Doctors are calling on the public to familiarize themselves with lifesaving CPR techniques after Buffalo Bills safety Damar Hamlin suffered cardiac arrest during a football game Monday night in Cincinnati.
Hamlin received CPR, which stands for cardiopulmonary resuscitation, to restore his heartbeat on the field, the Bills said in a statement. The NFL said separately that Hamlin received immediate attention from his team's medics, as well as independent medical staffers and local paramedics. The Bills tweeted Wednesday that he remained in critical condition but had shown “signs of improvement” late Tuesday.
The American Heart Association said it saw a 200% increase in web traffic to its CPR site after news of Hamlin’s cardiac arrest emerged.
“The lesson with Damar is that getting [CPR] started probably, as soon as possible, is the one thing that saved his life. He had the advantage of having health care staff in the field when most individuals in the United States don’t," said Dr. Paul Chan, a cardiologist at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri.
Most cardiac arrests in the U.S. — more than 350,000 a year — occur outside hospitals. Roughly 90% of those patients don't survive, often because they don't get medical attention right away. In about half of adult cases outside hospitals, there are no bystanders around to witness a person's collapse.
“With every minute of delay, there’s a 7 to 10% decrease in survivability," said Dr. Michael Emery, a sports cardiologist at the Cleveland Clinic.
That having been said, CPR is “the most profound, life-changing thing you could potentially learn and do for someone,” he added.
Doctors said the survival rate of people who go into cardiac arrest could improve if more people knew how to administer CPR, which involves pushing hard and fast on a person's chest with two hands at a rate of 100 to 120 compressions per minute. The AHA recommends that only doctors administer mouth-to-mouth breathing, another component of traditional CPR.
Learning CPR is like learning to tie your shoes — "it’s not hard,” said Dr. Jayne Morgan, a cardiologist at Piedmont Healthcare in Atlanta. She estimated that thousands of lives are saved every year by bystander CPR.
But doctors pointed to two factors that prevent people from delivering the lifesaving procedure: They're afraid to make a mistake, or they haven't received proper training.
In a 2018 national survey by the Cleveland Clinic, 54% of people in the U.S. said they knew how to do CPR, but just 17% said they knew that chest compressions alone were effective. If they are performed immediately, compressions can double or triple a patient's chances of survival, according to the AHA.
“You do not need a certification to save somebody’s life. If you are in the field when somebody has a cardiac arrest and you know CPR, you start CPR immediately," said Dr. Mariell Jessup, the AHA's chief science and medical officer.
Chan said most states have good Samaritan laws that protect people from potential legal repercussions of administering CPR in emergency settings. The AHA also has a playlist to help people achieve the right rhythm.
Doctors noted that formal CPR training, which often involves practicing on a dummy, is preferable to familiarizing yourself with the techniques online.
"You can certainly learn a lot by reading it online, and you can certainly watch videos and understand and learn the technique, but, ultimately, the best thing is to actually get into a class so you can actually practice," Morgan said.
"If you look at the number of people who are trained every year, it’s only about 2.5% of the population," said Dr. Lorrel Toft, a cardiologist at the University of Nevada.
Chan's research has shown that formal CPR training is conducted less often in Black and Hispanic communities than in white communities and that Black and Hispanic people are less likely than white people to receive bystander CPR at home or in public, which leads to lower survival rates after cardiac arrest.
Chan said formal trainings are usually held in hotels or convention centers that aren’t typically located in Black and Hispanic communities. And while some are free, many of them cost money: around $100 to $200 for a roughly three- or four-hour course, Chan said.
One strategy to eliminate barriers to CPR training is to administer it in schools, doctors said. More than 30 states require public school students to learn CPR before high school graduation. Jessup said the AHA has advocated for many years to expand the requirement to all 50 states.
But Toft said laws that require CPR training in schools tend to vary by state, so "the next step is to really standardize what that education looks like across the country." She developed a program called "Heart Class," which allows students to practice CPR by following along with a roughly 20-minute film.
Another possible solution, Toft said, is for the U.S. to require CPR training to obtain driver’s licenses — a strategy deployed in some Scandinavian countries.
"Sweden showed that by passing that law, they greatly increased the number of people trained and they actually saw an increase in survival following cardiac arrest as a direct result of that law," she said.