Sudden Cardiac Arrest / Pre-competition medical assessment

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Sudden Cardiac Arrest

Following the tragic death of Marc Vivien Foé during the FIFA Confederations Cup 2003 France, FIFA has been fully committed to a programme of research, education and practical implementation to prevent and manage emergency cardiac arrest on the football field. The pre-competition medical assessment (PCMA) has been routinely implemented for all FIFA competitions. It has also been adapted for the routine examination within the Member Associations in accordance with the international accepted guidelines and recommendations (see below).

IOC Medical Commission, 10 December 2004

Lausanne Recommendations for Sudden Cardiovascular Death in Sport

Preparticipation cardiovascular screening for athletes under 35 years starting to compete should include:

Step One

– Personal history taking (see table)
– Family history taking (see table)
– Physical examination with palpation of pulses and heart auscultation
– 12-lead rest ECG

Step Two

Selected cases with a suspicious finding on personal history, family history of potentially inherited cardiac disease, or with suspicious physical or ECG findings in Step 1 require further evaluation by an age-appropriate cardiac specialist to qualify the athlete for sport participation.

Examples of important questions to the player
Have you ever fainted or passed out when exercising?
Have you ever had chest tightness, cough, or wheezing which made it difficult for you to perform in sports?
Do you have or have you ever had racing of your heart or skipped heartbeats?
Do you get tired more quickly than your friends do during exercise?
Have you ever been told you have a heart murmur, a heart arrhythmia, rheumatic fever?
Are you taking any medications at the present time?
Has anyone in your family under the age of 50 years old died suddenly and unexpectedly?
Has anyone in your family been treated for recurrent fainting?
Has anyone in your family suffered unexplained drowning while swimming?
Has anyone in your family had an unexplained car accident?
Has anyone in your family had heart surgery?
Has anyone in your family experienced sudden infant death (cot death)?

Some of the questions to be asked to a player as recommended by the IOC

FIFA 11 steps to

Prevent SCD

A clear protocol has been developed and applied for field of play for the recognition, response, resuscitation and the removal of the player under sudden cardiac arrest. FIFA and F-MARC are committed to protecting the health of players worldwide by formulating the FIFA 11 steps to prevent sudden cardiac death in football and providing the FIFA Medical Emergency Bag (FMEB), including an automated electric defibrillator, to all 209 Member Associations. The FIFA 11 steps reflect the insight that a consistent approach to prevention, planning and protocol are of utmost importance when it comes to managing life-threatening medical emergencies on the field. The specialists agreed that a pre-participation screening, which identifies athletes with pre- existing conditions placing them at risk of SCD should be universally supported, and that a Pre-Competition Medical Assessment should be routinely undertaken.

  • PCMA – Player Medical History (PMH), Family History, and Physical Exam
  • ECG – 12-lead, resting, supine; initially + every year
  • Echocardiography – where necessary and at least once in the early career
  • Exercise Test where necessary and in athletes > 35 years old
  • Training and Equipment
  • CPR + AED training yearly for team staff and referees undertaken
  • FIFA Medical Emergency Bag available and checked
  • Emergency Medical Plan – roles and responsibilities allotted; on field response practiced and rehearsed at least once annually
  • Field-side medical team qualifications + logistics confirmed
  • Ambulance location and logistics confirmed
  • FIFA Medical Emergency Bag with AED in position and checked
  • Field-side Medical Team in position (games)
  • Ambulance, fully functional, in position (games)
  • Immediate recognition of collapsed player
  • Assume SCA if collapsed and unresponsive
  • Seizure activity and/or agonal respirations = SCA
  • Activation of Emergency Medical Plan
  • Early CPR and AED application
  • Start chest compressions
  • Retrieve, apply, and use AED as soon as possible
  • Early planned transition to Advanced Life Support

emergency planning

for SCA on the pitch

FIFA and F-MARC propose a standard for emergency preparedness and medical response to serious or fatal on-field injuries in football (Recommendation for emergency planning for SCA on the pitch).

It has been reported that lives have been saved by using this equipment or as a result of educational courses provided by FIFA and/or the Member Associations.

Life-threatening medical emergencies are a rare but possible event in football, however, sudden cardiac arrest (SCA) remains the leading cause of death during football. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent fatal outcomes.

Recommendations for emergency planning for SCA on the pitch
Every team and venue hosting football training or a competition should have a written emergency response plan for SCA.
Potential responders to SCA on the field (i.e. coaches, referees, physiotherapists, athletic trainers, and other medical staff) should be regularly trained in cardiopulmonary resuscitation and AED use, and demonstrate skills proficiency in this regard.
An AED should be immediately available on the pitch during competitions.
Both teams should review prior to the match the location of the AED and details of the emergency response plan.