was developing in real time. The league supported the decision by the coaches and players to at first suspend and then cancel the game within the hour, which did give time for the ambulance to leave the stadium area with Hamar’s mother.
Agreed. The NFL does a lot of bad shit, but I find the leveraging of this situation to dunk on them to be in poor taste.
 

leftfieldlegacy

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Absolutely not endorsing the NFL office. I do remember Buck and Aikman saying that te¡he teams were told they wold have 5 minutes to warm up and then the coaches spoke to each other and away we went.

So yeah, it remains to be seen whether in fact they were told to restart in 5 minutes.

And yes, the league should have taken over things the minute the ambulance was on the field.
Troy Vincent denies the league office told the teams to re start in 5 minutes
Troy Vincent, the NFL’s executive vice president of football operations, has denied suggestions that a conversation took place with commissioner Roger Goodell about a five-minute period for players to get warmed up after Damar Hamlin left the field, and that resuming play between the Buffalo Bills and the Cinicinnati Bengals was not considered at any stage.
“I’ve never seen anything like it since I was playing,” Vincent, a six-time Pro Bowl cornerback during his career, said in a conference call early Tuesday. “Immediately, my player hat went on, like, how do you resume playing after seeing a traumatic event in front of you?”
Vincent said the NFL took no steps toward restarting the game and did not ask players to begin a five-minute warmup period as ESPN’s broadcasters had announced. “It never crossed our mind to talk about warming up to resume play,” Vincent said. “That’s ridiculous. That’s insensitive. That’s not a place we should ever be in.”
 

trekfan55

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It’s a league that played ball days after JFK was assassinated. And yeah, I know Rozelle regretted it later, but still…
Things have changed.

The Olympics kept going after the 1972 terrorist attack, on the same Olympics.

Yes, they posptponed everything after 9/11 and had some real hard negotiations to move the Super Bowl. I believe the Fords (who own the Lions) played a key part there because there was a huge auto convention/show in NOLA and in the Superdome
 

Shelterdog

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I have heard this before but find it very hard to believe.

Survival rates for patients needing CPR in cardiac arrest outside of the hospital (especially without an AED) are like 10-15%.

Perform it perfectly, perform it poorly, whatever. It’s a very dire situation.

It would be crazy to be able to sue a bystander for not doing it right or saying their conduct more likely than not created a bad outcome.
Hard to say it has a lot of what folks call jury appeal. Guy has a massive heart attack, bystander does his best until EMTs arrive, guy dies, and you sue the bystander because he did the wrong number of compressions? Unless it's a truly outrageous situation it's hard to see it being particularly productive to sue folks.
 

Madmartigan

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Definitely not a replacement for in-person but this is the training that we require any adult volunteer to complete. Sudden Cardiac Arrest Course (nfhslearn.com)

In-person is MUCH different. I've taken in person probably 6 times (I chaperone summer camp every year and frankly there isn't much else to do). Every single time that I take it I do not press hard enough on the chest compressions. 2" doesn't seem like much until you have to actually press that deep in person. (alas this thread is too serious for the requisite that's what she said)
I took CPR training once and one thing I recall is that if you’re doing compressions the right way it’s pretty physically demanding and you will likely start to get tired after a bit. Ideally you would have a second person you can alternate with while you rest, if you have to do CPR for any extended period of time.
 

8slim

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Some form, yes, but I believe there are states where you’re not covered if you don’t perform it correctly, for example. Not the easiest thing for a non-professional in a life of death situation.
I don't think this is true and honestly it's a bit irresponsible to say it if you aren't 100% sure.
 

Al Zarilla

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Off the top of my head (in clinic so can't chase it down now) I believe it might have been initially based on recoveries of drowning victims, especially cold water, who occasionally have been resuscitated after REALLY long delays and had much less brain damage than would be expected.

There at least used to be a saying with resuscitations that no one was pronounced as "dead" until they were "WARM and dead" because of that affect.
So, empirical data, I'm sure followed up by plenty of theoretical research. Thanks.
 

Ed Hillel

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I don't think this is true and honestly it's a bit irresponsible to say it if you aren't 100% sure.
For CPR, I probably shouldn’t have said it, so I went back and edited. Go get CPR training, for your family if nothing else.

Other situations can be more tricky.
 

Jimbodandy

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Some form, yes, but I believe there are states where you’re not covered if you don’t perform it correctly, for example. Not the easiest thing for a non-professional in a life of death situation.
I have heard this before but find it very hard to believe.

Survival rates for patients needing CPR in cardiac arrest outside of the hospital (especially without an AED) are like 10-15%.

Perform it perfectly, perform it poorly, whatever. It’s a very dire situation.

