According to the CDC, approximately 2,000 people under the age of 25 die each year from sudden cardiac arrest. Hamlin’s injury has renewed conversations across the country about the importance of having certified athletic trainers and defibrillators on hand when young athletes train 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 might look like and protect athletes’ heart health.
It seems likely that Hamlin experienced what is known as commotio cordis. What is this?
“Commotio cordis is a life-threatening medical event that mostly occurs when young athletes (typically between the ages of 8 and 18) are struck in the chest with a hard ball such as a baseball or hockey puck, or receive a hard blow to the chest while player. a contact sport like soccer or football,” says Latifa Abdelli, a lecturer in pathophysiology in the Department of Health Sciences. “The sudden impact that occurs at just the right moment during a heartbeat triggers a sudden change in the electrical signals that is generated by heart cells, causing the heart to suddenly stop beating.”
Are there ways athletes can minimize their risk?
It is difficult to protect against this event, experts say.
“Chest protectors and vests can reduce trauma from blunt force trauma, but they won’t provide protection against commotio cordis,” says Abdelli. “Athletes can be trained in techniques to avoid direct hits to the chest area. Using softer, more pliable balls for sports like baseball or lacrosse can reduce the severity of the impact.”
The bottom line: “Automated external defibrillator (AED) systems must be present on 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 are taught how to recognize commotio cordis and how to perform CPR and use a defibrillator when someone has a cardiac event,” says Abdelli.
What is the role of the athletic trainer on a professional football team and how critical were the early actions of the doctors there that day?
The athletic trainer is the primary health care provider and coordinator of care for a professional football team and takes the primary role in designing, practicing and initiating the emergency response plan, says Carlos Gual, associate professor of the athletic training program. In an incident like this, “starting CPR and using a defibrillator within minutes is absolutely imperative to the cardiac chain of survival,” says Gual. “It is the role of the athletic trainer to make the initial assessment, recognize the condition and its severity, and initiate the appropriate plan of care.”
What does 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 return timeline will be most affected by how long they’ve been 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 such as cardiac arrest must progress through activities that increase cardiovascular exertion as part of a systematic and gradual plan.”
Although an athlete like Hamlin would be “higher conditioned” before the incident, deconditioning happens very quickly — within days — Schellhase says. And elite athletes are also expected to return to a higher level of performance than a non-elite athlete.
“Hamlin will have a specific recovery protocol with rules or phase timelines that he will follow as part of his treatment plan. He will need to be cleared medically before he can return to the track, but with the season almost over, there is no pressure to he must return quickly,” says Schellhase.
What are some of the priorities or specific regimens that his health care providers may have in mind as they help him recover?
There is no “one size fits all” for a recovery plan, says Schellhase.
“You wouldn’t train a cross-country runner the same way you would train a weightlifter—they emphasize different muscles, perform different sports skills, and use different energy systems,” she says. “Even if you look at a 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 trainers will prescribe customized activities for Hamlin that focus on the muscle groups, sports skills and his cardiovascular needs for his role as a 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 may experience with intubation?
Intubation effects and their severity can vary from patient to patient, speech pathologists say.
“With a tube in place, the patient is unable to speak and the muscles used for swallowing are immobilized,” says Vicki Lewis, a speech-language pathologist and instructor at the School of Communication Sciences and Disorders. “Once the tube is removed, a patient may experience weakness, discomfort, hoarseness, or cough while swallowing saliva, food, or liquids.”
Speech pathologists work with the medical team to examine a patient’s vocal cords and trachea for any resulting trauma.
“Some patients may experience edema (swelling of the neck), growth or ulceration, decreased sensation, or muscle atrophy after intubation,” says Lewis.
What are the most important factors for recovery of voice and swallowing?
After intubation, a speech pathologist will assess a patient and may make a recommendation regarding the need for additional rehabilitative treatment, such as swallowing or speech therapy.
“These recommendations can be critical in preventing aspiration pneumonia and the possibility of the patient being re-intubated and returning to the ventilator,” said Todd Fix, an instructor and speech-language pathologist in communication disorders.
“The recovery will vary and depends on the length of the 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 a role in the recovery process.”
Why is mental health support in situations like this so important to athletes and the sporting community?
Robin Kohn, a senior instructor and bachelor of social work program director for the School of Social Work, says service delivery is critical to the sports community because it demystifies the stigma around mental health by providing a safe environment for members of a team to express their concerns and feelings and supports their sense of emotional and physical safety.
“In an aggressive sport like football, asking for help and showing vulnerability is a sign of strength, not a sign of weakness,” says Kohn. “There is an overwhelming fear 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, such as asking if his team won after regaining consciousness or using Twitter to let his teammates know he was watching, helped 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 help players recognize their own feelings; realize the impact of the trauma; promote stability and predictability; validate feelings; restore resilience and regain control of the situation.
“Hamlin and his teammates witnessed a traumatic, horrific event that may have a lasting effect on his and his team’s functioning and mental, physical, social, emotional and spiritual well-being,” Kohn said. “There is an overwhelming fear of being vulnerable, a fear of the unknown, and they may experience grief associated with what happened.”
“There will be a need to restore or rebuild,” says Kohn. “Seeing other soccer players get injured in the future can be a trigger that restarts intrusive thoughts and feelings. 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 ), change overwhelming thought patterns, encourage open discussions about feelings and provide effective coping skills to manage any symptoms related to the traumatic event.”