JOHN DOHERTY: Stumbling on steps in standards

2014-02-03T21:00:00Z JOHN DOHERTY: Stumbling on steps in standardsJohn Doherty Sports Medicine
February 03, 2014 9:00 pm  • 

“Football is the most popular sport in the world,” reads the opening line in an article forwarded to me by Medscape last month.

“Medical emergencies on the football field are not common,” it goes on.

However, the “football” to which the article refers isn’t the game for which our nation stopped and watched two days ago. The article appeared in the British Journal of Sports Medicine.

Football in Britain is soccer to us. Even so, whether the sport is soccer or American football, medical emergencies are common enough. That is why the article goes on to “promote a standardized and consistent level of … care on the football field.”

That proposed standard is encapsulated in the article’s title: “The FIFA Medical Emergency Bag and FIFA 11 Steps to Prevent Sudden Cardiac Death.”

Federation Internationale de Football Association is the worldwide governing body for all levels of soccer. It sets the rules of the game and is the sponsor of the World Cup.

The medical kit mandated is what one would find in an advanced life support (ALS) ambulance.

The “11 Steps” are equally demanding, some more reasonable than others. Most controversial would be step two, the insistence on an annual electro-cardiogram (EKG).

“No, I don’t think every year is necessary (for an EKG),” says Munster cardiologist Amy Bales, MD, who offers a unique perspective as the parent of a high school soccer player.

However, Bales also differs with the current American standard that insists only on an annual physical. “Every child should have a screening EKG by high school age,” she says. “HCM (hypertrophic cardiomyopathy) is never picked up on a (physical) exam.”

HCM, the most common cause of sudden death in sports among high school and college-age athletes, occurs in one out of every 500 people.

The first symptom, all too often, is sudden death.

Aside from the annual EKG, Bales says the concept of the 11 steps is appropriate.

Step one is an annual physical exam.

Step three is an echocardiogram when necessary and at least once early in one’s career. Unlike an EKG, financial and human resources would factor in meeting this demand.

Step four seeks CPR & AED training for team staff and referees. Bales particularly likes the idea of referees being CPR-trained. “Then you are certain that someone is there, even at the lowest youth levels, until an ambulance arrives,” she says.

Step five insists on an ambulance at every game. “Once the competitive level gets high enough, like high school, yes,” says Bales. “But are you going to have an ambulance for 5-year-olds? That’s an overuse of resources.”

Step six refers to having the FIFA Emergency Bag and AED “in position.” Bales endorses the presence of an AED at every soccer game but finds the sophisticated and expensive equipment in the bag unrealistic. “It’s a lot to expect to have somebody there who can perform ALS. You can manage the airway with a bag and a mask until an ambulance arrives. As long as people know basic life support, that is enough,” she concludes.

The remaining five steps outline just that, basic life support, starting CPR and early use of an AED.

Nobody can argue with that.

John Doherty is a certified athletic trainer and licensed physical therapist. This column reflects solely his opinion. Reach him at Follow him on Twitter @JDohertyATCPT.

Copyright 2014 All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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