Keeping death off the roads: health and safety at work and play

The Association of Chief Police Officers is campaigning for all major public events using the highways in the United Kingdom to have a preparatory risk analysis. This is already done for the London marathon, which uses public highway and Royal Parks. Legally “duty of care” by the organisers to participants requires an appreciation of risk and possible action.

Risk analysis should include an assessment of the risk of sudden cardiac death to entrants in mass participation events such as the London marathon and the London to Brighton annual British Heart Foundation cycle ride. Both events attract thousands of participants, some with known heart disease, but many, inevitably from the numbers, with undiagnosed heart disease.

But are the cardiac risks in these events sufficient to warrant planned action, or should the spectre of sudden cardiac death be regarded as a rare and unwelcome intruder whose occasional presence cannot be prevented? Rare events, by their unpredictability, cannot always be prevented. Lightning strike kills a few sportsmen every year but would not be considered a significant or completely avoidable risk in the United Kingdom, whereas after Hillsborough, the risks of spectator panic and stampede at sports grounds are now covered by extensive legislation.

Britain has had a “laid back” approach to sudden cardiac death in sport, and the lay reaction to the tragedy of “Do something” may be answered by the scientific doctor, controversially, by saying “Don't just do something! Stand there! Until you know of something effective to do”. Effective prevention of sudden cardiac death in sport would entail the following.

1. Knowledge of the true extent of the problem. There is no centralised collection of statistics in the United Kingdom for sudden cardiac death in sport.

2. Recognition of the multiple causes, some associated with structural heart disease and some not, and their …