When Buffalo Bills player Damar Hamlin went into cardiac arrest after making a tackle during a game against the Cincinnati Bengals earlier this month, his teammates, fans, and millions of supporters watched and waited anxiously as he was cared for on the field and spent several uncertain days in intensive care.

According to the CDC, approximately 2,000 people under the age of 25 die each year due to sudden cardiac arrest. Hamlin’s injury has renewed conversations across the country about the importance of having certified athletic trainers and defibrillators on hand as young athletes practice and compete.

A panel of medical and rehabilitation experts from the College of Health Professions and Sciences weigh in on what happened, what his physical and mental recovery could look like, and protecting the heart health of athletes.

It seems probable that Hamlin experienced what’s known as commotio cordis. What is this?
“Commotio cordis is a life-threatening medical event mostly occurring when young athletes (typically between the ages of 8 and 18) are struck in chest with a hard ball like a baseball or a hockey puck or receive a hard hit to the chest while playing a contact sport like football or soccer,” says Latifa Abdelli, a pathophysiology lecturer in the Department of Health Sciences. “The sudden impact occurring at just the right time during a heartbeat triggers a sudden change in the electrical signals generated by heart cells causing the heart to suddenly stop beating.”

Are there ways athletes can minimize their risk?
It’s difficult to protect against this event occurring, experts say.

“Chest protectors and vests may reduce trauma from blunt bodily injury, but they will not provide protection from commotio cordis,” says Abdelli.  “Athletes can be trained in techniques to avoid direct hits to the rib cage area. Using softer, more pliable balls for sports like baseball or lacrosse may reduce the seriousness of the impact.”

The bottom line: “Automated external defibrillator (AED) systems need to be present at any field where contact sports or sports that use pucks or hard balls are played. If possible, an athletic trainer should be present, but regardless, coaches and athletes must be taught how to recognize commotio cordis and how to perform CPR and use an AED when someone has a cardiac event,” says Abdelli.

What is the athletic trainer’s role on a professional football team, and how critical were the early actions of the medical professionals there that day?
The athletic trainer is the primary healthcare provider and coordinator of care for a professional football team and takes primary role in designing, practicing and initiating the emergency action plan, says Carlos Gual, associate lecturer in the athletic training program. In an incident like this, “initiating CPR and using an AED within minutes is absolutely imperative for the cardiac chain of survival,” says Gual. “It’s the role of the athletic trainer to do the primary assessment, recognize the condition and its severity, and initiate the appropriate plan of care.”

What does physical fitness recovery look like for a professional athlete like Hamlin for this type of incident? Does an elite level of fitness contribute to a reduced recovery period?
“For elite professional athletes, their timeline for return will be most influenced by how long they have been held out,” says Kristen Schellhase, director of the athletic training program and assistant director of the School of Kinesiology and Rehabilitation Sciences.  “Any athlete experiencing a medical condition like a cardiac arrest must progress through activities that increase cardiovascular exertion as part of a systematic and gradual plan.”

Even though an athlete like Hamlin would be “higher conditioned” before the incident, deconditioning happens very fast — in a matter of days — says Schellhase. And elite athletes are also expected to return to a higher performance level than a non-elite athlete.

“Hamlin will have a specific recovery protocol with rules or stage timelines that he’ll follow as part of his plan of care. He’ll have to be medically cleared before he can return to the field, but with the season nearly over, there’s no pressure for him to return quickly,” says Schellhase.

What are some of the priorities or specific regimens could his healthcare providers have in mind as they help him recover?
There’s no “one size fits all” for a recovery regimen, says Schellhase.

“You would not train a cross country runner the same way you would train a weightlifter — they emphasize different muscles, perform different sport skills and use different energy systems,” she says. “Even if you look at one specific sport like football, the activities emphasized for a receiver are very different than the activities emphasized for a lineman.”

Schellhase says a team of athletic trainers, physical therapists, and strength coaches will prescribe tailored activities for Hamlin that focus on the muscle groups, sport skills and his cardiovascular needs for his role as professional football safety.

Hamlin was placed in a medically induced coma and intubated for several days. What are some of the side effects a patient can experience from intubation?
Intubation effects and their severity can vary from patient to patient, say speech pathologists.

“With a tube in place, the patient is not able to speak, and the muscles used for swallowing are immobilized,” says Vicki Lewis, a speech-language pathologist and instructor in the School of Communication Sciences and Disorders. “Once the tube is removed, a patient can experience weakness, discomfort, hoarseness or coughing while swallowing saliva, food or liquids.”

Speech pathologists work with the medical team to examine a patient’s vocal folds and trachea for any resulting trauma.

“Some patients may experience edema (swelling of the throat), growths or ulcerations, reduced sensation, or muscle disuse atrophy following intubation,” says Lewis.

What are the most important factors for voice and swallowing recovery?
After intubation, a speech pathologist will evaluate a patient and can make a recommendation regarding the need for additional rehabilitative treatment, such as swallowing or speech therapy.

“These recommendations can be crucial to prevent aspiration pneumonia and the potential for the patient to be re-intubated and return to the ventilator,” says Todd Fix, an instructor and speech-language pathologist in communication sciences disorders.

“Recovery will vary and depends on the length of intubation as well as the patient’s age, overall general and respiratory health and other medical conditions,” says Fix. “Patient access to follow up care and patient motivation can also play into the recovery process.”

Why are mental health supports in situations like this so important for athletes and the sports community?
Robin Kohn, a senior instructor and bachelor’s of social work program director for the School of Social Work says providing services is crucial to the sports community because it demystifies the stigma about mental health by providing a safe environment for members of a team to voice their concerns and feelings and support their sense of emotional and physical safety.

“In an aggressive sport like football, asking for help and showing vulnerabilities is a sign of strength, not a sign of weakness,” says Kohn. “There are overwhelming fears of being vulnerable and a fear of the unknown — that what happened to Hamlin, could happen to any athlete.”

“Hamlin actively communicating a sense of resilience, like when he asked if his team won after regaining consciousness or using Twitter to let his teammates know he was watching, helped with their emotional healing enough to return to play the following week,” she says.

After a traumatic experience like Hamlin’s, what role do social workers play in the recovery process for him and his teammates?
Licensed clinical social workers can assist players recognize their own emotions; realize the impact of the trauma; encourage stability and predictability; validate feelings; restore resilience and regain control of the situation.

“Hamlin and his teammates witnessed a traumatic, horrific event that can have a lasting effect on his and his team’s functioning and mental, physical, social, emotional and spiritual well-being,” says Kohn. “There are overwhelming fears of being vulnerable, a fear of the unknown and they could experience grief associated with what happened.”

“There will be a need for restoring or rebuilding,” says Kohn. “Seeing other football players injured in the future could be a trigger that reignites intrusive thoughts and emotions. A licensed clinical social worker can help with healing from this post-traumatic stress and by reinforcing the importance of having a positive support system (which they have), changing overwhelming thought patterns, encouraging open discussions of emotions and providing effective coping skills to handle any symptoms related to the traumatic event.”