Beyond the concussion discussion: Hamlin’s cardiac arrest prompts doctors to weigh in on safety in football

Much of the discussion on the health risks associated with playing pro football focuses on concussions and head injuries. But Buffalo Bills safety Damar Hamlin’s mid-game cardiac arrest on January 2, 2023, brought attention to the potential cardiovascular risks football players also face.

Are these athletes putting themselves in danger every time they step onto the field? And if so, what is being done to help ensure their safety?

First impressions of Hamlin’s cardiac arrest

To better understand the depth of Hamlin’s injury and the NFL’s approach to safety, MDLinx spoke with two members of its board of medical advisors, Kristen Fuller, MD, and Vincent Carr, DO, FACC, FACP, CHCQM-PHYADV.

Soon after Hamlin was reportedly struck in the chest during a tackle, some cardiologists and sports medicine doctors came to the conclusion that the blunt force to Hamlin’s chest led to commotio cordis—an arrhythmia that can force the heart to stop.

Commotio cordis, or “an agitation of the heart” is not common among football players, according to Drs. Carr and Fuller. But cardiac issues are common among all athletes, according to research.

A review published by Methodist DeBakey Cardiovascular Journal cited sudden cardiac death as “the most frequent medical cause of sudden death in athletes.”^[]

And according to an article published by Sports Health, commotio cordis is the second most common cause of sudden cardiac death among athletes, trailing hypertrophic cardiomyopathy.^[]

When asked about how Hamlin’s cardiac arrest will influence the medical dialogue about football safety—which is largely focused on brain injuries—Dr. Fuller didn’t expect it to have much of an impact.

“I don’t think this event necessarily shifts the conversation within the medical community about high-impact sports, specifically football, as this is always an ongoing topic of conversation,” she said. “But hopefully it will shed light among the general population in regard to the danger of these sports.”

Dr. Carr echoed these sentiments, calling attention to popular injuries among football players that often go unmentioned.

“We should recognize that there are many other injuries, mostly musculoskeletal, that are not routinely considered, and injuries to the torso, chest, and abdomen do occur infrequently,” he said.

Keeping players safe

As a high-impact sport, football creates conditions for a vast array of injuries to occur. What is the NFL doing to protect its players?

According to Dr. Carr, major sports organizations have made strides to prevent cardiac issues from endangering players’ lives by mandating that all teams have emergency equipment on the sidelines—along with trained personnel to operate it.

“The infrequent episodes of cardiac arrest have not been associated with as many deaths as occurred before the equipment mandates,” he said, noting that the majority of players now have access to effective resuscitation on the field and court.

In addition, some medical organizations are pushing for cardiologists to learn more about athlete-specific care and practice management.

For example, the American College of Cardiology (ACC) is hosting a “Care of the Athletic Heart” training course in 2023 to educate cardiologists and sports medicine doctors on the cardiological needs of the growing athlete population.

The ACC has provided screening procedures to assess individual athletes’ cardiac-related risks, but according to Dr. Carr, not all players choose to undergo them.

“The question of how much medical screening should be performed is largely overshadowed by patients and families who do not wish the medical profession to restrict their ability to perform collegiately or professionally,” Dr. Carr said.

Player safety is therefore influenced by a number of factors—some of which are personal to each player.

Mental well-being matters, too

Football players who suffer injuries may also deal with mental illnesses and disorders as a result of getting hurt.

“Recovering after any type of injury can have emotional and mental consequences,” Dr. Fuller said.

These consequences may vary, depending on the injury. For example, there is a known link between CTE and mental health disorders like depression, suicide, substance use disorders, and poor executive functioning, Dr. Fuller said.

When asked about what the NFL can do to better care for its players’ emotional safety and mental well-being after an injury occurs, Dr. Fuller suggested an addition she felt each team should add to its support staff.