Buffalo Bills safety Damar Hamlin (3) lies on the turf after making a tackle on Cincinnati Bengals wide receiver Tee Higgins, blocked from view, as Buffalo Bills linebacker Tremaine Edmunds (49) assists at the end of the play during the first half of an NFL football game between the Cincinnati Bengals and the Buffalo Bills, Monday, Jan. 2, 2023, in Cincinnati. After getting up from the play, Hamlin collapsed and was administered CPR on the field. (AP Photo/Joshua A. Bickel)

On Dec. 2, in the first quarter of the Monday Night Football game between the Buffalo Bills and Cincinnati Bengals, Bills safety Damar Hamlin made a routine tackle on Bengals receiver Tee Higgins. Hamlin stood up for a moment after the play before collapsing to the ground.

Moments later, the field was cleared for emergency medical personnel to attend to Hamlin, administer CPR, and use an automated external defibrillator (AED).

Hamlin lived to tell the tale, but the severity of his situation despite the fact that he hadn’t had a history of heart problems and that the hit wasn’t unusually forceful brought the topic of how medical emergencies are dealt with to the forefront of the national discourse around football’s violent nature. 

Among those who watched the game was Jeff Schroder, a college basketball referee who dealt with a similar situation while officiating a college basketball game between Southwest Minnesota State University and Wayne State College in Marshall.

“I’m not going to lie to you, it was hard on me,” Schroder said of watching Hamlin’s medical emergency unfold on television. “It brought back some vivid memories, that’s for sure.”

On New Year’s Eve in 2017, the SMSU mens basketball team was facing off against Wayne State in Marshall. The Mustangs led the Wildcats by 20 points at halftime and were well on their way to coasting to a win.

Schroder had been sick the week or two prior with a cold, but he felt fine the day of his heart attack. He hadn’t even felt any issues when he shoveled out his driveway earlier that morning, he said. It wasn’t until about five minutes into the second half that he felt like he was in trouble. During a media timeout, when he went to grab the ball, he could hardly get back up and he felt a wave of exhaustion fall over him, Schroder said. Shortly thereafter, he collapsed and doesn’t have any further memories until after he arrived in the Emergency room.

“I saw on the fast break, we were going to score, and he was his way down on the fast break, and he just dropped right in front of our bench. It was pretty obvious that he was in trouble,” SMSU head coach Brad Bigler said. “[Then-SMSU head athletic trainer Laura Crowell] screamed for someone to call 911 and I just remember telling our guys like, ‘get away, I don’t want you right in front of this if this turns bad.’ I remember the gym being absolutely silent.”

Crowell, along with fellow trainers Muffin Morris and Jess Swedzinski, began working on Schroder. He was breathing and had a pulse when they got to him, Crowell said, but he stopped breathing shortly after. 

Bigler’s brother-in-law, Jeremy Walker, also later contributed to the life-saving care efforts.

Walker, an anesthesiologist and interventional pain doctor, lives in Nashville with his wife and children, so he’s very rarely able to come to SMSU basketball games. He had only been to one or two SMSU basketball games prior to that night, Walker said.

“I didn’t see the initial event happen,” Walker said. “I had taken my son to the bathroom, and my wife was shouting from the door of the restroom, ‘Jeremy! Jeremy! You need to come out here quickly!” I kind of said, okay, we’ll come out as quick as we can, but I didn’t know it was an emergency or why she wanted me to come out there.”

When Schroder stopped breathing and lost his pulse, Walker intervened to help perform Crowell perform CPR. While CPR is better than doing nothing, the real life-saver was the AED that the team keeps behind the bench, Crowell said.

“You certainly want people to try [to perform CPR] if they don’t have an AED, it’s better than nothing… but if you have the AED, that increases your chances of survival enormously,” Crowell said. 

On his way out to the ambulance on a stretcher, Schroder gave a thumbs up to signal that he was going to be okay, Bigler said, but that still didn’t ease anyone’s anxiety about the situation.

