Many top European football stadiums are poorly equipped to handle spectator heart attacks, according to a study released Wednesday.
Nearly 30 percent of 187 major arenas in ten countries surveyed did not have external defibrillators, which deliver therapeutic electric shocks when a person's heartbeat has become wildly erratic or has stopped altogether.
The devices are proven life savers, but research has shown the window of time for effective use is narrow, rarely lasting more than three to five minutes.
There were 77 "sudden cardiac arrests" during a single season in the stadiums reviewed, which between them host 190 elite football teams, said the study.
Many crowded public venues -- especially those where stress levels can soar, as during a highly-charged match -- such as airports and casinos are equipped with defibrillators.
The distribution of the devices at football grounds was extremely uneven across different countries, the researchers reported.
In Italy and Norway, all of the stadiums examined had defibrillators, followed by France and Spain with over 90 percent, but in two countries more than half of stadiums were not equipped with the devices.
No Serbian stadiums had them, while only a quarter of those inspected in Greece had the machines on hand.
The study published in the European Heart Journal also looked at other factors than can save lives in the critical few minutes after an adverse heart event.
More than one in three stadiums did not have a so-called medical action plan for delivering emergency care.
About the same proportion also failed to provide even basic training to staff in cardio-pulmonary resuscitation, with only a quarter offering advanced instruction.
"Our investigation demonstrates a surprisingly high proportion of inadequacies regarding cardiovascular safety programmes in major European" football arenas, said Mats Borjesson, a cardiologist at Sahlegrenska University Hospital in Gothenburg, Sweden, the lead author of the study.
The absence of defibrillators at clubs more than five minutes away from a hospital was particularly worrying because it means that treatment within that critical time frame is not possible, he said by phone.
"As football is the biggest and best resourced sport in Europe, the situation may be even worse at venues for other types of sports," Borjesson, who works as a doctor for top-flight football teams in Sweden, said.
Neither the international football federation FIFA nor the Union of European Football Associations (UEFA) have guidelines or requirements for health equipment or training to treat on-site heart problems.
"The first step is for the European Society of Cardiology to prepare recommendations, which we are doing," said Borjesson.
The other countries included in the study were Austria, England, Holland and Sweden.