When Damar Hamlin collapsed after a cardiac arrest on an NFL field, the Buffalo Bills medical team initiated the league’s Emergency Action Plan within 10 seconds. It was life-saving medical attention that saved his life. It is not something many American football fans had witnessed before.
Followers of world soccer, however, have grown more familiar with these events occurring on the field of play. Whether in the domestic game, at the international level or in grassroots amateur football, global coverage and understanding of cardiac arrests have improved in recent years.
While Hamlin’s case is potentially unlike any of the most well-known incidents, the response to cardiac arrests in European soccer has improved significantly over the past decade, with provisions made across the professional and amateur games.
Here, The Athletic looks at what American football can learn about providing relevant precautions from the top to the bottom of the sport.
Damar Hamlin incident
Hamlin, a safety for the Bills, suffered a cardiac arrest on Jan. 2 when he collapsed on the field during his team’s game against the Cincinnati Bengals.
In response to the incident, medical staff on the field executed the NFL-mandated Emergency Action Plan (EAP), which the league said “worked as designed.”
His heartbeat was restored on the field before he was transferred to the University of Cincinnati Medical Center in critical condition. A week later, after making significant progress in his recovery, he was released to a Buffalo hospital for further testing. Then Wednesday, the Bills confirmed that he had been discharged from the hospital and will continue his rehabilitation at home.
While the exact reason why Hamlin’s heart stopped about nine minutes into the game is not known for certain, several prominent cardiologists have suggested that it may have been caused by commotio cordis. Commotio cordis is when blunt trauma to the chest occurs during a particular period in the cardiac electrical cycle, leading to cardiac arrest. There is no structural damage or anatomical change to the heart, and there are no underlying conditions that cause it. The force must be strong enough and at a precise time for this to happen.
Hamlin now faces a road to recovery, which could take months or even years. There has been encouraging progress made physically and neurologically, although symptoms may not manifest until later. Still, the long-term psychological impact of suffering the traumatic experience cannot be overlooked.
Cases of cardiac arrest in football
Christian Eriksen collapsed while playing at Euro 2020 but returned to captain Denmark at the 2022 World Cup (Sebastian Frej / MB Media / Getty Images)
Perhaps the most high-profile incident came when Christian Eriksen, contracted to Serie A side Inter Milan at the time, collapsed on the pitch while playing for Denmark against Finland in 2021 at Euro 2020.
As an elite-level athlete, Eriksen was checked annually and reported “normal” results, according to Professor Sanjay Sharma, a world-leading cardiologist who is cardiology advisor to the FA and the English Institute of Sport. Despite this, in the words of one of Denmark’s medics, their star player and captain had “gone.” His heart had stopped, meaning he was technically dead, before he was brought back to life by the rapid use of an AED (automated external defibrillator).
After the incident, Eriksen was fitted with an ICD (implantable cardioverter defibrillator) and left Inter, as it is forbidden for anyone equipped with a pacemaker to play professional football in Italy. In January 2022, he signed for Brentford, where he starred as the west London side secured Premier League status for the second season in their history. He moved to Manchester United in the summer, where he has established himself as a first-team regular. Eriksen has since described his recovery as “a miracle.”
Players suffering cardiac arrests in football is not a new phenomenon, although there appeared to be a spike in 2021, which raised global consciousness. While playing for Barcelona, Sergio Aguero, formerly of Manchester City, decided to retire after being taken off in a game against Alaves on Oct. 30, 2021, with what turned out to be a potentially life-changing heart problem. In September of the same year, Dylan Rich, a 17-year-old amateur player for Nottinghamshire side West Bridgford Colts, collapsed and died in an FA Youth Cup game. In one of the most well-known cases in English football, Fabrice Muamba made a recovery after collapsing on the pitch in March 2012. Unlike Eriksen, he was subsequently forced into retirement.
He has since opened Venturi Cardiology, a heart clinic in the northwest of England.
How soccer, at all levels, has improved its cardiac-arrest response
According to a 2020 study (covering 2014 to 2018), 617 player deaths were attributed to cardiac arrests during that period. The report focused on deaths “during or within one hour after training (all organized sports activities for football players) and competitions,” rather than players who died of cardiac arrests suffered outside of playing activities. Of the total sample, only 142 — 23 percent — survived, and for the minority, like Eriksen and Muamba, the quick reaction they received from a medical team on standby was decisive.
In the general population in the UK, only 10 percent of people who suffer cardiac arrest survive outside hospitals. The rate is so comparatively low, in part, because CPR or defibrillation services are not available fast enough, and screening procedures are not frequent enough.
Because of this, the English Football Association (FA) and other sporting organizations have increased screening frequency. Players are more frequently tested between the ages of 14 and 25, with a mandate for all academy players at age 16 to undergo a comprehensive screening procedure.
Screening involves a questionnaire to determine any concerning cardiac symptoms or a family history of heart disease, followed by an electrocardiogram (a graphical display of the electrical activity within the heart) and an echocardiogram (an ultrasound of the heart).
The Premier League has also announced the launch of its new Defibrillator Fund in response to Eriksen’s cardiac arrest, where thousands of automated external defibrillators will be provided to grassroots clubs and associations throughout England.
According to the Premier League, these 2,000 new life-saving devices have been made accessible to around 1.5 million players, coaches, officials and administrators across the grassroots game in England.
This initiative gives anyone — including members of the public — the means to save lives at football facilities at every level. In response to the Hamlin incident, the NFL’s New Orleans Saints and NBA’s New Orleans Pelicans announced that they would donate 67 defibrillators to schools in the local area. Still, access to defibrillators is not yet as readily available in the US, where, every year, more than 18,000 Americans suffer a cardiac arrest in public and could potentially be saved with immediate defibrillation.
(Top photo: Kirk Irwin/Getty Images)
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