It would be crazy to be able to sue a bystander for not doing it right or saying their conduct more likely than not created a bad outcome.
Neither my Red Cross trainer nor I am a lawyer, but she was very clear that folks in Massachusetts are safe if they attempt CPR and/or defibrillation in good faith. Absent intent to injure, which would be pretty crazy to prove, she insisted that the laws and case law is clear. It did come up.
 

djbayko

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The criticism of the league seems misplaced. It was a situation that was developing in real time. The league supported the decision by the coaches and players to at first suspend and then cancel the game within the hour, which did give time for the ambulance to leave the stadium area with Hamlin’s mother.
Yes. And the decision being made by the coaches and players is exactly where it should be, for this and potential future cases which may not be as obvious. They’re the ones wot the relationships, dealing with the trauma, and who have to put themselves on the line for a dangerous game. They know best.
 

Beomoose

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The lawsuit question has come up seemingly every time I've taken an in-person Red Cross CPR/AED course, the trainer usually confirms the local Good Samaritan legal protection. However they will often include an caveat that's a long the lines of: "if you begin CPR, you do not stop except to hand off to another person. No matter how bad the person seems, you're not Doctor [insert one of various TV doctors here] and you're not calling time of death. Stick with it until relieved."
 

Jeff Frye's Face Mask

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So, empirical data, I'm sure followed up by plenty of theoretical research. Thanks.
As someone who lectures on this topic at our institution, the history behind it is pretty interesting. The Edwin Smith Papyrus mentions the use of cooling (albeit with head wounds) to promote improved outcomes. There is also some fascinating Russian literature from the early 1800s of burying people in the snow and then having them survive.

Inducing hypothermia is pretty commonly accepted practice in this situation, though after reading the recent data, doesn’t seem to make a big difference (I was surprised to find this article from NEJM below). Data in support is pretty mixed.

Survival is basically a coin flip either way, though hopefully Hamlin’s otherwise healthy status will shift those odds in his favor a bit. And of course some that survive will have long term deficits.

I think part of the problem for these out of hospital arrests is that even with perfect care, there is almost no logistical way to start the process during the truly vulnerable window when there is no blood flow to the brain.

You can try to play catch up at the hospital and decrease the neuron demand for oxygen during the recovery phase, but often it’s simply too late.

Restoring and maintaining a normal electrical rhythm with a pulse ASAP is the critical factor here more than anything else.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8618610/


https://www.nejm.org/doi/full/10.1056/NEJMoa2100591
The data above, amongst a few other trials as well, is the reason that we now tend to aggressively target normothermia (goal temperature usually 37C or so) as opposed to hypothermia in this patient population. The bigger area of debate, at least in my opinion, in this arena at this point is how long you aggressively manage the temperature for. My institution pushes normothermia for at least 72 hours.

And yes, Hamlin's age and (presumed) underlying good health are definitely two positive things he has going for him at this point.
 

Euclis20

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I have heard this before but find it very hard to believe.

Survival rates for patients needing CPR in cardiac arrest outside of the hospital (especially without an AED) are like 10-15%.

Perform it perfectly, perform it poorly, whatever. It’s a very dire situation.

It would be crazy to be able to sue a bystander for not doing it right or saying their conduct more likely than not created a bad outcome.
Is the 10-15% survival rate for all patients who need CPR (whether or not they get it)? Or is the 10-15% survival rate for those who need AND receive CPR?
 

radsoxfan

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Is the 10-15% survival rate for all patients who need CPR (whether or not they get it)? Or is the 10-15% survival rate for those who need AND receive CPR?
As far as I know, it’s the % that have a cardiac arrest outside the hospital, need/get CPR, and then survive.

I think this very poor survival rate is 2-3x higher than the survival rate in the same population when CPR is not performed.
 

CPT Neuron

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Locally, we keep patients as close to 36.5-37 Celsius as possible for 24 hr minimum. After that, I'll get a call to evaluate them from a Neurologic standpoint to assist with prognostication. There are several key components to the exam based on the precise time of the exam from the hypoxic/ischemic event (cardiac arrest) that I will look for to try and provide families with some guidance. Even that data isn't foolproof, just a "best educated guess" based on previous patients with similar exam findings at a similar time with a similar mechanism of injury. I've had more than 1 patient who by all accounts should be left in a persistent vegetative state have full on appropriate conversations with me before leaving the hospital and, more than 1 patient who should recover much more robustly be left with a significant neurologic insult. Neurology is a precisely imprecise art and science...
 

radsoxfan

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As someone who lectures on this topic at our institution, the history behind it is pretty interesting. The Edwin Smith Papyrus mentions the use of cooling (albeit with head wounds) to promote improved outcomes. There is also some fascinating Russian literature from the early 1800s of burying people in the snow and then having them survive.



The data above, amongst a few other trials as well, is the reason that we now tend to aggressively target normothermia (goal temperature usually 37C or so) as opposed to hypothermia in this patient population. The bigger area of debate, at least in my opinion, in this arena at this point is how long you aggressively manage the temperature for. My institution pushes normothermia for at least 72 hours.

