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Death of Italian Soccer Player

April 27, 2012

Death of Italian Soccer Player Leads to Major Investigation

Livorno midfielder Piermario Morosini died after suffering cardiac arrest during his team's Serie B match at Pescara on Saturday. The young player's death has shocked the football community, who, only a few weeks ago, witnessed another dramatic cardiac arrest incident involving Bolton midfielder Fabrice Muamba.

Comparisons between the two cases are inevitable and are already underway. Many questions are already being raised about the level of preparedness and the scope of the emergency procedures at Pescara and, by contrast, the efficient response in England.

When carefully reviewing the video footage of the scene in Italy, you can clearly see that confusion was the rule. It seemed as if the emergency effort was the product of major improvisations, with no prior planning. An ambulance, for example, was delayed by three minutes outside the Pescara stadium because a city traffic police car was parked in front of the emergency passageway. Pescara prosecutor Valentina D'Agostini is investigating to see if this delay may have cost Morosini his life.

Video footage also shows chaos as a number of people surrounded Morosini, presumably attending to his medical needs. Looking at comparable footage of Fabrice Muamba's cardiac arrest in England, you get a sense that those emergency procedures were executed with a level of professionalism, organization, and calm that were absent from the fallen Italian player's situation.

When I asked Italian cardiologist Dr. Stefano De Servi, a world renowned Italian cardiologist and author of several research articles, if he thought a contingency plan was in place in the Pescara stadium to deal with such incidents, he told me that from the video footage it seemed that the unexpected event created chaos in the field with possible repercussions on the rescue procedures. There are also more specific issues related to the emergency effort that need to be addressed.

At the moment, there is much confusion as to exactly when Morosini was connected to a defibrillator (a machine that shocks the heart back to a normal rhythm).It is not clear from the video footage if Morosini was connected to the defibrillator on the field or only when he was already in the ambulance. When I raised this possibility to Dr.De Servi he told me it was a fair question and an issue that is pertinent to the incident. He went on to say that from the video footage it is not clear if the defibrillator was used or not. "It also seems that the electrocardiogram of the player was not monitored when he was taken out of the field", he said.

Morosini was carried off the field and into the ambulance with his shirt still on and intact. Usually in an emergency situation involving cardiac arrest, rescue personnel waste little time and cut open any clothing covering the victim's upper torso in order to access bare skin and begin defibrillation, because the positioning of the patches is essential to ensure maximum conductivity. At no point did the rescuers "clear" away from Morosini, which suggests that he was not defibrillated on the pitch. If Morosini's heart showed electrical activity while he was on the pitch, then rescuers missed a valuable opportunity to shock the player's heart back into rhythm.

Dr. Ernesto Sabatini, one of the doctors who treated the player, told the Italian press that after a cardiac arrest the clinical treatment in the first couple of minutes should consist of CPR. However, this is only the case when cardiac arrest occurs outside the hospital and is not witnessed by EMS personnel. However, in situations where a cardiac arrest is witnessed by rescuers and a defibrillator is available - as was the case involving Morosini - there is no need for CPR to be performed a few minutes prior to defibrillation. In such a scenario, a defibrillator should be immediately activated.

In these circumstances, the guidelines issued by the internationally-regarded American Heart Association, state that the victim should be connected to the defibrillator as soon as one is available. Morosini should have been connected to the defibrillator immediately on the pitch.

Whether he was going to be defibrillated or not is a different question. Being connected to the defibrillator does not necessarily mean that you will automatically be defibrillated. That will only happen if the device detects that the heart has a shock able rhythm.

The cases involving Piermario Morosini and Fabrice Muamba may offer invaluable information about how an emergency rescue operation involving cardiac arrest should be conducted. Muamba was stabilized on the pitch for several minutes before being taken to the ambulance. In contrast, Morosini was rushed to the ambulance - potentially without being connected to a defibrillator - even though it is considerably more difficult to stabilize a victim in a fast-moving vehicle than on solid ground. Morosini also may have lost critical seconds when CPR was interrupted; in these situations, every second is crucial. There is no room for mistakes or improvisation.

There are still many unanswered questions. The Pescara prosecutor's office, in addition to investigating the ambulance that was impeded from entering the stadium, should also examine the emergency procedures that attended Morosini. Only then may we be able to obtain the necessary information to put efficient and uniform emergency protocols in place around the world.

The fact that FIFA has not adopted or does not have in place policies and mandatory uniform emergency protocols followed by all countries under its jurisdiction, is simply a shame. Every player deserves the same chance of surviving cardiac arrest, and Piermario Morosini was denied his.

(Ricardo Guerra is an Exercise Physiologist. He has a Masters of Science in Sports Physiology from the Liverpool John Moores University. He has worked with several clubs and teams in the Middle East and Europe, including the Egyptian and Qatari national teams. The writer can be contacted at rvcgf@yahoo.com.)