NFL's medical action game plan worked well for Bills' Damar Hamlin
Bills players and staff pray for Damar Hamlin during the first half of an NFL game against the Bengals on Monday in Cincinnati. Credit: AP/Joshua A. Bickel
Players spend countless hours practicing and preparing for NFL games so when the time comes they know what to do.
So do the medical staffs for each of the league’s 32 teams.
While the three dozen or so doctors and other professionals who are on the sideline for every game in every stadium are rarely called upon to spring into action as they did Monday night when Bills safety Damar Hamlin suffered cardiac arrest in the first quarter of a game at Cincinnati’s Paycor Stadium, it is a situation they are required to rehearse at least once prior to each season in accordance with the Emergency Action Plan mandated in the collective bargaining agreement between the NFL and NFLPA.
"That Emergency Action Plan was executed to perfection,” NFL senior vice president of football operations Troy Vincent said on Wednesday, speaking through tears. “[The effort] that evening was outstanding. You gave our brother Damar another day to live, another chance to fight."
The flood of medical personnel and equipment that rushed onto the field to aid Hamlin in the seconds after he collapsed, the administration of CPR, and use of a defibrillator to restore his heartbeat and allow him to be transferred by ambulance from the stadium to a nearby hospital, were all choreographed and discussed in the preseason and revisited shortly before that game began.
When Hamlin was injured with approximately 5:58 left in the first quarter the game was stopped and the Emergency Action Plan immediately went into effect. Operations on the field shifted to fully support the medical response.
"My greatest fear had flashed in front of me at that moment,” Vincent said, “but for the goodness and grace of God Damar is still here."
According to the CBA, prior to each season, every team is required to design and implement an Emergency Action Plan to be followed in instances of severe trauma. The plans are reviewed by the NFL and NFLPA and must be approved by third-party experts. All EAPs include the designation of a nearby Level One Trauma Center and home teams are required to retain at least two certified crews of paramedics with advanced life support ambulances on site for each game.
Each team is required to practice its EAP twice prior to the start of the season, with one exercise taking place at the stadium and one at the team’s training facility if it is at a different location than where the games are played. The drills include, at a minimum, scenarios to treat spine and head trauma, isolated head trauma, heat illness, truncal trauma with hypotension (i.e. organ injuries or blood loss), and cardiac arrest/arrhythmia.
"It's not an exaggeration to say the skilled and immediate response prevented a very tragic outcome at that moment,” NFL chief medical officer Dr. Allen Sills said. “There was the right team with the right equipment and the right training on site to give care."
One hour before kickoff of every game the medical staffs from both teams, as well as unaffiliated medical staff in the stadium and the game’s on-field officiating crew, come together for a meeting led by the head physician for the home team. The NFL calls this the “60 Minute Meeting.” It is an opportunity to review stadium resources on hand such as transport carts and stadium exits, confirm the nearest hospital that's designated in the EAP, and assign roles for each of the potential first responders. The objective is to make sure everyone is on the same page should any health or safety issues arise.
As for the medical personnel, there are on average 30 or so healthcare providers at a stadium on game day to give immediate care to players. That includes team physicians, independent doctors, EMTs/paramedic crews and an airway management physician. It also includes the Visiting Team Medical Liaison (or VTML), which is a local emergency physician certified to practice medicine in the state where the game is being played.
“Other than a hospital, there is no better place to collapse than an NFL field due to the medical professionals and emergency care equipment,” said Dr. David Chao, an orthopedic surgeon and former NFL team physician who now covers sports injuries on his popular Twitter page @ProFootballDoc. “The combined medical professionals from both the Bills and the Bengals teamed up to save [Hamlin’s] life with quick action.”
Tom Rock began covering sports for Newsday in 1996 and became its NFL columnist in 2022. He previously was Newsday's Giants beat writer beginning in 2008.
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