Damar Hamlin is headed home to Buffalo!

MiracleOfO2704

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Jul 12, 2005
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Who knows if something congenital also going on, but this wasn't a random collapse.

He got hit in the chest and then his heart stopped, that's very different than the Hank Gathers/Reggie Lewis type collapse.
I think @doc and @fiskful of dollars alluded to it, but the leading idea is an event called commotio cordis, where a blunt force to the chest just before the T wave disrupts the electrical impulses that contract the heart. Brian Sutterer, a doctor that’s made a bit of a career talking about sports injuries, got one together quick for Hamlin:

View: https://youtu.be/H-G9mziXL9w
 

Ed Hillel

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Dec 12, 2007
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Who knows if something congenital also going on, but this wasn't a random collapse.

He got hit in the chest and then his heart stopped, that's very different than the Hank Gathers/Reggie Lewis type collapse.
His neck snapped back, as well, though I assume if it’s a neck or brain stem issue, he wouldn’t have stood up first?
 

CaptainLaddie

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Who knows if something congenital also going on, but this wasn't a random collapse.

He got hit in the chest and then his heart stopped, that's very different than the Hank Gathers/Reggie Lewis type collapse.
Sorry, right that's what I meant. Either undiagnosed or not, it's his heart, not his neck or something.
 

cornwalls@6

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Apr 23, 2010
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Gotcha. Prob not gonna watch.
Sounds like blunt chest injury then, rather than primary dysrhythmia. I was just remembering the horrible video of Hank Gathers collapsing.
Other mechanisms are still in the differential dx but commotio seems the most likely despite his age.
Is there any kind of genetic/congenital predisposition to being vulnerable to commotio cordis?
 

YTF

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It sounds like the on air crew did well. I had to turn it off. The fact that they were still cutting to commercials, a few of which were particularly ill timed, suggests to me that ESPN, a company whose major product is live events, doesn’t have a basic playbook in the event of an on air tragedy of any kind. For people asking me what I’d do differently - I don’t know. That’s the point. I wouldn’t improvise, I’d have an employee spend a day thinking through what parts of the broadcast would continue, what parts wouldn’t, how to direct the personalities, etc. then have it available for director/producer to turn to when something comes up. It doesn’t seem like they have that. That’s surprising to me. That’s all I’ve been saying.
What's the difference between what is being discussed now on Sports Center right now and the discussions that were being had in real time?
 

mauf

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If someone thinks it's the wrong time to point this out, I plead guilty, but every football fan over 50 knows some names...lambeau, nagurski, Lombardi, and, more than likely Chuck Hughes. But not schefter, it seemed. (Unless I missed it when I timed elsewhere).
Kolber did her job. McFarland his. Under the most difficult circumstances.
I dunno. Kolber was getting fed news updates and sharing them. Booger was offering a player’s perspective. Schefter had nothing to add. I give him credit for recognizing that and largely keeping his mouth shut. I mean, look at what Skip Bayless did tonight; knowing when to say nothing is an underrated trait.
 

ngruz25

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The immediate word was that they’d resume the game in 5 minutes after the ambulance left the field. But who really knows what was going on. Possible that was procedure “in the book” but the refs and coaches quickly decided to scrap that. I think we need to learn more before we rip the league.
I'm positive this is exactly what transpired. SOP after a lengthy delay is to allow the teams to warm up for a for a few minutes before play is resumed. This was treated like a power outage or a more common serious injury stoppage (unfortunately, not uncommon in the NFL). In this case, however, the injury was so much more grave that the SOP should not, and was not, followed. The teams were not in the condition needed to play, relayed this fact to the officials, the SOP was ditched, and the game was temporarily suspended and ultimately called.
 

radsoxfan

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Sorry, right that's what I meant. Either undiagnosed or not, it's his heart, not his neck or something.
Agreed it's his heart for sure.

But looks like one of those random unfortunate 1 in a million direct impact Commotio Cordis type situations rather than some congenital heart issue with a random collapse.
 

