How the Buffalo Bills’ emergency action rehearsals are going

The situation that Dr. Brian Clemency calmly announced to the room continued to evolve, and it was evolving quickly.

At first the victim spoke, but was very confused. He was moving his hands and feet, Clemency said, but he didn’t know where he was, even with the Bills signage all around.

But then the victim was convulsing.

As the Buffalo Bills’ athletic training staff and medical staff were joined by third-party medical providers in the Bills’ weight room, they worked together to provide care.

The seizure stopped and the group began loading the victim onto a stretcher. A few seconds later, the seizure started again.

At least that’s what Clémence staged. The victim was a model, and it was a rehearsal.

Rehearsals like this have been in place since 2014, but their importance took center stage after Bills safety Damar Hamlin suffered a cardiac arrest during a Monday Night Football game in January 2023 .

In the days and weeks that followed, as first responders were praised for saving Hamlin’s life, the league talked more about all the different protocols already in place. A few emergency doctors pointed out that it wasn’t luck: The staff had done the job they set out to do.

Part of this preparation includes annual rehearsals to work on different emergency scenarios in a realistic setting. Each team must hold rehearsals before its first preseason game.

The Bills held the first part of their emergency action rehearsal for 2024 on Monday. For a few hours, they reacted to whatever happened to the dummy, according to Clemence. They will hold the second part of rehearsal after open practice in August with some homework due between now and then.

Last week’s session was led by Clemency, an emergency medicine physician at the University at Buffalo.

“Everything that could go wrong goes wrong, so let’s do it here now,” Clemency said after rehearsal. “Let’s face the most difficult situation we can imagine, and that way we will be as prepared as possible.”

The hope, of course, is that none of this will ever be necessary. But preparation clearly pays off. Coincidentally, the Kansas City Chiefs staff held its rehearsal earlier this month, just three days before defensive lineman BJ Thompson suffered seizures and went into cardiac arrest during a meeting.

When that happened, the team knew exactly what to do. Thanks to quick and correct reactions, Thompson was treated and released from the hospital four days later.

“That was the first thing I did when I talked to the athletic trainers,” Dr. Jim Ellis said. “They said, ‘Thank God we did our practice on Monday.’ I mean, I think they would have been prepared for it anyway, sure though, just having that fresh in their minds was super cool.

Ellis is the NFL’s player health and safety emergency preparedness consultant, and he was also in attendance Monday at Orchard Park. He and his team attend a few rehearsals each year, taking turns on the 32 teams. When Ellis comes to the establishment, he looks for cohesion.

“We really don’t look at the medical and training staff when they’re doing their training,” Ellis told the Buffalo News before rehearsal. “We really look at the independent third-party groups that we use to make sure they meet our model.”

Part of this is even fine-tuning the smallest details when it comes to communication. After one scenario, Clemency noted that the count for rolling the victim onto a sign should be “1, 2, 3 – UP” and not just “1, 2, 3.” Coordinating timing on this one-syllable word can be crucial when 10 people are stabilizing a player with a head, neck or back injury.

“These are little things that, if we are all on the same page in advance, we can be sure to cope very well with large crowds,” Clémence proclaimed to the group during the debriefing. During Monday’s session, the group was presented with five different scenarios, including cardiac arrest, heat illness and a helmet-to-helmet hit.

Even though they knew the upcoming categories, they didn’t know what order they would be in or what wrinkles Clemence might add to them.

In the heat-illness scenario, the group was presented with a rookie who begins to stumble while leaving the field during training camp. Clémence announced that the victim’s temperature was rapidly changing in degrees Celsius, causing a stir.

“Keep cooling him down,” ordered assistant head athletic trainer Denny Kellington, as assistant athletic trainer Marissa Figueroa converted the temperature to Fahrenheit.

The issue forced a post-scenario discussion about the importance of having all equipment set to Fahrenheit in advance, but also having conversion stickers readily visible on the equipment. The Bills staff left the session knowing they would receive more of these stickers before the next rehearsal.

The scenarios were chosen not because of the likelihood of them occurring, but rather for the opposite reason.

“People deal with knee injuries every game. We see concussions, not every game, but almost every game. And we almost always evaluate for the presence of a concussion, whether there is one or not,” Ellis said. “So the biggest thing we try to do is say you have to be prepared for things that don’t happen every game.”

Hamlin’s rush on the field, watched live by tens of thousands in a stadium and millions more on television, was a perfect example. The evening allowed even the most casual fans to become aware of all the preparation that goes on behind the scenes. But since rehearsals began in 2014, the structure of rehearsals has not changed much. Yet there’s understandably a little more urgency to get it right these days.

“I don’t want to say it was a check-a-box type experience, but, you know, we went through a few scenarios, and usually it was during training camp. Usually it would last about an hour,” Ellis said. “So we looked at everything, but it just wasn’t the level of detail.”

Ellis is quick to credit NFL Chief Medical Officer Dr. Allen Sills for this increased level of commitment since he took office.

“I can tell you as someone who has been to an event and organized one, more or less, they haven’t reached the depth and strength that they have now,” Ellis said.

During the debriefing that immediately followed each scenario, Clemency was joined by Bills Head Athletic Trainer Nate Breske and Medical Director Dr. Leslie Bisson to discuss what could be improved as well as what which went well.

There was also plenty of time for questions. On a few occasions, the staff talked about what would happen if the situation instead happened in Rochester during training camp. They reviewed the small differences Rochester presented, whether in personnel or facilities – a different configuration of the cooling tank, for example.

“Let’s think about all of this,” Bisson said, as the team took a few extra minutes to work out details, from the angle of the ramp to the position of the equipment truck.

No detail is too small when the stakes are so high.

“It’s critical, I think, because I mean, we’re not going to get a second chance if this happens,” Breske said. “You have to be able to react immediately. And we have to get it right. We have loved ones, people who count on us to do the right things and make sure the right things happen. And then we can get the results we want.

Several people have also compared the importance of repetition to the reps players get every day. Monday went well thanks to the wealth of expertise, but also the camaraderie that comes with working long hours together throughout the season.

“We have a great team that is taking this very seriously and making sure that we have the impact that we need in case an emergency situation like this arises,” Breske said.