A new Swedish-led study found that Europe’s top football clubs need better treatment equipment and procedures in order to save lives of spectators who have heart attacks in large crowded venues while watching a sporting event.The study is the work of corresponding author Dr Mats Borjesson, associate professor of cardiology at Sahlgrenska Academy in Goteburg, Sweden, and colleagues, and is published online before print in the 3 March issue of the European Heart Journal.

Most of the researchers work as club doctors for some of Europe’s top football clubs and sports teams. For instance, Borjesson is a club doctor with GAIS, the Swedish premier division football team and also for the Swedish national women’s football team; Luis Serratosa is a club doctor with Real Madrid, Antonio Pelliccia is with the Italian Olympic team; and Klaus-Peter Mellwig is with the German national handball team.

Borjesson, who is also chairman of the sports cardiology section of the European Association of Cardiovascular Prevention and Rehabilitation (EACPR, which part of the European Society of Cardiology), told the media that they got the idea for the study from their work as club doctors, where it appeared to them that “the level of cardiovascular care available at sports arenas was varying, unknown and had not been studied specifically in Europe”.Borjesson and colleagues investigated 187 top European arenas used by 190 top soccer clubs in ten countries. They found that more than one in four did not have automated external defibrillators (AEDs) on site, and an even greater proportion had neither medical action plans nor basic or advanced training programmes for cardiopulmonary resuscitation (CPR).

The data they collected covered the 2005-6 season, during which no players or officials suffered a heart attack, but among spectators 77 heart attacks were recorded, equal to around 1 for every 589,000 spectators.

Borjesson said:

“Our study shows that many of these sports arenas are not adequately prepared to deal effectively with heart attacks among the spectators.”

“We believe that formal recommendations are needed urgently to improve safety for spectators and players. At the highest levels of sport, recommendations should be mandatory,” he urged.

Borjesson suggested the current inadequate situation is probably due to a lack of attention to safety rather than lack of funds, especially when you consider that the arenas they looked at belonged to top clubs with good resources.

“At present, there are no formal recommendations about cardiovascular safety procedures at sports arenas in Europe and there still appears to be a lack of knowledge in the non-medical part of the sport. Both education and recommendations in this regard are needed,” said Borjesson.For the study, the researchers sent out a survey to the ten participating countries via those countries’ members of the EACPR sports cardiology section.The 12-question survey asked about the average number of spectators and number of heart attacks registered during the full 2005-6 season, whether AEDs were available at the events, whether medical action plans existed, how many emergency staff were present, how much training they were offered and received, and travel time and distance to the nearest hospital.

A total of 190 clubs (135 in the top leagues and 55 in the second or lower leagues) responded: 37 from England, 29 from France, 25 from Holland, 24 from Spain, 21 from Sweden, 16 from Greece, 14 from Norway, 9 from Serbia, 8 from Austria and 5 from Italy. The number of arenas was 187 because a small number of the clubs shared the same arena.

The results showed that:

* 137 of the 190 clubs (72 per cent) had AEDs.

* 122 (64 per cent) of them had a written medical action plan for a sporting event.

* 123 (65 per cent) had a basic CPR training programme.

* 48 (26 per cent) had an advanced CPR training programme.

* 1 in 4 of the clubs that were more than 5 minutes away from the nearest hospital had no AEDs.

* There was an estimated minimum of 45 million spectators for the season of study, giving an incidence rate of one sudden cardiac arrest for every 589,000 spectators.

Borjesson said that the lack of AEDs at the clubs that were more than five minutes travel time to the nearest hospital was particularly worrisome because the goal of AED is to use it within 5 minutes of a heart attack.

But he also said there was no point in a club having AEDs at all if the staff weren’t trained how to use them, so the lack of medical action plans and training was also a serious concern.

He told the press that we already know from research that watching and being emotionally involved in a game of football increases the chances of people having heart attacks, particularly when they are middle-aged or elderly.

“Our study confirms that spectators, in addition to the athletes, need adequate emergency medical procedures in place and, indeed, they could represent the primary target for cardiovascular safety programmes in sports arenas, because they outnumber the players,” said Borjesson, intimating that this could be just the tip of the iceberg:

“As football is the biggest and best resourced sport in Europe, the situation may be even worse at venues for other types of sports.”

Source: European Society of Cardiology.