OCST

Sunny von Bulow
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A blow to the chest can cause sudden, cardiac death. It’s called commotio cordis. Essentially, the trauma causes a brief electrical spike. If it happens during a particular point of the cardiac cycle, it can stop the heart immediately. It is much much more common in young children due to the increased compliance of the chest wall. Most cases that I’ve ever heard of occur with a strike to the sternum, usually a punch or a ball – like in baseball or lacrosse.
It’s extremely rare. Only about 10 to 20 cases a year are reported. I don’t think I’ve ever heard of a case in anyone over the age of 20 years of age. Every case I’ve heard of, or attended to, involved baseball. I would think shoulder pads would prevent the anterior chest from this type of injury. Modern pads cover the upper/mid sternum and anterior chest. Resuscitation was historically dismal, but that has improved with better recognition. There is some speculation that certain individuals are more predisposed given a possible underlying dysrhythmia. The variables that are necessary for this to occur include the shape of the projectile, the velocity and timing of the incident. Without going into the specifics of the cardiac electrical cycle and repolarization, the most common underlying dysrhythmias include long QT syndrome, and a condition called Brugada syndrome.

A blow to the chest does transmit electrical activity through the chest wall into the heart. If this occurs, it creates an electrical spike which (if timed to occur exactly) can cause a "R on T phenomena". The waves of the EKG are labelled PQRST (U). This causes ventricular fibrillation which must be immediately electrically corrected (defibrillation) or else the heart will stop. Whenever I’m at the bedside and a patient’s heart stops (rare, but it happens enough) the quickest way I have to get it restarted is a thump, essentially a punch into the chest of the patient. It is thought that a normal punch to the chest confers approximately 2-5 J of energy. A punch, hit, ball, etc is more like 20-40J. Enough to stop the heart if it happens at the precise wrong time. To be clear, this is an enormously rare event. Just an awful situation. Defibrillation will almost surely save him if that's the issue. I'm sure the med staff on the field know this stuff cold and the defibrillators are all right there.

Edit: Docsplaining, clarity
I coach U12 softball in NYC. We are required to carry defibrillators to every game. Thank you for this explanation, which is more than we've ever been given. Of course it's a pain in the ass to carry them, and we've always grumbled about why would kids need defibrillators. I knew of the danger of chest impacts but not exactly how/why, or that children were MORE at risk.
 

fiskful of dollars

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Is there any kind of genetic/congenital predisposition to being vulnerable to commotio cordis?
There is speculation - but not objective evidence (the n of commotio is so, so low) that long QT syndrome and Brugada MAY be correlated with a higher incidence. Impossible to validate but it makes some physiologic sense.
 

DanoooME

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Kudos to Ryan Clark on his perspective, talking about his personal injury situations, making it clear it's nothing close to what Hamlin is going through and yet getting excellent points across about the desire to be playing and coaches helping the players make the best decisions in these types of situations.
 

kenneycb

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The fact that Schefter is an absolute shill for the league is pretty relevant to whether he should be the on air voice in a key moment, no?
That’s a fair point to debate. The criticism wasn’t that though - it was a run of the mill “Schefter sucks!” drive by of a premeditated opinion that did nothing to address whether Schefter did well tonight. The poster hates Schefter’s work and nothing he did tonight was going to change the poster’s opinion.
 

glennhoffmania

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I think @doc and @fiskful of dollars alluded to it, but the leading idea is an event called commotio cordis, where a blunt force to the chest just before the T wave disrupts the electrical impulses that contract the heart. Brian Sutterer, a doctor that’s made a bit of a career talking about sports injuries, got one together quick for Hamlin:

View: https://youtu.be/H-G9mziXL9w
Good stuff. Question for the docs. With all of the hits that football players take every game for years and years, we're probably talking about thousands and thousands of hits to the chest, how has this not happened before?
 

