Some of the fans who had attended the January 13, 2024 National Football League (NFL) playoff game between the Miami Dolphins and the Kansas City Chiefs in subzero conditions, in a game that became the largest livestreamed event in US history, have had to undergo amputations after suffering severe frostbite. Though these frostbites occurred nearly two months ago, many of the amputations only occurred recently after other treatment methods failed.

This information emerged last week when the Research Medical Center of Missouri issued a statement that it had been treating dozens of people who had experienced frostbite during an 11-day cold snap in January. Twelve of those people so far—including some who were at the January 13 game—had to undergo amputations involving mostly fingers and toes. Moreover, the hospital said more surgeries are expected over the next two to four weeks as “injuries evolve.”

The game, the coldest in Kansas City history and the fourth coldest in NFL history, was played in temperatures that dropped to minus 6 degrees Fahrenheit (-21 Celsius) with a wind chill of minus 27 (-33 Celsius.)

In anticipation of the subzero conditions, Arrowhead Stadium, where the game was played, opened warming stations around the stadium, offered free hot chocolate and encouraged fans to wear lots of layers to stay safe in frigid conditions. Fans also were allowed to bring heated blankets into the stadium and small pieces of cardboard to place under their feet on the cold concrete.

The efficacy of those measures was belied by the fact that the Kansas City Fire Department received nearly 70 calls for service during the game, with about half related to signs of hypothermia, according to Michael Hopkins, a spokesman for the department. 

Of those calls, 15 people were hospitalized, including seven for hypothermia and three for frostbite. The other five were hospitalized for injuries unrelated to the cold, Hopkins said.

The fire department’s numbers do not include other fans who sought help at an aid tent in Arrowhead run by the University of Kansas Medical Center, which reported that it had also treated a number of fans for frostbite.

Dr. Megan Garcia, the medical director of the Research Medical Center’s Grossman Burn Center, said in an interview with WDAF-TV that the Kansas City fans who came in with frostbite injuries had to schedule amputation surgeries after weeks of hospital treatment.

The treatment included rewarming the injured areas, applying antibiotics and thrombolytic therapy to dissolve blood clots and restore circulation, and hyperbaric oxygen therapy to boost oxygen to injured areas to reduce swelling.

Patients with frostbite experience “lifelong sensitivity and pain,” Dr. Garcia said, “and will always be more susceptible to frostbite in the future.”

Another playoff game scheduled for the next day between the Pittsburgh Steelers and the Buffalo Bills was postponed by one day because a blizzard had left up to two feet (0.61 meters) of snow in Buffalo and made traveling to the game too dangerous. 

The game in Kansas City, however, went on as scheduled despite the frigid weather, ostensibly because it did not present similar problems getting to Arrowhead Stadium, even though the National Weather Service warned of “dangerously cold temperatures” with windchills creating an added danger. 

According ESPN’s Marcel Louis-Jacques, the NFL claimed it elected not to postpone the game because there were “no public safety travel concerns for getting to the stadium” for fans, players, team or stadium personnel.

According to the NFL’s game operations policy manual, the stadium must have a snow and ice removal plan before the scheduled game in cold or snowy weather.

The manual goes on to say that if the “weather dictates, heated benches must be available to both teams and activate two hours prior to kickoff.” It does not, however, provide any guidance on whether to postpone the game in dangerously cold weather or how fans should approach extreme temperatures.

The conditions were so appalling that star quarterback Patrick Mahomes had to replace his helmet after it cracked because of the cold. Broadcasters took note of this, replaying video of the damaged helmet, but there was no discussion about what the same cold temperatures and wind chill were doing to the bones of the 70,000 spectators at the game.

The NFL conceals how its financial interests ultimately determine when and under what conditions games will be played. Besides not postponing a game that clearly should have been rescheduled, the league also refused to deviate from its previously scheduled kickoff time of 7:00 p.m. It could have at a minimum elected to start the game at an earlier time during the day when it would have been warmer. To do so, however, would have conflicted with the NFL playoff game between the Cleveland Browns and the Houston Texans that was scheduled for earlier that day.

During the playoffs, the NFL schedules its games so only one game is on at a time, thereby increasing the TV audience share and with it, broadcasting and advertising rates. 

To further complicate the matter for the NFL, both of these games were being broadcast by NBC and its streaming subsidiary Peacock. NBC is paying the NFL $2 billion per year for the rights to broadcast regular season Sunday night games and a limited number of playoff games.

On January 13, the Cleveland-Houston game was to be broadcast simultaneously on NBC and Peacock, but the Miami-Kansas City game was to be broadcast exclusively on Peacock, a first time for such an arrangement and a lucrative “jump-start” for NBC’s paid service. 

Peacock’s exclusive broadcast became the biggest livestreamed event ever in the US, with the game also driving record internet traffic. This broadcast, which was also available over-the-air only to NBC local stations in Miami and Kansas City, attracted nearly 28 million viewers, peaking at 24.6 million during the second quarter, and averaging 23 million. The figures also include out-of-home viewing and those streaming on mobile devices via the NFL+ app.

“We couldn’t be prouder of our partnership with Peacock and are thrilled with the results of the first-ever exclusively live streamed NFL playoff game,” said NFL commissioner Roger Goodell. “To best serve our fans, we need to ensure games are available to them as their viewing habits change and this includes digital distribution as we continue to help shape the future of the sports and entertainment industry.”

Goodell could have also thanked the freezing fans in attendance, some of whom are now missing fingers and toes, for providing the necessary background that served to enhance Peacock’s livestreamed presentation, and most importantly the NFL and NBC’s profits.