And yes, Hamlin's age and (presumed) underlying good health are definitely two positive things he has going for him at this point.
Thanks, that makes sense. I had a vague recollection there was a small (but real) benefit to the cooling procedures.

But it seems like the main benefit is simply close monitoring to avoid hyperthermia rather than the cooling itself.
 

PedroKsBambino

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As far as I know, it’s the % that have a cardiac arrest outside the hospital, need/get CPR, and then survive.

I think this very poor survival rate is 2-3x higher than the survival rate in the same population when CPR is not performed.
I suspect, checking with the actual doctors who know stuff, that those with an ICD implant are differently situated on all this, right? When they have a traumatic EP event like this they get an incredibly fast response from the ICD that no other person can get even with top-tier medical care available because response times will never approach an ICD.

I ask as someone with family members with ICDs, and out of curiosity...not directly relevant to Hamlin (or the discussion of Hamlin's prognosis)
 

doc

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Is the 10-15% survival rate for all patients who need CPR (whether or not they get it)? Or is the 10-15% survival rate for those who need AND receive CPR?
Not to be snarky here but if you need cpr and don’t get it your survival rate is 0%

cpr is not like on TV shows, something momentously bad has happened to you to need cpr , it’s a heroic last ditch effort to maintain a minimal amount of oxygen flowing to your brain and major organs until we fix what went wrong
 

SocrManiac

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Neither my Red Cross trainer nor I am a lawyer, but she was very clear that folks in Massachusetts are safe if they attempt CPR and/or defibrillation in good faith. Absent intent to injure, which would be pretty crazy to prove, she insisted that the laws and case law is clear. It did come up.
Just to put another stamp on this, I raised the same concerns when my wife (a pediatric APRN) intervened in a liquor store. She put me in my place about the Good Samaritan laws. We happened to be in Vermont, which actually requires bystanders render aid. The officer on the scene said she could have been fined if she didn't help (once her training and licensure was understood).
 

The Raccoon

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Not to be snarky here but if you need cpr and don’t get it your survival rate is 0%

cpr is not like on TV shows, something momentously bad has happened to you to need cpr , it’s a heroic last ditch effort to maintain a minimal amount of oxygen flowing to your brain and major organs until we fix what went wrong
Thank you!
Obviously you shouldn't start CPR on everyone who seems unconscious but may actually be just sleeping or passed out after having too many drinks.
But if there is no breathing and the heart has stopped beating the worst thing CPR can do is break some ribs of an already dead person - with the small (but not impossible) upside to potentially save their life.
 
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Arroyoyo

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I mean you just have to call the game a draw, refund fan tickets, refund sponsors that paid for slots that didn’t get airtime, and move onto just caring about his recovery.

The league generates $17 billion a year. It will be okay.
 

Arroyoyo

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Also, I’d probably push the playoffs back a week, eliminate the bye between the championship games and the SB, and push Week 18 back one week.

Teams have to be pretty rattled right now. Let these players have some time and space for a bit.
 

Jinhocho

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I mean you just have to call the game a draw, refund fan tickets, refund sponsors that paid for slots that didn’t get airtime, and move onto just caring about his recovery.

The league generates $17 billion a year. It will be okay.
It also had big implications for playoff seeding heading into this weekend. My guess is they have to consult with lots of parties as they handle this.
 

radsoxfan

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Not to be snarky here but if you need cpr and don’t get it your survival rate is 0%
This is not true, some people who need CPR don't get it and still survive. It's just about 4% instead of 10% or so.

https://www.ahajournals.org/doi/10.1161/jaha.117.007469

"In an analysis of >30 000 episodes of OHCA between 1990 and 2011, CPR was performed before EMS arrival in 51.1% of the cases (and not performed before arrival in 48.9% of people experiencing OHCA). The 30‐day survival was only 4.0% when CPR was not performed before EMS arrival, but was 10.5% (more than double the survival) when CPR was performed before EMS arrival."

I see online most places claiming CPR increases odds of survival in these out of hospital arrest situations 2-3x. That wouldn't be the case if the survival without CPR was 0%.

Obviously horrible statistics all the way around, but people do sometimes have a cardiac arrest, need CPR, don't get it, then have spontaneous return of cardiac output, and still survive.
 

Deathofthebambino

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I mean you just have to call the game a draw, refund fan tickets, refund sponsors that paid for slots that didn’t get airtime, and move onto just caring about his recovery.

The league generates $17 billion a year. It will be okay.
A "tie" moves the Bills back to the #2 seed, and puts KC on top. That means the Bills return to KC in the AFCCG, where they have been knocked out of the playoffs in each of the past 2 years.

Not sure how that's fair to Buffalo.

No idea what the NFL is going to do, but it's really a no win situation for everyone involved.