8slim

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It sounds like the on air crew did well. I had to turn it off. The fact that they were still cutting to commercials, a few of which were particularly ill timed, suggests to me that ESPN, a company whose major product is live events, doesn’t have a basic playbook in the event of an on air tragedy of any kind. For people asking me what I’d do differently - I don’t know. That’s the point. I wouldn’t improvise, I’d have an employee spend a day thinking through what parts of the broadcast would continue, what parts wouldn’t, how to direct the personalities, etc. then have it available for director/producer to turn to when something comes up. It doesn’t seem like they have that. That’s surprising to me. That’s all I’ve been saying.
I’ve been telling you that there is a LOT of contingency planning done at ESPN. Tons of it, for every situation. If you keep refusing to believe that it’s your choice.
 

mikeford

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Who knows if something congenital also going on, but this wasn't a random collapse.

He got hit in the chest and then his heart stopped, that's very different than the Hank Gathers/Reggie Lewis type collapse.
Yeah, it wasn't even like the Eriksen collapse from the 2020 Euros. Eriksen was still jogging around and just kinda slow motion collapsed. This was stand up, wobble, flat back bump out cold.
 

CaptainLaddie

dj paul pfieffer
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Sep 6, 2004
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A blow to the chest can cause sudden, cardiac death. It’s called commotio cordis. Essentially, the trauma causes a brief electrical spike. If it happens during a particular point of the cardiac cycle, it can stop the heart immediately. It is much much more common in young children due to the increased compliance of the chest wall. Most cases that I’ve ever heard of occur with a strike to the sternum, usually a punch or a ball – like in baseball or lacrosse.
It’s extremely rare. Only about 10 to 20 cases a year are reported. I don’t think I’ve ever heard of a case in anyone over the age of 20 years of age. Every case I’ve heard of, or attended to, involved baseball. I would think shoulder pads would prevent the anterior chest from this type of injury. Modern pads cover the upper/mid sternum and anterior chest. Resuscitation was historically dismal, but that has improved with better recognition. There is some speculation that certain individuals are more predisposed given a possible underlying dysrhythmia. The variables that are necessary for this to occur include the shape of the projectile, the velocity and timing of the incident. Without going into the specifics of the cardiac electrical cycle and repolarization, the most common underlying dysrhythmias include long QT syndrome, and a condition called Brugada syndrome.

A blow to the chest does transmit electrical activity through the chest wall into the heart. If this occurs, it creates an electrical spike which (if timed to occur exactly) can cause a "R on T phenomena". The waves of the EKG are labelled PQRST (U). This causes ventricular fibrillation which must be immediately electrically corrected (defibrillation) or else the heart will stop. Whenever I’m at the bedside and a patient’s heart stops (rare, but it happens enough) the quickest way I have to get it restarted is a thump, essentially a punch into the chest of the patient. It is thought that a normal punch to the chest confers approximately 2-5 J of energy. A punch, hit, ball, etc is more like 20-40J. Enough to stop the heart if it happens at the precise wrong time. To be clear, this is an enormously rare event. Just an awful situation. Defibrillation will almost surely save him if that's the issue. I'm sure the med staff on the field know this stuff cold and the defibrillators are all right there.

Edit: Docsplaining, clarity
As always, thank you so much for what you bring to this place. Seriously.
 

jercra

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Well, except the Bills/refs/everyone else necessary to make an NFL game happen need to know if they need to stay in Cincinnati tonight and potentially find lodging and rearrange travel. I think you do have to decide tonight whether or not you’re playing tomorrow.
I work in this line of business (though not the NFL) and can tell you that, while they definitely have contingency plans for suspension/resumption of play, it's still a massive headache and ordeal to put them in place and are usually weather based so there's generally a head start. It's less an issue for the teams since they have charter jets and can easily fly home/back tomorrow than it is for the rest of the operations staff. Getting all of the vendors, IT folks, press, etc. back tomorrow is a big challenge. There are hundreds of people involved in events like this. Of course, none of that really matters under the circumstances but thought I'd share for anyone interested.
 

