by Richard Brook

A little over a week ago, Andrew Deaner, the consultant cardiologist, and fan of Tottenham Hotspur who raced onto the pitch to aid Fabrice Muamba, spoke the words that British football had dreamed of hearing since March 17th; “His life is not in danger”.

The collective relief of the football community was palpable, that a tragedy both personal and public had been averted. Much has been spoken and written in the time since Muamba’s startling on-field collapse, about the screening programs that professional footballers undergo. The consensus seems to be that the current screening is at least adequate, with a few calls to increase the regularity of screening.

Fabrice Muamba was given a clean bill of health following a cardiac screening in August.

It would be remiss to call the screening program into question, instead the question is; are there other factors, in the life of a modern footballer that are causing an increased incidence of fatalities as a result of cardiac incidents, on the football field?

There were no recorded instances of a footballer, on the books of a British club, dying as a result of heart problems on the pitch between 1906 and 1990. Indeed the 1906 case, involved David “Soldier” Wilson of Leeds City (a club that existed until 1919). The player was reputedly a heavy smoker, and against advice attempted to re-enter the field of play after having left the field due to the pains in his chest. This seems a million miles away from the professionalism displayed by, and the healthcare available to, a modern professional footballer.

Why then have we seen three cardiac incidents that were either fatal or near-fatal, involving British-based players, in the last nine years?

While on-loan at Manchester City in 2003, 28 year old Marc Vivien Foe collapsed and died during a Confederations Cup semi-final between Cameroon and Columbia. In the 72nd minute of the tie Foe, with no player close to him, fell to the floor in the centre circle. Attempts to resuscitate the player, both on and off the field, were unsuccessful. Foe died shortly after arriving at the Stade de Gerland’s medical centre. City were among a number of his former clubs to retire Foe’s shirt number.

In 2007 Motherwell’s former Celtic and Sheffield Wednesday midfielder Phil O’Donnell passed away on the pitch under similar circumstances. On 29th December, during a 5-3 win against Dundee United, O’Donnell collapsed just as he was about to be substituted. He died on the way to the hospital, aged 35.

But for the quick actions of various medical personnel, Muamba’s own inner strength and a large slice of luck, he might have been tragically added to the list. On 17th March 2012, in the first half of Bolton Wanderers’ FA Cup quarter final with Tottenham Hotspur, Muamba went down with no-one around him and it immediately became clear that something was very wrong.

Football has prayed for Muamba, and we have had our “miracle”, and may that continue to its fullest conclusion.

Bolton’s club doctor, Jonathan Tobin later confirmed that Muamba had had 15 shocks to restart his heart before reaching the hospital and all told the 23-year-old’s heart had stopped for 78 minutes. Tobin also commented that “early signs of a good recovery” were positive.

Speaking of his dramatic rush from the stands to the pitch, Deaner said “something just twitched in me, I just ran on… When you see a cardiac arrest the adrenalin just starts pumping”. On Muamba himself Deaner stated that the recovery was highly unusual even for a very fit 23-year-old. Deaner went on: “If you’re ever going to use the word miraculous, it should be used here”. When men of science start using the word ‘miracle’, in however qualified a form, it is clear that something very unusual indeed has occurred.

Encouragingly the cardiologist now in charge of Muamba, Dr Sam Mohiddin, has stated that “a full recovery remains in the spectrum of things we could hope for”.

It isn’t just fans and wannabe football writers that are acknowledging the divide between past and present when it comes to cardiac arrests on the field of play. Former England international Viv Anderson tweeted: “In my day, if you turned up with a pair of boots and could run around you’d be playing. There was no such thing as screening. But like Kevin Keegan said on TV, I never remember anything like what happened to Fabrice, ever, in all the years I played”.

Of the reported cases of players based in Britain, dying on the playing field, the training pitch or resulting from something that occurred on the pitch, up to 1990 11% were related to cardiac events. Post 1990 this figure is 100%. Worldwide the figure up to 1990 is 24% (with a significant portion of those occurring from the mid-1970’s onwards), compared with 56% since that date (this figure would rise to 72% if you include players that collapsed and died, with no reason given).

It appears remiss that the authorities are not calling for a complete review of modern footballer’s lifestyles. By current standards of awareness there is no surprise that a heavy smoker, rejoining a match while having a heart attack, passed away, but for the incidence of such tragedies to be on the increase amongst the modern super-fit athletes that play the game today seems bizarre.

Today’s players undertake more fitness training than ever before, they adhere to specifically tailored diets, they spend more time in the gym than their predecessors and by and large live a more professional lifestyle. Is the issue that they are trained too hard? Is the intense pressure both to perform and of the media glare too great, causing a rise in stress levels? The answers are not apparent, but surely one, or more, of the footballing authorities with the resources should be researching these issues?

On Monday FIFA’s chief medical officer, Jiri Dvorak, promised that cardiac arrests in football would be on the agenda at FIFA’s medical conference in Hungary, in May. However, Dvorak’s comments seemed primarily focussed on screenings. A more holistic view of the demands on the modern football player might also be beneficial.

There is no implied criticism of the screening system. It is a sign of how seriously the governing bodies are taking the issue. Of course a number of the players mentioned by name and those included in the statistics had pre-existing heart conditions, but surely the players of the past also must have carried these latent ailments, and played with them, with far fewer casualties. What has changed to bring about the increase in such incidents?

Football has prayed for Muamba, and we have had our “miracle”, and may that continue to its fullest conclusion; however we cannot rely on the next player being so fortunate. We must hope that football’s authorities are working with more scientific means to establish a prevention that is better than the cure.