COLLABORATION. During the 2022 FIFA World Cup, FIFA has continued to evaluate a standardized protocol that will better prepare the medical team for incidents that may occur on the pitch. One of those invited to Qatar by FIFA to implement the protocol in the role of Venue Medical Officer (VMO) was Mats Börjesson, a professor at the University of Gothenburg and experienced team doctor.
The sports cardiology section of the European Society of Cardiologists has long worked on ways to reduce the risk of sudden cardiac death in connection with sports activities. Step by step, the society’s recommendations have been implemented in sports to increase medical safety in large stadiums. The new protocol for the International Federation of Association Football (FIFA) can be regarded as a result of this long-standing work based on sports medicine research.
Doctors with special assignments
The protocol now being tested by FIFA is called FIFA Poster for Emergency Action Planning (PEAP) and could represent the next step in the development of stadium safety. At the obligatory match meeting, the day before kick-off, everyone involved in the match goes through the procedures that apply during the match day, including how various medical events are to be handled. The protocol places great emphasis on preparation. Each participant on the teams’ medical staff can have specific assignments so that everyone knows “who is doing what.”
The protocol also introduces the new leading role of the FIFA Venue Medical Officer. Mats Börjesson was one of eight international, highly experienced team doctors invited by FIFA to assume this coordinating role during the World Cup, in his case at the Ahmad Bin Ali stadium, which holds 44,000 fans.
“The team doctors ultimately have medical responsibility for their players, and they decide what role they want to play regarding medical safety. They are also the ones who make medical decisions for their players. A Venue Medical Officer hired by FIFA coordinates the process among the team doctors and the emergency response staff on the sidelines,” says Mats Börjesson, who has just returned from his FIFA assignment in Qatar.
“I had the impression that many team doctors from different countries appreciated the function of a Venue Medical Officer. But it is important to remember that it is FIFA that ultimately evaluates the protocol and decides whether to use the method during major tournaments.”
Second trip to Qatar
FIFA invited Mats Börjesson to Qatar last year. At the time, he had the same coordinating role during the Arab Cup, which is the Arab world’s equivalent of the European soccer championship. The experience and statistics from this championship resulted in a publication showing that there were an average of 1.8 incidents per game that could lead to concussions in the tournament. When they were not sitting with the emergency medical staff on the sidelines, FIFA’s Venue Medical Officers had another assignment in the press gallery, as they did during this World Cup:
“We can carefully study filmed incidents on the pitch from angles that the team doctors may not have been able to see from their position on the pitch. We make them aware of whether someone receives a punch or a kick to the head that should be assessed and whether the players show indications of concussion to be evaluated before they could continue playing.”
Positive development in Sweden
Mats Börjesson has extensive experience as a team doctor during many major tournaments, such as the European Championships, World Championships and the Olympics, including with the Swedish women’s national soccer team. He holds a professorship in sports physiology specializing in sports cardiology and public health at the University of Gothenburg. He says that Sweden is well ahead when it comes to medical safety for athletes at the elite level. During the 1990s, there were some high-profile cases where young athletes died of sudden cardiac arrest. A few years ago, Börjesson, together with other researchers, demonstrated that the number of cases has since been cut in half in Sweden.
“We do not know exactly what caused the most fatalities, but there have been several changes in recent years that have probably been significant. On the one hand, both knowledge about cardiac arrest and the availability of defibrillators have increased sharply. In addition, it is now recommended that all elite athletes from 16 years of age undergo a screening to catch unknown hereditary heart defects, which are usually the underlying reason that athletes under the age of 35 experience cardiac arrest.”
- FIFA’s standardized protocols are described in an editorial in the British Journal of Sports Medicine: “Set-piece approach for medical teams managing emergencies in sport: introducing the FIFA Poster for Emergency Action Planning (PEAP)”; https://doi.org/10.1136/bjsports-2021-105126.
- The study showing that sports-related sudden cardiac death has been cut in half among young people in Sweden was published in 2019; DOI: 10.1016/j.resuscitation.2019.09.022.
- The consensus document on cardiovascular safety in sports arenas by the European Society of Cardiology (Mats Börjesson et al.; DOI: 10.1093/eurheartj/ehr178.
BY: ELIN LINDSTRÖM
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