OCST

Sunny von Bulow
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Why does the decision need to be made quickly?

It seems unlikely at this point, but if we got word an hour from now that Hamlin is going to be ok, I wouldn’t be surprised if both teams wanted to play.
I would think that warming up these 250-300+ bodies again, after they've cooled down, is asking for it re: hammies, quads, groin pulls etc.
 

Freddy Linn

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Again, this isn’t all that uncommon. With a couple cases of commotio cordis (the notable ones were 2012 and 2019 I think) every HS and youth lacrosse player had to buy new and expensive equipment to take the field again.

I suspect youth football will contemplate the same.
 

JFK35

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Jun 12, 2022
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The longer we don’t get a serious update… the sicker I feel.

hoping tomorrow we’re just talking about how this was an awful scare
 

glennhoffmania

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That’s a fair point to debate. The criticism wasn’t that though - it was a run of the mill “Schefter sucks!” drive by of a premeditated opinion that did nothing to address whether Schefter did well tonight. The poster hates Schefter’s work and nothing he did tonight was going to change the poster’s opinion.
I can't speak for that poster, but the second I saw Schefter in the studio I rolled my eyes- not because of what he was saying, but because he has a history of being tone deaf. And given that, it seemed like a poor choice on ESPN's part to put him on the air, regardless of how well or poorly he ended up doing.
 

BigSoxFan

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My 8 year-old son wanted to play lacrosse last year and the town was absolutely militant about making sure every kid had a chest protector on. They checked every kid before every practice/game. I never played lacrosse so got the general idea but didn’t appreciate the potential severity. Have a much better appreciation now. Parents, make sure your kids are wearing these when playing. Truly scary stuff.
 

loshjott

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Again, this isn’t all that uncommon. With a couple cases of commotio cordis (the notable ones were 2012 and 2019 I think) every HS and youth lacrosse player had to buy new and expensive equipment to take the field again.

I suspect youth football will contemplate the same.
My son who played catcher in HS also had to get a new protector with the extra protection over the heart.
 

dixielandbandana

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There is speculation - but not objective evidence (the n of commotio is so, so low) that long QT syndrome and Brugada MAY be correlated with a higher incidence. Impossible to validate but it makes some physiologic sense.
I'm not sure how rigorous the medical screening process is, but hopefully those would be seen on an EKG? I agree commotio cordis seems mostly likely, but the fact that they intubated even after ROSC makes me nervous
 

PedroKsBambino

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For the doctors: I am guessing they need to verify cardiac function, and then they have to assess the impact of reduced oxygen to the brain for the period of time it was impacted right? That takes some time, I would guess, not being a doctor. Just to say, delay in an update is not surprising here.
 

8slim

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I can't speak for that poster, but the second I saw Schefter in the studio I rolled my eyes- not because of what he was saying, but because he has a history of being tone deaf. And given that, it seemed like a poor choice on ESPN's part to put him on the air, regardless of how well or poorly he ended up doing.
He’s a part of that crew. He’s not going to be pulled off the air.
 

kenneycb

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It sounds like the on air crew did well. I had to turn it off. The fact that they were still cutting to commercials, a few of which were particularly ill timed, suggests to me that ESPN, a company whose major product is live events, doesn’t have a basic playbook in the event of an on air tragedy of any kind. For people asking me what I’d do differently - I don’t know. That’s the point. I wouldn’t improvise, I’d have an employee spend a day thinking through what parts of the broadcast would continue, what parts wouldn’t, how to direct the personalities, etc. then have it available for director/producer to turn to when something comes up. It doesn’t seem like they have that. That’s surprising to me. That’s all I’ve been saying.
Well they can’t immediately leave the game because they aren’t 100% sure what happened. They initially treated it like it was a spinal injury with multiple commercial breaks, which they don’t fully control. When they mentioned CPR they quickly cut again to commercial and then the studio as it became clear this wasn’t going to be a short injury. Given the game is still set to resume, they can’t play an E:60 story or whatever so they have to stay live. When it gets suspended, this becomes a news story and they 100% have to cover it live now.
 

