Bills Team doc turns spotlight of Damar Hamlin injury onto increasing bystander CPR/AED training

BUFFALO, N.Y. – For the fans, Damar Hamlin’s recovery from the cardiac arrest he suffered at the Buffalo Bills-Cincinnati Bengals matchup last January was nothing short of miraculous.

But Hamlin’s recovery was all the more stunning in light of what’s known about surviving sudden cardiac arrest: It is exceedingly rare. Roughly 350,000 people suffer an out-of-hospital-cardiac-arrest event each year, according to the American Heart Association, but only about 10% survive. However, if cardiopulmonary resuscitation (CPR) is performed immediately, the individual’s chance of survival can double, even triple.

In the months that followed Hamlin’s injury, that truth loomed large for Leslie J. Bisson, MD, the University at Buffalo sports medicine surgeon and Buffalo Bills medical director who leads the medical team that contributed to Hamlin’s incredible outcome.

“There was a lot of positive energy and thoughts and prayers for Damar and all of that is incredibly important, but at the end of the day, we had trained personnel with simple equipment and a plan,” he says, all of which significantly contributed to the ultimate positive outcome.

Amazingly, just a month later, Hamlin, the first responders who saved his life and the medical team at the University of Cincinnati Medical Center, were recognized at the NFL Honors awards show. A few months later, the Bills medical and training staff received the Pat Tillman Award for Service at the 2023 ESPY awards.

Those accolades felt “a little surreal” to Bisson, who says, “It’s a weird feeling because I don’t think any of us felt like heroes. It’s our job. We’re there primarily for these kinds of things. But if we can illuminate areas that maybe could benefit from more focused attention and move things to an even better place, then that would be phenomenal.”

Bisson began to feel that he and his fellow trainers now had a window of opportunity. He set out to see if he could make a difference.

In October, the Mother Cabrini Health Foundation awarded Bisson a $300,000 grant to address barriers to bystander cardiopulmonary resuscitation/automated external defibrillator (CPR/AED)  training in underserved communities in Buffalo. The goal is to train 8,000 Western New York student-athletes and their families in bystander CPR/AED use.

One of the safest places

Other than a hospital, Bisson says, an NFL stadium is one of the safest places in the world to sustain a life-threatening injury.

“The NFL is highly resourced,” says Bisson, June A. and Eugene R. Mindell, MD, Professor and Chair of the Department of Orthopaedics, senior associate dean for clinical transformation in the Jacobs School of Medicine and Biomedical Sciences at UB and president of UBMD Orthopaedics and Sports Medicine.

He notes that at a typical NFL game, dozens of medical personnel, who regularly rehearse their emergency action plan, are on the sidelines ready to spring into action.

“For years, the NFL has been mandating that all of its medical personnel regularly practice for an on-field cardiac arrest,” says Bisson.

And, as they would do after any player injury, in the weeks that followed Hamlin’s injury, the Bills medical team reviewed what happened, modifying protocols as a result of what was learned that night.

Bystander training disparities

But Bisson knew that it was a far different picture at amateur sporting events in the community and at local schools.

“I started paying attention to the data on CPR, how often it’s performed by bystanders and especially how there is a racial and community disparity in how often people get bystander CPR training in certain areas versus others,” he says. “I realized that our medical and athletic training team had a window of opportunity to possibly help close that gap. I began to think about what we could do if we wanted to move the needle on this.”

Bisson’s immediate goal was to train 3,000 Western New York high school athletes and their families in CPR and AED use, focusing on Buffalo’s historically underserved communities. He leveraged the UB orthopaedics department’s existing relationships with dozens of schools, thanks to its athletic trainer program that embeds trainers in those schools and communities.

Since August, the department has been working with the American Heart Association, Buffalo’s Black Nurses Association, UB’s Department of Emergency Medicine and New York State Senator Tim Kennedy to conduct hands-on sessions, teaching students and their families how to respond in the event that a cardiac arrest occurs.

Successful events have been held at area schools including the Buffalo Public Schools, Buffalo State College, and the Maryvale, Cheektowaga, Cleveland Hill and Lockport school districts.

The goal was to use the focus on bystander CPR to create a culturally sensitive, hands-only CPR training program; UB funded the initial efforts.

“We held a CPR awareness tent at the Juneteenth festival and the amount of engagement by participants was astonishing,” says Bisson.

The UB team divides CPR training into a series of incrementally advanced steps. The first is the most basic, a 90-second introduction to CPR, followed by small groups with an instructor where individuals get to practice with mannequins. The next stage links participants to instructional videos and certification courses. The final stage is CPR certification.

Using this method, the UB physicians and trainers have been able to train groups of as many as 400 participants in as little as 40 minutes during high school pre-season athletic meetings.

Funding will allow 8,000 to be trained

“The engagement of the trainers and trainees has been nothing short of inspiring,” says Bisson. “And our Cabrini funding will allow us to expand the training to 8,000 student-athletes and their families in the new year.”

The team is also applying for implementation science grants, which put evidence-based practices into the hands of people who can best disseminate them; the goal is to train school coaches to deliver hands-only CPR training to student-athletes and their families.

Upmost in Bisson’s mind is that glaring statistic that only 10% of people who experience cardiac arrest in the community are going to survive.

“Our message to all bystanders is simple,” he says. “Know the basics of how to respond, but even if you can’t do everything, doing something is still better than doing nothing at all. Damar was saved by trained people, the proper equipment and a solid, well-rehearsed plan.

“If we can get more people to feel comfortable calling 911, beginning chest compressions and finding and using an AED, we will be closing that gap, no matter where a cardiac arrest happens.”

More information on this initiative is in the cover story in the Fall 2023 issue of UB Medicine.