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For Damar Hamlin, NFL activated Emergency Action Plan. How does it work?


“Damar Hamlin spent last night in the intensive care unit and remains there today in critical condition,” the Bills said in a statement released Tuesday afternoon. “We are grateful and thankful for the outpouring of support we have received thus far.”

The NFL said on a conference call late Monday night that the league-mandated Emergency Action Plan (EAP) “worked as designed” in response to the situation.

“There was a terrific collaboration both with the team medical staffs and the independent medical providers who were on site there if something happened,” said Jeff Miller, the NFL’s executive vice president of communications, public affairs and policy, as well as health and safety initiatives.

Medical personnel attended to Hamlin on the field and appeared to administer oxygen and perform CPR for about eight minutes behind a wall of Bills players who shielded their teammate from cameras and fans in attendance. Medical personnel also used an automated external defibrillator (AED). The Bills said Monday night that Hamlin’s heartbeat was restored on the field before his transport to the hospital via ambulance.

The NFL’s EAP is utilized in instances of severe trauma, and up to on-field medical professionals to activate. The protocol — the requirements of which are outlined in the league and NFL Players Association’s collective bargaining agreement (CBA) —  is jointly agreed upon by the league and NFLPA and must be approved by a third-party expert before the start of each season.

Teams are required to rehearse their EAP twice prior to the start of the preseason, once at the stadium and once at the practice site — and the drilling must, at minimum, address scenarios relating to spine and head trauma, isolated head trauma, heat illness, cardiac arrest/arrhythmia and trauma to the abdomen/lower body that could lead to internal bleeding.

An hour before each game, team and league medical personnel, as well as third-party medical personnel assigned to the game, are required to meet on the field to cover in-game health and safety procedures, including the EAP. They reiterate the locations of emergency equipment (such as a defibrillator) and stadium exit routes in case a player needs transport. During this meeting, they also designate who among the physicians will be the lead in the event of cardiac arrest, as was the case in Hamlin’s situation.

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These personnel are all connected via headset and/or walkie-talkie during the course of a game and utilize a set of hand signals to indicate levels of players’ distress or care needed.

A team’s internal medical staff first rushes to an injured player when obvious distress is noted; on Monday night, the stoppage occurred with 5:58 left in the first quarter. Upon initial assessment, these personnel signal and communicate to the team, league and external medical professionals on site. Those attending to Hamlin first called for a stretcher, then the ambulance that transported him to UC Medical Center.

A quick response is “crucial” when a person suffers cardiac arrest, medical experts say, because when the heart stops beating, the brain also stops receiving oxygen and “significant damage can occur after just 4-6 minutes.”

On average, there are more than two dozen medical professionals and physicians from various fields required on-site for any NFL game. The NFL and NFLPA, through the CBA, mandate an “Airway Management Physician” (AMP) who must be Board certified in emergency medicine or anesthesia and credentialed at a Level I or Level II trauma center. The NFL and NFLPA also require lists of visiting team medical liaisons to coordinate local care and prescriptions teams can’t legally travel across state lines with certain medications such as painkillers — radiology technicians and independently-certified athletic trainers positioned on the field and/or in the booth who can act as spotters and can call for time stoppage.

The stadium also deploys two EMT/paramedics crews required to operate advanced life-support ambulances. These are different from “basic life-support” ambulances in their inclusion of airway and cardiac life-support equipment, among other variables. Those crews usually park in the tunnels leading to the fields and are connected via headset/walkie-talkie to the medical team.

On Monday night, medical personnel loaded Hamlin into the ambulance at approximately 9:10 p.m. ET after attending to him for about 15 minutes. It left for the hospital at approximately 9:22.

As a part of the EAP, teams must designate the closest Level 1 and Level II trauma centers. UC Medical Center, where Hamlin was transported, has a Level I trauma center and is less than four miles from Paycor Stadium. Dolphins quarterback Tua Tagovailoa was transported to the same hospital after suffering a concussion against the Bengals in Week 4.

Some cities don’t have a closely-accessible medical center with a Level 1 or Level II trauma center (another reason life-support ambulances are required), but the most direct travel plan to one needs to be outlined in the EAP. Los Angeles’ SoFi Stadium in Inglewood, Calif., for example, designated a number of medical facilities as a part of the medical action plan for last year’s Super Bowl, including three separate Level 1 trauma centers within 30 minutes or less (ground travel time for each was provided as a part of the plan).

(Photo: Kirk Irwin / Getty Images)





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