What can sport learn from Eriksen’s cardiac arrest?

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June 20, 2021
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    Christian Eriksen's on-pitch cardiac arrest in the opening week of Euro 2020 has put the provision of defibrillators in sport and screening of athletes into sharp focus.

    The distressing scenes in Copenhagen got many people thinking about where the nearest defibrillator to their local sports club is, whether they know how to perform CPR, and what the risks are.

    Studies suggest athletes with an underlying cardiac disease are about two-and-a-half times more prone to dying than someone who has the same disease and doesn't do sport.

    BBC Sport & new BBC Sounds podcast The Sports Desk took a look at the situation in England.

    What is the situation in English football?

    Defibrillators are mandatory at all grounds down to step four of the National League system. Below that, it's understood that about 90% of clubs at steps five and six have one.

    The Football Association has been working with a company to get defibrillators for grassroots clubs heavily subsidised.

    But because, according to FA rules, it isn't compulsory at grassroots level to have a defibrillator, it will be up to the clubs and local authorities whether they have one in place or whether they're using one in the local community.

    Some people think more can be done, with 51 cross-party MPs and peers writing to FA chief executive Mark Bullingham, calling for the organisation to fund defibrillators fully.

    Bullingham told the BBC's Today programme on Friday the FA is in an "OK place" on defibrillator coverage, and is "re-checking all figures" in community football, describing "good coverage in some areas and coverage that we need to improve on in others, which we're looking at right now".

    What has been the reaction?

    Unsurprisingly, there's been a huge spike in people seeking out information on cardiac arrest, with Eriksen's incident a stark reminder that young, fit people can still be at risk.

    The British Heart Foundation (BHF) said that in the five days after Eriksen's collapse, views to pages on its website on defibrillators and how to do CPR increased by more than 2,000%, and it saw record defibrillator sales.

    However, the BHF highlighted there is no clear network on the number and location of defibrillators in the UK.

    The charity is trying to address this by launching a new service called The Circuit, but said currently there are tens of thousands of automated external defibrillators (AED) not known about by the ambulance service.

    Dr Rob Cooper, a consultant at Liverpool Heart and Chest Hospital and the pitchside cardiologist for Liverpool FC told the Sports Desk Podcast: "This is an opportunity to raise the shortage of defibrillators in the public perception. Around 12 people under the age of 35 will suffer sudden cardiac death every week. These are preventable if they have access to defibrillators.

    "Public access defibrillators are only used in about 5-10% of out-of-hospital cardiac arrests. The UK coverage is patchy and one of the issues is that there is no combined central database to know where every defibrillator is. London has about three per square kilometre, Seattle has about 13 per square kilometre, so we are underserved.

    "I'm also a coach for an under-9s football team and most of the venues we go to play do not have a defibrillator. There is a lot of work to do in this regard."

    What might change?

    The FA told BBC Sport it hopes what happened to Eriksen will prompt sports organisations to review their emergency action plans to make sure they are up to date.

    UK Coaching has called for AEDs in every sports ground, while Bournemouth captain Steve Cook has bought a defibrillator for his local non-league football club.

    And the England and Wales Cricket Board has told BBC Sport it has agreed to give a £400,000 grant to the Club Cricket Charity, which will enable 600 defibrillators to be distributed to the cricket network.

    That's been in the pipeline for several months but demonstrates the work being done in this area.

    Eriksen collapse 'brought back a lot of emotion'

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    What about some other sports?

    There isn't a regulator or legislation that governs all sports on this, so the sports are responsible for working out their own minimum standards, and liaising with clubs and facilities in terms of implementing them.

    There is funding and training made available by Sport England.

    It seems that defibrillators are mandatory at grounds and stadia in most professional sports in England, including football, rugby league, rugby union and cricket.

    In rugby league, for example, there was a lot of focus on this area after the death of Wales international Danny Jones in 2015 during a game playing for Keighley Cougars.

    Racecourses typically have more than three defibrillators on site for horse race meetings.

    And the London Marathon told BBC Sport they have more than 120 defibrillators on the course.

    But UK Coaching have called for AEDs in all sports grounds, not just at the professional or elite level.

    The Resuscitation Council say only 3% of cardiac arrests happen within the recommended retrieval distance of a defibrillator.

    How rare is this kind of incident?

    Leading cardiologist Professor Sanjay Sharma said that what happened to Eriksen is "rare".

    In 2018, the results of a study he led into more than 11,000 footballers aged 16 and 17 were published, showing the risk of sudden cardiac death was one in 14,700. That just looked at young players, and across all the literature on this it seems the most cited figure is one in 50,000 for all athletes.

    Athletes with an underlying cardiac disease are at a slightly higher risk of dying than someone who has the same disease and doesn't do sport, because of the extra work the heart is doing. But clearly there are huge benefits of doing sport too.

    Dr Cooper added: "If somebody is in cardiac arrest… trying some form of resuscitation is better than not trying anything at all. Chest compressions and CPR are relatively easy to do and there are excellent resources on the British Heart Foundation website, Resuscitation Council UK, Sport England and the FA websites. They all have video to teach you how to do chest compressions and that's really important to allow you the time to get a defibrillator there.

    "Using a defibrillator can seem scary because it's electricity – but with public access defibrillators you cannot do any harm. You put the paddles on the chest and you follow the instructions that are written on the box and are also spoken out to you. Trying is better than not trying."

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