The Emergency Action Plan

Everything here rests on one number. For every minute an athlete is in cardiac arrest without cardiopulmonary resuscitation or defibrillation, the chance of survival falls by roughly 10 per cent. That is why the plan exists, and it is why every decision below is really a decision about seconds.

The target is concrete. A defibrillator should be sited at sports venues and training grounds so that a first shock, if appropriate, can be delivered within two minutes of the athlete's collapse.

Read that as a distance rather than a location. Two minutes has to contain recognition, somebody running there, running back, attaching the pads and the machine analysing. So the useful question is not whether the club owns a defibrillator, but whether someone can fetch it and return inside roughly a minute. One locked in an office two pitches away fails that test and is, functionally, not a defibrillator.

The rest follows from the clock. It should be on site and immediately accessible, positioned so that it is available to the wider community as well, ideally in an unlocked cabinet on an external wall. Its signage should be visible at a distance. Every member of the team should know where it is without being told: ask three people at your club, and if they hesitate, the plan has already failed.

Register it on The Circuit, the UK national defibrillator network, so that ambulance service call handlers can direct a caller straight to it. A defibrillator nobody has registered is invisible to the 999 system at the moment it is needed.

Maintenance is unglamorous and it is the commonest failure. Pads expire, batteries expire, and somebody has to own the check and record it.

Define the roles first, then confirm the named individuals and their deputies before each event. Roles are durable, but people leave, get injured or are away that weekend, so a plan built on names alone quietly decays. The roles worth defining are: who starts compressions, who fetches the defibrillator, who calls 999, who meets and directs the ambulance, who manages the squad and the spectators, and who leads. There should be a designated leader, and a second way of communicating if the first one fails.

The call has a shape. Dial 999 on speakerphone, say the words 'cardiac arrest', and give the location in a form the ambulance service can act on, because a postcode is not a pitch. A location-referencing service such as what3words, or a grid reference, earns its place here. Say that a defibrillator is needed. Current guidance is to make the call first and assess breathing while it connects, with the call handler able to help if you are uncertain what you are looking at.

Equipment gets listed, sited and owned: what there is, where it lives, who checks it and how often. The list scales with the level of cover. A community club plans around a defibrillator and people trained to use it. A squad with an immediate care trained clinician plans around a bag that someone actually checks.

Rehearsal is what separates a plan from a document. Run it with the people who would actually run it, at the venue, including the boring parts, because the boring parts are what fail: finding the key, opening the gate, discovering the stretcher does not fit through the door.

Sport-specific circumstances get planned for specifically. A collapse in water needs safe extraction before chest compressions can begin, although a trained rescuer may give rescue breaths in the water where that is appropriate.

Reaching the athlete is a permission problem as often as a physical one. Where practicable, competition officials should know the medical team is there and understand that a response to a suspected cardiac arrest overrides the normal access protocols for the field of play. That is not a courtesy extended by a sympathetic referee, it is the guideline, and it should not result in a sanction for the athlete or the team, or leave them treated as out of competition.

Some sports impose a time limit on medical treatment on the field. That limit does not apply to a suspected cardiac arrest. If your officials do not already know that, the time to tell them is the pre-event briefing, not while you are kneeling over a collapsed player.

Getting out matters as much as getting in. The plan settles where the ambulance waits, whether it can come onto the field of play or not, who meets it, which gates are unlocked and who holds the keys. It records a location reference for the venue in case further resources are needed.

Destination is agreed rather than assumed. Discuss the preferred receiving hospital, the pre-alert and any bypass pathway with the ambulance service and the hospital before the day, and where the presumed cause is cardiac that may mean a centre with interventional cardiology rather than the nearest emergency department. The final destination still depends on the presentation and on local pathways, and it is the ambulance service's decision. The plan's job is to have had the conversation beforehand.

Dignity belongs in the plan too: screens, a plan for the cameras, and a plan for the squad who have just watched a team-mate collapse. Afterwards there is a debrief and a welfare duty, and the people who ran your plan were often the athlete's friends.

• •Resuscitation Council UK's national best practice guide for resuscitation in community sports sets the two-minute target, the recommendation for an immediately accessible on-site defibrillator, the siting and signage expectations, registration on The Circuit, and the shape of the 999 call.
• •Resuscitation Council UK's field-of-play best-practice guideline covers the medical team's plan: defibrillator locations and who retrieves the closest, the access override and the sanction point, ambulance positioning and destination, and sport-specific circumstances.
• •Resuscitation Council UK's 2025 adult basic life support guidelines cover the call sequence and the resuscitation itself.
• •The Faculty of Pre-Hospital Care sets the immediate care in sport standards that determine what level of cover, and therefore what equipment, a given setting should plan around.

• •Survival falls by roughly 10 per cent for every minute without resuscitation or defibrillation.
• •The defibrillator is sited so a first shock can be delivered within two minutes of collapse.
• •Register the defibrillator on The Circuit, or 999 call handlers cannot direct anyone to it.
• •Define roles first, then confirm named individuals and deputies before each event.
• •A cardiac arrest response overrides normal field-of-play access rules, without sanction.
• •An unrehearsed plan is a document, not a plan.