The radio traffic moments after Buffalo Bills defensive back Damar Hamlin collapsed on the field Monday night in Cincinnati crackled with urgency.
“I don’t like how he went down,” one person said on a channel that appears to have included medical personnel on the sidelines.
Seconds later, as the gravity of Hamlin’s condition became clearer, another person was more emphatic.
“We’re going to need everybody,” he declared. “All-call, all-call,” the equivalent of a red alert.
The first person cut back in: “Call, bring everybody. We need an airway doctor, everybody. Bring the cot with the medics.”
The pleas were captured in recordings posted on a publicly available website that tracks emergency radio traffic. They marked some of the first urgent moments of the emergency response to a life-threatening crisis that rocked the N.F.L. and stunned fans at Paycor Stadium and millions more watching on “Monday Night Football.” For about a half-hour at the stadium, a small army of doctors, athletic trainers and emergency workers rushed to save Hamlin, who went into cardiac arrest after he took a hit to the chest while tackling a Cincinnati Bengals receiver.
On Thursday afternoon, doctors at University of Cincinnati Medical Center said Hamlin was “awake and breathing,” and though he could not speak because of his breathing tube, he asked in writing who had won the game between the Bills and Bengals.
The N.F.L., the Bills and Hamlin’s family have not definitively said what caused the 24-year-old player’s heart to stop beating, though the league’s chief medical officer, Dr. Allen Sills, said this week that it “certainly is possible” it was because of the blow to the chest. But photographs, videos and audio recordings of emergency workers talking on radio channels make clear the severity of Hamlin’s condition and the efforts to keep him alive.
At 9:20 p.m., for instance, someone calls a colleague looking for an attachment that measures carbon dioxide levels.
“We do have the other monitor with us,” a person responds.
The first person answers emphatically: “I need an end-tidal CO2 now per the doc.”
More on Damar Hamlin’s Collapse
When he is told that the device, which helps measure how well a patient is breathing, is on the way, he barks back: “Yeah, you need to step it up.”
The first minutes in Cincinnati provide a window into how the N.F.L. prepared for an episode like the one at Paycor Stadium — a crisis that people around football both privately saw as inevitable and hoped would never come. The N.F.L. and its teams, the stewards of a violent sport that hinges on frequent collisions but brings in billions of dollars, ensure that dozens of medical personnel are present at each game. Those people undergo extensive training so they can follow detailed protocols, some of which are mandated by the league’s collective bargaining agreement.
On Monday, a so-called airway management physician was on hand to help keep Hamlin alive. A specialist in emergency medicine or anesthesiology, the doctor is there in case a player stops breathing and requires intubation, and can be identified, along with a handful of other medical experts, by a red cap. By the time Hamlin was loaded into an ambulance on the field on Monday, he had received CPR and, according to the Bills, his heart had been restarted.
“There’s an old joke: If you’re going to have a cardiac arrest, have it at an airport or a football stadium,” said Dr. Rob Glatter, an emergency medicine physician at Lenox Hill Hospital who worked on the sideline at Jets home games for five seasons. “If you’re on the sidelines and you go down, if you’re a photographer, whatever you’re doing, your expectations of survival dramatically increase because of all the experts and equipment around.”
According to the N.F.L., about 30 trainers, doctors and other specialists are present for games. Some, like the trainers, orthopedists and primary care doctors, are associated with the teams. They are assisted by neurotrauma consultants who primarily treat concussions, paramedics, dentists, ophthalmologists and an airway management physician.
Many of them communicate with hand-held radios. On game days, N.F.L. stadiums are a web of communications networks serving everyone from radio and television broadcasters to coaches wearing headsets to emergency responders. The New York Times found the transmissions about Hamlin on a public website that records radio traffic from emergency frequencies. The time stamps on the recordings match the sequence of events that played out both on and off the field in Cincinnati, helping corroborate their authenticity.
It was often a moment-to-moment response. Emergency workers circulated word of the decision to postpone the game, sought supplies and called for escorts to the hospital and, in one instance, for a Bills doctor to reach the airport so he could join the team for its flight home.
About two minutes after the ambulance carrying Hamlin rolled off the field, radio traffic captured a call saying emergency workers needed assistance inside the vehicle.
“I need another medic in the back,” someone is heard saying. “We are right outside the gate,” he adds a few moments later.
According to the radio transmissions, local law enforcement officials expected the ambulance to depart the stadium immediately. But the ambulance did not leave for the hospital until after 9:23 p.m., according to radio traffic, more than 10 minutes after it drove off the field. At least one news report said that officials wanted to wait for Hamlin’s mother before departing the stadium, but the radio traffic suggests she traveled separately to the hospital.
The N.F.L. declined to explain the apparent delay, but doctors who have worked at N.F.L. games said it was possible that Hamlin had additional complications in the ambulance. If, say, a breathing tube was compromised, emergency workers may have wanted to fix it while the ambulance was parked, not while driving on potentially bumpy roads. Ambulances, they said, can be as equipped as an emergency room.
“Once the pulse is back, you want to transport him as soon as possible,” Dr. Glatter, the emergency medicine physician, said. “Sometimes, they delay transport if a patient is dropping. It can happen where one of the paramedics will hold the driver until he’s more stable.”
In the judgment of the N.F.L., Monday’s emergency and its aftermath were at once frightening and vindicating, evidence that detailed planning could — maybe — limit football’s fallout.
Dr. Matthew Matava, an orthopedic surgeon at Washington University in St. Louis who was the head team doctor for the Rams until they moved to Los Angeles in 2016, said the league’s preparations for such emergencies were “incredibly thorough.”
He said, though, that doctors, athletic trainers and others involved in emergency planning often focus their attention on the injuries most likely to occur in any given N.F.L. game: hamstring ruptures, ligament tears, concussions and the like. Although rehearsals and meetings routinely cover the possibility of a cardiac emergency, Dr. Matava said, “it is not the top one, two or three things that we’re going to think about as far as the most common injuries.”
Teams, though, still worried, and sometimes devoted time in the preseason to rehearse what to do in cases of cardiac arrest.
“We get down to the details: how you access the chest, how you open the jersey and the shoulder pads, when do you remove the helmet and shoulder pads, who is doing CPR, who is putting on the defibrillator pads,” said Dr. Jonathan A. Drezner, a team doctor for the Seattle Seahawks and the director of the Center for Sports Cardiology at the University of Washington. “All of these are fine details that we discuss and hope we never have to live in real time.”
Although the league and its players’ union have long feared a cardiac emergency in players, the mandate for an airway specialist is relatively new, reflecting football’s risks and heightened recognition of its perils.
Other professional leagues have experienced similar crises. In 1998, Dr. Matava helped treat Chris Pronger, a defenseman for the St. Louis Blues, when a puck hit his chest and his heart stopped. Pronger, who survived, was found to have suffered commotio cordis, in which a severe blow to the chest at a precise moment in the heart’s rhythm can stop its beating.
“It’s not so much if, but when, you’re dealing with emergency preparedness for sports injuries like this, especially with the number of collisions and the force involved with N.F.L. football,” Dr. Matava said.
Dmitriy Khavin and Ainara Tiefenthäler contributed production. Dahlia Kozlowsky contributed research.