From the Dean: Sports medicine, being ‘cardiac ready’ and farewell to Dr. Tinguely
As mentioned last week, I’m going to keep my cardiologist’s hat on for this week’s column and discuss some of the important factors involved in the reportedly miraculous recovery of NFL player Damar Hamlin. Based on news media reports, it appears that he suffered a cardiac arrest after a forceful blow to the chest during a recent football game, presumably because the chest trauma induced a very unstable heart rhythm that ordinarily leads to death. That he not only survived but apparently is returning to normal likely is related to three factors involved in his recent care: a well-choreographed rapid response team that was trained to handle emergencies like this; the immediate application of cardiopulmonary resuscitation (CPR); and the use of an automated external defibrillator (AED) to shock the heart rhythm back to normal.
One aspect of CPR that deserves emphasis is that especially in cardiac arrest events that are witnessed (such as this one), the highest priority is the use of chest compressions to maintain blood circulation to the body. Some of you may recall the now-outdated mantra of “A B C” – airway, breathe, circulate. We now use a more nuanced approach during cardiac arrest, but one where immediate chest compressions to get blood to the body (especially the heart and brain) is essential. This should be followed as soon as possible by use of the AED. Breathing for the victim is important, but it should not interfere with chest compressions or the use of the AED.
It is clear that having the three critical components in place in anticipation of a possible cardiac arrest – a well-rehearsed plan, training in CPR, and the availability of an AED – can have a major positive impact on outcomes, just as we saw with Mr. Hamlin. Thus, I thought that you might be interested in learning about the preparations and planning we have in place to protect our student athletes and others to the maximum extent possible. Under the leadership of Steve Westereng, associate professor and chair of our Department of Sports Medicine, we have developed emergency action plans (EAPs) for all of the venues where UND athletes participate. The plan is posted in the facility and the first item on the list of resources is the location of an AED. All UND athletic trainers are required to be current in their certification regarding CPR and AED operation. An AED is available on-site at all on-campus UND athletic facilities and at most off-campus home venues. If the off-campus home venue is not so equipped, an AED is brought in by UND staff for UND-hosted events. AEDs are checked monthly to make sure they are operational (i.e., batteries are not dead and AED pads not expired). For contact/collision sports, our sports medicine team meets with the visiting sports medicine staff to review the location of resources (such as an AED) and procedures prior to the competition. Analogous to what operating room teams do prior to the start of an operation, both sports medicine teams do a “medical time out” prior to the event to confirm details and protocols (such as location of the ambulance, AED, etc.).
Additionally, athletic training/sports medicine faculty, students, and team physicians practice emergency scenarios with the help of the UND SMHS Simulation Center at least annually. Athletic trainers and team physicians also meet yearly with local emergency medical technicians (EMT) and ambulance services to review EAPs and related protocols. Having all the components of an emergency response effort in place, including a well-trained team that follows an emergency action plan, the prompt use of CPR, and the utilization of an easily accessible AED, does not guarantee a successful outcome as appears to be the case with Mr. Hamlin, but it markedly increases that likelihood. Let’s just hope that our team never has to spring into action. But rest assured that if they have to, they are ready! And please remember – you too should be ready to help with bystander CPR if a cardiac event were to occur away from the athletic field. The American Heart Association (North Dakota | American Heart Association) provides such training for non-medical folks. Also, note that in 2020, UND was designated North Dakota’s first (and still only) Cardiac Ready Campus by the North Dakota Department of Health and Human Services, which as a cardiologist I very much appreciate.
Finally, a word of gratitude for the many contributions over the years of Dr. Steve Tinguely, who is retiring from UND this month. We held a reception for Steve this past Monday in our Grand Forks building, and it was a very warm and enjoyable event. Steve has distinguished himself in his multi-decade career at UND as a clinical educator, prior chair of the Department of Pediatrics, and most recently as our Chief Medical Accreditation Officer, where in 2022 he oversaw the SMHS’s very successful re-accreditation efforts of our medical curriculum. In honor and recognition of his contributions and achievements, Steve has been awarded the rank of Emeritus Professor of Pediatrics by the University. What an honor – and what a career! Many thanks, Steve, and all the best in the future.
Joshua Wynne, MD, MBA, MPH
Vice President for Health Affairs, UND
Dean, UND School of Medicine & Health Sciences