I am writing this article from the medical room of the Mordovia Arena in Saransk, Russia. I’m the FIFA Venue Medical Officer stationed here during the 2018 FIFA World Cup.

‍

One of our primary concerns as doctors covering major sporting events relates to being prepared to manage significant medical events. One of these is a sudden cardiac arrest (SCA). While this is a relatively rare event, there is, on average, one SCA per month among professional football players. As a result, it is important to be prepared. At this stadium we have AED’s (and other emergency medical equipment) available, have trained medical staff and have held extensive practice sessions.

‍

While treating an SCA is important, it may also be possible to prevent this from occurring. One way that this can be done it by conducting a comprehensive pre-competition medical assessment (PCMA). All players (and match officials) who attend the FIFA World Cup have completed this comprehensive assessment. The PCMA involves:

• A medical assessment (visit with a doctor)
• An electrocardiogram (ECG)
• An echocardiogram (echo)
• A panel of blood tests

‍

The FIFA PCMA divides the medical history into three sections; a general evaluation, orthopaedic assessment and a cardiovascular evaluation. A comprehensive orthopaedic and cardiovascular examination is conducted along with a more general medical examination (including height, weight, palpation of the thyroid gland, lymph nodes/spleen and abdomen, percussion of the lung). It is common to identify pre-existing musculoskeletal conditions during this assessment and to be able to initiate a management plan to limit the risk of future injury. The medical assessment also gives clinicians an opportunity to get to know their players better, to identify any possible doping control issues (and to apply for therapeutic use exemptions as needed) and to look for ways to improve performance.

‍

The aim of the ECG and echocardiogram is to try to detect an underlying cardiac condition – that may not have been identified during the medical evaluation. The ECG measures the electrical activity in the heart and can be a very effective way of identifying both structural heart disease as well as conditions that affect the conduction of electricity within the heart. The echocardiogram is an ultrasound scan of the heart. It can be used to define the heart anatomy and look for a structural abnormality. In some cases, a cardiac MRI or exercise test might also be needed.

‍

Finally, the blood tests may reveal the presence of an underlying medical problem, deficiency or risk factor for health problems. In general terms, the likelihood of identifying severe diseases is low – and is generally overestimated by players and coaches. An example of the potential utility of laboratory tests involves the assessment of iron status. It is known that in athletes who have very low iron stores (ferritin) there may be a demonstrable reduction in performance. This can be corrected with either iron supplementation or through changes in diet.

‍

To learn more about the FIFA PCMA, register and logon to the FIFA Diploma in Football Medicine. There is a module dedicated to the PCMA including how this is done at FC Barcelona.

‍