Marciano490

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These reporters are really shaken up. Can’t really blame them. This is so tough.
 

radsoxfan

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Good stuff. Question for the docs. With all of the hits that football players take every game for years and years, we're probably talking about thousands and thousands of hits to the chest, how has this not happened before?
It has happened before, it's just very rare.

The diagram from the video makes it look like it's a 10% chance or something... but it's obviously WAY more rare than that.

Not only do you need the perfect location/timing of the hit, but also likely some individual risk factors creating the perfect storm of badness.
 

DJnVa

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Are you related to Schefter or something?
It’s ok that Schaefer isn’t that kind of breaking news guy. He has contacts tho and league mouthpiece might’ve been the perfect guy to have. Not really his fault he’s not good at the other stuff. This was a pretty unique circumstance.
 

Mr Jums

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Good stuff. Question for the docs. With all of the hits that football players take every game for years and years, we're probably talking about thousands and thousands of hits to the chest, how has this not happened before?
If you're talking about professional football players in the NFL (or even college), it's much more common in adolescents (mean age is 15 years old) and it has to do with the fact that the chest wall is thinner in adolescents than adults. Even then, it takes hitting it at the right angle with the right amount of force at the exact right time in the cardiac cycle. That's why fisk and others have suggested that there may be an underlying cardiac rhythm disorder such as Brugada or other QT-lenghtening condition because otherwise it is unusual for this to happen to an adult.
 

AlNipper49

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His brain had no oxygen for 9 minutes apparently. It's super sad, I feel horrible for him. His mom was there.
 

mauf

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I would think that warming up these 250-300+ bodies again, after they've cooled down, is asking for it re: hammies, quads, groin pulls etc.
The league deals with a couple weather-related delays a year and doesn’t postpone games. The cool-down, warm-up thing was pretty far down the list of concerns tonight.

Seems that Burrow and the other Cincy captains went to the Bills’ locker room at about the moment it was reported that Hamlin wasn’t breathing on his own in the ambulance. The league took a while to share the news with the rest of us (probably for valid reasons), but it seems clear that was the moment that the folks on the ground in Cincinnati decided there would be no more football tonight. And rightly so.
 

OCST

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As someone just said online, this is a news event now. It’s being covered by the news networks. ESPN can’t cut to some 30 for 30 doc.
I agree.

I think SVP is doing a good job. I also think he's better equipped than most at the Worldwide Leader, in both brains and compassion. He's switching between small-scale details of this incident and big-picture implications pretty adroitly.

His conversation with Aikman was illuminating - he wanted Aikman to talk from his own experience, and a still very shaken Aikman (whom I have heard say he doesn't want his sons playing football) saying he had never seen anything like this.
 

glennhoffmania

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It has happened before, it's just very rare.

The diagram from the video makes it look like it's a 10% chance or something... but it's obviously WAY more rare than that.

Not only do you need the perfect location/timing of the hit, but also likely some individual risk factors creating the perfect storm of badness.
I think that was the issue with the chart. It made it look like the time during which it could occur was fairly significant compared to the full cardiac cycle.

Thanks
 

RG33

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Wow, how terrifying. Wasn’t watching, but my texts blew up. Just made my way through the last 5 pages here. Hopefully it is good news that he is still being referenced as critical. Thanks to Fisk and others for the explanation of commodio cortis — this is an incredible place. Prayers for Hamlin.
 

radsoxfan

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I think that was the issue with the chart. It made it look like the time during which it could occur was fairly significant compared to the full cardiac cycle.

Thanks
Yes way overly simplified...

Clearly thousands of kids/young men are getting chest impacts during that part of the cardiac cycle every day and this doesn't happen often.
 

Traut

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His brain had no oxygen for 9 minutes apparently. It's super sad, I feel horrible for him. His mom was there.
Is this being reported?

If he was getting CPR it seems unlikely he would suffer oxygen deprivation for 9 minutes.