By Dr. Anthony Policastro

On Monday, Jan. 2, millions of viewers tuned in to Monday Night Football. They expected to see a battle between two of the best teams in the league. What they saw instead was an instance of medical care at its best.

A little over five minutes into the game, Buffalo Bills safety Damar Hamlin made what seemed to be a routine tackle. When he got back up from making the tackle, he passed out and fell to the ground about two seconds later.

The announcers later indicated that CPR had been done and a defibrillator had been used. That meant that the injury was something called commotio cordis. 

To understand the injury we have to think about how blood flows. The upper chambers of the heart (atria) initially fill up with blood. They then empty the blood into the lower chambers (ventricles). The ventricles then pump the blood to the body and relax as they wait for more blood to come from the atria. At a normal heart rate the entire process takes less than 1 second.

We know that there is a period right after the ventricles pump the blood that makes the heart vulnerable. It lasts 20 milliseconds. That is 20/1000 of one second. So it is extremely brief. 

However, a blow to the chest at that exact moment can cause the heart to stop beating. That is what commotio cordis is. The usual cause is a thrown baseball that hits the chest, it can also be caused by a hit from a hockey puck, and even a punch.  In this case it was caused by the opposing player’s football helmet hitting Hamlin in his chest. There are about 30 such cases in the U.S. each year.

What usually follows such a hit is a period with the heart not figuring out how to get started again. There is no organized heartbeat. This is called ventricular fibrillation. The treatment for it is a shock from a defibrillator.

What happened next is what saved his life. Individuals do not survive unless there is immediate medical care. Some survivors will have neurologic damage from a lack of oxygen.

At the time that Hamlin went down, there was an immediate radio message from the sideline that said: “Go over to the cot. I don’t like how he went down.”  A few seconds later another voice said: “We’re going to need everybody. All call. All call.”

The lead in the process was Bills’ assistant athletic trainer Danny Kellington. He started CPR immediately upon arriving at Hamlin’s side. There was also a need for defibrillation with an automated external defibrillator (AED). That was also done promptly.

It was amazing that they got his heart going again. The question was whether they had preserved neurologic function. Hamlin required sedation for breathing issues. Those are common after situations where the lungs do not get enough blood. The lungs take about 72 hours to heal. 

At about that point,  Hamlin woke up enough to write the question: “Did we win?” That suggested good neurologic function. His doctor gave him the answer: “Yes. You won the game of life.”

The following Sunday, Bills’ wide receiver John Brown hauled in a 42 yard touchdown pass and handed the ball to Kellington once he reached the sideline.

COVID update- Sussex County remains in a high risk area for COVID-19. The numbers have not changed much but two of the three criteria have risen.

The overall number of new cases was under 194.68 per 100,000 last week. It has a climbed to 207.7 new cases per 100,000 since then.

Last week the level of admissions per 100,000 people was at 34.7 admissions per 100,000 people. This week the number has dropped slightly to 29.7 admissions per 100,000 people.

Percent of inpatients with COVID-19 was at 8.9 percent last week. This week it has increased slightly to 9.5 percent.