CNN
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When 24-year-old Buffalo Bills safety Damar Hamlin collapsed on the field from cardiac arrest during the January 2 game against the Cincinnati Bengals, millions of people witnessed a remarkable resuscitation in real time on live television.
As a trauma neurosurgeon myself, I was in awe of the dozens of medical professionals – athletic trainers, doctors and EMTs – who put their years of training into action within seconds. The immediate recognition that this wasn’t a routine injury and the speedy administration of CPR and defibrillation saved his heart, his brain and his life. Six weeks later, we now hear Dr. Thomas Mayer, the medical director of the NFL Players Association, say “I guarantee you that Damar Hamlin will play professional football again.”
The rescue response was awesome to watch and reflected the remarkable resources and planning that go into every game played in the NFL. As a parent, though, I couldn’t help but wonder what would’ve happened if Hamlin faced this when he was still in high school. What if it would’ve happened to any of my three teenage kids at their school? Would they have been saved as well?
Sudden cardiac deaths are rare in young people, but you may be surprised to know that the US Centers for Disease Control and Prevention estimates that there are about 2,000 such deaths in people under the age of 25 every year.
While the overall number of cardiac arrests has stayed largely consistent, there is no question that school safety efforts – and cardiac arrest survival rates – have improved over the years. Florida was the first state to enact laws requiring automated external defibrillators, or AEDs, in schools in 1999, and there are now 20 states, along with the District of Columbia, with similar mandates, according to the American College of Cardiology. Even in most of the states with no requirement on the books, AEDs are available in the majority of schools.
Most venues with more than 200 people – large businesses, stadiums, casinos and concert halls – are required to have AEDs as well, but there has been a major focus on schools in recent decades, considering that about 20% of the US population is on school grounds at any one time. In the past quarter-century, we went from hardly any AEDs being present in schools to a remarkable awareness of the lifesaving potential they hold. That increased awareness and attention to defibrillators and CPR has directly resulted in more athletes surviving, says Dr. Jonathan Drezner, a sports medicine specialist and team physician for the Seattle Seahawks.
He points out that when he began investigating sudden cardiac arrest in young athletes in the early 2000s, survival rates hovered around 11%. A more recent study of young athletes from 2014 to 2018 found that survival rates have climbed to an average of 68%. That’s an improvement of more than 500% in less than two decades.
Still, we can and must do better, especially at the high school level. While there is increased awareness and availability of AEDs, none of that matters if the lifesaving device can’t be accessed within two to three minutes.
As part of a CNN investigation, we wanted a detailed understanding not just of AED availability in schools but of real-life accessibility. Speed matters when someone has suddenly dropped due to cardiac arrest. The best estimates are that every minute without defibrillation reduces survival by up to 10%.
That’s why Dr. Victoria Vetter, a cardiologist with the Cardiac Center at Children’s Hospital of Philadelphia, told us that “just having an AED is not sufficient.”
“You need to make sure that there is an accessible AED that is not locked in the nurse’s office or in some back office,” Vetter said.
The American Heart Association recommends that defibrillators be placed within a two- to three-minute walk. Unfortunately, even in schools that have diligently purchased devices – typically at a cost of $1,000 to $2,000 – too many of them are not readily accessible.
One small study of secondary public schools in Ohio and southeast Michigan found that in more than 70% of the 24 public schools surveyed, the devices simply couldn’t be reached in time. Another study of schools in Oregon found that people in just half of the schools surveyed could access the devices within four minutes of a field or arena. In Vermont, 81% of the state’s 74 schools had defibrillators near athletic fields or arenas; half of the time, the AEDs were kept in the main office, with the nurse or in the lobby.
As part of our investigation, we defined AED access as knowing where the AEDs are in case of emergency. But it is essential to make sure they are always fully charged and that drills are regularly run to ensure people know how to use them.
“We have fire drills in schools generally, every month. We have active shooter drills. But we do not in most schools have sudden cardiac arrest drills,” Vetter said.
Nationally, she said, just a handful of states require schools to practice cardiac emergency plans.
Many people have held up the NFL’s cardiac response as the gold standard: quick action and accessibility. Watching the remarkable 30-person team of professionals who saved Hamlin, many would argue that most high schools don’t have the resources to employ dozens of medical professionals.
But it doesn’t take an army to save a life.
“A single person can save a young athlete’s life if they promptly recognize cardiac arrest, call for help, start CPR and someone gets the AED,” said the Seahawks’ Drezner. “The treatment algorithm really is that simple.”
For many schools, that person would be an athletic trainer, the medical professional on the field.
And yet, in about a third of the nation’s high schools, there is no access to athletic trainers at all.
“You have to ask yourself: When those athletes get injured, who’s addressing those injuries? Who’s there to provide the emergency action plan in case something like this happens?” asked Kathy Dieringer, president of the National Athletic Trainers’ Association.
Drezner’s work has found that the survival rate from cardiac arrest for young athletes nearly doubled to over 80% when an athletic trainer was present or an AED was used. Part of the reason is that schools with athletic trainers were also the ones most likely to have emergency plans and AEDs. As things stand now, schools least likely to have athletic trainers are in urban or rural areas, and the schools most likely to have them are in the suburbs, areas that tend to have higher incomes.
“If I were a parent, I would ask those questions,” Dieringer said. “Where are the AEDs in my school? Are they accessible, and does someone know how to use them if they’re needed?”
Sudden cardiac arrest is a leading cause of death in young competitive athletes, with one study finding as many as one death every three days in youth sports.
One of those deaths was 16-year-old Matthew Mangine Jr., a soccer player at St. Henry District High School in Erlanger, Kentucky. In 2020, Matthew collapsed on the soccer field.
“There were five AEDs at the school that night, and one wasn’t brought to him,” his father, Matthew Mangine Sr., told the local news. “That night, his initial shock came from EMS. They arrived roughly 12 minutes after he was down.” Matthew died an hour later at the hospital.
John and Luann Ellsessar also know that pain well. They lost their 16-year-old son, Michael, on the football field when he went into cardiac arrest during a game in 2010. “There was no ambulance or AED on the field, and it took 15 minutes for the squad to arrive,” John told CNN. “If that ambulance is arriving 15 minutes later, he’s already 150% gone.” John recalls that the doctors at the hospital worked on Michael for 45 minutes before pronouncing him dead.
Fortunately, this wasn’t the story for Peter Laake. In 2021, the star lacrosse player was already on the varsity team as a freshman at Loyola Blakefield in Towson, Maryland. Peter was hit on the left side in what was apparently a normal play, but what followed wasn’t normal at all. Peter told me he blacked out and collapsed on the field.
Jeremy Parr, the school’s athletic trainer, said he immediately went to Peter’s side and checked for a pulse.
“With no pulse, no breathing, we needed to get the AED and EMS activated as soon as possible,” Parr told me when I spoke with him recently.
CPR was started, and in Peter’s case, the AED data showed that his heart was beating again within two to three minutes.
Within three weeks, Peter was back on the field.
It’s an example of how things should work and could work in all schools.
Training in CPR for all staff, athletic and educational. Availability and accessibility of AEDs with regular drills to make sure execution is flawless. An emergency action plan that is posted and reviewed.
As a parent, you can and should ask about all of this yourself. After witnessing what happened to Hamlin, I did just that with the athletic department at my own children’s school.
In a world where we have many complicated problems, saving someone’s life is possible with the knowledge and resources we have right now. With a plan, it is easy. We often prioritize buses, fields and athletic equipment, but cardiac safety must also be at the top of the list.
As Parr told me, when the unthinkable happens, “every athlete deserves the chance to survive.”
