Cardiologist Dr. Jonathan Kim was home watching Monday Night Football when he saw a Buffalo Bills safety collapse on the field.
Kim, chief of sports cardiology at Emory University, knew right away how serious the incident was for Damar Hamlin, a 24-year-old safety.
“I thought it looked like cardiac arrest — because he was up, and went immediately down,” said Kim. “As a sports cardiologist, and in our community, this is obviously ... the thing you worry about the most about the young athletes you care about.”
About nine minutes into the game, Hamlin took a hard hit to the chest, colliding with Cincinnati Bengals receiver Tee Higgins during a tackle. Hamlin got to his feet, then immediately fell backward. While on the field, he was given cardiopulmonary resuscitation as his teammates formed a human wall around him, shielding the lifesaving activity from tv cameras. As of Tuesday afternoon, he was listed in critical condition.
The broadcast of his terrifying injury on live tv has reinvigorated debate about the necessity of cardiac screenings of the youngest athletes, including high school players. For parents, it can be seen as another layer of assurance their child will be safe on the field.
But performing mass cardiac screening tests for all high school athletes to identify risk factors is not currently recommended. Instead, cardiologists say the best way to prepare for the possibility of these rare events in sports is to have staff trained in CPR and to have schools and teams equipped with defibrillators that can restore a normal heartbeat in an emergency.
Heart tests like an electrocardiogram (EKG) and echocardiogram or ultrasound of heart, can reveal some, but not all, defects. But screenings for young athletes with no other indication of heart defects can result in high false positive test results, potentially causing the anxiety of further tests and stopping a healthy young person from playing a sport.
Instead, experts say recognizing warning signs and risk factors, and obtaining an accurate medical history can be effective ways to reduce the risk of sudden death in sports.
Kim, who is also a team cardiologist for sports teams including the Atlanta Falcons, said he was not speaking on behalf of the Falcons but that a good emergency plan should include a team of trainers, immediate recognition of cardiac arrest, immediate initiation of CPR, and access to a defibrillator.
Dr. Stuart Berger, who is the chief of cardiology in the department of pediatrics at Northwestern University Feinberg School of Medicine and the chair of the American Academy of Pediatrics Section on cardiology, agrees. He said (EKG) and echocardiograms are not “going to tell us everybody who has something underlying that’s going to be associated with the potential of sudden cardiac arrest.”
“The key,” he said, “is to be aware that these things can happen to kids. It’s not common but it can happen and you have an emergency plan. The other key part is everybody on this planet should learn CPR and learn how to use a (defibrillator).”
Athletic trainers using such a defibrillator saved the life of a Savannah high school football player in October. Kameron Cody, a freshman defensive lineman at Benedictine Military School, collapsed during practice, and trainers Brian Tuten and Ed Livingston performed CPR and shocked Cody’s chest three times.
Benedictine coach Danny Britt called the incident “devastating.”
”Every single player on our team saw that kid being resuscitated and the trainers ripping his shirt off,” he said. “I can tell you there wasn’t anybody on that field that cared about football at that moment. Everybody is concerned about one thing, and it’s that young man. We’re thankful he’s still with us.”
Cody has recovered and hopes to play football again, Britt said.
In 2019, an athletic trainer at Thomson High School used a defibrillator to save the life of Quindrecus Moss, who collapsed during a morning practice. He reportedly was unable to breathe on his own for 38 minutes. Moss recovered.
Years earlier, these stories were less likely to have good endings. During the 2002-03 academic year, three Georgia high school athletes died after collapsing during competitions or practices.
Among them was Ryan Boslet, a Chattahoochee High School football player with a medical condition that went undetected by a preseason physical.
News coverage, including a series of articles in The Atlanta Journal-Constitution, pointed out schools’ lack of certified athletic trainers and defibrillators. Roughly half of metro Atlanta’s 111 schools responded to the series in ensuing months by buying, or planning to buy, defibrillators.
More than 20 schools hired full-time athletic trainers. In 2005, the Georgia Legislature passed the Ryan Boslet bill, which required more stringent and standardized physicals. In 2008, the Legislature required all high schools to have defibrillators and provided financial assistance to schools that had trouble affording them.
The Georgia High School Association in 2019 required all coaches to learn CPR and get training in how to use a defibrillator.
”We looked at the recommendations and ... revamped a whole lot of things,” GHSA executive director Robin Hines said. “It’s hard to be opposed to things that are going to make us safer.
Most sudden cardiac deaths are in older adults, particularly those with heart disease, according to the Mayo Clinic. Yet sudden cardiac arrest is the leading cause of medical death in young athletes. Estimates vary, but some reports suggest that about 1 in 50,000 to 1 in 80,000 young athletes die of sudden cardiac death each year, according to the Mayo Clinic.
Sudden cardiac arrest is commonly confused with a heart attack, but they are different conditions. Heart attacks are caused by blockages in the heart that prevent normal blood flow. Heart attack symptoms can appear suddenly, but they more often begin hours, days or weeks before a heart attack.
Sudden cardiac arrest, on the other hand, usually happens immediately and without warning. It occurs when the heart beats irregularly. A very fast heartbeat causes the lower heart chambers (ventricles) to quiver uselessly instead of pumping blood. This irregular heart rhythm is called ventricular fibrillation.
Any condition that puts a strain on the heart or damages heart tissue can increase the risk of sudden cardiac arrest. Some conditions that can lead to cardiac arrest in young people include congenital heart conditions and heart rhythm disorders.
Dr. John Cantwell, who served as a team physician for the Atlanta Braves and as the chief medical officer for the 1996 Atlantic Olympic Games, pointed to the possibility that Hamlin suffered from a rare and potentially fatal condition known as “commotio cordis” in which the heart’s rhythm is disrupted by a blow to the chest.
“And that is the reason when I worked with the Braves and during my Olympic work I wanted automated defibrillators right on hand,” said Cantwell, a cardiologist at Piedmont Heart Institute in Buckhead who also served as a cardiology consultant for Georgia Tech athletics. “The Braves had them in their dugout. At the Olympics, we had them every place because things like that can happen.”
“The quicker you defibrillate somebody, the better their odds of recovery.”
— Staff writer Shelia Poole contributed to this article.