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Another death of a young footballer? Is this acceptable? How can we reduce the risk of cardiac deaths in nonleague football

A 26 year old footballer playing in the ninth tier of English league football collapsed and died during a game . Daniel Wilkinson was playing for Shaw Lane a West Yorkshire nonleague side.  There are no reported further facts on the cause of death . Other than that he appeared to have had a cardiac arrest 

Daniel had been playing for various nonleague clubs having originally signed a professional contract with Hull City in 2010.

There have recently been a plethora of reported deaths and collapses of young footballers during games.  What are the likely causes?  There are many causes of sudden death in the general population however the most likely cause would be an undiagnosed form of cardiomyopathy or a massive subarachnoid haemorrhage. Or a few more unusual causes of sudden cardiac death that may or may not have cardiac structural defects. 

There are differing forms of cardiomyopathy however they all have inappropriately thickened portions of the heart muscle . A common form is hypertrophic left ventricular obstructive cardiomyopathy . HOCM. The real risk is a double risk that the condition is undiagnosed and the propensity for serious and often fatal cardiac arrhythmias. This would be a possibility for Daniel. 

Over the years a greater awareness of this condition which can be both treated and managed has come about. Andy Scott the ex-Brentford player and manager and now chief scout had his career ended by a diagnosis of HOCM. He now regularly campaigns for the charity CRY which advocates routine echocardiography which mostly is the diagnostic test needed for a diagnosis. 

Deaths have been reported in all forms and levels of football and the most recent death in UK nonleague football was Junior Dian a 23 year old player with Tonbridge Angels who collapsed and died In Juky 2015. Other than occasional causes of death that include being struck by lightening most cases are reported as was Daniel Wilkinson as cardiac arrest or possible heart attack. Heart attacks are relatively rare in this population and it is likely that sudden arrhythmias such as from cardiomyopathies were the cause. 

Daniel was the seventh reported death in 2016 with 6 having similar features.  In fact 47 such deaths have been recorded since 2010 in Europe. Mostly these cases were young players aged 20-30 and mostly sudden collapse. Only one case is formally reported as right ventricular cardiomyopathy. 

In Italy for many years players have had to be tested and obtain cardiac certificates. Some testing clearly goes on in top tier football but how much In nonleague?  There is an argument that routine screening using ECG and Echo could be the optimal screening tool . These are not expensive tests and even in lower tiers of nonleague football some wages are high enough for players or clubs to fund this testing. 

Some nonleague players such as Tobi Alabi were fortunate and survived and also now campaign for cardiac testing . 

http://www.isthmian.co.uk/standing-ovation-for-heart-campaigner-17933

Nonleague football should take a view on what it considers reasonable to protect their mostly young players who play for some degree of payment . If the FA can impose regulations designed to allow financial probity then they should be able to propose some form of health regulations. There needs to be some form of mandatory cardiac screening for young footballers 

https://www.theguardian.com/football/2014/mar/17/tobi-alabi-heart-stopped-dead-fabrice-muamba
The other issue is that all football clubs should have defibrillation equipment . In an acute emergency where cardiac arrest has occurred speed is of the essence and an immediate defibrillation is the best option in all cases. Defibrillators are cheap and save lives. They are also easy to use and should be available at every football club at any level. There is really no debate about this.