Last night, the NFL world watched in Prime Time as Damar Hamlin, 24 year-old Bills Safety, made a routine tackle on an opposing receiver. The impact to his chest pad was visually unremarkable; he went to the ground and popped back up like he had done ten thousand times before. This time though, he didn’t stay up. Over the next 9 minutes, medical staff diligently worked to keep his heart pumping blood. They administered CPR continuously and ultimately employed a defibrillator when a normal cardiac rhythm could not be established. The AED did it’s job – a heartbeat was restored, oxygen was given, and Damar was loaded into an ambulance to be taken to UC Health, one of the best trauma centers in the United States. As ER doctors across the internet said in the wake of the event, the actions of the care providers on the field made the largest impact on ensuring his survival.

Once Damar reached the hospital, he was intubated (received a breathing tube), which is standard procedure for any patient whose heart had stopped prior to arrival. His friend and agent Jordan Rooney tweeted that his vitals were back to normal and they were running tests, and the Bills organization released a statement overnight confirming that his heartbeat was restored on the field and he remained in critical condition at the time of their update. That was 9 hours ago as of this writing, and is the only official information available at this time.

It isn’t shameful to want to follow the dramatic wave of activity that crests behind an event like this one. Concern for others, even for those whose name you didn’t know until this happened, is a valid and normal human response. Getting worked up about policies, procedures, the who-said-whats and the why-didn’t-theys is also normal. There are a few things worth clearing up and speaking plainly about, so while we wait for news regarding Damar’s condition, let’s spend some time together and talk about sports injury risk, pride, duty, moving mountains, and what it means to spectate tragedy.

Injuries, Pride, and Sports

Injury is an ever-present risk in sports. Contact sports may experience this risk at greater volume, but any pursuit of athletics carries with it the potential to harm your body. American football is unquestionably one of the more dangerous sports actively played each year, but it is unique in that of all the high contact, high injury risk sports, it is unquestionably the most watched across the world. This viewership contributes to the NFL also having one of the greatest sports economies in human history, which in turn allows for a significant amount of resources to be allocated to injury prevention and treatment. Just as the US Military and NASA’s research and development of new scientific breakthroughs has improved life for the average American, so too have the advances in medical technology and treatment bettered the lives of all patients across this and other countries. It may seem odd to say, but the passion of an astronaut is not so different from the passion of a pinnacle athlete; neither wants to be hurt in pursuit of their goals, but both will accept astronomical risk to achieve their dreams.

Pride is at the heart of this decision to accept risk. The kind of pride that drives someone to achieve greatness is uncommon, but the combination of this pride, the drive required to fuel it, and the physical and mental equipment needed to actually achieve it – that’s an incredibly rare combination. Damar Hamlin is one of these people. Of the roughly 1 million high school football players in America, about 6 percent will play in college. Of that remaining group, only about 1.5% will be drafted. Damar Hamlin was drafted in the 6th round. Only about 5% of players drafted in the sixth round ever make the starting roster of an NFL team. That puts him in exceedingly rare company. You can be certain that each time he puts on his uniform and lives his dream, he is proud to be there.

Those of us who have never felt that pinnacle of pride and accomplishment will reasonably ask the question, does this make him regret playing football? It may be presumptuous to say but I don’t think that question occurs to people as proud as Damar. I’m not sure asking him that question is even polite, let alone meaningful. Alex Smith, another NFL player who faced his mortality as a spiral fracture of his leg necrotized and threatened to end his life, put it this way: “I’m not the same. The leg was a reminder of all the things I had lost. Now I wake up proud of my leg and what we’ve been through.” Alex Smith ultimately returned to football for a short time after his recovery, saying “It was an amazing place to be. I was so happy to be out there and to be in the moment, playing the game I love.” That season, he led his team to the playoffs. If you’re like me and you spend your time watching these guys instead of being one of these guys, then maybe like me you don’t really get it. But also like me, I hope you respect the hell out of it.

The Duty of Care for Medical Professionals

The NFL’s injury analytics give each player a 4.1% chance of being injured in a game to a degree that they miss a week (check out this awesome writeup for more detailed info). But emergent situations requiring an ambulance and specialized care providers occur a handful of times each season. Even so, there are always between 20 and 30 medical professionals on standby at each NFL game, along with between 1 and 7 ambulances depending on the stadium. Imagine standing on the sidelines for 17 games each year, knowing that your chances of being needed are roughly 5 in 272. Would you still be ready to act when needed? This is a powerful responsibility, and on Monday night the NFL world saw how prepared those caregivers were to fulfill their duty. 9 minutes is a long time to perform CPR in front of 66,000 people and a couple dozen television cameras. Bleacher Report had this to share in their article about emergency medical care during a football game:

“The nightmare scenario? A player stops breathing.

