Approach to Pitchside Cardiac Arrest

Team leader — brings: Phone or radio, and the completed PEAP sheet with the contact numbers.

• Player's LEFT side, level with the chest (PEAP black mark). Hands-off where possible.

Head · airway & cervical spine — brings: Laryngeal mask airway (i-gel) and bag-valve with reservoir.

• At the player's HEAD (PEAP orange mark). Hands stay on the head until the neck is cleared or fully immobilised.

Chest — brings: Nothing. First hands on the player.

• Player's RIGHT side, level with the chest (PEAP red mark).

Pelvis — brings: Oxygen cylinder.

• Player's RIGHT side, level with the pelvis (PEAP blue mark), next to Red.

Legs — brings: Scoop stretcher and splints.

• Player's RIGHT side, level with the lower legs (PEAP white mark), next to Blue.

Equipment · bag & AED — brings: FIFA Emergency Care Bag and AED.

• At the HEAD on the player's LEFT, with the FIFA bag and AED open beside you (PEAP green mark).

1 · Recognise (At once)

• Non-contact collapse = sudden cardiac arrest. Enter at once — do not wait for the ball to go out of play.
• Unresponsive to voice or touch. Gasping, slow breathing or slow seizure-like movements are cardiac arrest, not a fit.
• Red checks for signs of life: breathing and carotid pulse together, no more than 10 seconds.
• Black ensures the ambulance is called.

2 · Chest compressions (No delay)

• Red starts compressions in the middle of the chest: 5–6 cm deep, 100–120 per minute, full recoil.
• 30 compressions to 2 breaths until the i-gel is in.
• Airway and breathing are not the first priority in adult cardiac arrest: compressions and the AED come first.

3 · AED and shock (The moment it arrives)

• Green applies the AED as soon as it arrives — do not wait for the current 30-count. Red keeps compressing while the pads go on.
• Analysis: hands off. Shock advised: Green checks that everyone is clear and that oxygen is removed (it can stay on a closed loop such as an i-gel), then shocks.
• After the shock: no pulse check. Restart compressions at once.
• Rhythm check every 2 minutes; swap the person compressing.

4 · Airway and oxygen (Once CPR + AED are running)

• Orange inserts the i-gel (FIFA's adjunct of choice in cardiac arrest) and attaches the bag valve.
• Blue connects oxygen at 15 L/min to the bag reservoir.
• With the i-gel in: continuous compressions, one breath every 10th compression (about 10 per minute). If it leaks: 30:2.
• No i-gel: OPA or NPA with a face mask is a two-person technique at 30:2.

5 · Prepare the transfer (Planned before kick-off)

• FIFA's protocol: after the third shock and medications, the team leader considers extricating the player.
• Best: the ambulance comes onto the field to the player. Agree this before the match.
• Otherwise: log roll on Orange's count — Red chest, Blue pelvis, White legs — onto a long spinal board (a scoop can also be used).
• Strap the player, the board and the AED together as one unit.
• A mechanical chest-compression device, where available and the team is trained on it, is fitted before the move so compressions are barely interrupted.

6 · Stop-and-start carry (≤ 10 s each)

• On Black's command, lift and carry for no more than 10 seconds — Green counts out loud.
• Then put the player down and give at least 2 minutes of compressions before the next carry.
• Repeat until the player is inside the ambulance. Continue CPR en route.
• Destination: a hospital with 24/7 coronary angiography, agreed before the match.
• ALS if trained: adrenaline 1 mg IV after the 3rd shock (as soon as possible if non-shockable), then every 3–5 min; amiodarone 300 mg after the 3rd shock, 150 mg after the 5th.