“You still don’t know if he’s going to be okay,” Bigler said of his thoughts as the game resumed after the incident. “It was such an awkward moment, where nobody knows if they should even be playing this game. We know we have a responsibility at some level to finish this game, but it was a lot of raw emotion… As a coach, you’re just hoping nobody else gets injured in those moments. It was kind of just like, ‘let’s all run the clock and get out of here.'”

Schroder had quadruple bypass surgery on Jan. 2. Nine months and 29 days later, Schroder was back to refereeing college basketball games. It wasn’t an easy path back. Schroder saw a counselor and took anxiety for months leading up to resuming officiating, but the anxiety went away shortly after he got back. 

“Once the game started, I was completely fine. I have been ever since then, I haven’t thought about it one bit while I’m refereeing,” Schroder said. “Once the ball went over at the tip, it was fine.”

Looking local

When Hamlin went into cardiac arrest on the field on Monday Night Football, a team of trained physicians rapidly made their way onto the field. Medical staff performed CPR on Hamlin for over eight minutes, an AED was used, and an ambulance was at the ready to transport him to a hospital. Yet, collegiate and high school athletics departments don’t have access to the same resources as the National Football League. When a medical emergency unfolds at the local level, what protocols do local sports enforce?

At the high school level, all Minnesota State High School League athletic departments are required to have an emergency action plan (EAP) on file to start the year, according to Marshall High School athletic director Mitch Gruning. The EAP varies situationally depending on the medical emergency and location and delegates tasks necessary to stabilize the situation, from crowd control to calling the emergency medical services. 

In the case of Tiger football, this means athletic trainers on-site for all varsity home games and some support for practices and lower-level games depending on availability, Gruning said.

While Marshall used to have emergency medical services on-site for football games about 10 years ago, the athletic trainers have since replaced them.

“A lot of school districts went that way because athletic trainers are most often provided by hospitals or medical facilities. We currently have a contract with Avera Medical to help provide our trainers at a shared cost,” Gruning said. “They were able to work an agreement out where we could have a trainer on-site, not just for football, but volleyball, hockey… versus previous years, when you’d have EMS on site for football and that was your only kind of medical support that we had available.”

For Marshall, the most common need for emergency medical support is concussions, Gruning said, adding that he has not seen a situation in which the school has had to call EMS for support during his time as an athletic director or coach.

SMSU has a similar setup to Marshall in terms of how they prepare for athletic medical emergencies. The university has a 42-page document detailing its EAP.

Additionally, they have six full-time athletic trainers who are split between athletic events. Trainers are available at all home competitions and most away competitions, according to SMSU head athletic trainer Amy Schmiesing. 

The NSIC mandates that athletic trainers travel with the football team, Schmiesing said, but SMSU also sends their trainers on the road with mens and womens basketball, soccer, wrestling, softball, and baseball.

Football is also required to have a physician on the sideline, but the same requirement isn’t applied to other sports.

“Luckily, our physician is a big fan, so she does come to quite a few events,” Schmiesing said.

While 

Despite the medical support available, not every medical emergency ends with the victim walking away. SMSU has had two athletes pass away from aneurysms, offensive lineman Ben Bundy in 2012 and wheelchair basketball player John Herndon in 2012, Crowell said. In those cases, there’s only so much that staff or equipment can do to try to solve the issue because CPR and AEDs can’t be used to save the athlete’s life.

As for equipment, Marshall High School has an AED on-site at all of their indoor activities and an athletic trainer will bring one to outdoor activities, Gruning said. Many of these AEDs are located on the SMSU campus, where some Marshall teams compete. 

There are six AEDs in the SMSU sports medicine department, which are present at every game and practice. The general rule of thumb, according to Schmiesing, is that they need to be located within two minutes of a medical emergency response time.

Both SMSU and Marshall High School meet this guideline, although still more could be done to promote health and safety for athletes, coaches, and officials.

“My hope would be to try to get more outdoor facilities, whether it be with the high school, the college [SMSU], or the city, to have AEDs on site,” Gruning said. “There’s a trainer that’s there that’s managing that, but you could have community members be aware of where that’s at to help support if someone needs it.”