The effective implementation of these guidelines will require the cooperation of several agencies, including competition organisers, the host venue and team, independent medical providers, health system resources and national sports governing bodies.

A comprehensive emergency action plan is a crucial part of the prompt and effective response to an athlete who has had SCA.41 We recommend the development of an emergency action plan based on relevant field-of-play regulations for that sport and its international federation, and up-to-date risk assessments of the sports activity and venue(s) in question. The emergency action plan should be reviewed and rehearsed on a regular basis. A suggested emergency action plan is provided in box 1.

How athletes, team, venue and match officials recognise possible SCA when someone collapses on the field of play.

The location or staging point of the field-of-play medical team, and how they will gain access to a collapsed athlete safely and rapidly.

The nature of a pre-event medical meeting to review the EAP and its implementation.

Who will perform CPR and defibrillation.

Who will purchase and maintain defibrillator(s) and make them immediately available when needed.

Whether to use an AED or a manual defibrillator.

Location of all AED and who will retrieve the closest one in case of an emergency.

How to maintain the safety and dignity of the athlete during initial resuscitation and when moving them from the field of play.

How to perform essential interventions on the field of play following SCA.

Which advanced interventions to perform on the field of play, and how to perform them, following SCA.

Moving an athlete from the field of play and transporting them to a hospital:

Mode of transport.

Positioning of a waiting ambulance relative to the field of play—including if ambulance can come directly onto field of play or not.

Immediate destination after leaving the field of play.

Geographical location (eg, GPS) if additional medical resource are required.

How protocols should differ for sport-specific special circumstances, for example:

Moving an athlete to a place of safety and using rescue aids, where necessary, following collapse in water.

The possibility of traumatic injury and danger to rescuers in equestrian events and high-speed events.

How protocols should differ for participant-specific special circumstances, for example:

The composition of the field-of-play medical team(s):

Number of people.

Expertise and skills.

Team leadership

Role during the response and positioning around an athlete who has collapsed.

Provision of appropriate medical equipment.

Positioning of and access to medical equipment, including that carried immediately to a collapsed athlete and more advanced equipment that might be needed subsequently.

Communication issues:

Between team leader and team.

Between different teams.

Devices (eg mobile phones, radios), including provision for remote areas and back-ups should primary communication methods fail.

The need to have clear guidelines about the different roles and responsibilities of field-of-play medical team(s) and other team(s) tasked with dealing with medical emergencies in the crowd and/or surrounding environs. The need to have clear guidelines about offering appropriate debriefing and support to athletes, officials and others who have witnessed or helped treat someone in cardiac arrest.

SCA also may occur on the field of play during training as well as during competition. Athletes may train (at training venues) far more than they play (at a competition venue) and the availability of field-of-play medical teams at different venues may not be the same. Emergency response plans should consider this. For competitions, a pre-event medical meeting should gather medical and emergency care personnel prior to a competition to review the emergency action plan and enhance coordination before an emergency occurs. This meeting, also referred to as a pre-event ‘medical time out’, should include home and visiting team medical personnel, venue medical staff and officials, and emergency care personnel.42

Organisations should also have detailed plans about training for the dedicated teams that respond to an athlete with SCA, including the content of training and the frequency with which training is provided. Some sports will already have specific directions about the composition and training of the field-of-play medical team(s). Training should be consistent with current resuscitation guidelines and include:

There should also be plans for training other people who may witness an athlete collapsing on the field of play, such as team, venue and match officials, which include details about frequency and content of refresher training. This training should include, at a minimum, recognition of SCA in the field of play, delivery of high-quality chest compressions and familiarisation with and use of an AED. There are several virtual or online resources that demonstrate what SCA can look like,43 including on the field of play.44

Field-of-play officials and venue managers should have an understanding of the principles guiding the transfer of a collapsed athlete from the field of play and transport to a hospital.