“We have a physician on the sidelines who is available for emergency airway management,” Matava reassured. “Typically, these are anesthesiologists or emergency medicine physicians. You will know them because they have a red hat on and typically stand on the 30- or 40-yard line.”

Their interviewee also shared, “(The airway physicians) are a great insurance policy, but no one has had to be intubated during an NFL game so far. But again, it’s one of those things you want to be better prepared than not.” Reports on Damar’s care indicate that he was intubated at the trauma center, but it’s comforting to know that if it had been required in the moment, he would have received the treatment he needed.

Moving Mountains vs Emergency Response

Response time was immediate for Damar Hamlin’s health care, but it was a different story for the NFL’s reaction on how to handle the game afterward. The procedures in place for emergent injuries are written with the intention of guiding the process of continuing the game, but when an accident this severe occurs, standard procedure falls short. The NFL and both team organizations have a lot of communicating to do. First, confirming the sentiment that the game should be cancelled with all parties. This is not a given, as much as the mood of the spectating crowd and national audience may have reflected. Players will play through almost anything, and an NFL game has never been postponed due to injury – including some as gruesome as Alex Smith’s previously mentioned leg injury.

Once they had confirmation that all parties consented to a postponement, teams had to determine travel plans. Many Bills players wanted to stay, but with no reasonable way to book that many hotel rooms, it was decided that players could stay and book their own room or return to Buffalo on the pre-scheduled flight. Much less simple was the announcement of the decision to postpone. the NFL had been made aware that the ambulance was still at the stadium (speculation here is better left alone, though an EMT’s priority is always to transport their patient to a hospital immediately unless care requirements demand the ambulance remain at rest). If the NFL were to announce the postponement quickly, they could introduce a traffic barrier to the ambulance. In the end they opted to wait until Damar reached the hospital to officially postpone the game. In a somewhat unexpected turn, very few fans had yet to leave the stands, though it’s unlikely that the crowd believed the game would continue. More likely, the people in attendance, fearing that a player may have lost his life, were simply not ready to leave yet.

Spectating Tragedy

Witnessing tragedy in the course of everyday life is unfortunately something that most of us will experience at some point or another – a deadly car crash seen on the side of the road, the loss of an ailing family member in a hospital bed, the slow decline of a friend’s health. Some of us have the misfortune of bearing witness to more shocking events, especially on television news. It’s different, though, as a spectator. Spectators plan their evening, sometimes travel significant distances, deal with traffic and parking, build their anticipation and ultimately enjoy the rare privilege of taking in a live game. The energy of the stadium is palpable, the noise is intoxicating and the action is intense. All of this comes rolling to a stop when a player goes down, but it happens frequently enough that, when at first it goes on longer than expected it can be a little frustrating. The cart comes out, and the crowd understands this is serious. The ambulance comes, and now there’s a wholly new and more ominous energy in the stadium. Many dedicated fans have likely seen this once or twice before and are respectfully silent. But now, the ambulance isn’t leaving. While before some players were praying on their respective sidelines, now both teams are intermingled on the field, forming large circles and several are openly crying. The ambulance still hasn’t left. It’s been 10 minutes, now 15. Looking around, very few people have left the stands. The buzz of conversation in a liminal moment like this is typically thinned with laughter, but the murmur in the stadium is hushed and anxious. Finally, mercifully, the stadium screens show that the game has been postponed. The collective march to the parking lot is a somber one, and the conversation on the drive home is a lot different than you thought it would be on the drive in. There’s a special, awful kind of bond that large groups of people can develop in a communal experience like this. If, like my best friend, you sat in your apartment parking lot with a bunch of neighbors you’d never really met and watched the complex burn down, you may have felt this connection of shared loss. But when you lose nothing while watching together as someone else potentially loses everything, the survivor’s guilt doesn’t dissipate easily; nobody wants to be the first to let go, the crowd must all collectively decide to stop looking and go home.

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Please join me in gratitude for the medical professionals who performed their duties admirably yesterday, and join me in admiring the players who accept the risk of bodily harm to play a beautiful game for us and for themselves. Wait with me to hear positive news on Damar Hamlin’s recovery, and follow the methodical and unenviable work that NFL schedulers, organizations, and players must perform to keep the season moving towards the playoffs. As of this post, it has been announced that Bills/Bengals will not be resumed this week, and commissioner Goodell has released a statement. I love football, I really do. It produces some of the most impactful stories in sports, and at times like these I want to acknowledge the strength and fortitude of those who continue to play on after real dangers remind us that we aren’t invincible. Hopefully Damar will be back with us soon to tell us how he feels.